Development of an audio and computer cognitive behavioral therapy for depression in older adults.

Background: The purpose of this paper is to discuss the development of two novel technology-based interventions for depression in older adults while comparing older adults' preferences for audio-based and computer-based cognitive behavioral therapy for depressive symptoms. The audio program consisted of eight compact discs and a workbook while the computer program consisted of 11 modules of similar duration provided on a tablet PC. Both interventions consisted of the following topics: 1) introduction, 2) identifying and changing unhelpful thoughts, 3) addressing feelings, 4) relaxation, 5) engaging in pleasant events, 6) assertiveness, and 7) problem-solving. Methods: Fifty-one older adults were recruited from medical settings and rural communities and randomly assigned to an immediate treatment group (computer or audio) with minimal contact or a four-week minimal contact delayed treatment control condition. Results: Participants rated computer-based and audio-based cognitive behavioral therapy fairly equally, with 75% of those who received audio treatment and 85% of those who received computer-based treatment indicating benefits to their mood.Discussion: Computer-based or audio-based cognitive behavioral treatments may be valuable, low-cost modalities to deliver psychotherapy to older adults with depressive symptoms within a health care setting. Both modalities seem to be accepted by older adults.

Gerontological social work and cardiac rehabilitation.

Cardiac rehabilitation is a setting in which integrating social work services can benefit older adults. Many cardiac rehabilitation patients endorse symptoms of stress and depression following a cardiac event, impeding their ability to participate fully in cardiac rehabilitation services or recover from a heart attack. Gerontologically trained social workers can improve the care of older adults with heart disease in a variety of ways and this paper discusses the potential roles social workers can play in enhancing care. Two examples demonstrating how community academic partnerships can lead to improved options for older adults following a heart attack are discussed. First, using a microsystems approach, social workers embedded within cardiac rehabilitation may improve patient quality of life, address social service needs, provide mental health treatment, and assist in the completion of standard cardiac rehabilitation assessments. Second, using a macrosystems approach, social workers can help communities by developing partnerships to establish infrastructure for new cardiac rehabilitation clinics that are integrated with mental health services in rural areas. Social workers can serve an important role in addressing the psychological or social service needs of cardiac rehabilitation patients while increasing access to care.

Diabetes, Depression, and Cognition: a Recursive Cycle of Cognitive Dysfunction and Glycemic Dysregulation.

PURPOSE OF REVIEW: The study aims to examine the effects of diabetes and depression on executive functioning (EF) and to review the effects of EF deficits on diabetes management. RECENT FINDINGS: Both type 2 diabetes and depression influence EF, and in turn, EF has an impact on diabetes management. Individuals with both comorbidities (i.e., diabetes and depression) experience greater deficits in EF than individuals with just one of the morbidities (i.e., depression or diabetes). The disruption in EF results in poor diabetes management and poor emotion regulation which ultimately increases the probability of a recursive cycle of depression and hyperglycemia. This recursive cycle can ultimately lead to diabetes-related complications.

Older adults' attitudes toward depression screening in primary care settings and exploring a brief educational pamphlet.

OBJECTIVES: This study aimed to assess older adults' (OAs') attitudes toward depression screening in primary care settings with a survey and explore the impact of an educational pamphlet on these attitudes. METHODS: Older adults above age 55 (N = 140) were randomly stratified by sex to an intervention or control group. The study included a baseline assessment, posttest, the Geriatric Depression Scale-Short Form, a two-page pamphlet on health and mood, and a 10-question quiz. RESULTS: On the basis of survey responses, most participants (93.6%) were willing to complete a depression screen at their doctor's office, and 92.1% perceived depression screening as valuable to their health care. Participants rated the Geriatric Depression Scale-Short Form positively. The survey also provided information on how screening could be conducted in primary care settings to maximize OAs' comfort. Participants preferred screening in the waiting room or examination room instead of the nurse's station. Those receiving the pamphlet became significantly more willing to be screened for depression than those who did not, F(1, 134) = 4.47, p = 0.04. CONCLUSION: Most OAs appear receptive to completing a depression screen in primary care settings. Educating OAs about the value of depression screening and tailoring recognition systems to account for preferences may be an initial step in improving recognition rates. Copyright © 2017 John Wiley & Sons, Ltd.

Hearing and quality of life in older adults.

OBJECTIVES: We assessed quality of life (QoL) in older adults with and without hearing loss (HL) and studied how hearing aids were associated with QoL. We hypothesized participants with normal hearing would have significantly better QoL than participants with HL and hearing aids, and participants with HL but no aids would have the worst QoL. METHOD: At the University of Alabama and rural public health departments in surrounding counties, we tested 100 males and females aged 60-87 using pure-tone audiometry. They completed Short Form-36 and Medical Outcome Study assessments. We analyzed data with MANCOVA (covariate income). RESULTS: Participants without hearing aids had significantly poorer QoL than participants with normal hearing, who did not significantly differ from participants with aids. General health drove the difference. CONCLUSIONS: Hearing aids are associated with better QoL than having HL and going without aids. Clinical psychologists can improve coping among those with HL and motivate hearing aid use.

Effects of Integrated Telehealth-Delivered Cognitive-Behavioral Therapy for Depression and Insomnia in Rural Older Adults.

BACKGROUND: We examined the effects of integrated cognitive-behavioral therapy for depression and insomnia (CBT-D + CBT-I) delivered via videoconferening in rural, middle aged and older adults with depressive and insomnia symptoms. METHOD: Forty patients with depressive and insomnia symptoms were randomized to receive either 10 sessions of CBT-D + CBT-I or usual care (UC). Patients in the integrated CBT condition were engaged in telehealth treatment through Skype at their primary care clinic. Assessments were conducted at baseline, post-treatment, and 3-month follow-up. RESULTS: CBT-D +CBT-I participants had significantly greater improvements in sleep at post-treatment and 3-month follow-up as compared to the UC participants. The time by group interaction for depression was not significant; both the CBT-D + CBT-I and UC conditions had a decrease in depressive symptoms over time. CONCLUSION: While integrated CBT benefits both depression and insomnia symptoms, its effects on depression are more equivocal. Further research should consider expanding the depression treatment component of integrated CBT to enhance effectiveness.

The role of interpersonal sensitivity, social support, and quality of life in rural older adults.

The mental health of elderly individuals in rural areas is increasingly relevant as populations age and social structures change. While social support satisfaction is a well-established predictor of quality of life, interpersonal sensitivity symptoms may diminish this relation. The current study extends the findings of Scogin et al by investigating the relationship among interpersonal sensitivity, social support satisfaction, and quality of life among rural older adults and exploring the mediating role of social support in the relation between interpersonal sensitivity and quality of life (N = 128). Hierarchical regression revealed that interpersonal sensitivity and social support satisfaction predicted quality of life. In addition, bootstrapping resampling supported the role of social support satisfaction as a mediator between interpersonal sensitivity symptoms and quality of life. These results underscore the importance of nurses and allied health providers in assessing and attending to negative self-perceptions of clients, as well as the perceived quality of their social networks.

Effects of Home-Delivered Cognitive Behavioral Therapy (CBT) for Depression on Anxiety Symptoms among Rural, Ethnically Diverse Older Adults.

BACKGROUND: We examined the effects of home-delivered cognitive-behavioral therapy (CBT) for depression on anxiety symptoms in an ethnically diverse, low resource, and medically frail sample of rural, older adults. METHOD: This was a secondary analysis of a randomized clincial trial with 134 rural-dwelling adults 65 years and older with decreased quality of life and elevated psychological symptomatology. Anxiety symptoms were assessed with the anxiety and phobic anxiety subscales of the Symptom Checklist-90-Revised (SCL-90-R). RESULTS: Compared to a minimal support control condition, CBT for depression resulted in significantly greater improvements in symptoms of anxiety and phobic anxiety from pre-treatment to post-treatment. CONCLUSION: Home-delivered CBT for depression can be an effective treatment for anxiety in a hard-to-reach older populations. CLINICAL IMPLICATIONS: Additional research should explore integrated anxiety and depression protocols and other treatment modalities, including bibliotherapy or telehealth models of CBT, to reduce costs associated with its in home delivery. Flexibility in administration and adaptations to the CBT protocol may be necessary for use with vulnerable, rural older adults.

Affective mediators of the association between pleasant events and global sleep quality in community-dwelling adults.

This study explored the association of engagement in pleasant events and global sleep quality, as well as examined the intermediary roles of positive affect and depressive symptoms in this association. Data were derived from the Midlife in the United States-II study. The sample consisted of 1054 community-dwelling adults. Participants completed the Pittsburgh Sleep Quality Index and indicated the frequency and enjoyableness of experiences on a positive events scale. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Positive affect was measured using the Mood and Symptoms Questionnaire. Regression analyses indicated more frequent engagement in pleasant events was associated with better global sleep quality. Depressive symptoms, but not positive affect, partially mediated the association between pleasant events and global sleep quality. The findings suggest that behavioral engagement in pleasant events may be related to global sleep quality via depressive symptoms, but not positive affect. These findings highlight the potential for engagement in pleasant activities to influence both mood and sleep.

Effect of individualized social activities on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility.

OBJECTIVES: The study examined the effect of an individualized social activities intervention (ISAI) on quality of life among older adults with mild to moderate cognitive impairment in a geriatric psychiatry facility. METHOD: This randomized control trial consisted of 52 older adults (M = 70.63, SD = 5.62) with mild to moderate cognitive impairment in a geriatric inpatient psychiatry facility. A 2 (group condition) × 2 (time of measurement) design was used to compare the control (treatment-as-usual) and intervention (treatment-as-usual plus ISAI) conditions at pre- and post-treatment. ISAI consisted of 30- to 60-minute sessions for up to 15 consecutive days. The Dementia Quality of Life instrument and Neurobehavioral Rating Scale-Revised were used to examine quality of life and behavioral and psychological symptoms of dementia at pre- and post-treatment. RESULTS: Intent-to-treat analyses indicated a significant time × group condition interaction on quality of life, with this effect remaining when only completer data were included. There was no evidence of a significant treatment effect on behavioral and psychological symptoms of dementia. CONCLUSION: Findings suggest that individualized social activities are a promising treatment for cognitively impaired geriatric inpatients.

Health Care Communication and Agreement and Disagreement About Symptoms Within the Context of Multimorbidity.

Informal caregivers for older adults often act as medical 'proxies' based on their assumed knowledge of the care recipient's illness-related symptoms. Differences between symptom descriptions given by care recipients and caregivers, however, raise questions about the validity of proxy reports. Community-dwelling caregivers and their care recipients with chronic, multi-morbid conditions revealed similar numbers of symptoms reported as well as average symptom distress. Dyads with care recipients who scored higher on negative affect were more likely to have significantly lower. Results suggested the possibility of identifying and intervening with dyads who may be 'at-risk' for divergent symptom reporting. This awareness may increase the ability to engage in informed and shared medical decision making throughout the illness trajectory.

Treatment of depressive symptoms in diverse, rural, and vulnerable older adults.

BACKGROUND: We examined the effects of home-delivered cognitive-behavior therapy (CBT) on depressive symptoms among rural, diverse, and vulnerable older adults. Furthermore, we differentiated depression into its two salient aspects: psychological and somatic. METHOD: Data came from a randomized controlled experiment of CBT on 134 individuals residing in rural Alabama. RESULTS: Cognitive-behavior therapy resulted in significantly lower depressive symptom severity scores. When depressive symptoms were categorized as psychological or somatic, CBT was found to significantly improve the former but not the latter. Notably, there was a trend toward somatic symptom improvement. CONCLUSION: Cognitive-behavior therapy can be an effective treatment for depression in a hard-to-reach group of older adults. Home delivery affords advantages but is also an expensive delivery modality. Diverse older adults responded to the CBT intervention.

Cognitive bibliotherapy and memory training for older adults with depressive symptoms.

OBJECTIVES: Substantial evidence indicates that depressed participants perform more poorly than nondepressed participants on a number of memory tasks. Cognitive deficits associated with depression (i.e., poor allocation of attention, poor encoding strategies), may help explain why depressed older adults are particularly prone to evidence poorer memory performance. METHOD: The present study compared the impact of two self-administered treatment protocols, cognitive bibliotherapy for depression plus memory training (CBT + MT) and cognitive bibliotherapy alone (CBT), to a wait-list control condition on measures of memory functioning and depression in a group of older adults experiencing depressive symptoms and memory complaints. RESULTS: Results provide partial support for CBT as a treatment for depressive symptoms; however, memory training augmentation did not produce improvements. CONCLUSION: Suggestions for improving retention of older adults in self-administered treatments are discussed.

Do manualized treatments for depression reduce insomnia symptoms?

OBJECTIVE: Researchers evaluated the effect of manualized treatments for depression on comorbid symptoms of insomnia. METHOD: Hierarchical linear modeling was used to analyze archival data collected from 14 studies (N = 910) examining the efficacy of psychological treatments for depression in adults. RESULTS: Participants receiving a psychological treatment for depression experienced significantly more relief from symptoms of insomnia with overall, early-, middle-, and late-night sleep than those not receiving such treatment. CONCLUSION: Symptoms of insomnia in those with an average (or lower) level of depression can be reduced through psychological treatment for depression. However, more severe depressive symptoms do not receive great relief from sleep disturbance and may require an additional treatment component targeting symptoms of insomnia.

Memory and cancer: a review of the literature.

The mental health of cancer survivors has not always been the primary emphasis of treatment protocols since physical health outcomes have taken precedence. Older cancer survivors experience a double jeopardy since they are at risk for memory impairments and mild cognitive impairment and because they are greater than 55 years of age. Of the 9.6 million cancer survivors in the US who have completed active treatment, many report cognitive difficulties, with labels such as "chemo brain," "not as sharp," "woolly-headedness," or the "mind does not work as quickly". To date, most of our knowledge of cognitive impairment in cancer survivors comes from female breast cancer survivors. Studies indicate that these survivors have diminished executive function, verbal memory, and motor function. Cancer survivors want to live independently in the community for as long as possible however, these cognitive deficits may prevent this desired lifestyle. To broaden our understanding this paper reviews the literature on the cognitive impairment and memory deficits experienced by three groups of cancer survivors breast, colorectal, and prostate cancer, that make up 60% of all survivors nationally. Even though mental health declined after a cancer diagnosis, the long-term outcomes of cancer survivors did not differ from persons without cancer in depression or cognitive function.

Telehealth cognitive behavior therapy for co-occurring insomnia and depression symptoms in older adults.

OBJECTIVE: Telehealth has proven effective with a wide range of disorders, but there is a paucity of data on the use of telehealth using cognitive-behavior therapy (CBT) with late-life insomnia and depression. This pilot study was designed to examine the feasibility and effectiveness of using telehealth to treat older adults with comorbid insomnia and depression living in rural Alabama. METHOD: Five patients received 10 sessions of CBT for insomnia and depression. Patients were engaged in treatment via Skype from their primary care physician's office. Assessments were conducted at baseline, posttreatment, and 2-month follow-up. RESULTS: Patients exhibited clinically significant improvement in both insomnia (sleep diaries and Insomnia Severity Index) and depression (Hamilton Rating Scale for Depression) at posttreatment, and these gains were well maintained at 2-month follow-up. CONCLUSIONS: These preliminary data suggest that telehealth may be an effective means of providing treatment to older adults, including underserved populations.

A self-help behavioral activation treatment for geriatric depressive symptoms.

This study investigated behavioral activation (BA) bibliotherapy as a treatment for late-life depressive symptoms. BA bibliotherapy was administered using Addis and Martell's Overcoming depression one step at a time as a stand-alone treatment that was completed by participants (N=26) over a 4-week period [Addis, M.E., & Martell, C.R. (2004). Overcoming depression one step at a time. Oakland, CA: New Harbinger Publications, Inc.]. Results of an immediate intervention group were compared with those of a delayed treatment control group and treatment response for both groups was evaluated at 1-month follow-up. Primary outcome results showed that symptoms on a clinician-rated measure of depressive symptoms, Hamilton Rating Scale for Depression, were significantly lower at post-treatment for those who received immediate BA bibliotherapy compared with those who were in the delayed treatment control condition. However, self-reported depressive symptoms (a secondary outcome measured via the Geriatric Depression Scale), were not significantly different at this period. Because study control was lost after the delayed treatment group received the intervention, within-subjects analyses examining both treatment groups combined showed that clinician-rated depressive symptoms significantly decreased from pre-treatment to both post-treatment and 1-month follow-up. Self-reported depressive symptoms were significantly lower from pre-treatment to 1-month follow-up. These findings suggest that BA may be useful in treating mild or subthreshold depressive symptoms in an older adult population.

Therapist and client race/ethnicity match: an examination of treatment outcome and process with rural older adults in the deep south.

This study investigated the effects of race/ethnicity (r/e) match in cognitive-behavioral therapy with rural older adults. Races/ethnicities represented in this study were African-American and White. Treatment followed a CBT treatment protocol and was provided by MSWs to clients in their homes. Results indicated little evidence of differences in outcome and process for matched and non-matched dyads for number of sessions attended, changes in quality of life and psychological symptoms, overall quality of therapy sessions, or the number of sessions considered of unsatisfactory quality. Our findings are consistent with recent research on r/e matching and extend these findings to a sample of rural older adults.

Treating the aged in rural communities: the application of cognitive-behavioral therapy for depression.

Many rural communities are experiencing an increase in their older adult population. Older adults who live in rural areas typically have fewer resources and poorer mental and physical health status than do their urban counterparts. Depression is the most prevalent mental health problem among older adults, and 80% of the cases are treatable. Unfortunately, for many rural elders, depressive disorders are widely under-recognized and often untreated or undertreated. Psychotherapy is illustrated with the case of a 65-year-old rural married man whose presenting complaint was depressive symptoms after a myocardial infarction and loss of ability to work. The case illustrates that respect for rural elderly clients' deeply held beliefs about gender and therapy, coupled with an understanding of their limited resources, can be combined with psychoeducational and therapeutic interventions to offer new options.

Older adults' acceptance of psychological, pharmacological, and combination treatments for geriatric depression.

We examined older adults' ratings of the acceptability of geriatric depression treatments. We presented 120 community-dwelling participants with vignettes describing an older adult experiencing either mild to moderate or severe depression. Participants rated the acceptability of three different treatments: cognitive therapy (CT), antidepressant medication (AM), and a combination treatment of CT and AM (COM). For general acceptability, participants rated COM as a more acceptable treatment for depression than both CT and AM. With respect to perceived negative aspects of treatments, they rated CT as a more acceptable treatment for mild to moderate depression than both AM and COM. Participants rated both COM and CT as more acceptable treatments for severe depression than AM. Results indicate that combining psychotherapy and AM may be viewed as most acceptable by community-dwelling, nondepressed older adults.