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Nonadherence to antidepressants interferes with optimal treatment of late-life depression. This analysis examines clinical and treatment factors predicting medication nonadherence in difficult-to-treat late-life depression.Secondary analysis of data from a clinical trial of antidepressant pharmacotherapy for Major Depressive Disorder in 468 adults aged 60+ years. All participants received venlafaxine XR for 12 weeks. Nonremitters were randomized to augmentation with either aripiprazole or placebo for 12 additional weeks. Medication adherence was assessed 14 times over 24 weeks. The analyses examined sociodemographic, clinical, and treatment factors that may predict antidepressant nonadherence during early (weeks 1-6), late (weeks 7-12), and augmentation (weeks 13--24) treatment.Poor cognitive function and early response were predictive of early nonadherence. Poor cognitive function and prior nonadherence were predictive of late nonadherence. Living alone was associated with nonadherence both late and during augmentation treatment.Future studies should consider the role of early response and cognitive function to improve antidepressant adherence, particularly among older adults who live alone.

Background We aimed to identify trajectories of inflammation in older adults at elevated risk for syndromal depression and anxiety and to determine whether baseline physical, cognitive, and psychosocial factors could distinguish 15-month longitudinal trajectories. Methods Older adults (N = 195, mean age (±SD) = 74.4 years (9.0) participating in three depression and anxiety prevention protocols completed a comprehensive battery of psychosocial assessments and provided blood samples for analysis of interleukin-6 (IL-6) every 3 months over a maximum of 15 months. Group-based trajectory modeling identified trajectories. Adjusted logistic regression examined associations between baseline factors and trajectory groups. Results Two 15-month trajectories were identified: stable lower IL-6 levels (84%; mean (±SD) = 3.2 (2.1) pg/mL); and consistently higher IL-6 levels (16%; mean = 9.5 (7.4) pg/mL). Poor sleep quality predicted consistently higher levels of IL-6 (OR = 1.9, 95% CI = 1.03–3.55). Conclusion Poor sleep quality may represent a therapeutic target to reduce inflammation.

Objective We sought to determine whether the aspects of white matter connectivity implicated in major depression also relate to mild depressive symptoms in family dementia caregivers (dCGs). Methods Forty-one dCGs (average age=69 years, standard deviation=6.4) underwent a 7 Tesla 64-direction (12-minute) diffusion-weighted imaging sequence. We compared the fractional anisotropy (FA) of 11 white matter features between dCGs with (n=20) and without (n=21) depressive symptoms (Patient Health Questionnaire-9 scores ≥5). Results Caregivers reporting depression symptoms had lower FA in tracts connecting to the posterior cingulate cortex (Cohen's d = −0.9) and connecting dorsolateral prefrontal with rostral cingulate regions (Cohen's d = −1.2). Conclusions Posterior cingulate and dorsolateral prefrontal-to-rostral cingulate white matter, implicated in prior studies of major depression, appear relevant to mild depression in dCGs.

Background Interventions to prevent depression in older adults have mainly focused on young-old ambulatory adults, not on the old-old with disabilities who receive supportive services in their homes. Objective The Depression Agency-Based Collaborative (Dep-ABC) is a single-blind pilot randomized controlled trial assessing the effect of an intervention-development strategy using problem-solving therapy (PST) on the risk of common mental health disorders in this vulnerable population. Methods The intervention involved six to eight sessions of PST over 12 weeks. Participants were followed up to 12 months postintervention. Results Dep-ABC randomized 104 participants—68.4% of eligible and 17.5% of all older adults screened. The proportion of participants with incident major depressive disorder or generalized anxiety disorder was 11.4% in PST and 14.3% in the enhanced usual care control arm. A test of the interaction between time and intervention for anxiety symptoms favored the PST arm (p = 0.04). Conclusion PST did not lower the risk of incident common mental illness but did lower anxiety symptom burden. Apart from low power, the effects of PST may have been blunted by referral for medical and aging services in the enhanced usual care group.

INTRODUCTION: After an extended period of caregiving, the death of a family member with dementia can provide a sense of relief to individuals because caregiving has ended and their loved one is no longer suffering. Little is known about pre-death factors associated with feeling relieved after the death of a family member with dementia. This study examined: (1) pre-death factors associated with caregiver relief; and (2) whether caregiver relief is associated with post-bereavement adjustment, namely complicated grief and depression symptoms. METHODS: Participants were bereaved caregivers (CG) aged 28 – 90 years old, drawn from the Resources for Enhancing Alzheimer’s Caregiver Health study (REACH, N = 223) and the Family Caregiver Transition Support study (FaCTS, N=89). In each sample, demographics were assessed at baseline and CG relief was assessed at the first follow-up assessment post death. Each study administered a similar bereavement battery to CGs following the death of their care recipients (CR). RESULTS: CGs of late-stage dementia patients (FaCTS) reported more relief compared to CGs of early- to mid-sage dementia patients (REACH). CGs were more likely to experience relief if they were prepared for their CRs death and if they perceived their CR’s death to be a relief for the CR. A multivariate regression model showed that greater CG relief was associated with less complicated grief post-bereavement. CG relief was not significantly associated with depression symptoms. CONCLUSIONS: We show prospectively that the caregiving experience impacts feelings of relief and that feeling relieved facilitates post-bereavement adjustment by lessening symptoms of complicated grief.

Objective To determine the acceptability of clinical interventions for depression prevention, identification of clinical characteristics associated with intervention engagement is needed. The purpose of this study is to describe levels and correlates of participant engagement in Problem Solving Therapy (PST) in adults 60 and older with subthreshold depression. Methods As part of a clinical trial to prevent depression among older adults with subthreshold depression, participants who were randomized to receive PST completed 6–8 sessions in which they learned skills to solve self-selected problems that were contributing to stress and reduced quality of life. To measure participants' engagement with PST, interventionists completed 3 scales that rated participants' level of participation in problem solving activities, understanding of the multistep process of PST, and between-session homework effort. Using logistic regression, we examined whether physical health, level of cognitive function, gait speed, and disability served as correlates of engagement in the PST intervention. Results Gait speed, a measure of physical and cognitive health, was significantly associated with engagement in PST. Participants who walked faster were more likely to engage with PST compared to participants who walked more slowly. No other baseline variables were significant correlates. Conclusions Older adults who walk more slowly may need alternative delivery methods to fully engage in PST. Gait speed reflects physical and cognitive health, and predicts frailty, disability, and psychomotor speed slowing. For these reasons, gait speed may be a marker for factors that will serve to predict poorer engagement in psychosocial interventions like PST.

Objective Critical gaps remain in understanding optimal approaches to intervening with older couples. The focus of this report is to describe the pros and cons of incorporating spousal dyads into depression-prevention research. Methods In an intervention development study, the authors administered problem-solving therapy (PST) dyadically to participants with mild cognitive impairment (MCI) and their caregivers. Dyads worked with the same interventionist in the same therapy session. The dyadic PST (highlighted in a case example of a husband with MCI and his wife/support person) and the potential feasibility of the program are described. Results The authors found that the wife of the individual with MCI could be trained as a PST coach to help her husband learn and use problem-solving skills. A decrease in depressive symptom severity was observed for the individual with MCI, which was sustained over 12 months of follow-up. Neither the husband nor wife experienced an incident episode of major depression over the course of the study. Conclusion Dyadic interventions need to be further developed in geriatric psychiatry; proven methods such as PST can be modified to include patients' support persons. Recommendations are offered for developing randomized controlled trials that aim to recruit dyads and prevent depression in at-risk older married couples.

To evaluate the safety and acceptability of a novel 8-week intervention integrating exercise, exposure therapy, cognitive restructuring, and a home safety evaluation, conducted by a physical therapist, in reducing fear of falling and activity avoidance. To collect preliminary evidence of efficacy.Randomized pilot study comparing the intervention to time- and attention-equivalent fall prevention education.Participants' homes.42 older adults with disproportionate fear of falling (high fear, low to moderate objective fall risk).Falls Efficacy Scale-International, modified Activity Card Sort, satisfaction, falls.Relative to education, the intervention reduced fear of falling (d = 1.23) and activity avoidance (d = 1.02) at 8 weeks, but effects eroded over a 6-month follow-up period. The intervention did not increase falls, and participants rated the exercise, exposure therapy, and non-specific elements as most helpful.An integration of exercise and exposure therapy may help older adults with disproportionate fear of falling, but modifications to the intervention or its duration may be needed to maintain participants' gains.

Introduction Following the death of a spouse, many older adults have difficulty performing self-care activities. For example, they may feel no reason to wake up, eat meals, or go to bed on a regular schedule. Disruptions of these key social “time cues”, or zeitgebers, in turn decrease the stability of circadian rhythms, placing these individuals at high risk for major depressive disorder (MDD) and other adverse health consequences related to poor self-care. Preserving the stability of individuals’ time cues (sleep, meals, and physical activity) after the death of a spouse may reduce depression symptoms, thereby preventing the onset of MDD and promoting a healthy adaptation to bereavement. The purpose if this study is to examine the feasibility and acceptability of a behavioral intervention that is grounded in the circadian timing system and its impact on depression symptoms in older spousally bereaved adults. Methods We developed the Widowed Elders’ Lifestyle after Loss (WELL), a pilot randomized controlled prevention trial of digital monitoring of sleep, meals, and physical activity for older spousally-bereaved adults who were at high risk for MDD. The design of WELL builds on prior studies addressing circadian rhythms in bereaved adults for the reduction of depression symptoms. The intervention arm involved 12 weeks of behavioral self-monitoring using a tablet-based app (designed by the STS), in which older adults aged 60+ track the timing and regularity of sleep, meals, and physical activities. Participants in the intervention arm also received weekly motivational health coaching. Participants were assessed at baseline, directly after the 12-week intervention period, and then at 3, 6, and 9 months post-intervention using structured diagnostic interviews and symptom rating scales. Participants in the enhanced usual care arm who reported new depression symptoms were referred to their primary care physician, as in the intervention arm. The primary outcomes of the trial were feasibility and acceptability of intervention components. The secondary outcomes were change in depression symptoms. Actigraphic technology was used to examine the 24-hour rest-activity rhythm – a downstream indicator of the circadian clock – as a mediator of depression outcomes. Results WELL randomized 50 participants, 96.2% of eligible and 34.5% of all older adults screened. Participants in the treatment arms were similar at baseline in structured self-reports. WELL was rated highly by participants; 88% were compliant in digital monitoring and 96% were retained over follow-up. One comment speaks for many in that “WELL helped organize my life.” Depression symptom burden in the intervention arm significantly declined over follow-up, compared to enhanced usual care. There was a significant increase in the regularity of participants’ rest-activity rhythm from pre- to post-intervention. The significant increase in rhythm regularity was correlated with reductions in depression symptoms, as measured by the Hamilton Rating Scale for Depression. These data will be used in confirmatory clinical trial of efficacy. Conclusions A behavioral intervention that is based on the circadian timing system, using both digital monitoring and motivational health coaching, appears to be feasible and acceptable to participants. An intervention that targets the regularity of day- and nighttime activities may reduce depression in older spousally-bereaved adults. The methodological innovations of this project may advance the field of late-life depression prevention. This research was funded by Supported in part by NIH MH103467