Leveraging Adult Protective Service Interaction to Offer Evidence-Based Treatment for Depression in Elder Neglect/Self Neglect

Overview

The purpose of this study is to test the feasibility and acceptability of an evidence-based treatment for depression delivered over an ipad, computer, or smartphone can help Adult Protective Services (APS) clients with their activities of daily living to evaluate whether reductions on measures of depression and apathy (a) mediate reduced Elder Neglect/Self Neglect (EN/SN) behaviors; and (b) whether secondary posited mediating mechanisms are also active in impacting depression and apathy

Interventions

• Behavioral APS Treatment as Usual
  APS agencies conduct in-home investigations of alleged abuse and neglect against disabled and older adults. Investigations result in short-term stop-gap measures, primarily brief case-management centering on referral linkage to community-based services and provision of resource allocation. No direct psychological services or treatments are provided by APS, however referral to other services is also standard.
• Behavioral Intervention-Behavioral Activation (BA)
  Participants will be will be guided through 8 one-hour sessions via home telehealth by the study community health worker. Each weekly \< 60 minute BA session will include modules focusing on 1) Psychoeducation for depression and techniques for self-management, including pharmacologic and psychosocial treatment options; 2) Introduction of BA and guided problem-solving techniques to enhance self efficacy for managing depression and other chronic illnesses; 3) BA and problem-solving techniques to s

Primary outcome measures

• Change in depression as assessed by the Patient Depression Questionnaire (PHQ-9) [Time frame: baseline, post-treatment ( 8 weeks after baseline), and 3 months]
• Change in apathy as assessed by the Apathy Motivations Index (AMI) [Time frame: baseline, post-treatment ( 8 weeks after baseline), and 3 months]
• Change in Elder Neglect/Self Neglect (EN/SN) as evidenced by study developed goal attainment scale [Time frame: baseline, post-treatment ( 8 weeks after baseline), and 3 months]

Secondary outcome measures (2)

• Change in social connection as assessed by the Lubben Social Network Scale [Time frame: baseline, post-treatment ( 8 weeks after baseline), and 3 months]
• Change in social isolation as assessed by Patient-Reported Outcomes Measurement Information System (PROMIS 8) [Time frame: baseline, post-treatment ( 8 weeks after baseline), and 3 months]

Eligibility criteria

Inclusion criteria

• APS Case in APS Region VI- Must have open case
• PHQ 9 score- Must have score of nine (9) or more

Exclusion criteria

• Previous mental health diagnosis of bipolar disorder, psychotic disorders, and moderate to severe dementia
• Assessment of Consent Proxy- Those who need assessment of consent proxy
• Suicidal Intent (as indexed by PhQ-9 question 9)- Those scoring 2 or 3
• Current Alcohol and Drug Dependency- As evidenced by Cut down, Annoyed, Guilty, and Eye-opener (CAGE) score of 3 or more

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Treatment

Study locations

United States · 1 center

• The University of Texas Health Science Center at Houston — Houston

Identifiers

NCT: NCT06910267 · HSC-MS-24-1021 · 1P30AG086563-01

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗