Complicated Grief Treatment in Elderly Adults

描述（由申请人提供）：本申请是响应PA-03-014邀请老年人赠款申请的申请的第二次修订。对应用程序进行了修改，以解决审查人员的关切，并增加额外的试点数据。老年人是最有可能失去亲人的人口群体。根据全国老龄问题理事会（http：www.aoa.gov/prof/ Statistics/profile/2Q03/2003profile.pdf），2002年，1 000多万美国老年人丧偶。这些人有可能出现一种叫做创伤性或复杂性悲伤的衰弱反应（CG：现在用于这种情况的术语）。研究证实，复杂的悲伤可以可靠地识别，并发生在大约10-20%的丧亲之痛。CG似乎承担了丧亲之痛负面后果的大部分风险。CG可以影响健康状况，并影响有关个人医疗保健的决定。符合CG共识标准的丧偶受试者患高血压的风险是不符合CG共识标准的受试者的10倍，而CG受试者在死亡后的几个月内看医生的可能性要低17倍。尽管其患病率高且发病率高，但尚无有效的治疗方法。本申请的PI开发了一种名为复杂悲伤治疗（CGT）的新型心理疗法，现已完成了一项由18岁以上成年人组成的研究（MH 60783），证实了这种方法的有效性。然而，大多数参与者不到60岁。> 60岁的参与者（n=29）不太可能就业，更可能独自生活。CGT和IPT在老年人和年轻人中产生了类似的结果，两组对CGT的反应更好。然而，确认老年人的疗效是很重要的，因为老年人在适应悲伤方面比年轻人有不同的脆弱性和不同的问题。因此，我们聚集了一批经验丰富的老年医学研究人员，他们擅长评估和管理老年人的问题，例如身体虚弱，认知功能障碍，社交孤立，日常生活中断。我们建议在年龄> 65岁的个体中进行CGT与IPT的随机对照研究。我们的具体目标是：1）比较CGT和标准IPT的16次会议的结果。我们假设CGT将产生比IPT更高的应答率和更短的应答时间，并且应答者将显示出显著更高的

DESCRIPTION (provided by applicant): This application is the second revision of an application that responds to PA-03-014 inviting grant applications for older adults. The application is modified to address reviewers concerns and to add additional pilot data. Seniors are the demographic group most likely to be bereaved. According to the National Council on Aging (http://www.aoa.gov/prof/ Statistics/ profile/2Q03/2003profile.pdf), in 2002, more than 10 million older Americans were widowed. These people are at risk for a debilitating reaction called Traumatic or Complicated Grief (CG: the term now used for this condition). Studies confirm that Complicated Grief can be reliably identified and occurs in about 10-20% of bereaved individuals. CG appears to carry much of the risk for negative outcomes of bereavement. CG can affect health status and influence decisions about personal health care. The risk of hypertension is 10 times greater among widowed subjects who meet consensus criteria for CG compared to those who do not, while subjects with CG are 17 times less likely to have visited a physician in the months since the death. Despite its high prevalence and significant morbidity, there are no proven efficacious treatments. The PI of this application developed a novel psychotherapy called Complicated Grief Treatment (CGT), and has now completed a study (MH60783) comprised of adults over age 18, that confirmed efficacy of this approach. However, most participants were less than 60 years old. Participants > age 60 (n=29) were less likely to be employed and more likely to live alone. CGT and IPT produced similar results in older and younger adults, with better response to CGT in both groups. However, confirmation of efficacy among seniors is important, since older people have different vulnerabilities and different problems in adjusting to grief than younger adults. We thus assembled a group of highly experienced geriatric researchers skilled in assessment and management of problems in older people, e.g. physical infirmity, cognitive dysfunction, social isolation, disruption of daily routine. We propose to conduct a randomized controlled study of CGT v IPT in individuals > 65 years of age. Our specific aims are: 1) To compare results of 16 sessions of either CGT or standard IPT. We hypothesize that CGT will produce a higher response rate and shorter time to response than IPT, and that responders will show significantly greater