Although minority elders represent the fastest growing segment of an aging US population, they have less access to mental health care and prevention of disability, lagging well behind non-Latino whites, and suffering significant disparities. Blacks and Latinos have the greatest risk for disability, with striking disparities in healthy aging. This includes elderly immigrants who exhibit elevated depressive and anxiety symptoms, and higher rates of disability than the native-born population; yet, they often go undiagnosed or underdiagnosed. This is a missed opportunity given that mood disorder treatment has been shown to reduce disability days and that several risk factors for disability, such as functional mobility are modifiable. Research suggests that a contributing factor may be an insufficient supply of professional providers and the inability of evidence based treatments to reach and be acceptable to minority elders. An IOM committee recently reported that the severe workforce shortages in providing mental health care to elder adults required novel approaches to resolve. To address these disparities and prevent disability among minority elders, the proposed R01 examines how to successfully build collaborative research for the provision of evidence-based mental health and disability prevention treatments in community-based settings. Promising results in a few international studies show improved access and quality of mental health outcomes and reduced disability when interventions are delivered by Community Health Workers. Yet limited and inconsistent evidence of the efficacy of CHW-led interventions in the US context remains. While the number of community-based health interventions has grown exponentially to address these service disparities, there is a lack of systematic assessment of whether they lead to increased community capacity and systems change, and whether they improve the quality of care and potentially decrease disability. Our proposed study endeavors to address this limitation. As such, the proposed R01 will be one of few efforts that simultaneously study the three components necessary for a successful intervention: efficacy, since the intervention must work, acceptability among clients, and feasibility and sustainability within the organization. It seeks to understand the role of the partnerships in increasing community capacity for a combined mental health and disability prevention intervention, and evaluating the acceptability, efficacy, feasibility and sustainability of the intervention delivere by CHWs and exercise trainers to Latino, African American and Asian elders with moderate to severe mood symptoms and at risk of disability.

Public Health Relevance

The rapid expansion of the aging population is outstripping the development of mental health and disability prevention services necessary to respond to their needs. The proposed revised R01 aims to evaluate whether partnerships between academic researchers, minority elders, and the community-based organizations which serve them can expand community resources and capabilities to effectively provide mental health services and reduce the risk of disability in minority elders.

National Institute of Health (NIH)
National Institute on Aging (NIA)
Research Project (R01)
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Health Disparities and Equity Promotion Study Section (HDEP)
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Fazio, Elena
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Massachusetts General Hospital
Independent Hospitals
United States
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Alegría, Margarita; Alvarez, Kiara; Falgas-Bague, Irene (2017) Clinical Care Across Cultures: What Helps, What Hinders, What to Do. JAMA Psychiatry 74:865-866
Alegría, Margarita; Alvarez, Kiara; Ishikawa, Rachel Zack et al. (2016) Removing Obstacles To Eliminating Racial And Ethnic Disparities In Behavioral Health Care. Health Aff (Millwood) 35:991-9