Abstract
BackgroundThere is a need to improve psychotherapeutic approaches to treatment for vulnerable older adults with depression in terms of both clinical practice and health care supply. Against this background, PSY-CARE is testing the feasibility and effectiveness of outpatient psychotherapy for home-living older adults in need of care with depression in Berlin, Germany, and neighboring suburban areas.MethodsIn a two-arm single-center pragmatic randomized controlled trial (RCT), manual-guided outpatient psychotherapy will be compared to brief psychosocial counseling. The study population will be compromised of older adults with clinically significant depressive symptoms who have a long-term care grade, as assessed by the German compulsory state nursing care insurance. In the intervention group, individual cognitive-behavioral psychotherapy tailored to the specific needs of this population will be offered by residential psychotherapists as part of the regular healthcare service. In the active control group, participants will receive individual psychosocial telephone counselling and a self-help guide. The planned sample size is N = 130 (n = 65 participants per group). The reduction of depressive symptoms (primary outcome) as well as the maintaining of activities of daily living, quality of life, and functioning will be assessed with questionnaires provided at baseline, after the end of the intervention and after three months. Feasibility and process evaluation will be conducted qualitatively based on documentation and interviews with psychotherapists, gatekeepers and the participants.DiscussionPSY-CARE investigates the potentials and limitations of providing outpatient psychotherapeutic treatment meeting the demands of vulnerable home-living older adults with depression under the real conditions of the health care system. The study will provide practical implications to improve access to and quality of outpatient psychotherapy for this poorly supplied population.Trial registrationThe trial is registered at ISRCTN55646265; February 15, 2019.
Highlights
There is a need to improve psychotherapeutic approaches to treatment for vulnerable older adults with depression in terms of both clinical practice and health care supply
Meta-analyses and systematic reviews have provided extensive evidence that psychotherapeutic interventions are effective for treating depression in the older population, with strongest evidence for cognitive and behavioral therapy (CBT), life review therapy (LR) and problem-solving therapy (PST) [8, 9]
Vulnerable older adults with depression including very old, frail and care-dependent older adults were mostly excluded from these studies [10], despite advances for psychotherapeutic research in the context of specific comorbid conditions including chronic obstructive pulmonary disease (COPD), heart failure, Parkinson’s disease, stroke, early stages of dementia and suicidal ideations [for an overview, see [11]]
Summary
There is a need to improve psychotherapeutic approaches to treatment for vulnerable older adults with depression in terms of both clinical practice and health care supply. Against this background, PSY-CARE is testing the feasibility and effectiveness of outpatient psychotherapy for home-living older adults in need of care with depression in Berlin, Germany, and neighboring suburban areas. Compared with the general older population, community-based studies have consistently documented at least two or three times higher rates of depression among older adults with chronic physical conditions, cognitive deficits and/ or sensory limitations, i.e. conditions that often along with functional impairment and dependence on informal and formal support systems for medical care, transport and other essential needs (e.g., [1,2,3,4,5]). Psychotherapy for this rapidly growing population is understudied in terms of clinical practice, feasibility, efficiency and effectiveness
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