PATH TO THE PEOPLE: ENGAGING CULTURALLY AND EDUCATIONALLY DIVERSE OLDER ADULTS IN PROBLEM-BASED PSYCHOSOCIAL INTERVENTIONS

Abstract

1/5 of older adults are of a diverse ethnic or racial background. Older minorities with depression report higher levels of disability and are more persistently ill than non-Hispanic white older adults despite lower utilization of mental health care. In addition, 40% of homebound older adults have a psychiatric illness but have limited access to mental health services. Despite increased illness burden, both minority and homebound older adults are underrepresented in clinical trials. Furthermore, the education level of participants in clinical trials tends to be higher than what is observed in a culturally diverse clinic population. Problem Solving Therapy (PST) is an effective intervention to treat depression and disability in older adults. While most PST trials have been conducted in ambulatory settings, the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS) intervention was developed as a home-based intervention for medically ill, homebound older adults with depression. Given the high prevalence of cognitive disorders in homebound older adults, Kiosses and colleagues developed Problem Adaptation Therapy (PATH) for older adults with depression and cognitive impairment. This psychosocial intervention utilizes compensatory strategies, environmental adaptations and caregiver involvement. Montefiore Home Care (MHC) serves a culturally and educationally diverse patient population. In 2016, the MHC-Geriatric Psychiatry Program pursued two funding opportunities to provide problem based psychosocial interventions in the home. The first was a New York City Department of Health and Mental Hygiene grant to partner with the Jewish Services for the Aged to provide PEARLS to homebound older adults in the Bronx. Secondly, MHC partnered with Weill Cornell, under the leadership of Dr. Dimitris Kiosses, on a Fan Fox and Leslie R. Samuels Foundation grant to pilot PATH for depressed and cognitive impaired older adults. Over ¾ of the patients served by these programs are minority older adults, most of which have less than 12 years of education. Moreover, Kiosses and colleagues found that PATH not only reduced depression and disability, but it improved cognitive outcomes over 24 weeks. During this session, presenters will describe disparities in clinical trial recruitment, present strategies to overcome these difficulties, and discuss how MHC incorporated both PEARLS and PATH into a clinical setting. Presenters will share results from the Home-Delivered PATH vs. Supportive Psychotherapy study for older adults with depression and mild cognitive impairment. Finally, presenters will discuss how these findings will inform the translation of study interventions into clinical care for culturally and educationally diverse populations.