The mission of the proposed Advanced Center for Interventions and Services Research (ACISR) is to produce and disseminate knowledge and practices aiming to reduce the burden of depression and disability in older persons, promote the growth of investigators, and advance the methodology needed to carry this work into the future. The rapid increase of older persons (73% increase is anticipated in US by year 2020) and the multiple diseases and disabilities complicating their care make geriatric research a national priority. We focus on late-life depression because of its overwhelming consequences on the health of older persons. Depression is the leading cause of disability and contributes to medical morbidity, mortality, personal suffering, family disruption, and the cost of care. We have worked to understand the biological, medical, cognitive, and psychosocial problems of depressed elders and use this knowledge to develop interventions designed for their complex clinical problems. At the same time, we target patient acceptance and adherence to treatment, as well as barriers to care at the provider and the system level, which leave the majority of depressed elders under-treated, disabled, and suffering. We believe that our Center has become a national resource for studies of this largely neglected population. Our main strengths have been the assembly of a harmoniously working team with complementary skills and a research organization that promotes synergy at the conceptual, methodological, and research implementation levels. We are proud of our record in peer-reviewed publications, federal grants, career development, training programs, and community outreach. The ACISR will offer us the opportunity to continue our efficacy studies and further strengthen our effectiveness and practice research, so that we can increase the impact of evidence-based care. Our partner will be the Westchester Department of Senior Programs and Services (WDSPS), the County organization that implements most programs for social support and sustenance of older persons in our community. We expect this partnership to bring our interventions to community agencies, where most depressed elders are served. We propose to use Westchester County as a """"""""laboratory"""""""" in which we will study the delivery of efficacious treatments on a community-wide basis. We are confident that our work will both advance scientific knowledge and have a broad impact on the care of depressed, disabled elders.
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