Seniors can be taught to fight depression, study shows

Persistent depression often afflicts frail and isolated older adults. But they can be taught at home how to beat back the blues through practical problem solving, exercise and social activity, a Seattle study released today says.

After a year, study participants were far more likely than non-participants to cut their depressive symptoms in half — symptoms like poor appetite, trouble falling asleep and feelings of hopelessness. Many participants managed to get rid of their depression completely.

As a result, their health status and emotional well-being improved and they tended to be hospitalized less, says the study that appears in tomorrow's edition of the Journal of the American Medical Association.

"It was a lifesaver for me," says Chuck Lazenby, 72, who fell into despair and drinking after his partner of 50 years died of a sudden heart attack one night.

The study called PEARLS — Program to Encourage Active Rewarding Lives for Seniors — was conducted by the University of Washington's Health Promotion Research Center in collaboration with Aging and Disability Services, a city of Seattle division, and Senior Services.

"This is an attempt to reach the most vulnerable population in our society,'' says Dr. Jim LoGerfo, the UW center's director.

The Health Promotion Research Center is leading a nationwide research initiative on healthy aging for the U.S. Centers for Disease Control and Prevention, which paid for the PEARLS study. The goal is to create programs that can be scientifically shown to improve the health of older adults and replicated at low cost in communities nationwide.

PEARLS cost $630 per participant per year, which includes eight in-home sessions with a social worker over 19 weeks and after that monthly follow up phone calls.

The plan now is to seek Medicaid funding for a broader PEARLS demonstration in this state. "The reduction in hospitalization is so tantalizing it might be a good investment on their part to look at it,'' LoGerfo says.

Efforts also are under way to make the anti-depression program available to a broader range of older people across the state both through senior centers as well as in-home settings. Older refugees and immigrants likely will be a focus.

Depression is avoidable

Late-life depression affects 15 to 20 percent of older Americans, says Dr. Paul Ciechanowski, a co-investigator and psychiatrist on the study. Yet, doctors and their older patients often wrongly assume depression is an unavoidable consequence of aging.

Patients also may be too proud to ask for help. For whatever reason, only about half of depressed older adults receive treatment and of those, many don't receive adequate treatment, Ciechanowski says.

This needless psychological suffering, the costly health-care ramifications and the large numbers of aging baby boomers on the horizon are driving a national search for solutions.

The PEARLS study replicates and extends the 2002 findings of a national study called IMPACT — Improving Mood: Promoting Access to Collaborative Treatment for Late Life Depression — the largest study on depression in the U.S.

Seattle was one of seven cities in the IMPACT study, which found problem-solving therapy, increased social activity and targeted medication management works with depressed patients who were seen in medical clinics.

PEARLS takes that approach out of the primary care setting and into the community and people's homes. It also relies on partner agencies in the community to help with the work.

A JAMA editorial says depression studies such as PEARLS "provide evidence-based hope for millions of elderly persons living in the dark tunnel of major depression or the only slightly less dim tunnels of 'lesser' depressions.''

Life's losses are frequently the trigger. Careers end. Family and dear friends die. The body starts to give out. Independence is tough to maintain.

Seniors with chronic conditions or physical limitations can end up stuck in the house, feeling isolated and useless. Adults over age 65 represent 13 percent of the U.S. population, yet account for 18 percent of all suicides in 2000.

The two-and-a-half-year study sent social workers from Aging and Disability Services into the homes of 138 low-income seniors, age 60 and older, most of whom were single and had serious disabilities.

The social workers primarily focused on a home-based problem solving therapy that emphasizes exercise and increased socialization.

PEARLS patients learn to identify what's bothering them and write down practical step-by-step solutions.

"It's like breaking the bundle one stick at a time,'' Ciechanowski says.

A social worker followed up with encouraging visits and phone calls to keep patients on track. But ultimately, patients were expected to solve their own problems, which helped them regain a sense of control over their lives.

If a participant didn't improve in the first few weeks, the study's care management team recommended that a primary care doctor evaluate the person for antidepressant medication.

Regaining control after losing partner

Lazenby spiraled down after his partner died.

"It was such a shock. After 50 years, I was alone and making decisions for myself. I had no close friends," says Lazenby, a retired office manager from Seattle.

He disguised his despair by drinking heavily, hanging out with false friends at bars and spending too much money. He stopped managing his diabetes and, at the lowest point, considered suicide by driving off a ferry dock.

"I was vulnerable and I didn't really care.''

Many people tried to help him, but he never could shake the despondency.

Luckily, an observant senior center worker recognized his symptoms and suggested he contact the PEARLS research project.

For starters, Lazenby was helped to see that financial difficulties were making him a nervous wreck. As a result, he managed on his own to find a cheaper apartment that he loves.

Life's been mostly uphill since. "I'm back doing the things I like to do,'' he says.

That's volunteering at church and in the community and walking from his home on Seattle's Capitol Hill down to Pike Place Market to buy flowers and free range eggs. He attends the theater and, on his doctor's recommendation, is learning to cook again.

Recently, he entertained several friends and "it felt good.'' His diabetes is under control. So is his bank account.

And he's no longer consumed with grief over his partner.

"I do admit I talk to him. But nobody's around so they can't lock me up. I feel he's with me.''

Funding needed to expand PEARLS

Aging and Disability Services now uses the PEARLS approach with its low-income, homebound clients throughout King County.

The dream is to find funding to make it widely available in all kinds of settings and in a culturally relevant way to older people who have limited English speaking ability, says the agency's director Pam Piering.

Montana Smith, 84, has just started using the PEARLS strategy to try to overcome three big life shocks in the last year.

The small, normally active woman underwent knee replacement surgery, learned an adult son has cancer and had to move out of her home in Seattle's Rainier Valley for a year, because of Sound Transit light rail construction.

The move has been especially difficult, even though her 88-year-old cousin gave her a front bedroom in his house. Smith doesn't have her own comfortable mattress and the front stairs are so steep it hurts her new knee to go up and down. Her car needs repair, so she has to depend on her family to take her places.

"It bothered me,'' she says. "Sometimes I felt like I was cranky and cross. Then at night, I'd go to bed and cry and I wouldn't know why.''

Now she meets regularly in her cousin's home with social worker Carl Kaiser, who's monitoring her symptoms of depression and helping her identify step-by-step solutions to problems.

Smith dearly wants to see and help care for her sick son more often. But he lives in Tukwila and she's never been one to take the bus.

So she resolves to ask her cousin to drive her there and another family member to pick her up. She also commits to try to find a way to get her car fixed.

One of her early successes at problem solving was taking the easier back way out of her cousin's house, instead of taking the steep front stairs.

"I even ventured over to a granddaughter's and I left my cane at home,'' says Smith, who held onto someone's arm instead.

"I made it over and back and I was proud of myself.''

Marsha King: 206-464-2232 or