title: Home-delivered problem adaptation therapy (PATH) for depressed, cognitively impaired, disabled elders: A preliminary study.
abstract: OBJECTIVE
  This preliminary study examines the efficacy of 12-week home-delivered problem adaptation therapy (PATH) versus home-delivered supportive therapy (ST) in reducing depression and disability in 30 depressed, cognitively impaired, disabled older adults.
  
  
  METHODS
  A 12-week randomized clinical trial. Research assistants were unaware of the participants' randomization status. Assessments were conducted at baseline, 6 weeks, and 12 weeks.
  
  
  METHODS
  Weill-Cornell Advanced Center for Interventions and Services Research.
  
  
  METHODS
  Thirty elders with major depression, cognitive impairment, and disability were recruited through advertisement and the Home-Delivered Meals Program of the Westchester County Department of Senior Programs and Services.
  
  
  METHODS
  PATH is a home-delivered intervention designed to reduce depression and disability in depressed, cognitively impaired, disabled elders. PATH is based on problem-solving therapy and integrates environmental adaptation and caregiver participation. PATH is consistent with Lawton's ecologic model of adaptive functioning in aging.
  
  
  METHODS
  Depression and disability were measured with Hamilton Depression Rating Scale-24 items and Sheehan Disability Scale, respectively. Client Satisfaction Questionnaire was used to assess patient satisfaction with treatment.
  
  
  RESULTS
  Mixed-effects model analyses revealed that PATH was more efficacious than ST in reducing depression and disability at 12 weeks. Participants in both treatment groups were satisfied with treatment.
  
  
  CONCLUSIONS
  This preliminary study suggests that PATH is well accepted and efficacious in depressed elders with major depression, cognitive impairment, and disability. Because this population may not adequately respond to antidepressant medication treatment, PATH may provide relief to many patients who would otherwise remain depressed and continue to suffer.
authors.affiliation: Department of Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Medical College of Cornell University, New York, NY, USA. dkiosses@med.cornell.edu
authors.forename: Dimitris N
authors.initials: DN
authors.lastname: Kiosses
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Arean
authors.forename: Linda
authors.initials: L
authors.lastname: Teri
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 / Q000150:complications / Q000628:therapy*; D003865:Major Depressive Disorder / Q000150:complications / Q000628:therapy*; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D015577:Geriatric Assessment; D006699:Home Care Services; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000379:methods*
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