Home-Delivered Intervention for Depressed, Cognitively Impaired Elders

描述（由申请人提供）：晚年严重抑郁、认知障碍和残疾会导致医疗和精神疾病的发病率和死亡率。可获得的抗抑郁药物使不到40%的抑郁、认知障碍的老年人得到缓解，而针对这一人群的社会心理干预尚不发达且研究不足。这项随机临床试验是PI的第一个R01，将测试问题适应疗法（PATH）的效果，这是一种新的家庭提供的心理社会干预，用于治疗患有严重抑郁症、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，因为它专注于患者的生态系统（即患者、护理人员和家庭环境），并针对与抑郁和残疾相关的行为问题。本研究建立在PI的K23奖的基础上，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PATH在减少这一人群的抑郁和残疾方面有效的信号。招募将通过康奈尔大学高级干预和服务研究中心（ACISR）社区网络单元的三个合作机构的家庭送餐项目进行。参与者将是176名患有单极重性抑郁症、认知障碍（从轻度认知缺陷到轻度至中度痴呆水平）和日常生活工具活动障碍的老年人（bb - 64岁）。所有参与者都将有一个可用的照顾者（家庭、重要的其他人或专业人员），并将随机分配到12周的PATH或st治疗中，研究评估将在研究开始（基线）以及随机化后的2、4、6、8、10、12和24周进行。本研究旨在验证以下假设：在12周的治疗期间，家庭提供的PATH比家庭提供的ST更有效：a)减少患者的抑郁和残疾；b)增加患者和护理者的自我效能感。在完成12周的治疗后，参与者将被额外随访12周，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（MSW）。我们选择培训msw，为未来的有效性和实施项目铺平道路。在全国许多以社区为基础的社会服务中都有msw，通常提供心理社会干预，并且可以通过医疗保险报销这些服务。该提案与NIMH的战略目标以及NIMH老年科的建议一致。

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. PUBLIC HEALTH RELEVANCE: Depression, cognitive deficits and disability co-exist in older adults and contribute to detrimental consequences. Available antidepressant treatments do not meet the needs of the majority of depressed, cognitively impaired, disabled elders. If found to be effective, the proposed home- delivered intervention may provide relief to a large group of depressed elders and their families.