'Who tells me when to stay active or to leave?' age differences in and predictors of endorsement of prescriptive views of aging.

OBJECTIVES: Prescriptive views of aging (PVoA) are normative age-based expectations about age-appropriate behavior for older adults, e.g. that they should stay fit/active (active aging norms) but also behave altruistically toward younger generations (altruistic disengagement norms). We aimed at examining age differences in endorsement of active aging and altruistic disengagement and investigated predictors of endorsement. METHOD: In the AGEISM Germany survey, a representative sample of N = 1,915 German participants was recruited, covering a wide age range (Mage=56.57 years, 16-96 years). Cross-sectional data was collected via computer-assisted telephone interviews. RESULTS: Active aging was more strongly endorsed than altruistic disengagement. Endorsement of both PVoA was higher in older age groups - even more pronounced for altruistic disengagement. Endorsement of both norms was positively associated with positive age stereotypes. Furthermore, active aging was predicted by age centrality whereas altruistic disengagement was predicted by negative age stereotypes. Age was still a robust predictor of PVoA even after entering additional predictors. CONCLUSION: Although associated, prescriptive age norms (i.e. beliefs how older people should behave) and descriptive age norms (i.e. beliefs about how older adults and the aging process are like) represent partly independent belief systems, highlighting the importance to assess & further investigate predictors and consequences of PVoA, which become more prevalent with age.

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

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).

Life-space mobility among home-living older adults with care needs and clinical depression-A cross-sectional analysis.

OBJECTIVES: While life-space mobility is key for wellbeing, social participation and access to health care, vulnerable older adults face physical and mental barriers that may restrict mobility. The present exploratory study examined associations between physical functional limitations, depressive symptoms, life-space mobility and outpatient health care utilization. METHODS: Cross-sectional data from 197 community-dwelling older adults with care needs and clinical depression was collected. Life-space assessment composite score (LS-C), instrumental activities of daily living scale (iADL), Geriatric Depression Scale (GDS-12) and outpatient health care utilization have been assessed. Multiple regression analyses were conducted. RESULTS: Mean LS-C score was 31.8 (SD = 17.7, range: 0-92), indicating low mobility levels. Depressive symptoms (ß = -0.21, p = 0.001) and iADL (ß = 0.54, p < 0.001) were significantly related with life-space mobility, over and above age and living alone. An interaction effect between depressive symptoms and iADL was not significant (ß = -0.07, 0.17, p = 0.26). Moreover, life-space mobility was positively associated with primary care (ß = 0.19, p = 0.02) and mental health care utilization (ß = 0.33, p < 0.001). CONCLUSIONS: Life-space mobility appears to be largely restricted in home-living vulnerable older adults with clinically significant depression; and factors associated with these restrictions appear to be physical and mental. The interplay of depression, mobility and health care utilization and its potential for interventional approaches need further investigations. Present findings underline an urgent need for new health care services that allow mobility-impaired older patients to receive mental health outpatient treatment in their own home. CLINICAL TRIAL REGISTRATION: The trial was prospectively registered with the ISRCTN registry (Trial registration number: ISRCTN55646265, registered February 15, 2019).

Psychotherapists' experiences providing at-home psychotherapy for home-living older adults with long-term care needs and depression.

This study used qualitative methods to explore psychotherapists' experiences conducting at-home psychotherapy with older adults (60 + years) with long-term care needs and depression. We conducted semistructured interviews with 16 female psychotherapists (26-70 years old) who delivered at-home cognitive behavioral therapy to home-living older adults with long-term care needs and depression. We additionally conducted 10 patient case studies. Using an adaption of the methodology of grounded theory, we iteratively developed a hierarchical model. Results showed that psychotherapists experienced three dilemmas: (a) pushing for change versus acknowledging limitations, (b) providing help versus maintaining boundaries, and (c) being a guest in the patient's home versus the host of a psychotherapy session. The absence of a shared understanding of therapy and confrontation with patients' existential suffering intensified the experience of the dilemmas. The dilemmas generated professional self-doubt and negative emotions, which in turn triggered a reflexive process and ultimately participants' professional development. Participants found a way to integrate drives initially perceived as mutually exclusive, and further developed their professional self-image and therapeutic techniques. We interpret the dilemmas as reflecting difficulty reconciling the "curing" and "caring" treatment paradigms. Practice and support managing the three dilemmas along with reflection on the curing paradigm, views on old age, and fear of existential suffering should be part of qualifications for psychotherapists working with older adults in need of care. Cooperating with other care providers may relieve the pressure on psychotherapists to provide forms of support that could lead to overburden and impede therapeutic progress. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

[Strengthening prevention and health promotion in and for old age]. / Prävention und Gesundheitsförderung im und für das Alter stärken.

BACKGROUND: Disease prevention and health promotion in and for old age have become increasingly more important. Nevertheless, more (national) research and implementation in practice is needed, as the international comparison shows. OBJECTIVE: To develop guiding principles for research and practice on prevention and health promotion in and for old age. MATERIAL AND METHODS: As part of an iterative process, members of the German Society of Gerontology and Geriatrics came together in workshops and symposia to formulate key guiding principles and fields of action for prevention and health promotion. RESULTS: The following were worked out: 1) prevention and health promotion are useful and possible up to oldest age, 2) prevention and health promotion for advanced age should start early, 3) prevention and health promotion must take into account the diversity and heterogeneity of the life situations of old people, 4) prevention and health promotion promote and demand self-determination and participation, 5) prevention of multiple illnesses must be given greater attention, 6) prevention of the need for long-term care and prevention in long-term care must be treated equally, 7) prevention and health promotion must be thought of in terms of life worlds and across sectors, paying particular attention to aspects of social inequality and a focus on resources, 8) prevention and health promotion and the related research must be interdisciplinary and transdisciplinary and be applied at different levels, from molecular to societal. DISCUSSION: The guiding principles outline the focal points of future-oriented ageing, health and healthcare research and open up fields of action but also show the limits of this approach for political decision-makers, researchers and practitioners.

Experiences of Home-living Vulnerable Older Adults with Clinical Depression during the COVID-19 Pandemic: A Qualitative Study.

OBJECTIVES: Little is known about the diversity of older adults' experiences during the COVID-19 pandemic. We therefore investigated the pandemic experiences of home-living vulnerable older adults with depression, an understudied subpopulation. METHODS: We conducted unstructured interviews with N= 20 older (60+ years) adults with clinical depression receiving care in their homes in June and again in December 2020. Interviews were coded according to the grounded theory approach. RESULTS: We identified eight themes. Participants described feeling disconnected before and during the pandemic, which they attributed to their physical impairments and old age. Their social relations with family, medical providers, and caregivers helped them feel connected. Participants did not feel significantly impacted by the COVID-19 pandemic, but they missed social and physical contact. During the pandemic, isolation was normalized. Participants therefore experienced loneliness due to their isolation, but also a sense of togetherness with the rest of society. Isolation within the home was re-framed as cocooning, which provided a sense of autonomy. Participants nevertheless expressed resignation. CONCLUSIONS: Home-living vulnerable older adults with depression experienced loneliness but also a degree of relief during the pandemic. CLINICAL IMPLICATIONS: Positively re-framing isolation and the stability of formal caregiving helped participants endure feeling disconnected during the pandemic.

Evaluation of Recruitment Strategies for Home-Living Vulnerable Older Adults With Depression: Findings From a Randomized Controlled Psychotherapy Trial.

OBJECTIVE: Vulnerable older adults, such as physically impaired or care-dependent individuals, are vastly underrepresented in psychotherapy research. Improving their inclusion in randomized controlled trials is necessary to determine the effectiveness of psychotherapy in this population. This study is the first to systematically evaluate strategies to recruit home-living vulnerable older adults with clinically significant depression into a large randomized controlled psychotherapy trial. Potential participants were approached directly (self-referral) or via cooperation with gatekeepers (gatekeeper-referral). METHODS: Successful recruitment strategies and the person initiating the first contact with the study team were recorded. Recruitment strategies were compared with respect to the number of inquiries and inclusion rates, study personnel's time investment, and participant characteristics (sociodemographics, functional and cognitive status, depression and anxiety scores). RESULTS: Most of the N = 197 participants were included via gatekeeper-referral (80.5%, 95% confidence interval = [74.9, 86.1]), but time investment for gatekeeper-referrals was five times higher than for self-referral by media reports. Clinical psychologists and medical practitioners referred the largest proportion of participants (32.3% each) and referral by medical practitioners led to highest inclusion rates (55.6%; χ²(3) = 8.964, p <0.05). Most participants were referred from a hospital setting (50.3%), whereas referral numbers by medical practices were low (15.9%). Participants who initiated the first contact themselves had higher inclusion rates and were less functionally impaired. CONCLUSION: Including home-living vulnerable older adults into psychotherapy trials requires simultaneous implementation of diverse recruitment strategies. Medical practitioners and psychologists, especially in hospitals, are the most effective recruitment strategy, but self-referral via media is most cost-efficient in terms of time investment.

Concordance of self- and informant-rated depressive symptoms in nursing home residents with Dementia: cross-sectional findings.

BACKGROUND: Depression is highly prevalent in nursing home residents living with moderate to severe dementia. However, assessing depressive symptoms in residents with dementia can be challenging and may vary by rater perspective. We aimed to investigate the concordance of, and factors associated with self- and informant-rated depressive symptoms in nursing home residents with dementia. METHODS: Cross-sectional data was collected from N = 162 nursing home residents with dementia (age: 53-100; 74% women). Self-ratings were assessed with the Geriatric Depression Scale, while the depression and anxiety items of the Neuropsychiatric Inventory were used for informant-ratings. Cohen's Kappa was calculated to determine the concordance of both measures and of each with antidepressant medication. Multivariate associations with sociodemographic variables, self- and informant-rated quality of life, dementia stage, neuropsychiatric symptoms, functional status and antidepressant medication were analysed with linear mixed models and generalized estimating equations. RESULTS: Concordance between self- and single item informant-rated depressive symptoms was minimal (Cohen's Kappa = .22, p = .02). No concordance was found for self-reported depressive symptoms and the combined informant-rated depression-anxiety score. Self-reported depression was negatively associated with self-rated quality of life (ß = -.32; 95%CI: -.45 to -.19, p < .001), informant-rated quality of life (ß = -.25; 95%CI: -.43 to -.07, p = .005) and functional status (ß = -.16; 95%CI: -.32 to -.01, p = .04), whilst single item informant-rated depression revealed negative associations with informant-rated quality of life (ß = -.32; 95%CI: -.52 to -.13, p = .001) and dementia stage (ß = -.31; 95%CI: -.52 to -.10, p = .004). The combined informant-rated depression-anxiety score showed negative associations with self-rated quality of life (ß = -.12; 95%CI: -.22 to -.03, p = .01) and dementia stage (ß = -.37; 95%CI: -.67 to -.07, p = .02) and a positive association with neuropsychiatric symptoms (ß = .30; 95%CI: .10 to .51, p = .004). No concordance was found with antidepressant medication. CONCLUSIONS: In line with our expectations, low agreement and unique association patterns were found for both measures. These findings indicate that both instruments address different aspects of depression und underline the need for comprehensive approaches when it comes to detecting signs of clinically relevant depressive symptoms in dementia. TRIAL REGISTRATION: The trial was registered with the ISRCTN registry (Trial registration number: ISRCTN98947160 ).

How young psychotherapists experience working with older patients.

Preliminarily findings from experimental and survey research suggests that psychotherapy with older adults is an area of practice in which psychotherapists do not feel positive and confident. This qualitative study is the first to explore how young psychotherapists experience and perceive their therapeutic work with older patients. To do so, we provide an in-depth perspective of how young (aged 27-35) psychotherapists experience providing psychotherapeutic treatment for older patients (aged over 65). Semistructured interviews were conducted with 20 psychotherapists in training (14 women, six men). They were recruited via psychotherapeutic training institutions and geropsychiatry clinics in Germany. The grounded theory approach was used to analyze the data. We found that the participants had various attitudes toward older adults (respectful/admiring, caring/supportive, doubtful, and open) that were related to individual social and biographic experiences with older adults. The participants' attitudes and personal experiences were also found again in their reported therapeutic behavior toward older patients. The finding further showed that the treatment setting (inpatient vs. outpatient) had an additional impact on the participants' perception of and therapeutic behavior toward older patients. Our findings demonstrated that the participants experienced various challenges and particularities when working with older patients. Young psychotherapists who work with older patients should be supported by psychotherapeutic training institutions through supervision and guidance on how to deal with clinical challenges. Furthermore, it can be valuable for young psychotherapists to critically reflect their attitudes toward older adults and personal motives for their therapeutic behavior toward older patients. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Does age matter? Initial treatment goals of older adults with major depression in outpatient cognitive behavioural therapy.

BACKGROUND: Personal treatment goals (PTG) are important means to tailor psychotherapy to the needs of the patient, leading to increased engagement and greater improvement in relevant outcomes. According to lifespan developmental research, motivational goals in old age differ from goals of younger people, with management of losses rather than growth becoming more prevalent. However, this study is the first to systematically investigate age-specific differences in PTGs. METHOD: We used routine data from patients with major depression assessed at the beginning of outpatient cognitive behavioural therapy. Initial high-priority PTGs were assessed using the Bern Inventory of Treatment Goals (BIT-C). Older patients (≥60 years, n = 52) were matched to younger patients (<60 years, n = 52) with regard to severity of depression, number of comorbidities, gender and level of education. RESULTS: Using a mixed method approach, high-priority PTGs of both age groups were focused most strongly on reducing depressive symptoms and, subsequently, anxiety. At the same time, older patients focused more strongly on PTGs related to well-being and functioning, while younger patients' emphasis was on personal growth. Furthermore, better coping with the ageing process and physical losses emerged as important PTGs for some older patients. CONCLUSION: Initial PTG themes are specific to diagnosis, but also seem to differ in regard to age. Thus, it is important to develop age-sensitive measures that allow appropriate and efficient tailoring of psychotherapy to meet older patients' needs and preferences.

Perceived need for treatment and non-utilization of outpatient psychotherapy in old age: two cohorts of a nationwide survey.

BEACKGROUND: Older adults with mental health problems may benefit from psychotherapy; however, their perceived need for treatment in relation to rates of non-utilization of outpatient psychotherapy as well as the predisposing, enabling, and need factors proposed by Andersen's Model of Health Care Utilization that account for these differences warrant further investigation. METHODS: We used two separate cohorts (2014 and 2019) of a weighted nationwide telephone survey in Germany of German-speaking adults with N = 12,197 participants. Across the two cohorts, 12.9% (weighted) reported a perceived need for treatment for mental health problems and were selected for further analyses. Logistic Generalized Estimation Equations (GEE) was applied to model the associations between disposing (age, gender, single habiting, rural residency, general health status), enabling (education, general practitioner visit) non-utilization of psychotherapy (outcome) across cohorts in those with a need for treatment (need factor). RESULTS: In 2014, 11.8% of 6087 participants reported a perceived need for treatment due to mental health problems. In 2016, the prevalence increased significantly to 14.0% of 6110 participants. Of those who reported a perceived need for treatment, 36.4% in 2014 and 36.9%in 2019 did not see a psychotherapist - where rates of non-utilization of psychotherapy were vastly higher in the oldest age category (59.3/52.5%; 75+) than in the youngest (29.1/10.7%; aged 18-25). Concerning factors associated with non-utilization, multivariate findings indicated participation in the cohort of 2014 (OR 0.94), older age (55-64 OR 1.02, 65-74 OR 1.47, 75+ OR 4.76), male gender (OR 0.83), lower educational status (OR 0.84), rural residency (OR 1.38), single habiting (OR 1.37), and seeing a GP (OR 1.39) to be related with non-utilization of psychotherapy; general health status was not significantly associated with non-utilization when GP contact was included in the model. CONCLUSION: There is a strong age effect in terms of non-utilization of outpatient psychotherapy. Individual characteristics of both healthcare professionals and patients and structural barriers may add to this picture. Effective strategies to increase psychotherapy rates in those older adults with unmet treatment needs are required.

Depressed Older Patients with Death Wishes: Experimental Evidence for Psychotherapists' Age and Health Bias.

Objectives: When psychotherapists encounter an older patient with depression and death wishes, especially when burdened by physical illness, they may be subject to judgmental biases. This study investigates how this group of patients with highest suicide risk may experience discrimination both on age and health status. Methods: Using a 2 × 2 [chronological age x physical health status] vignette design, psychotherapists (N = 147) were randomly presented with one of the four variants of a case describing a patient with depression and death wishes (i.e., 78 years old + poor physical health; 78 years old + normal physical health; 48 years old + poor physical health; 48 years old + normal physical health). Afterward, participants' attitudes toward the case were assessed. Results: In case of the hypothetical patient's old age and poor health status, participants did not underestimate the pathological significance of his death wishes, but nevertheless showed less optimistic treatment attitudes and less confidence in psychotherapeutic treatment. Conclusions: Psychotherapists' age bias and health bias may serve as two potentially fatal factors influencing the provision of mental health services. Clinical Implications: Psychotherapists may contribute to better mental health-care provision of older adults with depression and the prevention of late-life suicide by increasing awareness of their age and health bias.

Outpatient psychotherapy for home-living vulnerable older adults with depression: study protocol of the PSY-CARE trial.

BACKGROUND: There is a need to improve psychotherapeutic approaches to treatment for vulnerable older adults with depression in terms of both clinical practice and health care supply. Against this background, PSY-CARE is testing the feasibility and effectiveness of outpatient psychotherapy for home-living older adults in need of care with depression in Berlin, Germany, and neighboring suburban areas. METHODS: In a two-arm single-center pragmatic randomized controlled trial (RCT), manual-guided outpatient psychotherapy will be compared to brief psychosocial counseling. The study population will be compromised of older adults with clinically significant depressive symptoms who have a long-term care grade, as assessed by the German compulsory state nursing care insurance. In the intervention group, individual cognitive-behavioral psychotherapy tailored to the specific needs of this population will be offered by residential psychotherapists as part of the regular healthcare service. In the active control group, participants will receive individual psychosocial telephone counselling and a self-help guide. The planned sample size is N = 130 (n = 65 participants per group). The reduction of depressive symptoms (primary outcome) as well as the maintaining of activities of daily living, quality of life, and functioning will be assessed with questionnaires provided at baseline, after the end of the intervention and after three months. Feasibility and process evaluation will be conducted qualitatively based on documentation and interviews with psychotherapists, gatekeepers and the participants. DISCUSSION: PSY-CARE investigates the potentials and limitations of providing outpatient psychotherapeutic treatment meeting the demands of vulnerable home-living older adults with depression under the real conditions of the health care system. The study will provide practical implications to improve access to and quality of outpatient psychotherapy for this poorly supplied population. TRIAL REGISTRATION: The trial is registered at ISRCTN55646265 ; February 15, 2019.

Age cues in patients' descriptions influence treatment attitudes.

Objectives: Ageism on the part of service providers has been widely cited as an important factor limiting access to and adequate quality of mental health services for old, especially very old adults. The objective of this study was to analyze how treatment attitudes depend on age cues in patients' descriptions.Method: A sample of psychotherapists-in-training (N = 114) responded to questions concerning a naturalistic case vignette of a male patient with symptoms of depression. Based on random assignment, participants either read the original (real-life) case description including very-old age cues ('very-old patient condition') or the manipulated case description ('middle-aged patient condition') which was identical with the exception that the most salient age cues were replaced by a younger chronological age of the patient (52 years) and age-neutral cues (e.g., "black hair" instead of "light grey hair"). All other aspects of the vignette including the patient's psychological symptoms and medical conditions were kept constant.Results: Participants showed less favorable attitudes towards the patient in the 'very-old patient condition' relative to the patient in the 'middle-aged patient condition', as indicated by more negative affect, less conviction in the treatability of the patient, a poorer prognosis, less interest in treatment provision as well as less subjective treatment competence.Conclusion: Mental health care providers' 'age bias' continues to be a problematic factor in psychotherapy with older adults. An "age-aware education" for psychotherapists is needed for better realizing the potentials of psychotherapy with older adults.

Current state of research on psychotherapy for home-living vulnerable older adults with depression.

Older home-living vulnerable adults often suffer from chronic conditions accompanied by restrictions in mobility, social participation and reduced independence. Among this rapidly growing population depression is a common and serious health problem; however, there are shortcomings in the diagnosis of depression and provision of psychotherapy. Despite growing evidence in treating depression among the group of nursing home residents or the "young-old", there is a research gap regarding needs-oriented healthcare strategies for very old, frail or care-dependent older adults living at home. The present article provides an overview of different outpatient psychotherapeutic treatment approaches for vulnerable older adults with depression, in particular adaptations tailored to those who are homebound or in need of care. Based on the current state of research, this article derives recommendations for psychotherapy in this special setting to consider the physical and psychosocial resources of this patient group. Furthermore, healthcare strategies for embedding psychotherapy in collaborative, telehealth or home-delivered healthcare services are described and their applicability as psychosocial support for older adults during the coronavirus disease 2019 (COVID-19) pandemic is discussed. Psychotherapy is an efficacious treatment for depression in home-living vulnerable older adults. Further implementing telehealth or home delivered settings, individually tailored psychotherapeutic approaches as well as collaborative and stepped care approaches can increase utilization and medical supply of this patient group. More research and innovative programs are needed to improve access to and provision of psychotherapeutic care as well as their social inclusion.

[Gerontologically oriented study programs in Germany : Critical review]. / Gerontologisch orientierte Studiengänge in Deutschland : Kritische Bestandsaufnahme.

The objective of this article is a state-of-the-art analysis and critical reflection of the status quo of gerontologically oriented study programs in higher education in Germany. The major impulse for writing this article was provided by the newly established working group "Gerontological Education", which was inaugurated at the joint annual conference of sections III and IV of the German Society of Gerontology and Geriatrics in Mannheim in 2015. A systematic review of gerontological study programs shows that the number of such programs has increased in Germany over the past decade. At the same time there has been a dynamic development across the country whereby well-established programs were closed and new ones were initiated. New study programs were primarily initiated at universities of applied sciences and private universities. A tendency away from explicit gerontology programs towards other academic disciplines (e.g. sociology, social work, psychology, sports, health and rehabilitation sciences) in combination with gerontological contents can be observed. These degree programs are rooted in their respective disciplines and focus primarily on health and social issues. Given the heterogeneity of study programs the working group "Gerontological Education" could become a new forum for leaders of such programs, students, alumni and employers of gerontologists for critical reflection and further development of gerontological quality benchmarks.

[Life review of nursing home residents with depression : Qualitative study of experiences from behavioral therapists within a pilot study]. / Lebensrückblick bei Pflegeheimbewohnern mit Depression : Qualitative Studie über Erfahrungen von Verhaltenstherapeuten im Rahmen eines Pilotprojekts.

AIM: There is a need to develop and implement psychotherapeutic approaches to treatment for nursing home residents with depression. In addition to existing quantitative outcome studies, this qualitative study provides an in-depth look at therapists' work in providing outreach ambulatory cognitive-behavioral treatment with elements of a life review intervention in a pilot project. The goal was to generate action-guiding knowledge that can improve the care of nursing home residents with depression. DESIGN AND METHODS: The study provides a triangulation of data collection from participant observation and focused group interviews. The analysis of a group discussion with six psychotherapists and two supervisors followed the framework of grounded theory and included various discussions with experts from the fields of psychology, sociology and public health. RESULTS: Normalizing situations and managing current challenges appeared to be central therapeutic elements, whereas the purpose in life and coming to terms with the past were of minor importance. IMPLICATION: Preliminary results suggest that a modified version of cognitive-behavioral therapy using elements of simple reminiscence and individualized biographical work may be an effective treatment approach for nursing home residents with depression. Making the unique experiences of psychotherapists into the object of research opens up the possibility to bring about discussion of the benefits and limitations of psychotherapy under the real conditions of the healthcare and nursing system.

Attitudes towards seeking mental health services among older adults: personal and contextual correlates.

OBJECTIVES: Especially older adults underutilize professional mental health services. However, little is known about the factors associated with older adults' attitudes towards seeking mental health services (ATSMHS). We therefore investigated a wide range of contextual (e.g. physical access, residence) and personal (e.g. perceived social support, life satisfaction, openness to experience) predictors of ATSMHS in a sample of older community-dwelling adults in Germany. We predicted that representations of old age as well as perceptions of (younger) psychotherapists would be uniquely important for determining ATSMHS. METHOD: A diverse sample of N = 156 older adults (Mage = 71.5 years, SD = 6.4, range: 60-92) completed questionnaire measures. We used hierarchical linear regression analyses to identify predictors of ATSMHS. RESULTS: In the final saturated model, female gender, urban residence, personal and vicarious experience with psychotherapy, and higher perceived social support were each associated with more positive ATSMHS. In addition, more positive representations of old age and less negative perceptions of (younger) psychotherapists explained unique variance in ATSMHS over and above the other predictors. The overall model was significant and explained 49% of the variance in ATSMHS. CONCLUSION: Our findings can be used to inform interventions to improve older adults' ATSMHS. Interventions that seek to improve older adults' representations of their own aging as well as of psychotherapists may be useful for reducing the treatment gap.

[Feasibility, Practicability, and Acceptance of Outpatient Psychotherapy for Home-living Older Adults with Depression in Need of Care in Germany]. / Implementierbarkeit, Praktikabilität und Akzeptanz ambulanter Psychotherapie für zuhause lebende ältere Menschen mit Depression und Pflegebedarf ­ Ergebnisse des Innovationsfondsprojekts PSY-CARE.

OBJECTIVE: This study investigates the feasibility of outpatient psychotherapeutic depression-treatment for home living older adults in need of care within the German health-care system. METHODS: PSY-CARE is a manual based, pragmatic randomized controlled trial investigating the effects of short-term behavioural therapy for home living adults aged 60+ with clinical depression and need of care. RESULTS AND CONCLUSION: Our results suggest that health policy should implement home-visits, interprofessional cooperation and involvement of relatives as standard outpatient psychotherapy elements. Specialised geropsychological training for psychotherapists is needed.