Healthy IDEAS

Abstract

This study evaluated an evidence-based intervention for depression delivered by case managers in three community-based service agencies to high-risk, diverse older adults. Case managers were trained to provide screening and assessment, education, referral and linkage, and behavioral activation. Outcomes addressed depression, general health status, social and physical activation, and mental health services use at baseline and 6 months. Participants (n = 94) were predominantly women (79%) and Hispanic (44%), with a mean age of 72 years. Mean Geriatric Depression Scale-15 scores differed significantly between baseline and 6 months (9.0 versus 5.5). At 6 months, significantly more participants knew how to get help for depression (68% versus 93%), reported that increasing activity helped them feel better (72% versus 89%), and reported reduced pain (16% versus 45 %). The authors conclude that nonspecialty providers can be trained to successfully implement an evidence-based self-management intervention for depression with frail, high-risk, and diverse older adults.

Behavioral activation for depression in older adults: Theoretical and practical considerations

“…Acierno et al (2012) showed that individuals with varied levels of training and expertise (ranging from recent graduates of bachelor programs in psychology to experienced social workers) were able to implement behavioral activation. Moreover, behavioral activation interventions delivered via telephone Quijano et al, 2007) or videoconferencing (Lazzari et al, 2011) were also effective. These findings suggest considerable simplicity and flexibility in implementation, which has important implications for future research and practice.…”

“…They presented with major or minor depression, and comorbid anxiety was assessed in five studies (Acierno et al, 2012;Dozeman et al, 2011;Meeks et al, 2006;Thompson et al, 1987;Turner & Leach, 2009). Few studies included older adults with cognitive impairment (Snarski et al, 2011;Teri et al, 1997), chronic medical illness (Dozeman et al, 2011;Meeks et al, 2008;Quijano et al, 2007), chronic pain Meeks et al, 2006;Quijano et al, 2007), or diagnoses of psychiatric disorders such as schizophrenia (Snarski et al, 2011); thus, there is limited evidence for the effectiveness of behavioral activation with such individuals. Conclusions are also limited for individuals of more advanced age (85 years and older) and older adults with severe depression.…”

“…This study also collected data from a pedometer as an objective measure of the client's physical activity. Several studies assessed self-rated engagement in terms of frequency and pleasantness of activities (Meeks et al, 2006(Meeks et al, , 2008Rokke et al, 1999;Thompson et al, 1987;Yon & Scogin, 2009) and frequency and duration of social and physical activity (Quijano et al, 2007). Only two studies included staff-reported activity participation and direct observation of activity participation and affective responses (Meeks et al, 2006(Meeks et al, , 2008.…”

“…Several studies demonstrated the successful implementation of behavioral activation interventions by nonmental-health professionals such as case managers (Quijano et al, 2007), occupational therapists (Sood et al, 2003), residential care staff (Cernin & Lichtenberg, 2009;Dozeman et al, 2011;Meeks et al, 2006Meeks et al, , 2008, and family caregivers (Teri et al, 1997). Acierno et al (2012) showed that individuals with varied levels of training and expertise (ranging from recent graduates of bachelor programs in psychology to experienced social workers) were able to implement behavioral activation.…”

“…Studies in the community included outpatient clinics (Acierno et al, 2012;Bottonari, Roberts, Thomas, & Read, 2008;Gallagher & Thompson, 1982;Lazzari, Egan, & Rees, 2011;Rokke, Tomhave, & Jocic, 1999;Thompson, Gallagher, & Breckenridge, 1987;Turner & Leach, 2009) and the client's home (Quijano et al, 2007;Teri, Logsdon, Uomoto, & McCurry, 1997;Yon & Scogin, 2009). Studies in residential care settings included assisted living (Cernin & Lichtenberg, 2009;Dozeman et al, 2011), nursing homes (Meeks, Looney, Van Haitsma, & Teri, 2008;Meeks, Teri, Van Haitsma, & Looney, 2006), a shortterm rehabilitation unit (Sood, Cisek, Zimmerman, Zaleski, & Fillmore, 2003), and inpatient psychiatric care facilities (Clignet, Van Meijel, Van Straten, Lampe, & Cuijpers, 2012;Snarski et al, 2011).…”