Does age matter? Initial treatment goals of older adults with major depression in outpatient cognitive behavioural therapy

Compliance with CBT referral in nursing home residents diagnosed with depression: Results from a feasibility study

Objectives

Patient-level factors that influence compliance with a recommendation for CBT in nursing home residents diagnosed with depression were identified.

Methods

Within a cluster-randomized trial on stepped care for depression in nursing homes (DAVOS-study, Trial registration: DRKS00015686), participants received an intake interview administered by a licensed psychotherapist. If psychotherapy was required, patients were offered a referral for CBT. Sociodemographic characteristics, severity of depression, loneliness, physical health, antidepressant medication, prior experience with psychotherapy, and attitudes towards own aging were assessed. A binary regression determined predictors of compliance with referral.

Results

Of 123 residents receiving an intake interview, 80 were recommended a CBT. Forty-seven patients (58.8 %) followed the recommendation. The binary logistic regression model on compliance with recommended CBT was significant, χ2(9) = 21.64, p = .010. Significant predictors were age (Odds Ratio (OR) = 0.9; 95 % Confidence Interval (CI) = 0.82, 0.99; p = .024) and depression (OR = 1.33; 95 % CI = 1.08, 1.65; p = .008).

Conclusion

Within the implemented setting compliance rate was comparable to other age groups. Future interventions should include detailed psychoeducation on the benefits of psychotherapy on mild depressive symptoms in older age and evidence-based interventions to address the stigma of depression. Interventions such as reminiscence-based methods or problem-solving could be useful to increase compliance with referral, especially in very old patients (80+). Language barriers and a culturally sensitive approach should be considered when screening residents.

Training in Aging as a Diversity Factor: Education, Knowledge, and Attitudes Amongst Psychology Doctoral Students

The population of older adults is growing rapidly and there will be an increased need for psychological services for this population. Current estimates indicate a significant workforce gap such that all psychologists, regardless of specialty area, will likely be called upon to work with older adults. Education and experience in the care of older adults has been consistently connected with improved competence and interest in working with this population. Further, the APA requires that training programmes adequately cover aspects of individual diversity, though age-related education and training may be largely lacking and/or minimally addressed. The present study explores age-related training within a sample of psychology doctoral students. Participants (n = 85) consisted of doctoral trainees recruited via email (listserv) to complete an anonymous online survey as part of a larger study. Results indicate that (1) training in aging varies and is inadequate in some programmes; (2) knowledge in aging varies and is associated with training opportunities; (3) training in aging is less than training in race/ ethnic diversity; and (4) attitudes toward older clients are most strongly predicted by extent of training in aging. The authors offer suggestions for expanding age-related aspects into generalist training.

Motivation and Psychotherapy in Older Adults with Care Needs and Depression

Abstract. The utilization of psychotherapy for home-living, vulnerable older adults with depression is limited. Understanding patients’ motivation is essential to tailoring psychotherapy to their needs and improving therapeutical efficacy. Based on cross-sectional data obtained from a pragmatic, randomized controlled trial (PSY-CARE study), this study investigated general intake concerns (ICs) and patients’ treatment goals (PTG) of home-living older adults with depression. Data on ICs ( N = 251 older adults interested in participation) were analyzed using qualitative content analysis. Data on PTGs ( N = 86 participants receiving psychotherapy) were analyzed quantitatively. Main ICs included reducing depressive symptoms and coping with new (health) situations. PTGs focused on coping with health problems and age-related losses. The results provide clinicians with valuable insights into motivational factors in this vulnerable and hard-to-reach population.