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Community-Integrated Home-Based Depression Treatment in Older Adults
A Randomized Controlled Trial
Paul Ciechanowski, MD, MPH;
Edward Wagner, MD, MPH;
Karen Schmaling, PhD;
Sheryl Schwartz, MPA;
Barbara Williams, PhD;
Paula Diehr, PhD;
Jayne Kulzer, MPH;
Shelly Gray, PharmD, MS;
Cheza Collier, PhD, MPH, MSW;
James LoGerfo, MD, MPH
JAMA. 2004;291:1569-1577.
Context Older 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.
Objective To determine the effectiveness of a home-based program of detecting and managing minor depression or dysthymia among older aldults.
Design and Setting Randomized controlled trial with recruitment through community senior service agencies in metropolitan Seattle, Wash, from January 2000 to May 2003.
Patients One 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.
Interventions Patients 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 Measures Assessments of depression and quality of life at 12 months compared with baseline.
Results At 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).
Conclusions The 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.
Author Affiliations: Departments of Psychiatry and Behavioral Sciences (Dr Ciechanowski), Health Services (Drs Ciechanowski, Williams, and LoGerfo and Mss Schwartz and Kulzer), Biostatistics (Dr Diehr), and Medicine (Dr LoGerfo), Health Promotion Research Center (Drs Williams and LoGerfo and Mss Schwartz and Kulzer), and School of Pharmacy (Dr Gray), University of Washington, Seattle; W. A. MacColl Institute for Healthcare Innovation, Center for Health Studies, Group Health Cooperative, Seattle (Dr Wagner); University of Texas at El Paso (Dr Schmaling); and Chronic Disease Prevention and Healthy Aging, Prevention Division—Public Health, Seattle and King County (Dr Collier).
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