Home-Delivered Intervention for Depressed, Cognitively Impaired Elders

为抑郁、认知障碍的老年人提供上门干预

• 批准号: 8793812
• 负责人: DIMITRIS N KIOSSES
• 金额: $ 35.5万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-05 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8793812
• 关键词: Aftercare; Antidepressive Agents; Attention; Bispecific Antibody 2B1; Calendar; Caregiver Burden; Caregivers; Characteristics; Classification; Clinical; Cognitive deficits; Communities; Community Networks; Country; Dementia; Depressed mood; Development; Disabled Persons; Disease remission; Ecosystem; Educational process of instructing; Effectiveness; Elderly; Environment; Family; Family Caregiver; Feeling; Future; Health; Health Services Research; Home environment; Impaired cognition; Impairment; Intervention; Interview; Lead; Letters; Major Depressive Disorder; Measures; Mediator of activation protein; Medical; Medicare; Mental Depression; Mental Health Services; Mentored Patient-Oriented Research Career Development Award; Montgomery and Asberg depression rating scale; Morbidity - disease rate; National Institute of Mental Health; Outcome; Outcome Study; Participant; Patients; Population; Population Intervention; Problem Solving; Problem behavior; Procedures; Randomized; Randomized Clinical Trials; Recommendation; Recording of previous events; Recruitment Activity; Research; Research Design; Research Personnel; Self Efficacy; Services; Signal Transduction; Social Work; Social Workers; Supportive care; Testing; Training; Treatment outcome; Voice; World Health Organization Disability Assessment Schedule; alternative treatment; base; cognitive disability; comparative efficacy; depressive symptoms; design; disability; efficacy testing; environmental adaptation; geriatric major depression; improved; innovation; instrumental activity of daily living; meetings; mortality; primary outcome; programs; psychosocial; response; skills; therapy development; treatment duration; treatment effect

DESCRIPTION (provided by applicant): Late-life major depression, cognitive impairment and disability contribute to medical and psychiatric morbidity and mortality. Available antidepressants bring to remission fewer than 40% of depressed, cognitively impaired elders while psychosocial interventions for this population are underdeveloped and understudied. The proposed randomized clinical trial, the PI's first R01, will test the efficacy of Problem Adaptation Therapy (PATH), a new home-delivered psychosocial intervention for elders with major depression, cognitive impairment, and disability, compared to home-delivered Supportive Therapy (ST). PATH is innovative because it focuses on the patient's ecosystem (i.e. the patient, the caregiver, and the home-environment) and targets behavioral problems related to both depression and disability. This study builds on the PI's K23 award that supported the development of PATH, provided evidence for the feasibility of recruitment, randomization, retention, assessment procedures and implementation of PATH, and offered a signal that PATH is efficacious in reducing depression and disability in this population. Recruitment will be conducted through the Home Delivered Meals programs of 3 collaborating agencies of the Community Network Unit of the Cornell Advanced Center for Interventions and Services Research (ACISR). Participants will be 176 elders (>64 years) with unipolar major depression, cognitive impairment ranging from mild cognitive deficits up to the levels of mild to moderate dementia, and impairment in instrumental activities of daily living. All participants will have an available caregiver (family, significant other, or professional) and will be randomized to 12 weekly sessions of PATH or ST. Research assessments will be performed at study entry (baseline), and at 2, 4, 6, 8, 10, 12 and 24 weeks after randomization. The study is designed to test the hypotheses that home-delivered PATH is more effective than home-delivered ST a) in reducing patient's depression and disability and b) in increasing patient and caregiver's self- efficacy over the 12-week treatment period. After the completion of 12 weeks of treatment, participants will be followed for an additional 12 weeks to measure sustained effects of treatment. Therapists will be Master's level Social Workers (MSW) of the ACISR. We elected to train MSWs to pave the way towards future effectiveness and implementation projects. MSWs are available in many community-based social services across the country, often offer psychosocial interventions, and can be reimbursed through Medicare for these services. The proposal is consistent with NIMH strategic objectives as well as recommendations from the NIMH Geriatric Branch.

描述（由申请人提供）：晚期重度抑郁症、认知障碍和残疾导致医学和精神病发病率和死亡率。现有的抗抑郁药物使不到40%的抑郁症，认知障碍的老年人得到缓解，而对这一人群的心理社会干预措施还不发达，研究不足。拟议的随机临床试验，PI的第一个R01，将测试问题适应疗法（PATH）的有效性，PATH是一种新的家庭提供的心理社会干预，用于患有重度抑郁症，认知障碍和残疾的老年人，与家庭提供的支持疗法（ST）相比。PATH是创新的，因为它关注患者的生态系统（即患者，护理人员和家庭环境），并针对与抑郁症和残疾相关的行为问题。这项研究建立在PI的K23奖项的基础上，该奖项支持了PATH的发展，为PATH的招募、随机化、保留、评估程序和实施的可行性提供了证据，并提供了一个信号，表明PATH在减少该人群的抑郁和残疾方面有效。招募将通过康奈尔高级干预和服务研究中心（ACISR）社区网络单元的3个合作机构的家庭送餐计划进行。参与者将是176名老年人（>64岁），他们患有单相重度抑郁症，认知障碍范围从轻度认知障碍到轻度至中度痴呆，以及日常生活工具性活动障碍。所有受试者都将有一名可用的护理人员（家庭、重要他人或专业人员），并将被随机分配至12个每周一次的PATH或ST。研究评估将在研究入组（基线）和随机分配后2、4、6、8、10、12和24周进行。该研究旨在检验以下假设：在12周的治疗期内，家庭提供的PATH比家庭提供的ST a）在减少患者的抑郁和残疾方面以及B）在增加患者和护理者的自我效能方面更有效。在完成12周的治疗后，将对参与者进行额外12周的随访，以测量治疗的持续效果。治疗师将是ACISR的硕士级社会工作者。我们选择培训医务社工，为今后的有效性和实施项目铺平道路。全国各地的许多社区社会服务机构都有医务工作者，他们经常提供心理社会干预，并可以通过医疗保险报销这些服务。该提案符合NIMH的战略目标以及NIMH老年分支的建议。

项目成果

Psychosocial interventions for late-life major depression: evidence-based treatments, predictors of treatment outcomes, and moderators of treatment effects.

晚期重度抑郁症的社会心理干预措施：基于证据的治疗，治疗结果的预测因素以及治疗效果的主持人。

• DOI: 10.1016/j.psc.2011.03.001
• 发表时间: 2011-06
• 期刊: PSYCHIATRIC CLINICS OF NORTH AMERICA
• 影响因子: 1.7
• 作者: Kiosses, Dimitris N.;Leon, Andrew C.;Arean, Patricia A.
• 通讯作者: Arean, Patricia A.

Depression and Suicidal Ideation During Two Psychosocial Treatments in Older Adults with Major Depression and Dementia.

患有重度抑郁症和痴呆症的老年人在两次心理社会治疗期间的抑郁症和自杀意念。

• DOI: 10.3233/jad-150200
• 发表时间: 2015
• 期刊: Journal of Alzheimer's disease : JAD
• 作者: Kiosses,DimitrisN;Rosenberg,PaulB;McGovern,Amanda;Fonzetti,Pasquale;Zaydens,Hana;Alexopoulos,GeorgeS
• 通讯作者: Alexopoulos,GeorgeS