Combining bibliotherapy and community-based intervention: An alternative model for treating depression in older adults with health problems.

Abstract

Older persons who suffer from health problems leading to functional impairment are at risk for developing depression. Moreover, the combination of functional impairment and depression creates a complex situation requiring special treatment consideration. A successful intervention must address issues unique to late-life depression and must do so in the context of physical disability caused by serious health problems. The purpose of this work was to create a community-based intervention program that would address the needs of this special population of older persons. An intervention based on behavioural principles and on an empirically validated model, Lewinsohn's (1986) Control Your Depression , was modified to suit the needs of this population. The modifications included three distinctive features. First, the program was designed to be readable and relevant to the life circumstances of older adults with special physical impediments. Second, the aim of the program was to deliver this intervention in a self-administered, minimal-contact format, in order to facilitate access to this under-serviced population. Third, the program was adapted to be delivered by non-mental health professionals---in this case, home-care nurses---who were in a health-care delivery role with older individuals. These three elements were combined to create an efficacious model of service delivery that was able to overcome barriers to access, make use of existing community resources, address special issues of functional impairment, and that was deliverable with minimal supervision. This model was tested in three separate series, each with two participants. A multiple-baseline design allowed a data-driven refinement of the model, and was also well-suited for behavioural analysis. In Series A, we tested the feasibility of the model. Results indicated that the program is feasible, and especially highlighted the role of reinstating pleasant activities in alleviating depression in these participants. Series B further examined the role of pleasant activities. Results confirmed the initial findings that reinstating pleasant activities is a pivotal part of the treatment for this population. Some adjustments were added to produce a finalized model in Series C, with positive results. Overall, these three series of studies indicated that the model is feasible, deliverable, and efficacious in reducing depression in older participants. In addition, results showed a positive impact on participants' functional ability, especially in the areas where the impairment is reversible, such as social functioning and activities of daily living. This model has implications for future applications that encourage the development of alternative models of intervention capable of meeting the unique needs of special populations