Treating Depressed, Cognitively Impaired Elders

描述（由候选人提供）：此应用程序的目的是支持候选人的研究培训，成为一个独立的调查员在心理治疗领域的抑郁症，认知障碍，残疾老人。老年人的抑郁、认知障碍和残疾往往并存，并导致痛苦和家庭破裂。此外，许多抑郁、认知障碍的老年人对抗抑郁药物的反应缓慢、差或不稳定。尽管需要非药物干预，但大多数心理治疗研究都集中在认知完整的“年轻老年”有限残疾患者或具有明显残疾的痴呆患者上。因此，现有的治疗方法不能完全满足大量患有中度认知障碍和残疾的抑郁症老年人的需求。这位候选人决定把他的职业生涯奉献给照顾这一人群。他建议使用问题解决疗法（PST）作为他的治疗框架，并在其中整合补偿策略，使患者能够绕过他们的行为限制，并参与PST过程。补偿策略是从其他认知受损的精神病人群的文献中“进口”后，适当的调整。治疗是在病人自己的家中进行的，残疾病人在那里度过了大部分时间，经历了大部分问题。家庭成员/护理人员被邀请参与，在需要时，利用技术来帮助患者解决问题，并增加患者的积极互动和愉快的事件。因此，拟议的治疗旨在创造一个“生态系统”，使病人的能力，以解决自己的问题。拟议的培训旨在加强候选人在补偿策略、涉及照顾者的治疗方法、手册开发以及与治疗试验相关的实验设计和统计方面的技能。目前的治疗手册草案将在收到顾问的意见和在奖励的第一年半期间治疗10名患者的意见后进行升级。由此产生的治疗，然后，试点测试（N=60），通过比较它与家庭提供的支持性心理治疗。来自全国精神分裂症和抑郁症研究联盟和康奈尔大学老龄化研究和临床护理中心支持的小型试点研究的初步数据为拟议研究的可行性提供了证据。参与者将是韦斯特切斯特县高级项目和服务部家庭送餐计划的抑郁症、认知障碍、残疾接受者，该计划是康奈尔大学ACISR研究网络发展核心的合作伙伴。

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.