This is the first study to report that successful treatment of depression in older adults also improves their ability to perform tasks critical to independent living such as keeping track of medications or managing money. Prior clinical trials of successful treatment of depression in this age group reported improvement in emotional functioning, but had not demonstrated that improved emotional health also translated into improved physical health. Older adults with depression report persistent greater functional impairment than those without depression.
"This study is important for two reasons," said Christopher Callahan, M.D., Cornelius W. and Yvonne Pettinga Professor in Aging Research at the IU School of Medicine. "First, it shows that even older adults with failing physical health can be successfully treated for depression. Second, it shows that treating the depression also helps slow the physical decline."
Dr. Callahan is director of the Indiana University Center for Aging Research and principal author of the article.
Study participants were placed randomly into two groups. One group received standard care for depression from their primary care physician. A depression clinical specialist (a nurse or psychologist) as well the patient's primary care physician co-managed depression treatment for those in the second group.
In both groups, patients whose depression improved were more likely to experience improvement in physical functioning than patients whose depression was not successfully treated, the study found.
Depression was more likely to improve in those who received treatment by collaborative care management than those who had usual care. One hallmark of the intervention was the "stepped care" approach or the ability to increase the intensity of the treatment over time if patients did not respond to initial treatments.
This study is part of Project IMPACT, which followed 1,801 patients age 60 and older with major depressive symptoms for 12 months. Participants in the IMPACT study, the largest clinical trial of late-life depression reported to date, were from 18 primary care clinics across the United States.
"Patients with late-life depression often experience a downward spiral of worsening depression and function," the study authors concluded. "Effective treatment of late-life depression by a collaborative stepped-care program in primary care may interrupt this downward spiral."
In an accompanying editorial, Duke University's Dan Blazer, M.D., Ph.D., noted the bench-to-bedside practicality of this research. "The findings of the IMPACT study are prime for translation into clinical practice changes that will improve the quality of life for many older adults. Primary care practices take note!"
The study was supported by grants from the John A. Hartford Foundation, the California Healthcare Foundation, the Hogg Foundation and the Robert Wood Johnson Foundation.