Enhanced Medical Rehabilitation for Late-Life Depression After Disablement

描述(申请人提供)：老年人如果遭受了致残的医疗事件，如髋部骨折，很可能会患上抑郁症。晚年抑郁症(LLD)对急性医疗康复造成不利影响，增加了持续性抑郁症和残疾的风险。现有的急性医疗康复环境？熟练护理设施(SNF)和住院康复设施(IRF)？没有充分满足抑郁老年人的需求，导致错过了情感和功能恢复的机会。 这款R34将为抑郁症老年人开发增强的医疗康复，这些老年人在残疾医疗事件后进入SNF。这种强化康复护理的目标是减少抑郁症状，改善功能。干预措施将包括(1)高强度的PT&OT，和(2)结合心理健康专业知识的全面团队管理。 在本R34中，我们将分三个阶段开发增强型医疗康复：(1)制定治疗手册；(2)试点并反复修改干预措施；(3)在SNF中进行干预的初步随机试验，并与常规护理进行比较。R34由一个在康复研究和医疗环境中的心理健康干预方面拥有专业知识的多学科团队领导 公共卫生相关性：致残医疗事件(如髋部骨折)在美国老年人中每年大约发生600万次。在这种情况下，晚年抑郁(LLD)的发生率很高，它干扰了从医疗事件中恢复，并增加了功能依赖、制度化和死亡率。如果成功，这项提议将对公共卫生产生重大影响，因为它将开发一种适用于急性医疗康复环境的有效的LLD非药物治疗方法。

DESCRIPTION (provided by applicant): Elderly persons who have suffered a disabling medical event, such as a hip fracture, are likely to develop depression. Late-life depression (LLD) adversely affects acute medical rehabilitation, increasing the risk for persistent depression and disability. Existing acute medical rehabilitation settings ? skilled nursing facilities (SNFs) and inpatient rehabilitation facilities (IRFs) ? do not adequately meet the needs of depressed elders, resulting in a missed opportunity for affective and functional recovery. This R34 will develop enhanced medical rehabilitation for depressed older adults who are admitted to a SNF after a disabling medical event. The goal of this enhanced rehabilitative care is to reduce depressive symptoms and improve function. The intervention will consist of (1) high intensity PT & OT, and (2) comprehensive team-based management that incorporates mental health expertise. In this R34 we will develop enhanced medical rehabilitation in three stages: (1) develop a treatment manual; (2) pilot and iteratively modify the intervention; (3) carry out a preliminary randomized trial of the intervention in a SNF, with usual care comparison. The R34 is led by a multidisciplinary team with expertise in rehabilitation research and in mental health interventions in medical settings PUBLIC HEALTH RELEVANCE: Disabling medical events (such as hip fracture) occur approximately 6 million times per year in elderly persons in the US. There is a high incidence of late-life depression (LLD) in this context, which interferes with recovery from the medical event and increases functional dependence, institutionalization, and mortality. If successful, this proposal will have a significant public health impact, in that it will develop an effective nonpharmacological treatment for LLD that is applicable to the acute medical rehabilitation setting.