TUESDAY, April 6, 2004 (HealthDayNews) -- There's hopeful news for older people struggling with depression or chronic physical problems, thanks to two new studies from opposite ends of the nation.
A relatively inexpensive program of in-home intervention can ease the symptoms of depression that affect an estimated 15 percent to 20 percent of older Americans, according to psychiatrists at the University of Washington School of Medicine.
And there's an 80 percent chance that an older person who suffers a disabling condition will regain the ability to meet his basic needs within six months, Yale University researchers report.
Both studies appear in the April 7 issue of the Journal of the American Medical Association.
The key to success in both cases is a continuing effort to provide the services needed by those elderly people. But an accompanying editorial in the journal questions the ability of the nation's health-care system to make that commitment.
In the Washington study, a group led by Dr. Paul Ciechanowski, assistant professor of psychiatry, brought in-home counseling to 72 older Seattle residents, most of them living alone on a low income and diagnosed with depression.
Seniors like these need help because "they have decreasing function, and they can become overwhelmed because there are fewer and fewer emotional resources available to them," Ciechanowski said. The basic idea behind the research was to bolster those resources, he added.
"There were in-home visits by trained social workers, eight one-hour sessions where they carried out problem-solving treatments but also focused on physical and social interventions," Ciechanowski said.
For instance, the social workers encouraged their clients to stay active by asking them about their interests and then giving them information about local activities directed at those interests. They also urged the seniors to keep in touch with family and friends in their lives. The home visits were followed up by periodic phone calls.
At the end of a year, 43 percent of the seniors who got help had at least a 50 percent reduction in symptoms of depression, compared to only 15 percent of a matched group of people who did not get help. More than one-third of the people in the treatment group were completely free of depression, compared to 12 of those who did not get help, according to the study.
The Yale research followed 754 people 70 years old and older for more than five years. During that period, 420 of them experienced some kind of disability, such as a hip fracture, said Dr. Susan E. Hardy, a postdoctorate fellow in geriatric medicine, and a leader of the study.
Some earlier research had suggested that recovery from a severe disability was relatively rare, Hardy said. But 399 of the participants who became disabled regained the ability to meet their basic personal needs -- such as bathing, walking and dressing themselves -- within a year. And 57 percent of them maintained that independence for at least six months.
The catch, Hardy said, is that "these people are at a very high risk of having more disabilities" and the U.S. health-care system often "does not provide the amount of care they need."
One of the things needed, Hardy added, is a change in the standard advice given to older persons who suddenly find themselves with a disability.
Instead of telling them to get lots of bed rest, the better strategy would be to encourage them to be more active, she said.
Ciecchanowski said the University of Washington's program wasn't all that expensive. He calculated the cost at $630 per person. An effort to expand the program is under way, but on a small scale -- 20 to 30 more participants -- and "we are working to obtain more funding," he said.
One problem with trying to bring help to depressed older people who live alone is "there are numerous barriers to the delivery of mental health care for older adults," Dr. Jeffrey M. Lyness, associate professor of psychiatry at the University of Rochester Medical Center in New York, said in an accompanying editorial. One of those barriers is financial.
The nation's current health-care system "can only be described as discriminatory" because it doesn't provide as much funding for mental disorders as for physical problems, Lyness said.
"But the cost of not caring for these people is substantial," he added.
"People who are depressed cost the health-care system a lot of money, not only for treatment of depression but also for general health care. Not treating their depression gives only the illusion of saving money," he said.
The hope is that publication of the University of Washington findings "will help raise awareness of the problem and that treatment might work," he added.
More information
For more on depression in older people, visit the National Library of Medicine. The National Institute on Aging offers a wide range of health information for seniors.
