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Collaborative care reduces depression in elderly

A collaborative care intervention reduced depressive symptoms among older adults receiving primary care, according to recent findings.

“One in seven older people meet criteria for depression. Effective therapeutic strategies are needed in older people with depressive symptoms who also have comorbid diseases and impaired quality of life,” Simon Gilbody, PhD, of University of York, Heslington, England, and colleagues wrote. “There is limited research about older people with mild depressive disorders who have insufficient levels of depressive symptoms to meet diagnostic criteria (called subclinical, subthreshold, or subsyndromal depression) but also reduced quality of life and function.”

To assess efficacy of a collaborative care intervention for reducing and preventing depression in older adults, researchers conducted a randomized clinical trial among 705 individuals aged 65 years and older with subthreshold depression receiving care at a primary care center. Study participants were randomly assigned to receive collaborative care coordinated by a case manager who assessed functional impairments related to mood symptoms (n = 344) or usual primary care (n = 361).

Retention at 4 months was 83%, with a higher loss to follow-up in collaborative care (24%), compared with usual care (10%).

At 4 months, participants who received collaborative care had lower Patient Health Questionnaire scores, with a group difference of –1.31 points (P < .001), compared with those who received usual care.

A lower proportion of participants who received collaborative care met criteria for depression at 4 months (17.2% vs. 23.5%; RR = 0.83; 95% CI, 0.61-1.27; P = .25) and 12 months (15.7% vs. 27.8%; RR = 0.65; 95% CI, 0.46-0.91; P = .01).

“[This trial] provides new evidence that collaborative care improves outcomes for at least some patients with subthreshold depression,” Kurt Kroenke, MD, of VA Health Services Research

and Development, Indianapolis, wrote in an accompanying editorial. “A principal component of treatment in [this trial] was behavioral activation. Other brief psychological therapies such as cognitive behavioral therapy and problem-solving therapy have also proven effective in some studies. Accessibility of these psychological treatments can be enhanced by telephone or web-based delivery. Patients with persistent symptoms, functional impairment, and a desire for treatment may particularly benefit.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.