Supportive Therapy Versus Problem Solving Therapy in Treating Depressed, Cognitively Impaired Older Adults

Depression, cognitive impairment, and disability often coexist in older adults and can lead
to patient suffering and family disruption. Moreover, many depressed, cognitively impaired
older adults have slow, poor, or unstable response to antidepressant drugs. Despite the need
for treatments other than medication, most psychotherapy research focuses on either
cognitively intact patients with limited disability or on dementia patients with pronounced
disability. Thus, the available treatments do not fully address the needs of the large
number of depressed elders with intermediate cognitive impairment and disability. Previous
studies with cognitively impaired psychiatric populations have taught participants
compensatory strategies to overcome their behavioral and cognitive limitations. This study
will evaluate the effectiveness of a type of psychotherapy called problem solving therapy
(PST) as well as specially tailored compensatory strategies, in treating depressed,
cognitively impaired older adults.

All participants in this single-blind study will undergo initial evaluations, including a
2-hour interview to assess depression, memory, and physical functioning; questions about
medical history; and a neuropsychological exam. Participants will then be randomly assigned
to one of two treatment groups: PST or supportive therapy. Participants assigned to PST will
receive 12 weekly PST sessions conducted at the home of the participants. During these
sessions, a therapist will identify the participant's difficulties in life related to
depression and physical functioning and will provide strategies to overcome these
difficulties. The goal of treatment is to improve adaptive functioning in the home
environment, which in turn may reduce depression and disability. The first session will last
between 1 and 2 hours, and the remaining 11 sessions will last 1 hour. Participants assigned
to supportive therapy will also receive 12 weekly treatment sessions with a therapist
conducted at the home of the participants. During supportive therapy sessions, the therapist
will help participants to express feelings and to focus on their strengths and abilities
when working through difficulties and transitions. For all participants, initial assessments
will be repeated at Weeks 4, 8, 12, and 24.