AIDElong - Acute Illness and Depression in Elderly: Sustained improvement after group psychotherapy in geriatric patients, a follow-up of longterm effects in a randomized controlled trial

Abstract

Abstract Objectives: Comorbid depression is highly prevalent in very old adults hospitalized for acute medical illness. It is associated with poorer physical and functional outcome. Cognitive behavioral therapy (CBT) is effective in independent living older adults, but data on very old patients with acute illness and effects on functional status are missing. Design: Randomized, controlled cross-over trial of group CBT Setting and Participants: We recruited in-patients of a geriatric university department >65 years with depression (Hospital Anxiety and Depression Scale HADS >7). Intervention took place after hospital discharge in a day care setting. Methods: Patients were randomized to an immediate active intervention group (IG) or a waiting list control group (CG). IG patients were invited immediately after discharge to 10 to 15 weekly behavioral group therapy sessions. After 4 months (T1), CG patients switched to active intervention, while IG were followed under control conditions. Final evaluation took place after 12 months (T2). Results: 56 patients (82.0±6.2 years, HADS 18.8+7.0) were randomized to IG, 99 patients (81.9+5.9 years, HADS 18.1+8.3) to CG. IG patients improved significantly at T1 (HADS 10.4+5.2). Improvement was sustained under control conditions at T2 (11.9+7.8). CG patients did not improve on waiting list (T1 22.9+8.3), but after initiation of active treatment (T2 16.0+8.5) (ANOVA: F=3.75, p=0.026). Concomitantly, functional parameters such as Barthel Index and Timed-Up-and-Go differed significantly between groups with better courses in IG patients. Among IG patients, 4 (7.1%) deceased and 2 (3.6%) were newly admitted to a nursing home, among CG, 15 (15.2%) and 10 (10.1%) respectively. Conclusions and Implications: Cognitive behavioral group therapy yields sustained improvement of depressive symptoms in very old geriatric patients, if administered in a multimodal approach immediately following hospitalization for acute medical illness. Concomitant with improvement of depressive symptoms, patients benefit in terms of functional status and medical outcome. Clinical Trial Registration: www.germanctr.de ; DRKS 00004728