COPD affects 15 percent of older adults and is the fourth leading cause of death in the US. Approximately 20 percent of COPD patients have major depression, a condition that contributes to suffering but also to poor treatment adherence leading to increased disability and morbidity. The study will investigate the effectiveness of an intervention aimed at facilitating the implementation and adherence to a treatment algorithm based on AHCPR guidelines in depressed COPD patients. The cornerstone of the intervention is the use of Health Specialists (HS), who will collaborate with the patients? own physicians and help them to offer timely and appropriately targeted treatment recommendations for pharmacotherapy. The HS will also visit patients at their homes and offer education, directions and support aimed at improving their adherence to medical, psychiatric, and rehabilitative recommendations. In addition, the HS will provide to families, and physicians education on depression. We hypothesize that this intervention will increase the prescription of adequate antidepressant treatment by physicians, enhance treatment adherence by patients, and reduce depressive symptomatology, suicidal ideation, and disability over a 26-week post-discharge follow-up period. The subjects will be 180 elderly patients consecutively admitted to two pulmonary rehabilitation centers (2-week length of stay), suffering from major depression and COPD. The impact of the intervention (offered to half of the sample, N=90) will be contrasted with that of usual care (N=90). We targeted in this study one of the most disabled and suffering segments of the population. We used, in our design, our research experience with depressed COPD patients, the PROSPECT multicenter study of primary care elderly patients, our home care study, and the geriatric depression studies of our Intervention Research Center. If found effective, this """"""""intervention"""""""" can be broadly implemented, as it can be used by visiting nurse staff after retraining. Finally, we believe that our approach to the care of depressed, medically ill patients can generate a practice model that has the ability to rapidly incorporate advances made in clinical science.
| Yohannes, Abebaw Mengistu; Raue, Patrick J; Kanellopoulos, Dora et al. (2016) Predictors of All-Cause Mortality in Patients With Severe COPD and Major Depression Admitted to a Rehabilitation Hospital. Chest 149:467-473 |
| Avari, Jimmy N; Alexopoulos, George S (2015) Models of care for late-life depression of the medically ill: examples from chronic obstructive pulmonary disease and stroke. Am J Geriatr Psychiatry 23:477-87 |
| Alexopoulos, George S; Kiosses, Dimitris N; Sirey, Jo Anne et al. (2014) Untangling therapeutic ingredients of a personalized intervention for patients with depression and severe COPD. Am J Geriatr Psychiatry 22:1316-24 |
