Two hundred seniors are being randomly assigned to receive prevention-oriented interventions and will get about 12 sessions of different kinds of behavioral therapy, with booster sessions provided at regular intervals. Researchers will then follow patients for a year to track how many get depression diagnoses.
Another 200 seniors in control groups for the three arms of the study will receive patient education only and then quarterly assessments of their mood, physical functioning and cognition.
Seniors with mild cognitive impairment who receive interventions are assigned to problem-solving therapy, a highly structured process that teaches people how to identify unresolved issues in their daily lives and find concrete solutions.
Seniors in the osteoarthritis arm of the project are getting a slightly different intervention that incorporates cognitive behavioral therapy because the perception of pain is often intimately linked to psychological distress. They are also receiving therapy to address sleep problems.
"I learned how to bring my pain under control using my mind as opposed to pills and such," said Belisle, of Moon Township, Pa., who has knee arthritis and gout. He rates his daily pain at 5 on a 10-point scale. Until he received help from the Pittsburgh program last summer, he said, he'd never dreamed of getting any kind of therapy.
"Good grief, no, I didn't need that. I was self-sufficient and an ex-Marine who knew everything," he said. "I didn't understand before that when all these negative thoughts clutter your brain, you can't manage your pain or any of your other problems as well. I tell you, I learned a heck of a lot."
Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy organization that is not affiliated with Kaiser Permanente.
Depression symptoms may not resemble those in younger adults. Older people with depression are less likely to report intense feelings of sadness and more inclined to say things such as "my food doesn't taste right; I'm not sleeping well; I'm having trouble concentrating," said Barry Lebowitz, a professor of psychiatry at the University of California at San Diego School of Medicine.
Minor depression in older adults — feelings of helplessness or a loss of pleasure in life that doesn't rise to the threshold of major depression — is also a significant concern and should not be overlooked, Lebowitz said. Up to 20 percent of older adults are thought to have "sub-threshold" depression; this substantially raises their chance of developing major depression, according to a 2006 study in the American Journal of Psychiatry.