Depression, cognitive, and functional outcomes of Problem Adaptation Therapy (PATH) in older adults with major depression and mild cognitive deficits

Kanellopoulos, Dora; Rosenberg, Paul B.; Ravdin, Lisa; Maldonado, Dalynah; Jamil, Nimra; Quinn, Crystal; Kiosses, Dimitris N.

doi:10.1017/s1041610219001716

Cited by 17 publications

(11 citation statements)

References 54 publications

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“…Apart from the primary diagnosis of MDD, other complex needs were highlighted, such as cognitive impairment (Kanellopoulos et al . 2020), Parkinson's disease (Dobkin et al . 2018), type 2 diabetes mellitus (de Groot et al .…”

Section: Resultsmentioning

confidence: 99%

“…Moreover, conventional antidepressant treatments demonstrated limited effectiveness in reducing depressive symptoms and disability in PMDD with cognitive impairment, underscoring the need for enhanced and tailored psychosocial CMHIs (Kanellopoulos et al . 2020). The presence of physical disability amongst PMDD with comorbid Parkinson's disease also posed as an accessibility barrier to CMHIs (Dobkin et al .…”

Section: Resultsmentioning

confidence: 99%

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Community mental health interventions for people with major depressive disorder: A scoping review

Tan

Goh

2022

Int J Mental Health Nurs

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People with major depressive disorder continue to be marred by chronically pernicious yet preventable outcomes in the biopsychosocial aspects. With the reallocation of healthcare resources towards the fight against the coronavirus 2019 pandemic, much emphasis has been placed on existing community mental health interventions to ameliorate the disruption of mental health services. Moreover, the recent propulsion of community mental health services by the World Health Organization Mental Health Action Plan 2013-2030 ignited the need to bolster existing community interventions by providing comprehensive, responsive and integrated mental healthcare. The enhanced emphasis on mental healthcare in the community and the heightened demands of people with major depressive disorder underscores the need to explore the current state of community mental health interventions. This scoping review examined 51 primary studies published from year 2010 to 2020 using Arskey & O 0 Malley's five-stage framework and provided an overview of the impact of existing community mental health interventions for people with major depressive disorder. Findings using thematic analysis have recommended the adoption of person-centred community mental healthcare via the biopsychosocial approach for people with major depressive disorder. Enablers of community mental health interventions were driven by culturally appropriate care and augmented by technology-driven modalities. Challenges and gaps of community mental health interventions include the perpetuation of stigma and misconception, complex demands of persons with major depressive disorder and lack of holistic and long-term outcomes. Given the impact of major depressive disorder on the various biopsychosocial aspects, it is envisioned that our insights into the enablers and barriers of community mental health interventions will guide prospective interdisciplinary and nurse-led interventions in holistically improving the care of persons with major depressive disorder in the community settings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Community mental health interventions for people with major depressive disorder: A scoping review

Tan

Goh

2022

Int J Mental Health Nurs

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“…However, since depressive symptoms may interfere with motivation, lifestyle interventions may need to be paired with motivational strategies, psychotherapy, or anti-depressant medications to be effective for adults with depression. In fact, targeted treatment of depression has shown evidence of improving cognitive outcomes and overall disability [ 41 ]. These data combined with our results suggest that assessment and treatment of subclinical depression should be an integral factor in future multidomain interventions in older adults.…”

Section: Discussionmentioning

confidence: 99%

Depressive symptoms exacerbate disability in older adults: A prospective cohort analysis of participants in the MemAID trial

et al. 2022

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Background Maintaining independence in older age is an important aspect of quality of life. We investigated depressive symptoms as an important modifiable risk factor that may mediate the effects of physical and cognitive decline on disability. Methods We prospectively analyzed data from 223 adults (age 50–85; 117 controls and 106 with type-2 diabetes) over 48 weeks who were participating in a clinical trial “Memory Advancement by Intranasal Insulin in Type 2 Diabetes.” Data from self-reported disability (World Health Organization Disability Assessment Schedule) and depressive symptoms (Geriatric Depression Scale) were obtained from baseline, week 25, and week 48 visits. Cognition (Mini-mental status examination) and medical comorbidities (Charlson Comorbidity Index) were assessed at baseline. Longitudinal analysis assessed the extent to which change in depressive symptoms predicted worsening disability. Mediation analyses were performed to determine the extent to which depressive symptoms accounted for disability associated with worse cognition, walking speed, and comorbidities. Results At baseline, depressive symptoms, cognition, and walking speed were within normal limits, but participants had a high 10-year risk of cardiovascular mortality. Depressive symptoms were related to disability at baseline (p<0.001), and longitudinally (p<0.001). Cognition, walking speed, and comorbidities were associated with disability at baseline (p-values = 0.027–0.001). Depressive symptoms had a large mediating effect on disability longitudinally: the indirect effect on disability via depression accounts for 51% of the effect of cognition, 34% of the effect of mobility, and 24% of the effect of comorbidities. Conclusions Depressive symptoms substantially exacerbated the effects of worsening cognition, gait speed, and comorbidities on disability. In our sample, most individuals scored within the “normal” range of the Geriatric Depression Scale, suggesting that even subclinical symptoms can lead to disability. Treating subclinical depression, which may be under-recognized in older adults, should be a public health priority to help preserve independence with aging.

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“…Compared with supportive therapy, PST was more effective in reducing disability in older clients with depression and executive dysfunction (Areán et al, 2010). Problem adaptation therapy (PATH) is an example of a home-delivered psychotherapy based on PST that involves caregiver participation, and it significantly reduced depression and improved functioning among older adults with comorbid depression, cognitive impairment, and disability (Kanellopoulos et al, 2020). IPT has been modified for use with depressed older adults with cognitive impairment and their caregivers (IPT-ci; Miller, 2009; Miller & Reynolds, 2007).…”

Section: Theory Research and Practice Of Intervention With Older Adultsmentioning

confidence: 99%

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

Lind¹,

Poon²,

Birdsall³

2022

Clinical Psychology: Science and Practice

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To address the shortage in geriatric behavioral health professionals, it is crucial for more psychologists to become competent in working with older adults. This article will provide an overview of foundational geropsychology knowledge regarding intervention, consultation, and related services. We will begin by reviewing general and specialized psychological interventions with older adults, as well as adaptations based on aging-related changes and diverse care settings. Next, we will review health and medical factors that can impact service delivery. We will highlight characteristics of different treatment settings and interdisciplinary collaboration in providing consultation services, as well as services such as health promotion and illness prevention. We will summarize administrative best practices when psychologists work with older clients, including documentation of medical necessity for psychological services, billing, and reimbursement procedures compliant with state and federal laws and regulations. Finally, we will end with a discussion of ethical and legal considerations such as informed consent, confidentiality, substitute or end-of-life decision-making and potential conflicts of interest, diminished capacities, and elder abuse and neglect. Public Health Significance StatementGiven the growing population of older adults aged 65 and older, there is a need for psychologists who are competent to provide psychological services to older adults. Psychologists who find themselves working with older adults are encouraged to enhance their knowledge and competencies specific to diverse older adult populations and treatment settings to ensure high quality care of older clients. The authors hope that information provided within this article will serve as a guide to providing foundational knowledge competencies related to providing interventions and consultation services with older adult clients.

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Depression, cognitive, and functional outcomes of Problem Adaptation Therapy (PATH) in older adults with major depression and mild cognitive deficits

Cited by 17 publications

References 54 publications

Community mental health interventions for people with major depressive disorder: A scoping review

Community mental health interventions for people with major depressive disorder: A scoping review

Depressive symptoms exacerbate disability in older adults: A prospective cohort analysis of participants in the MemAID trial

Intervention, consultation, and other service provision: A foundational geropsychology knowledge competency.

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