Home-delivered problem adaptation therapy (PATH) for depressed, cognitively impaired, disabled elders: A preliminary study.
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.
Kiosses
Dimitris N
DN
Department of Psychiatry, Weill-Cornell Institute of Geriatric Psychiatry, Weill Medical College of Cornell University, New York, NY, USA. dkiosses@med.cornell.edu
Arean
Patricia A
PA
Teri
Linda
L
Alexopoulos
George S
GS
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*
Am J Geriatr Psychiatry. 2007 Nov;15(11):968-78
17846101
J Psychiatr Res. 1975 Nov;12(3):189-98
1202204
Int J Geriatr Psychiatry. 2006 Dec;21(12):1139-49
16955421
Arch Gen Psychiatry. 1999 Aug;56(8):713-8
10435605
J Gerontol. 1982 Jan;37(1):91-9
7053405
J Chronic Dis. 1987;40(5):373-83
3558716
J Gerontol A Biol Sci Med Sci. 2007 Sep;62(9):1002-9
17895439
Gerontologist. 2002 Dec;42(6):799-806
12451161
Lancet. 2005 Jun 4-10;365(9475):1961-70
15936426
Int J Psychiatry Med. 1997;27(2):93-105
9565717
Am J Psychiatry. 2005 Nov;162(11):1996-2021
16263837
Eval Program Plann. 1979;2(3):197-207
10245370
Am J Psychiatry. 2000 Aug;157(8):1317-23
10910797
J Gerontol B Psychol Sci Soc Sci. 1997 Jul;52(4):P159-66
9224439
Int J Geriatr Psychiatry. 2007 Feb;22(2):99-100
17245798
Neuropsychopharmacology. 2004 Dec;29(12):2278-84
15340393
Am J Geriatr Psychiatry. 2003 Jan-Feb;11(1):46-52
12527539
Int J Geriatr Psychiatry. 2007 Feb;22(2):101-5
17096459
Am J Psychiatry. 1996 Jul;153(7):877-85
8659609
Am J Geriatr Psychiatry. 2008 Mar;16(3):229-39
18310553
Am J Geriatr Psychiatry. 2007 Jul;15(7):553-63
17586780
Psychiatr Clin North Am. 2005 Dec;28(4):805-20, vii-viii
16325730
Br J Psychiatry. 2001 Mar;178:234-41
11230034
Arch Gen Psychiatry. 1996 Apr;53(4):305-12
8634008
J Neurol Neurosurg Psychiatry. 1960 Feb;23:56-62
14399272
Ment Health Serv Res. 2002 Dec;4(4):245-7
12558011
Am J Geriatr Psychiatry. 2002 Jan-Feb;10(1):98-106
11790640
Dialogues Clin Neurosci. 2008;10(4):419-30
19170399
Neuropsychopharmacology. 2004 Dec;29(12):2266-71
15340392
J Am Geriatr Soc. 2006 May;54(5):809-16
16696748