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Problem-Solving Therapy for Late-Life Depression in Home Care: A Randomized Field Trial

From the Center for Mental Health and Aging, School of Social Welfare, State University of New York, Albany, NY (ZDG, JM); St. Peter’s Home Health Care, Albany, NY (JM); Jewish Home and Hospital of New York Research Division, New York, NY (AH); Weill Medical College, Cornell University, White Plains, NY (MLB); Department of Medical Education, Albany Medical College, Albany, NY (EM).

Objective: The authors present data from a pilot research program initiated to develop, refine, and test the outcomes of Brief Problem-Solving Therapy in Home Care (PST-HC) that targets the needs of older adults identified with severe depressive symptoms in an acute home care setting.

Methods: A pilot randomized clinical trial compared the impact of PST-HC to usual care (UC) in a sample of older medically ill home care patients identified with severe depressive symptoms. Forty patients were randomly assigned to either six weekly sessions of PST-HC in their home or standard home care services. Depression, quality of life, and problem-solving ability were measured at baseline, posttreatment, three-month follow-up, and six-month follow-up by blinded evaluators.

Results: All 40 patients provided follow-up data. No differences between the two groups were found on any demographic variables. Outcome data suggested significant improvements in depression scores over time after PST-HC, relative to UC. PST-HC patients reported higher quality of life and problem-solving ability scores relative to UC.

Conclusion: Results suggest that PST-HC is well tolerated and holds promise for reducing persistent depressive symptoms. The authors discuss limitations in terms of the "real-world" applicability of this psychosocial treatment for late-life depression.

Key Words: Problem solving therapy • depression • home care • elderly • randomized trial