title: A home-delivered intervention for depressed, cognitively impaired, disabled elders.
abstract: OBJECTIVE
  Problem Adaptation Therapy (PATH) is a new home-delivered intervention designed to reduce depression and disability in depressed, cognitively impaired, disabled elders. A new intervention is needed in this population as antidepressant treatment is effective in only a minority of these patients.
  
  
  METHODS
  PATH focuses on the patient's ecosystem, which includes the patient, the caregiver, and the home environment, to address the needs of depressed, cognitively impaired, disabled elders. It builds on the therapeutic framework of Problem Solving Therapy (PST), which has been efficacious in decreasing depression and disability in cognitively intact depressed elders. To address the needs of depressed elders with advanced cognitive impairment, PATH incorporates environmental adaptations and invites caregiver participation.
  
  
  RESULTS
  To illustrate the administration of PATH, two case studies with varying degrees of cognitive impairment and caregiver participation are presented. Both patients were administered 12 weeks of PATH at their home. At the end of treatment their depression and disability was significantly reduced.
  
  
  CONCLUSIONS
  PATH is a new home-delivered intervention for depressed elders with cognitive impairment and disability focusing on reducing depression and disability by employing environmental adaptations and inviting caregiver participation. This intervention may provide a treatment alternative for a population with limited success of antidepressant treatment.
authors.affiliation: Weill Cornell Medical College, White Plains, NY, USA. dkiosses@med.cornell.edu
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Kiosses
authors.forename: Linda
authors.initials: L
authors.lastname: Teri
authors.forename: Dawn I
authors.initials: DI
authors.lastname: Velligan
authors.forename: George S
authors.initials: GS
authors.lastname: Alexopoulos
mesh_terms: D000223:Adaptation, Psychological; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000628:therapy*; D003866:Depressive Disorder / Q000628:therapy*; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D015577:Geriatric Assessment; D006699:Home Care Services; D006801:Humans; D008297:Male; D011613:Psychotherapy / Q000379:methods*; D016896:Treatment Outcome