An Evidence Based Treatment Approach for Older Adults. Helen Stewart, MSW, LCSW Michelle Bonadies, LCSW

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1 Introduction ti to PEARLS: An Evidence Based Treatment Approach for Older Adults Pillars Helen Stewart, MSW, LCSW Michelle Bonadies, LCSW

2 Overview Depression in Older Adults What is PEARLS? Experience with implementation of PEARLS

3 Depression in older adults Depression is one of the most common mental health problems in older adults Up to 20% of older adults suffer from depression Rate of suicide among older adults is higher than that of any other age group, especially 85+

4 Clinical i l depression is NOT a normal part of aging. g

5 Depression can be triggered by: serious or chronic medical condition loss of functioning loss of independence increased isolation

6 According to the National Institute on Mental Health, healthcare h costs are significantly higher for older adults who are suffering from depression in addition to a chronic medical condition.

7 Why do older adults not seek out mental health services?

8 Symptoms of depression in older persons may differ somewhat from symptoms in other populations. It could be characterized by: Memory problems Social withdrawal Confusion Vague complaints of pain Irritability Inability to sleep Delusions, hallucinations (in some cases)

9 When depression is left untreated: Increases risk for medical illness, such as heart disease Increases risk of cognitive decline Suppresses the immune system Increases risk of suicide Delays recovery from illness

10 Research has shown that psychotherapy and medication work well in treatment for depression in older adults. One such treatment is PEARLS which has One such treatment is PEARLS, which has been developed and researched by the Health Promotion Research Center at the University of Washington.

11 PEARLS Program to Encourage Active and Rewarding Lives Included in the National registry of Evidence-based and Promising Practices of SAMHSA

12 PEARLS is based on 3 fundamental principles: What a client is experiencing are symptoms, and the symptoms are due to depression. There is a close link between depression and unsolved poblems problems. Increasing participation in social, physical, and other pleasant activities leads to a decrease in depressive symptoms.

13 PEARLS has been found to be effective in treating minor and major depression and dysthymia in older adults (60 and older) as well as adults with epilepsy (more recent findings) A randomized controlled study using PEARLS found that t clients receiving i PEARLS were more likely to have a 50% or more reduction in symptoms than those not receiving the intervention. ti Study also found that older adults receiving PEARS tended to have fewer hospitalizations

14 Collaboration Collaboration among: PEARLS counselor Primary Healthcare provider Psychiatrist

15 Problem Solving Approach PEARLS is based on the premise that t unsolved problems lead to depression Common Sense Brief treatment Focus on here and now Addressed a broad range of issues

16 Problem Solving Cont. Goals include: Increasing client s understanding of the link between current symptoms and current problems Increasing client s ability to clearly define the problem and set concrete/realistic goals Teaching problem solving skills

17 Behavioral Activation Helps clients reestablish healthy routines, increase positive experience. Includes physical activity, social activity and pleasurable activities. These lead to increase mood and better functioning.

18 PEARLS Implementation Recruitment and Identification of potential clients Screening: PHQ-9 Cognitive ability Exclusionary conditions PEARLS 8 session 19 week period Follow up calls

19 Screening PHQ-9 to screen for depression Screen for exclusionary conditions (psychosis, bipolar disorder and/or substance abuse) Brief 6-item memory Cognition Screen

20 PEARLS sessions Session 1: generate problem list and select one to teach the PST Sessions 2-7: PST and behavioral activation Sessions 1-3 are weekly; sessions 4 & 5 are every other week and sessions 6-8 are monthly Session8: Final Session Monthly follow-up calls

21 PHQ-9 completed every session Monthly consultation with psychiatrist Collaboration with Primary Healthcare Provider

22 My experience with PEARLS My first client is a 90-year-old Caucasian male living in independent living in a Senior building. S d li t i 66 ld Hi i f l Second client is a 66-year-old Hispanic female living in a Senior building.

23 Difficulties in implementation Length of treatment Different learning styles Unsolvable problems Solutions in problem solving treatment

24 Benefits of PEARLS Short term model Empowerment High confidence Recognizing symptoms of depression Concepts of PEARLS can relate to Concepts of PEARLS can relate to other clients

25 Website: Complete PEARLS toolkit downloaded for free Includes PHQ-9 and other screening tools Tracking and data management tools Contact Info- 708-PILLARS Michelle Bonadies- ill it Helen Stewart-

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