A model for intervention research in late-life depression.
OBJECTIVE
To serve as a conceptual map of the role of new interventions designed to reduce the burden of late-life depression.


METHODS
We identified three needs to be addressed by intervention research: (1) the need for novel interventions given that the existing treatments leave many older adults depressed and disabled; (2) the need for procedures enabling community-based agencies to offer interventions of known efficacy with fidelity; and (3) the need to increase access of depressed older adults to care.


RESULTS
Our model orders novel interventions according to their role in serving depressed older adults and according to their position in the efficacy, effectiveness, implementation, and dissemination testing continuum. We describe three interventions designed by our institute to exemplify intervention research at different level of the model. A common element is that each intervention personalizes care both at the level of the individuals served and the level of community agencies providing care. To this end, each intervention is designed to accommodate the strengths and limitations of both patients and agencies and introduces changes in the patients' environment and community agencies needed in order to assimilate the new intervention.


CONCLUSIONS
We suggest that this model provides conceptual guidance on how to shorten the testing cycle and bring urgently needed novel treatments and implementation approaches to the community. While replication studies are important, propose that most of the support should be directed to those projects that take rational risks, and after adequate preliminary evidence, make the next step along the testing continuum.
Alexopoulos
George S
GS
Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, 21 Bloomingdale Road, White Plains, NY, USA. gsalexop@med.cornell.edu
Bruce
Martha L
ML
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003153:Community Health Services / Q000592:standards; D003866:Depressive Disorder / Q000523:psychology / Q000628:therapy*; D005852:Geriatric Psychiatry; D015438:Health Behavior; D006297:Health Services Accessibility; D006801:Humans; D008875:Middle Aged; D008962:Models, Theoretical