Treating Depressed, Cognitively Impaired Elders

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DESCRIPTION (provided by candidate): This application aims to support the candidate's research training to become an independent investigator in the area of psychotherapy for depressed, cognitively impaired, disabled elders. Depression, cognitive impairment, and disability in the elderly often coexist and lead to suffering and family disruption. Moreover, many depressed, cognitively impaired elders have slow, poor, or unstable response to antidepressant drugs. Despite the need for non-pharmacological interventions, most psychotherapy research focuses on either cognitively intact, "young old" patients with limited disability or on demented patients with pronounced disability. Thus the available treatments do not fully address the needs of the large number of depressed elders with intermediate cognitive impairment and disability. The candidate decided to devote his career to the care of this population. He proposes to use Problem Solving Therapy (PST) as his treatment framework and integrate in it compensatory strategies enabling patients to circumvent their behavioral limitations and participate in the PST process. The compensatory strategies are "imported" from literature on other cognitively impaired psychiatric populations after appropriate adaptation. The treatment is administered at the patients' own homes, where disabled patients spend most of their time and experience most of their problems. Family members/caregivers are invited to participate, when needed, utilizing techniques to help patients with problem solving and with increasing the patients' positive interactions and pleasant events. Thus the proposed treatment aims to create an "ecosystem" that allows the patients' competencies to be brought to bear in solving their own problems. The proposed training aims to strengthen the candidate's skills in compensatory strategies, treatment approaches involving caregivers, manual development, and experimental design and statistics relevant to treatment trials. The current draft of the treatment manual will be upgraded after receiving input from consultants and from treating 10 patients during the first 1.5 year of the award. The resultant treatment will, then, be pilot-tested (N=60) by comparing it with home delivered Supportive Psychotherapy. Preliminary data from a small pilot study, supported from the National Alliance of Research on Schizophrenia and Depression and the Cornell Center for Aging Research and Clinical Care, provides evidence for the feasibility of the proposed study. The participants will be depressed, cognitively impaired, disabled recipients of the Home Delivered Meals Program of the Westchester County Department of Senior Programs and Services, a partner of the Research Network Development Core of the Cornell ACISR.