FROM JAMDA
Short-term cognitive-behavioral therapy is an effective intervention for geriatric patients with comorbid acute illness and depression, judging from the findings of a trial of 155 patients.
“The results presented here confirm the interaction of depression with cognitive and functional performance in this vulnerable study population,” wrote Jana Hummel, MD. “However, the extent of the effect on almost all levels of health was unexpected.”
CBT previously had not been used as a treatment for older patients with acute physical illness and comorbid depression, according to Dr. Hummel and her associates ( JAMDA. 2017;18:341-9 ).
The authors recruited patients aged 82 years, plus or minus 6 years, from a 170-bed hospital that served as the Center for Geriatric Medicine at the University of Heidelberg, Germany. Patients who had been admitted to the hospital had a Hospital Anxiety and Depression Scale ( HADS ) score of greater than 7. Those with dementia or a life expectancy of less than 1 year were excluded from the study, reported Dr. Hummel of the Geriatric and Gerontopsychotherapeutic Practice in Mannheim, Germany, and her associates.
After the patients were discharged, the clinicians began the active intervention. The investigators randomized 56 people into the CBT intervention, a 15-session, manualized program designed for elderly patients who were based at home. The program included several group sessions held at the hospital’s day clinic and two individual sessions conducted by psychotherapists with expertise in gerontology.
The control group was made up of 99 people. Patients in both groups received antidepressants and other medication, the authors reported in the Journal of the American Medical Directors Association.
Four months after discharge, the patients’ severity of depression as measured by HADS scores was significantly lower among the patients in the psychotherapy group than in the usual care group (1.56 plus or minus 1.4, compared with 3.13 plus or minus 1; P less than .001). Likewise, patients in the psychotherapy group also scored lower on the Hamilton Rating Scale for Depression than did those in the control group (10.57 plus or minus 6.4, compared with 21.47 plus or minus 6.9; P less than .001).
In order for CBT to be effective for this population, arrangements might need to be made to transport patients to intervention sites, according to Dr. Hummel and her associates. Alternatively, the treatment could be administered in nursing homes. Ultimately, the authors said, “the interventions have to be tailored to the individual needs, severity of depression, and health situation.”
One limitation of the study is that the cognitive function of some elderly patients could prevent them from benefiting from CBT. However, Dr. Hummel and her associates said they are optimistic about such interventions for other geriatric patients.
“CBT provides psychological benefit to older patients with depressive symptoms, and it also can reverse some of the functional and cognitive decline associated with depression, they wrote. “It may prove to be an important tool in the treatment of depression in old age and multimorbidity.”
The study was funded with grants from the Robert Bosch Foundation and the Dietmar Hopp Foundation. Dr, Hummel and her associates declared no conflicts of interest.
ghenderson@frontlinemedcom.com
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