Cornell ACISR in Late Life Depression

ACISR的任务是制定和传播综合干预措施，有效地针对导致老年抑郁症的复杂临床和社会因素，最大限度地减少医疗保健的分裂，并可以在现行的医疗报销制度下实施。老年人的迅速增加（预计到2020年美国将增加73%）以及使他们的护理复杂化的疾病和残疾使老年研究成为国家的优先事项。我们关注晚年抑郁症，因为它是导致残疾的主要原因，增加了医疗发病率和死亡率，造成痛苦、家庭破裂，并增加了护理成本。我们提出了一个具有挑战性的项目，扩大我们对抑郁症治疗结果的临床、社会心理和生物学预测因素的研究，并利用这些发现和我们的临床经验，开发针对患者和环境水平的个性化干预措施，目标是预防晚年抑郁症的不良后果。为了最大限度地发挥我们的影响，我们将在大多数抑郁症老年人接受护理的环境（初级保健）和为有特殊临床（残疾）和社会需求（贫困）的老年人提供服务的环境中开展工作。为了缩短从发现到实践的道路，我们计划在社区中与我们的社区合作伙伴一起完成大部分工作。

The mission of the proposed ACISR is to produce and disseminate comprehensive interventions that effectively target the complex clinical and social factors contributing to late-life depression, minimize the splintering of health care, and can be implemented under the current health reimbursement system. The rapid increase of older persons (73% increase is anticipated in US by year 2020) and the diseases and disabilities complicating their care make geriatric research a national priority. We focus on late-life depression because it is the leading cause of disability, increases medical morbidity and mortality, causes suffering, family disruption, and increases the cost of care. We propose a challenging program that expands our studies on clinical, psychosocial, and biological predictors of depression treatment outcomes and uses these findings and our clinical experience to develop interventions personalized at the patient and the setting level with the goal to preempt adverse consequences of late-life depression. To maximize our impact we will work both in settings in which most depressed elders receive care (primary care) and in settings serving elders with special clinical (disability) and social needs (poverty). To shorten the road from discovery to practice we plan to do most of this work in the community and together with our community partners. Our community partner will be the Westchester Geriatric Mental Health Coalition, which consists of medical practices, community mental health clinics, home healthcare agencies, rehabilitation hospitals, and government organizations who share our concerns. We propose to use Westchester County as an "incubator" of novel interventions, which we will further test at a national level in order to establish their public health significance. We are confident that we can meet the challenges of this work because of: 1. Our organizational experience in integrating research, methodology, community, and training activities into a cohesive, seamlessly-working system; 2. our research structures for ethics, scientific and logistic support, and training of staff; 3. our "know-how", history and explicit plans in developing sustained partnerships with community agencies and learning from them; 4. our expertise in research methods development; and 5. our record and commitment to fostering the development of new investigators that will continue to invigorate our field. This application proposes a model of research development that can rapidly translate clinical, psychosocial, and biological findings into personalized interventions, shorten the way from discovery to community practice and benefit many depressed seniors, including those with severe pathology and limited resources who are neglected by traditional research.