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Treating the Depressed Elderly in Their Homes

A practical intervention improved depression in homebound elderly patients and tended to lower their hospitalization rates.

Among the 15% to 20% of elderly individuals with clinical depression in the U.S., many have minor depression and dysthymia rather than major depression. In homebound elderly who are socially isolated and medically ill, these two conditions are associated with significant disability, yet are unlikely to be recognized and treated. These researchers evaluated the effectiveness of a home-based intervention administered by social workers to low-income, mostly homebound seniors. A total of 138 patients diagnosed with minor depression or dysthymia (average age, 73) were randomized to receive either usual care or the intervention, Program to Encourage Active, Rewarding Lives for Seniors (PEARLS).

Seventy-two percent of participants were referred by social agencies, and 28% were self-referred; 72% lived alone; 42% belonged to a racial or ethnic minority group; 36% received antidepressant medications at baseline. Over 19 weeks, recipients of PEARLS received an average of 6.6 visits, which involved problem-solving therapy and focused on the patients regularly becoming physically active and increasing interactions outside the home. Significantly more recipients of PEARLS than comparison patients reached the clinical endpoints of >50% improvement in depression scores or complete remission at 12 months. Intervention recipients tended to have fewer hospitalizations than comparison patients. The total mean cost of the intervention per patient was $630.

Comment: This practical and effective intervention may not only improve the quality of life of isolated elderly individuals, but may also reduce disease burden and hospital costs. Antidepressant medication was not a focus of this study: Further refinements adding medication management may enhance the effectiveness of this home-based program.

— Joel Yager, MD

Published in Journal Watch Psychiatry May 20, 2004

Citation(s):

Ciechanowski P et al. Community-integrated home-based depression treatment in older adults: A randomized controlled trial. JAMA 2004 Apr 7; 291:1569-77.

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