Category: Aging and Older Adults
Keywords: Depression | Primary Care | Comorbidity
Presentation Type: Symposium
Primary care settings are the de facto mental health services site for the majority of older adults with depression. The majority of older adults are prescribed antidepressant medication for depression therapy, although they prefer psychotherapy. Nonadherence to antidepressant medication is common and leads to unnecessary poor outcomes including suicide and non-suicide mortality, hospitalization, and nursing home placement. The TIP study tested the effectiveness of a brief psychosocial intervention to improve adherence among older primary care patients prescribed pharmacotherapy by their physicians.
All participants were adults age > 55 years prescribed an antidepressant for depression and recruited within ten days of their prescription. Participants were randomly assigned to the intervention (TIP) or treatment as usual (TAU). TIP participants identified barriers to adherence, including stigma, misconceptions and fears, and engaged in problem-solving to develop a personalized adherence strategy. TIP was delivered in 3 brief contacts in the first 6 weeks of care. Research assessments were conducted at baseline, 6, 12 and 24 weeks to assess self-reported adherence and depression. TIP was hypothesized to improve adherence to 80% or better at both 6 and 12 weeks.
231 patients were randomized. Participants had a mean age of 67.3, 72% were female, 13.4% of Hispanic origin, and 19.99% African American. There were no demographic or clinical differences between the TIP and TAU groups. TIP participants as a group were three times more likely to be adherent at both 6 and 12 weeks (OR=3.27, 95% CI 1.73-6.17, p < 0.001). There were no significant. Adherence was unrelated to number of medications or illnesses. In both groups, patients who reported 80% adherence at both 6 and 12 weeks showed greater improvement in depression severity. TIP increased early improvement of depression, but did not affect the long term course of improvement.
TIP is an effective brief psychosocial intervention to improve adherence, with improved adherence associated with improved depression. Depression treatment outcome among vulnerable older adults could be improved with attention to early nonadherence.
Professor of Psychology, Department of Psychiatry
Weill Cornell Medical College
Friday, November 17
1:45 PM – 3:15 PM
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