Depression in older adults can have dire consequences. It can exacerbate physical problems, lead to dementia and ultimately affect the ability of a person to live independently.
A local team of researchers is currently in the midst of a three-part study called iMANAGE to determine ways to prevent depression in older adults, and hopes to recruit some of its participants through AgeWell, a partnership between the Jewish Association on Aging, Jewish Family & Children’s Service of Pittsburgh and the Jewish Community Center of Greater Pittsburgh. AgeWell is a one-stop shop for resources serving more than 6,000 elder adults locally.
“Because we serve so many older adults, and because there are so many researchers in the area, it seemed a natural fit to work together,” said Jordan Golin, a doctor of psychology and director of clinical services at JF&CS. “We have a lot of experience in working with seniors directly, and they have a lot of experience researching seniors.”
The iMANAGE studies are funded primarily by the National Institute of Health, and focus on improving mild memory problems, managing daily stress and improving sleep, and managing knee pain — all problems that can lead to depression if not addressed.
“We are in discussions with AgeWell to help us recruit participants,” said Dr. Charles Reynolds, the UPMC professor of geriatric psychiatry and senior associate dean of the University of Pittsburgh School of Medicine. “We also draw a great deal upon the experience and wisdom of AgeWell, which is devoted to the well-being and care of Pittsburgh’s senior citizens.”
The “big picture” that connects the three iMANAGE studies, Reynolds said, is the prevention of depression.
“Each study stands on its own,” he said, “but they contribute to each other. By preventing depression, we help seniors preserve their ability to live independently as long as possible.”
Each study—the RECALL Study, the Depression ABC Study, and the RAPID Study—deals with different populations of the elderly, each at risk for depression.
“To prevent depression is to promote brain health,” Reynolds said. “Depression is toxic to the brain.”
The RECALL study, co-directed by Dr. Meryl Butters and Dr. Ariel G. Gildengers, deals with older adults who have a predementia condition called Mild Cognitive Impairment. People with MCI are at risk for depression, according to Reynolds, and once they become depressed, that depression can lead to dementia.
The Depression ABC study, directed by Dr. Steve Albert at the University of Pittsburgh, deals with older adults, many of who are homebound, who receive agency-based services, Reynolds said. The participants in the Depression ABC study have some measure of social, physical or mental frailty.
The RAPID study, directed by Dr. Jordan Karp, deals with older adults who are living with chronic pain in their knees, mostly stemming from arthritis. The limitation of mobility resulting from the pain is connected to high rates of co-existing depression, according to Reynolds.
The theme cutting across all three of these studies is depression.
“Depression is the unwanted co-traveler,” Reynolds said. “Once you have it, it amplifies the disability coming from the other conditions. The idea is to prevent depression.”
While most of the previous research on depression has focused on treatment, the iMANAGE studies differ in that they focus on prevention.
“This is an idea whose time has come,” Reynolds said, adding that the focus on prevention is “strongly reinforced” by the Affordable Care Act.
Prevention does not involve the use of anti-depressants or other psychotropic drugs, Reynolds said.
“Rather, the focus is on healthy lifestyle choices and improved coping,” he said. “The key intervention that cuts across the studies is teaching people problem-solving skills, including active coping and resilience. We want to help people feel they can beat the challenges facing them rather than feeling helpless and overwhelmed.”
Other depression prevention strategies include improving the quality of sleep, and exercise, which promotes both heart health and brain health, Reynolds said.
Prevention strategies have been shown to be highly effective, Reynolds said.
In a previous depression prevention study using problem-solving therapies among older adults, the incidence of clinical depression was reduced to 8 percent in a population where the expected incidence was between 20 and 25 percent.
The iMANAGE studies have bridged the gap between the large senior population of Pittsburghers, and its wealth of researchers, said Dr. Daniel Rosen, a past chair of AgeWell, and professor of the School of Social Work at the University of Pittsburgh, as well as a member of the iMANAGE team.
“iMANAGE has reached out to break through the silo of academic efforts and what’s happening in the community,” Rosen said. “It’s an incredible opportunity to provide cutting-edge depression prevention initiatives to the adults we’re serving.”
“The mission of AgeWell is to have older adults living at home as independently as long as possible,” he continued. “That goal aligns perfectly with iMANAGE.”
AgeWell can serve as “the point of entry” to learn more about the iMANAGE studies, according to Rosen. Cooperation between AgeWell and the iMANAGE studies is a “win-win,” he said.
“For AgeWell, the benefit is having older adults living safely and independently. iMANAGE has the same goal,” he said. “By having community network unity, iMANAGE is promoting the message that we’re interested in what the community is doing.”
(Toby Tabachnick can be reached at firstname.lastname@example.org.)