Can offering support to at-risk older adults -- those with chronic illnesses, pain and cognitive problems, as well as those who are frail, socially isolated, disabled and emotionally vulnerable -- improve care for seniors and prevent this cascade of negative consequences?
There's been little research on whether preventing mental illness in older adults is possible, but some promising evidence comes from a 2008 analysis by a team from the Netherlands. The analysis combined results from 19 studies and found that various interventions reduced the incidence of depression by 22 percent. Other reports suggest that even greater reductions are possible, but it's unclear how long the impact of preventive measures can persist and what kind of follow-up is necessary.
The most significant barrier to preventive care addressing mental health concerns is a lack of Medicare coverage. Although the government program now covers depression screening for seniors, it doesn't pay for psychological treatments for people who may be vulnerable but don't yet have a mental health diagnosis.
That may change under the national health care overhaul as new models of care, such as accountable care organizations, receive financial incentives to guard the health of their patients, including older adults on Medicare.
But first, research needs to establish a stronger evidence base for the value of interventions aimed at promoting health and preventing serious illness. And that's where the project at the University of Pittsburgh comes in.
“Our goal is to teach people ways to regulate their mood, protect themselves from downward emotional spirals and counteract the learned helplessness at the core of depression,” said Reynolds, who is also director of the university's Aging Institute.
Testing Different Therapies
The Pittsburgh study is a five-year endeavor, which started in 2011. It focuses on three groups of seniors known to be especially vulnerable to developing depression: those with mild cognitive impairment, those with osteoarthritis of the knee and those who are frail and in need of social and medical assistance.
Two hundred seniors are being randomly assigned to receive prevention-oriented interventions and will get about 12 sessions of different kinds of behavioral therapy, with booster sessions provided at regular intervals. Researchers will then follow patients for a year to track how many get depression diagnoses.
Another 200 seniors in control groups for the three arms of the study will receive patient education only and then quarterly assessments of their mood, physical functioning and cognition.