We propose the creation of an Advanced Center for Interventions and Services Research focused on Late Life Mood Disorders (ACISR/LLMD: P30 MH52247-11). The biopsychosocial differences between older and younger persons with mood disorders yield major differences in pharmacologic and psychotherapeutic treatment considerations, in the risk for dementing disorders, in the amplification of disability associated with coexisting medical disorders, in the risk for completed suicide, and in access to quality mental health services. Our Clinical Research Center (1995-2000) and Intervention Research Center (2000-2005) in Late Life Mood Disorders has generated a number of findings with a significant impact on the clinical practice and research in late life mood disorders. In addition, we have been able to nurture a growing pool of junior and senior investigators (17 new K awards) working in this area. The goal of the proposed ACISR/LLMD is to provide a research infrastructure to promote investigations that ultimately will improve real world practice in the care of elderly living with depression and other severe mood disorders. We propose to focus on 1) prevention and rehabilitation: e.g., the prevention of depression in elderly at high risk, such as those who have suffered strokes; the prevention of suicide in elderly with depression; the prevention or delay of cognitive impairment in depressed elderly; and the rehabilitation of medically frail elderly with depressive illness, such as those with MI or hip fracture; 2) improving treatment of difficult to treat late life mood disorders and providing assistance to families, e.g., those who fail to respond to first line pharmacotherapy, and those living with psychotic depression or with bipolar disorders; and 3) identifying and removing barriers to effective treatment practices in the community, especially in older primary care African Americans, in the nursing home, and in the rehabilitation setting. Fundamental to all these themes is alliance building with patients, families, health care providers, and a range of community partners in primary care, long term care, and rehabilitation settings- all towards the objective of improving adherence with best treatment practices. Together with our primary community partners--the Coordinated Care Network, Community Medicine Incorporated, and the Mental Health Association of Allegheny County--we have formed the Pittsburgh Late-Life Mood Disorders Treatment Research Collaborative Network. Our research partners in the community will guide and shape our research agenda and activities, allowing our work to have a major impact on the care of older persons living with mood disorders and related conditions.
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