Effectiveness of Psychotherapy for Community-Dwelling Vulnerable Older Adults with Depression and Care Needs: Findings from the PSY-CARE Trial.

IF 2.6 3区医学 Q3 GERIATRICS & GERONTOLOGY Clinical Gerontologist Pub Date : 2024-05-21 DOI:10.1080/07317115.2024.2353702

Paul Gellert, Sonia Lech, Felicia Hoppmann, Julie Lorraine O'Sullivan, Eva-Marie Kessler

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Abstract

Background: For older adults with care needs, evidence for the effectiveness of psychotherapy on depression is scarce.

Methods: In PSY-CARE, a pragmatic randomized controlled trial, N = 197 home-living older adults with depression and care needs were randomized into outpatient psychotherapy or an active control condition. Residential psychotherapists offered age-sensitive cognitive-behavioral psychotherapy (at-home if needed). Control group participants received telephone counseling and a self-help guide. Outcomes were assessed at baseline (T1), after (T2), 3 months after (T3), and 12 months after the intervention (T4).

Results: There was a significant decrease in depressive symptoms across both arms with Cohen's d T4-T1 = .52 in the psychotherapy and .55 in the control group. Mixed models revealed no statistically significant difference in primary and secondary outcomes between interventions. Posthoc, we found control group participants with greater ADL limitations experienced significantly increased depressive symptoms compared to those reporting lower limitations.

Conclusions: Interventions were successful in reducing depressive symptoms, even though treatment fidelity was decreased due to the COVID-19 pandemic. We could not demonstrate superior effectiveness of psychotherapy for older adults with care needs.

Clinical implications: Findings suggest that psychotherapy may be an important and superior treatment to circumvent aggravation of depression in older patients with high functional limitations.

Trial registration: The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN55646265, February 15, 2019).

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心理疗法对居住在社区、有抑郁症和护理需求的弱势老年人的疗效：PSY-CARE 试验结果。

背景对于有护理需求的老年人来说，心理治疗对抑郁症的疗效还缺乏证据：在 PSY-CARE 这一实用随机对照试验中，N=197 名患有抑郁症并需要护理的居家老年人被随机分配到门诊心理治疗或积极对照组。住院心理治疗师提供对年龄敏感的认知行为心理治疗（如有需要，可在家中进行）。对照组参与者则接受电话咨询和自助指南。结果分别在基线（T1）、干预后（T2）、干预后 3 个月（T3）和干预后 12 个月（T4）进行评估：结果：两组的抑郁症状均有明显减轻，心理治疗组的 T4-T1 Cohen's d = 0.52，对照组的 T4-T1 Cohen's d = 0.55。混合模型显示，干预措施的主要和次要结果在统计学上没有明显差异。事后分析发现，ADL 受限程度较高的对照组参与者与受限程度较低的对照组参与者相比，抑郁症状明显加重：结论：尽管 COVID-19 大流行导致治疗忠诚度下降，但干预措施还是成功地减轻了抑郁症状。我们无法证明心理疗法对有护理需求的老年人有更好的疗效：临床意义：研究结果表明，心理治疗可能是一种重要且优越的治疗方法，可避免功能高度受限的老年患者抑郁症加重：该试验在ISRCTN注册中心进行了前瞻性注册（试验注册号：ISRCTN55646265，2019年2月15日）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Gerontologist GERIATRICS & GERONTOLOGY-PSYCHIATRY

CiteScore

6.20

自引率

25.00%

发文量

审稿时长

>12 weeks

期刊介绍： Clinical Gerontologist presents original research, reviews, and clinical comments relevant to the needs of behavioral health professionals and all practitioners who work with older adults. Published in cooperation with Psychologists in Long Term Care, the journal is designed for psychologists, physicians, nurses, social workers, counselors (family, pastoral, and vocational), and other health professionals who address behavioral health concerns found in later life, including: -adjustments to changing roles- issues related to diversity and aging- family caregiving- spirituality- cognitive and psychosocial assessment- depression, anxiety, and PTSD- Alzheimer’s disease and other neurocognitive disorders- long term care- behavioral medicine in aging- rehabilitation and education for older adults. Each issue provides insightful articles on current topics. Submissions are peer reviewed by content experts and selected for both scholarship and relevance to the practitioner to ensure that the articles are among the best in the field. Authors report original research and conceptual reviews. A unique column in Clinical Gerontologist is “Clinical Comments." This section features brief observations and specific suggestions from practitioners which avoid elaborate research designs or long reference lists. This section is a unique opportunity for you to learn about the valuable clinical work of your peers in a short, concise format.