Complicated Grief Treatment in Elderly Adults

描述（由申请人提供）：本申请是响应PA-03-014邀请老年人资助申请的申请的第二次修订。修改应用程序以解决审查者的关注点，并添加额外的试验数据。老年人是最有可能失去亲人的人口群体。根据美国老龄问题全国委员会（http://www.aoa.gov/prof/ Statistics/ profile/2Q03/2003profile.pdf）的数据，2002年，美国有1000多万老年人丧偶。这些人面临着被称为创伤性或复杂悲伤（CG：现在用于这种情况的术语）的衰弱反应的风险。研究证实，复杂悲伤可以被可靠地识别出来，大约10-20%的丧亲者会出现这种情况。CG似乎对丧亲之痛的负面后果有很大的风险。CG可以影响健康状况并影响有关个人保健的决定。在符合CG共识标准的丧偶受试者中，高血压的风险是不符合CG共识标准的受试者的10倍，而患有CG的受试者在死亡后几个月内看医生的可能性要低17倍。尽管发病率高，发病率高，但尚无有效的治疗方法。该应用程序的PI开发了一种名为复杂悲伤治疗（CGT）的新型心理疗法，现在已经完成了一项由18岁以上成年人组成的研究（MH60783），证实了这种方法的有效性。然而，大多数参与者的年龄都在60岁以下。60岁以下的参与者（n=29）就业的可能性较小，更有可能独自生活。CGT和IPT在老年人和年轻人中产生相似的结果，两组对CGT的反应都更好。然而，确认老年人的有效性是很重要的，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，我们召集了一组经验丰富的老年研究人员，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、社会孤立、日常生活中断。我们建议在50 ~ 65岁的个体中进行CGT vs IPT的随机对照研究。我们的具体目标是：1)比较16次CGT和标准IPT的结果。我们假设CGT比IPT产生更高的反应率和更短的反应时间，反应者表现出显著的差异

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