Models of Care for Late-Life Depression of the Medically Ill: Examples from Chronic Obstructive Pulmonary Disease and Stroke

Abstract

Depression worsens most treatment outcomes in medically ill older adults. Chronic medical illnesses weaken and demoralize patients and compromise their ability to adhere to treatments requiring consistency and effort. Acute medical illnesses create a psychosocial storm that finds patients and their ecosystem unprepared. We describe two intervention models that can be used to target and personalize treatment in depressed, chronically or acutely medically ill older adults. Personalized Adherence Intervention for Depression and COPD (PID-C) is a model intervention for depressed patients with chronic medical illnesses. It targets patient-specific barriers to treatment engagement and aims to shift the balance in favor of treatment participation. PID-C led to higher remission rates of depression, reduction in depressive symptoms, and reduction in dyspnea-related disability. Addition of problem solving training enables patients to utilize resources available to them and hopefully improve their outcomes. Ecosystem Focused Therapy (EFT) is a model intervention for depression developing in the context of an acute medical event. It was developed for patients with post-stroke depression (PSD) and targets five areas, part of the “psychosocial storm” originating from the patient’s sudden disability and the resulting change in the patient’s needs and family’s life. A preliminary study suggests that EFT is feasible and efficacious in reducing depressive symptoms and signs and disability in PSD.

A risk prediction model for post-stroke depression in Chinese stroke survivors based on clinical and socio-psychological features

“…The comprehensive life event was estimated with LES, which quantifies the mental stimulation of daily life. This was not entirely in agreement with previous studies of stroke survivors, which reported that comprehensive life event stimulus not a major life event [ 14 , 17 ], and that negative life event [ 18 ] and stressful life event exposure [ 3 , 18 ] was associated with PSD. Regarding personality traits, stable characteristics were assumed to influence the process of creating the illness cognition.…”

Transforming community well-being through patients' lived experiences

“…A patient's ecosystem is important to improving the patient experience and creating wellbeing. For example, ecosystem-focused therapy (EFT) in treating post-stroke depression aims to develop a collaborative approach to motivate the patient and assist the patient and family in developing a rehabilitation plan that includes drawing on community resources (e.g., support groups and recreational services for physically challenged individuals) (Avari & Alexopoulos, 2015). The importance of supporting patients by expanding their ecosystem includes the involvement of family and friends, other patients, access to care and services, and transition and continuity (Gerteis et al, 1993;Jenkinson et al, 2002;Rathert, Brandt, & Williams, 2012).…”

Advances in Psychotherapy for Depressed Older Adults

“…Patients who further experience depression face added challenges in their ability to care for themselves and adhere to a demanding medical and rehabilitation regimen [30]. …”