Treating Older Patients with Major Depression and Severe COPD

描述（由申请人提供）：COPD影响15%的老年人，是美国第四大死亡原因。超过20%的COPD患者患有重度抑郁症。患有严重COPD的患者每天都生活在身体不适中，被迫采取妥协的生活方式，并且必须科普由于知道他们不可避免的恶化和死亡而导致的士气低落。抑郁症的悲观、无助和冷漠导致他们听天由命，并加剧了他们的士气低落。执行功能障碍发生在大约一半的抑郁症COPD患者中，并降低了他们制定行为策略以解决其治疗需求和生活问题的能力。这些问题因COPD的治疗要求而变得复杂，需要患者积极参与。一个抑郁、意志消沉、认知能力受损、身体虚弱的病人最不想做的就是坚持锻炼计划，去看医生和治疗中心，重新设计他/她生活中的社交方面。因此，他们放弃治疗和其他活动，并经历痛苦的生命结束。我们开发了一种干预措施（PST-AE），将治疗依从性增强程序（AE）与问题解决疗法（PST）相结合。PST-AE提供教育和直接建议，以提高治疗依从性，并传授行为策略，以满足患者复杂的治疗需求，抑郁症状和残疾。我们假设PST-AE比AE更能减少抑郁和残疾，改善生活质量和COPD治疗依从性。我们建议在160例从住院康复医院连续招募的重度抑郁症和重度COPD患者中验证这些假设，这些患者将被随机分配接受14次PST-AE（N=80）或AE（N=80），并在26周内进行系统评估。我们的目标是人口中最残疾和最痛苦的群体之一。在我们的设计中，我们利用了我们对抑郁的COPD患者的研究经验、初级保健老年患者的前景多中心研究以及我们的ACISR的老年抑郁症研究。如果发现有效，PST-AE可以广泛实施，因为它可以被再培训后的访问护士专业人员使用。除了COPD之外，PST- AE可能是患有各种慢性衰弱性疾病的患者的护理模式，这些患者通常发展为抑郁症，放弃，并且具有较差且通常致命的结局。由于PST-AE的一个主要重点是改善治疗依从性，这种治疗抑郁症、内科疾病患者的方法可以产生一种实践模式，这种模式能够迅速融入临床科学的进步。

DESCRIPTION (provided by applicant): COPD affects 15% of older adults and is the fourth leading cause of death in the US. More than 20% of COPD patients have major depression. Patients with severe COPD live with daily physical discomfort, are forced to a compromised life style, and have to cope with demoralization caused by the knowledge of their inescapable deterioration and death. The pessimism, helplessness, and worthlessness of depression, lead to resignation and worsen their demoralization. Executive dysfunction occurs in about half of depressed COPD patients and reduces their ability to develop behavioral strategies to address their treatment needs and their life problems. These problems are compounded by the demanding treatment of COPD that requires active patient participation. The last thing that a depressed, demoralized, cognitively compromised, and physically weak patient wants to do is to pursue a consistent exercise program, go to doctors and treatment centers, and reengineer the social aspects of his/her life. As a consequence, they give up on treatment and other activities and experience a painful end of life. We developed an intervention (PST-AE) that integrates treatment adherence enhancement procedures (AE) with problem solving therapy (PST). PST-AE offers education and direct suggestions for improving treatment adherence and imparts behavioral strategies for meeting the patients' complex treatment needs, depressive symptoms, and disability. We hypothesize that PST-AE will reduce depression and disability and improve quality of life and adherence to treatment of COPD more than AE. We propose to test these hypotheses in 160 patients with major depression and severe COPD consecutively recruited from an inpatient Rehabilitation Hospital who will be randomly assigned to receive 14 sessions of PST-AE (N=80) or AE (N=80) and be systematically rated over 26 weeks. We target one of the most disabled and suffering segments of the population. We used, in our design, our research experience with depressed COPD patients, the PROSPECT multicenter study of primary care elderly patients, and the geriatric depression studies of our ACISR. If found effective, PST-AE can be broadly implemented, as it can be used by visiting nurse professionals after retraining. Beyond COPD, PST- AE may be a model of care for patients with a variety of chronic, debilitating disorders, who often develop depression, give up, and have a poor and often fatal outcome. As a major focus of PST-AE is improvement of treatment adherence, this approach to the care of depressed, medically ill patients can generate a practice model that has the ability to rapidly incorporate advances made in clinical science.