Treating depression in disabled, low-income elderly: a conceptual model and recommendations for care.
BACKGROUND
The treatment of depression in low-income older adults who live in poverty is complicated by several factors. Poor access to resources, disability, and mild cognitive impairment are the main factors that moderate treatment effects in this population. Interventions that not only address the depressive syndrome but also manage social adversity are sorely needed to help this patient population recover from depression.


METHODS
This paper is a literature review of correlates of depression in late life. In the review we propose a treatment model that combines case management (CM) to address social adversity with problem solving treatment (PST) to address the depressive syndrome.


RESULTS
We present the case of Mr Z, an older gentleman living in poverty who is also depressed and physically disabled. In this case we illustrate how the combination of CM and PST can work together to ameliorate depression.


CONCLUSIONS
The combination of age, disability, and social adversity complicates the management and treatment of depression. CM and PST are interventions that work synergistically to overcome depression and manage social problems.
Areán
Patricia A
PA
Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medical College, University of California, San Francisco, USA. pata@lppi.ucsf.edu
Mackin
Scott
S
Vargas-Dwyer
Eleanor
E
Raue
Patrick
P
Sirey
Jo Anne
JA
Kanellopolos
Dora
D
Alexopoulos
George S
GS
D000368:Aged; D000369:Aged, 80 and over; D019090:Case Management; D003156:Community Mental Health Services / Q000458:organization & administration; D003695:Delivery of Health Care / Q000458:organization & administration; D003866:Depressive Disorder / Q000628:therapy*; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D006299:Health Services for the Aged / Q000458:organization & administration; D006801:Humans; D008297:Male; D011203:Poverty