Community-integrated home-based depression treatment in older adults: a randomized controlled trial.
2004
ContextOlder adults with social isolation, medical comorbidity, and physical
impairment are more likely to be depressed but may be less able to seek appropriate
care for depression compared with older adults without these characteristics.ObjectiveTo determine the effectiveness of a home-based program of detecting
and managing minor depression or dysthymia among older aldults.Design and SettingRandomized controlled trial with recruitment through community senior
service agencies in metropolitan Seattle, Wash, from January 2000 to May 2003.PatientsOne hundred thirty-eight patients aged 60 years or older with minor
depression (51.4%) or dysthymia (48.6%). Patients had a mean of 4.6 (SD, 2.1)
chronic medical conditions; 42% of the sample belonged to a racial/ethnic
minority, 72% lived alone, 58% had an annual income of less than $10 000,
and 69% received a form of home assistance.InterventionsPatients were randomly assigned to the Program to Encourage Active,
Rewarding Lives for Seniors (PEARLS) intervention (n = 72) or usual care (n
= 66). The PEARLS intervention consisted of problem-solving treatment, social
and physical activation, and potential recommendations to patients' physicians
regarding antidepressant medications.Main Outcome MeasuresAssessments of depression and quality of life at 12 months compared
with baseline.ResultsAt 12 months, compared with the usual care group, patients receiving
the PEARLS intervention were more likely to have at least a 50% reduction
in depressive symptoms (43% vs 15%; odds ratio [OR], 5.21; 95% confidence
interval [CI], 2.01-13.49), to achieve complete remission from depression
(36% vs 12%; OR, 4.96; 95% CI, 1.79-13.72), and to have greater health-related
quality-of-life improvements in functional well-being (P = .001) and emotional well-being (P = .048).ConclusionsThe PEARLS program, a community-integrated, home-based treatment for
depression, significantly reduced depressive symptoms and improved health
status in chronically medically ill older adults with minor depression and
dysthymia.
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