Leveraging Adult Protective Service Interaction to Offer Evidence-Based Treatment for Depression in Elder Neglect/Self Neglect

Conditions studied

Depression in Old Age

About this study

The purpose of this study is to test the feasibility and acceptability of an evidence-based treatment for depression delivered over an ipad, computer, or smartphone can help Adult Protective Services (APS) clients with their activities of daily living to evaluate whether reductions on measures of depression and apathy (a) mediate reduced Elder Neglect/Self Neglect (EN/SN) behaviors; and (b) whether secondary posited mediating mechanisms are also active in impacting depression and apathy

Interventions

• Behavioral: APS Treatment as Usual — APS agencies conduct in-home investigations of alleged abuse and neglect against disabled and older adults. Investigations result in short-term stop-gap measures, primarily brief case-management centering on referral linkage to community-based services and provision of resource allocation. No direct psychological services or treatments are provided by APS, however referral to other services is also standard.
• Behavioral: Intervention-Behavioral Activation (BA) — Participants will be will be guided through 8 one-hour sessions via home telehealth by the study community health worker. Each weekly \< 60 minute BA session will include modules focusing on 1) Psychoeducation for depression and techniques for self-management, including pharmacologic and psychosocial treatment options; 2) Introduction of BA and guided problem-solving techniques to enhance self efficacy for managing depression and other chronic illnesses; 3) BA and problem-solving techniques to support medication management and adherence strategies; 4) BA to develop strategies and techniques for communicating with health providers and/or support resources to foster positive mood and self management; and 5) Developing a relapse prevention plan, which includes identifying triggers for lower functioning, support resources, and practice of BA techniques.

Primary outcomes

• Change in depression as assessed by the Patient Depression Questionnaire (PHQ-9) (baseline, post-treatment ( 8 weeks after baseline), and 3 months)
• Change in apathy as assessed by the Apathy Motivations Index (AMI) (baseline, post-treatment ( 8 weeks after baseline), and 3 months)
• Change in Elder Neglect/Self Neglect (EN/SN) as evidenced by study developed goal attainment scale (baseline, post-treatment ( 8 weeks after baseline), and 3 months)

Eligibility information

Study locations

• The University of Texas Health Science Center at Houston, Houston, Texas 77030 United States