Late-life depression is a large, escalating public health problem that often interacts with other health conditions and leads to spiraling disability that simultaneously threatens independence and health-related quality of life (HRQoL), and increases health care costs. Depression affects 24% of older adults in assisted living (AL) settings, but rates of recognition and treatment are low and underscore the need for alternative depression prevention and treatment methods in AL. A novel and promising intervention is a computerized cognitive training program known as Road Tour, which has shown serendipitous benefits for reducing depression symptoms and the onset of suspected clinical depression consistent with Beck's model of cognitive depression. As a self-directed, user-friendly "game", Road Tour overcomes common attitudinal and resource-related barriers that impede treatment in AL settings, and holds considerable promise for interrupting the potential downward spiral of depression-related disability for 1 million AL elders. The purpose of this study is to evaluate th effect of Road Tour on processing speed, depression symptoms and suspected clinical depression, and depression-related comorbidities among AL residents in Iowa. We will use a two-arm, parallel, RCT comparing Road Tour training to attention control training using computerized crossword puzzles among 300 adults 60 years old or older. We will actively engage 15-30 AL facilities as study partners who implement the training at their sites and assist with the evaluation process. RE-AIM methods will be used to develop AL-specific recruitment and enrollment protocols, educate AL staff about the study, and oversee computerized training by participating residents, as well as their family members and AL staff. Our three specific aims are to: (1) establish the effect of Road Tour on improving cognitive processing speed in AL;(2) evaluate the effect of Road Tour on reducing depressive symptoms and the risk of onset of suspected clinical depression in AL;and, (3) evaluate the effect of Road Tour on the depression-related health outcomes of anxiety, pain, and HRQoL in AL. Participants will receive 10 hours of computerized training over 5-6 weeks, and 4 hours of booster training at months 5 and 11. Outcomes are the UFOV for speed of processing (Aim 1), the CESD-12 and PHQ-9 for depressive symptoms and suspected clinical depression (Aim 2), and the SF-36 for HRQoL, the BPI for pain, and GAD-7 for anxiety (Aim 3). Data will be collected using telephone interviews at baseline, post-training (6-8 weeks), and at 26- weeks and 52-weeks. Each person will serve as their own control in linear panel analyses that use GEE to correct for clustering, as well as general linear mixed effects models. This study is the first step in evaluating depression-related outcomes of using Road Tour in AL settings. Subsequently, we will replicate the study while collecting the appropriate biomarkers and fMRIs to identify the precise mechanisms of action.
Late life depression, which affects 24% of assisted living residents, often interacts with other social and health problems to cause a downward disability spiral that is costly to both older individuals and society. The multiple barriers that interfere wth depression being recognized and treated in AL settings support the need for alternative approaches to prevent and treat depression. The purpose of this study is evaluate the effect of a computerized cognitive training intervention that functions like a game on depression symptoms, suspected clinical depression, and depression-related health outcomes among older adults in assisted living settings.