Session 100 - A Path Forward: A Culturally Relevant Psychosocial Intervention for Depression in Cognitive Impaired Older Adults

Abstract

Abstract: As the geriatric population increases, it has also become more diverse. According to the 2011 U.S. Census Bureau, 8 % of older adults are Non-Hispanic Black and 7% are Hispanic/Latino. Similarly in Bronx County New York, 53% of patients speak a language other than English in the home. The Bronx has a growing Hispanic and non-Hispanic Black population, which faces a high prevalence of poverty, medical morbidity and comorbid depression. In a pilot study conducted at the Bronx-based Montefiore Geriatric Neurology Center, rates of depression were over 40%. Ethnic minorities are less likely to be included in research trials and have less access to innovative treatment modalities. Hispanics and Non-Hispanic Blacks are also less likely to seek mental health treatment and to find antidepressants acceptable. According to the Alzheimer's Association, about 200,000 Latinos in the United States have Alzheimer's disease dementia (AD). Moreover the highest prevalence of dementia is found in Latin America at 8.5%. In 2004 Montefiore Home Care in collaboration with Cornell Westchester division established the Montefiore Home Care Geriatric Psychiatry Program (MHC-GPP) to provide depression screening for homebound, medically ill older adults. During the 13 years of this program, the MHC-GPP has not only identified and treated homebound adults with depression, but has reached a population comprised of mostly Hispanics and Non-Hispanic Blacks (49% and 30%, respectively). Additionally the program has identified cognitive disorders as 3/4 of the new diagnoses identified by the MHC-GPP were neurocognitive disorders. Previous literature has shown depression to be one of the most common neuropsychiatric symptoms of AD and dementia related disorders, with a prevalence from 25% to 75% of patients. Unfortunately, previous trials have also shown that depression in the setting of AD is minimally responsive to antidepressants. This population is also unlikely to benefit from short term evidenced based psychotherapeutic modalities such as Problem Solving Therapy (PST) due to cognitive limitations. Furthermore, depending on state mental health regulations, patients with neuropsychiatric symptoms of dementia cannot be served in a mental health clinic. Kiosses and colleagues developed a non-pharmacological intervention to treat older adults with depression in the setting of dementia known as Problem Adaptation Therapy (PATH). PATH is an evidenced based intervention using personalized strategies to decrease depression and disability in older adults with depression and cognitive impairment. To achieve this goal, PATH utilizes a simplified problem solving approach, employing compensatory strategies, environmental adaptations to bypass cognitive and functional limitations while incorporating the caregiver when necessary. In a randomized trial, PATH was yielded a significantly greater reduction in depression and disability when compared to home delivered supportive psychotherapy. In 2016, Montefiore and Cornell Westchester, collaborated again in a pilot study to adapt PATH to serve the diverse Bronx and Westchester county populations. In this program PATH is delivered in English and Spanish and in the home or office, in order to evaluate the efficacy of this model in all settings and establish the sustainability of this model within a larger and diverse health network. During this session, the presenters will describe the development and advances in the PATH model and various adaptations and how this model was adapted in Montefiore Medical Center health network. The director of MHC-GPP will discuss how the PATH is incorporated into a certified home health agency (CHHA) to reach homebound adults with complex medical and social backgrounds. Finally the presenters will discuss implications for future directions in aging research centered on emotional dysregulation and dementia while impacting a more diverse population of older adults.