A Telephone-Based Program to Provide Symptom Monitoring Alone vs Symptom Monitoring Plus Care Management for Late-Life Depression and Anxiety

Abstract

IMPORTANCE Mental health (MH) conditions are undertreated in late life. It is important to identify treatment strategies that address variability in treatment content and delivery and take individual-specific symptoms into account, particularly among low-income, community-dwelling older adults. OBJECTIVE To evaluate program feasibility and MH outcomes among community-dwelling older adults randomized to 1 of 2 treatment arms of varying intensity of evidence-based, collaborative MH care management services (ie, the Supporting Seniors Receiving Treatment and Intervention [SUSTAIN] program) that provide standardized, measurement-based, software-aided MH assessment and symptom monitoring and connection to community resources via telephone. DESIGN, SETTING, AND PARTICIPANTS Trial participants were 1018 older, community-dwelling, low-income adults prescribed an antidepressant or anxiolytic by a primary care or non-MH professional and experiencing clinically significant MH symptoms at intake. The participant subsample was drawn from a larger parent sample of older adults enrolled in the SUSTAIN program. Individuals were randomized to receive MH symptom monitoring alone (hereafter monitoring alone) or MH symptom monitoring plus care management (hereafter care management) provided by an MH professional. Baseline characteristics were examined, and changes in clinical MH outcomes were evaluated at 3-month and 6-month follow-up. The study dates were August 5, 2010, to May 5, 2014. INTERVENTIONS Monitoring alone or care management delivered by an MH professional. MAIN OUTCOMES AND MEASURES Overall MH functioning (primary) and depressive and anxiety symptoms. RESULTS A total of 509 participants were randomized to the monitoring alone group and 509 to the care management group; 377 and 401 completed Ն2 research assessments in the monitoring alone and case management groups, respectively. Compared with those randomized to monitoring alone, individuals randomized to care management showed greater improvements in the 3 domains of MH functioning (β [SE], 0.

Telephone‐based management of chronic pain in older adults in an integrated care program

“…Pain Care Management was delivered as an adjunct to depression or anxiety care management . Participants in PACE's care management program received monitoring of medication adherence and side effects, symptom monitoring, and problem solving strategies focused on 1 to 2 treatment goals, such as restarting a hobby or walking.…”

“…The lack of significant change in depression scores is in contrast to a previous study of CM with the same patient population. 20 The relative stability in depression scores in the current study may reflect the complexity of chronic pain and its challenges for treatment.…”

“…Pennsylvania's Pharmaceutical Assistance for the Elderly enrollees who filled a prescription for at least one antidepressant, anxiolytic, and/or antipsychotic medication were referred to a telephone‐based clinical care management program for assessment of depression, anxiety, and chronic pain. The program is modeled after the integrated care program deployed within the Department of Veterans Affairs and the successful evaluation of care management outcomes for older adults with depression and anxiety …”

Utilization Barriers and Medical Outcomes Commensurate With the Use of Telehealth Among Older Adults: Systematic Review

“…The research supports strong medical outcomes incident to the use of telehealth as follows: decreased psychological distress [ 32 , 42 , 46 , 51 , 60 , 68 , 70 , 71 , 76 ], increased autonomy [ 29 , 34 , 35 , 46 , 48 , 52 - 54 , 56 , 62 , 67 , 75 , 76 ], increased cognitive ability [ 27 , 28 , 31 , 41 , 50 , 51 , 54 , 69 ], and many others. This review supports an increased quality of life for those who adopt telehealth [ 29 , 32 , 44 , 53 , 67 , 69 ].…”

“…Table 5 lists the outcomes with their associated references, number of occurrences, and probability of occurrence in this review. The most common theme for medical outcomes associated with telehealth interventions was decrease in psychological distress (decrease in anxiety symptoms, decrease in depressive symptoms, decrease in embitterment, decrease in grief, decrease in worry, decrease in loneliness, increase in emotional support, and increase in mood), with 21 of 118 (18%) occurrences [ 32 , 42 , 46 , 51 , 60 , 68 , 70 , 71 , 76 ]. The theme associated with quality of life factors was listed as an increase in autonomy (increase in locus of control, increase in autonomy, increase in responsibility, increase in motivation to self-manage, and increase in independence), with 18 of 118 (15%) occurrences [ 29 , 34 , 35 , 46 , 48 , 52 - 54 , 56 , 62 , 67 , 75 , 76 ].…”