Improving Mood in Assisted Living Settings

Late-life depression is a large, escalating public health problem that often interacts with
other health conditions and leads to spiraling disability that simultaneously threatens
independence and health-related quality of life (HRQoL), and increases health care costs.
Depression affects 24% of older adults in AL settings, but rates of recognition and treatment
are low and underscore the need for alternative depression prevention and treatment methods
in AL. A novel and promising intervention is a computerized cognitive training program known
as Road Tour, which has shown serendipitous benefits for reducing depression symptoms and the
onset of suspected clinical depression consistent with Beck's model of cognitive depression.
As a self-directed, user-friendly "game", Road Tour overcomes common attitudinal and
resource-related barriers that impede treatment in AL settings, and holds considerable
promise for interrupting the potential downward spiral of depression-related disability for 1
million AL elders.

The purpose of this study is to evaluate the effect of Road Tour on processing speed,
depressive symptoms and suspected clinical depression, and depression-related comorbidities
among AL residents in Iowa. The investigators will use a two-arm, parallel, RCT comparing
Road Tour training to attention control using computerized crossword puzzles among 370 adults
55 years old or older. The investigators will actively engage 15-30 AL settings and their
associated facilities as study partners who implement the training at their sites and assist
with the evaluation process. The investigators will help each AL setting develop AL-specific
recruitment and enrollment protocols, educate AL staff about the study, and oversee
computerized training by participating residents, as well as their family members and AL
staff.

The investigators' three specific aims are to: (1) establish the effect of Road Tour on
improving cognitive processing speed in AL; (2) evaluate the effect of Road Tour on reducing
depressive symptoms and the risk of onset of suspected clinical depression in AL; and, (3)
evaluate the effect of Road Tour on the depression-related health outcomes of anxiety, pain,
and HRQoL in AL.

Participants will receive 10 hours of computerized training over 5-6 weeks, and 4 hours of
booster training at months 5 and 11, for a total of 18 hours of training. Outcomes are
changes in the Useful Field of View (UFOV) test for speed of processing (Aim 1), changes in
the 12-item Centers for Epidemiologic Studies Depression scale (CESD-12) and the 9-item
Patient Health Questionnaire (PHQ-9) for depressive symptoms and suspected clinical
depression (Aim 2), and changes in the Short Form 36-item Health-Related Quality of Life
(HRQoL) Questionnaire (SF-36) for HRQoL, the Brief Pain Inventory (BPI) for pain, and 7-item
Generalized Anxiety Disorder questionnaire (GAD-7) for anxiety (Aim 3). Data will be
collected using telephone interviews at baseline, post-training (6-8 weeks), and at 26-weeks
and 52-weeks. Linear mixed effect models that adjust for the clustering within AL settings
will be used with main effects specified for treatment group and time, as well as their
two-way interaction. This study is the first step in evaluating depression-related outcomes
of using Road Tour in AL settings.

Inclusion Criteria:

- 55 years old or older

- reside in one of the participating AL settings or affiliated sites

- capable of providing informed consent

Exclusion Criteria:

- self-reported insufficient visual acuity (with glasses) to use a computer

- self-reported physical inability to use a computer mouse and keyboard

- non-English speaking