NEWS | August 31, 2018

Improving depression care for older adults

UC Davis Health working on collaborative care model with family members, friends

(SACRAMENTO)

Researchers and clinicians at UC Davis Health have launched a new study for older adults with depression that is designed to enhance their treatment and care with more focused assistance from patient family members and close friends.

Led by the UC Davis Department of Psychiatry and Behavioral Sciences, in collaboration with UC Davis’ Primary Care Network, the project will develop a shared-care approach at the primary care level to improve mental health interventions for older adults.

“Unfortunately, there is a serious shortage of mental health professionals, and very few community psychiatrists and therapists accept Medicare payments for mental health services due to low reimbursement rates,” said Lorin Scher, associate professor of psychiatry and behavioral sciences and principal investigator for the study.

Lorin Scher Lorin Scher

“As a result, for older adults primary care physicians become the only treatment option for depression care. That’s where family members and friends, who we are calling ‘care partners,’ can play an important role, attending clinic visits with patients and providing needed support at home.”

Scher noted that the prevalence of depression remains high in primary care populations, particularly for patients with cardiovascular disease, diabetes and other chronic illnesses. Previous UC Davis Health research revealed that older adults suffering from depression are often untreated or undertreated in clinical settings.

“Little is known about how best to engage family members in depression treatment to improve outcomes,” Scher added. “Our study aims to examine how providers can better include family members and friends of patients in a collaborative care model.”

According to a study published in 2011, major depression is a serious public health problem that affects from 2 to 5 percent of older adults age 65 years and older in the general population, and up to 10 percent of older adults seen in primary care clinics. For individuals with a chronic illness, major depression affects approximately 30 percent of adults over the age of 65.

The current study is recruiting up to 150 patients (65 years and older with major depression) at two UC Davis primary care clinics, and an equal number of care-team partners who will be accountable for important tasks in helping address the depression. Friends and family care partners will be trained to assist with specific responsibilities such as patient education, treatment support and symptom monitoring.  

The collaborative care model includes a team of clinicians and a licensed clinical social worker who is responsible for the bulk of the specific care plans for each patient. The project complements existing behavioral health services within the UC Davis Primary Care Network, which include “e-consults,” wherein physicians can ask specialists specific questions and have them answered in the patient’s electronic medical record within 72 hours. Other services include tele-psychiatry (videoconferencing with a psychiatrist) and outpatient clinics, as well as an emphasis on more proactive care to improve population health management.

The research also aligns with UC Davis Medical Center’s ongoing efforts to provide care using the nationally recognized patient-centered medical home model, which aims to improve health care in America by transforming how primary care is organized and delivered.

“Our models for better health and better health care all point to a more inclusive approach,” Scher said. “That means having clinicians engage more with care partners who are loved and trusted by patients to enhance treatment, interventions and outcomes. Health professionals are learning that collaboration across professions and within the community is often the best medicine. Our study is designed to help optimize that approach.”

In addition to Scher, other researchers and staff from UC Davis Health include David Liu, Isaac Smith, Julie Weckstein and Susan Perry.

The three-year study is supported by a grant from the California-based Archstone Foundation, a private nonprofit grant-making foundation whose mission is to prepare society to meet the needs of an aging population. This is the second grant to UC Davis Health as part of the foundation’s “Care Partners: Bridging Families, Clinics, and Communities to Advance Late-Life Depression Care”project. Ladson Hinton, interim chair for the UC Davis Department of Psychiatry and Behavioral Sciences, will also be serving as part of the evaluation team for the grant, in collaboration with other researchers from the University of Washington.