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A growing body of research suggests that homework assignments facilitate positive outcomes in psychotherapy. We describe a cognitive behavioral outpatient therapy that stresses the important role homework plays in psychotherapy outcomes and that is found to be successful for treating emotional distress in both older adults and family caregivers. Just as a number of barriers can make it difficult for older clients to commit to regular therapy appointments, a variety of factors can also influence their completion of homework. We also address key issues frequently encountered when fostering homework compliance among older adults and utilize case vignettes to illustrate successful approaches to address these barriers. We present basic tenets for effective homework completion regardless of age group as well as several methods to address homework challenges that we find to be particularly pertinent for therapists treating today's older adults., (Copyright 2002 Wiley Periodicals, Inc.)

The authors evaluated the efficacy of desipramine-alone, vs. cognitive/behavioral therapy-alone (CBT) vs. a combination of the two, for the treatment of depression in older adult outpatients. Patients (N=102) meeting criteria for major depressive disorder were randomly assigned to one of these three treatments for 16 to 20 therapy sessions. All treatments resulted in substantial improvement. In general, the CBT-Alone and Combined groups had similar levels of improvement. In most analyses, the Combined group showed greater improvement than the Desipramine-Alone group, whereas the CBT-Alone group showed only marginally better improvement. The combined therapies were most effective in patients who were more severely depressed, particularly when desipramine was at or above recommended stable dosage levels. The results indicate that psychotherapy can be an effective treatment for older adult outpatients with moderate levels of depression.

Alzheimer disease (AD) has a drastic effect on the lives of those affected by the disease. Surprisingly little research has studied the personal and social consequences for AD patients. Many appear to go through six stages of change as the disease progresses, but any individual's path through the disease may vary substantially. AD also has a drastic effect on family members who serve as caregivers for people with the disease. These effects are much more studied and better documented. The burdens and, in some cases, benefits of the caregiver role differ from person to person. Race and ethnicity are among the variables that seem to play a role in the caregiver's response. The economic costs of AD are considerable, both for "formal" services, paid for in the money economy, and "informal" services, provided without monetary payment. The direct costs, both formal and informal, are largely, but not entirely, borne by the patient and the patient's family. The overall costs to society clearly amount to scores of billions of dollars.

Information regarding one's genetic risk for a particular disease might effectively inform medical, financial, and reproductive decisions and perhaps promote established risk reduction behaviors. However, genetic testing may also lead to significant levels of anxiety, depression, or other forms of distress, especially when psychological coping strategies and social reserves are not adequate to manage positive or inconclusive results. This paper focuses on the psychological impact of predisposition genetic for Alzheimer disease (AD). We present stress and coping models that capture the essence of this impact and discuss the potential role of counseling and follow-up interventions. The discussion draws primarily from the experiences of professionals working with other diseases, and seeks to expand that experience into the AD arena. In addition, we emphasize two issues we believe need additional attention in the psychological literature regarding genetic testing and counseling: (i) the psychosocial vulnerability of individuals being tested and, (ii) the sociocultural context of the AD patient and their family members.