Home-Delivered Problem Adaptation Therapy (PATH) for Depressed, Cognitively Impaired, Disabled Elders: A Preliminary Study

Objectives: This preliminary study examines the efficacy of 12-week home-delivered problem adaptation therapy (PATH) versus home-delivered supportive therapy (ST) in reducing depression and disability in 30 depressed, cognitively impaired, disabled older adults. Design: A 12-week randomized clinical trial. Research assistants were unaware of the participants' randomization status. Assessments were conducted at baseline, 6 weeks, and 12 weeks. Setting: Weill-Cornell Advanced Center for Interventions and Services Research. Participants: Thirty elders with major depression, cognitive impairment, and disability were recruited through advertisement and the Home-Delivered Meals Program of the Westchester County Department of Senior Programs and Services. Intervention: PATH is a home-delivered intervention designed to reduce depression and disability in depressed, cognitively impaired, disabled elders. PATH is based on problem-solving therapy and integrates environmental adaptation and caregiver participation. PATH is consistent with Lawton's ecologic model of adaptive functioning in aging. Measurements: Depression and disability were measured with Hamilton Depression Rating Scale-24 items and Sheehan Disability Scale, respectively. Client Satisfaction Questionnaire was used to assess patient satisfaction with treatment. Results: Mixed-effects model analyses revealed that PATH was more efficacious than ST in reducing depression and disability at 12 weeks. Participants in both treatment groups were satisfied with treatment. Conclusions: This preliminary study suggests that PATH is well accepted and efficacious in depressed elders with major depression, cognitive impairment, and disability. Because this population may not adequately respond to antidepressant medication treatment, PATH may provide relief to many patients who would otherwise remain depressed and continue to suffer. (Am J Geriatr Psychiatry 2010; 18: 988-998)