The goal of Care Partners is to develop a community of clinics, community-based organizations, and researchers in California who will work together to improve care for depressed older adults through strengthening the involvement of family members / friends and community-based organizations in care. For each of the seven partnerships in the first cohort and the seven partnerships in the second cohort, a team of primary care providers, family members and / or community partners will work with researchers to develop, refine, and evaluate innovative treatment programs for depressed older adults. In addition to building valuable partnerships between families, community-based organizations, and primary care clinics caring for depressed older adults, this initiative will produce innovative approaches to late-life depression care that can be replicated in similar sites in California and beyond.
Background
Depression is common in older adults and it comes at a high cost to patients and their families. Major depression affects 2-5% of community dwelling older adults and 5-10% of older adults in primary care settings (Lyness et al 1999; Blazer 2003; Mojtabai et al 2004; Byers et al. 2010). Late-life depression impairs quality of life (Unützer et al. 2000) and the ability to function and enjoy old age (Alexopoulos et al. 1996). It is associated with increased healthcare costs (Unützer et al. 1997; Katon et al. 2003), family stress and increased risk of suicide. Depression is the most important, and arguably the most treatable, risk factor for completed suicide (Conwell et al. 2002).
Over the past two decades, there has been significant progress in our ability to diagnose and treat depression in older adults. For example, research has demonstrated that collaborative care programs in which primary care physicians are supported by mental health professionals to treat depression in older adults can dramatically improve the effectiveness and cost-effectiveness of depression treatment (Unützer et al. 2002; Bruce et al. 2004). However, despite these advances, many depressed older adults either do not access treatment or fail to engage sufficiently in treatment to benefit. Vulnerable groups at particularly high risk for ineffective depression care include minorities, older men, and older adults with multiple medical problems, less formal education and / or lower socioeconomic status (Hinton et al. 2006; Hinton et al. 2012). Closing these gaps in care to improve access to effective depression treatment is important and timely. One of the most promising approaches to improving the reach and effectiveness of late-life depression care is the systematic involvement of family members and community based organizations that work with older adults in depression care (Hinton et al. submitted; Bartels et al. 2013). These resources have tremendous potential to improve access to care, engagement and participation in treatment, the patient care experience, and quality of care for depressed older adults. These community-engaged partnerships have tremendous potential to improve:
- access to care;
- engagement in treatment;
- the patient care experience;
- quality of care for depressed older adults; and
- ability to address social needs
Jürgen Unützer, MD, MPH, MA, an internationally recognized geriatric psychiatrist and mental health services researcher, who has two decades of experience leading the development and testing of innovative models to improve depression treatment for older adults, including the largest depression treatment trial conducted to date as well as various initiatives to disseminate proven models of care. Dr. Unützer founded the UW AIMS Center (Advancing Integrating Mental Health Solutions) to improve health of populations by advancing the research and implementation of collaborative care. The Care Partners project was support in part through AIMS center clinic experts and developed resources.
Dr. Ladson Hinton, a nationally recognized expert in minority mental health and aging at UC Davis (UCD) who has worked extensively with minority populations, including Latinos, Asian Americans and African Americans, with a focus on caregiving, depression and cognitive impairment. He currently directs a center funded by the National Institute on Aging focused on reducing health disparities in older Latinos, the Latino Aging Research Resource Center at UCD, and the Education Core of the UCD Alzheimer’s Disease Center which promotes outreach to minority communities.
The University of Washington (UW) AIMS Center (Advancing Integrated Mental Health Solutions; aims.uw.edu) has over 15 years of experience assisting funders, policy makers and healthcare organizations in the development and implementation of multi-site initiatives to develop, test, implement and scale effective programs for common mental disorders like depression. These efforts include a 12-year collaboration with the John A. Hartford Foundation that resulted in the development, testing and national dissemination of the IMPACT model, which has become the gold standard of depression treatment in primary care. Since the conclusion of the original IMPACT trial, the AIMS Center has participated in several multi-state studies and implementation initiatives of depression care programs.