The efficacy of home-delivered cognitive-behavioral therapy (CBT) in improving quality of life and reducing psychological symptoms in older adults was examined in this study. One hundred thirty-four participants, predominately African American and characterized as primarily rural, low resource, and physically frail, were randomly assigned to either CBT or a minimal support control condition. Results indicate that CBT participants evidenced significantly greater improvements in quality of life and reductions in psychological symptoms. Mediation of treatment through cognitive and behavioral variables was not found despite the acceptable delivery of CBT by research therapists. These data suggest that treatment can be effective with a disadvantaged sample of older adults and extend efficacy findings to quality of life domains. Creating access to evidence-based treatments through nontraditional delivery is an important continuing goal for geriatric health care.

Rural dwelling elders who experience mental health problems often have difficulty finding help since rural communities often lack adequate mental health service providers. This paper reports on the initial phase of a 5-year, interdisciplinary clinical research study that is testing the effectiveness of providing a home delivered, therapeutic psychosocial intervention, aimed at improving the emotional wellbeing and the quality of life of medically frail elders who live in rural communities. In the early phases of this study, the clinical research team encountered a number of interesting and often unanticipated challenges as it attempted to recruit study participants and provide services to them. In this article, we examine these challenges and share what we have learned so far about providing mental health services to elderly persons living in rural environments.

Targeting both hopelessness and engagement in pleasant events may be helpful in improving the quality of life of vulnerable, rural older adults.

A large proportion of service providers in our country are social workers. The use of social workers as mental health therapists however, has not been adequately evaluated in the literature. This aim of this study was to evaluate a sample of clinically trained, masters-level social workers in their delivery of in-home Cognitive Behavioral Therapy (CBT) to a group of primarily rural, medically frail older adults. The social workers in this study received extensive didactic and experiential CBT training. Audio-taped sessions were randomly selected and evaluated independently. Results showed that the social workers adequately delivered CBT as measured by the Cognitive Therapy Scale (CTS). Older adult participants also evidenced pre-post treatment improvements suggesting that the social workers’ delivery of CBT facilitated improvement. These results suggest that social workers can be viable providers of CBT in clinical and research settings.