Treatment of Depression Improves Physical Functioning in Older Adults

Authors

  • Christopher M. Callahan MD,

    1. From the *Indiana University Center for Aging Research, Indianapolis, IndianaRegenstrief Institute, Inc. Indianapolis, IndianaDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana§University of Washington School of Medicine, Seattle, WashingtonGroup Health Cooperative of Puget Sound, Seattle, WashingtonSouth Texas Veterans Health Care System, San Antonio, Texas#University of Texas Health Science Center at San Antonio, San Antonio, Texas**Duke University School of Medicine, Durham, North Carolina††Division of Research, Kaiser Permanente, Oakland, California‡‡University of California at Los Angeles, Los Angeles, California.
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  • Kurt Kroenke MD,

    1. From the *Indiana University Center for Aging Research, Indianapolis, IndianaRegenstrief Institute, Inc. Indianapolis, IndianaDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana§University of Washington School of Medicine, Seattle, WashingtonGroup Health Cooperative of Puget Sound, Seattle, WashingtonSouth Texas Veterans Health Care System, San Antonio, Texas#University of Texas Health Science Center at San Antonio, San Antonio, Texas**Duke University School of Medicine, Durham, North Carolina††Division of Research, Kaiser Permanente, Oakland, California‡‡University of California at Los Angeles, Los Angeles, California.
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  • Steven R. Counsell MD,

    1. From the *Indiana University Center for Aging Research, Indianapolis, IndianaRegenstrief Institute, Inc. Indianapolis, IndianaDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana§University of Washington School of Medicine, Seattle, WashingtonGroup Health Cooperative of Puget Sound, Seattle, WashingtonSouth Texas Veterans Health Care System, San Antonio, Texas#University of Texas Health Science Center at San Antonio, San Antonio, Texas**Duke University School of Medicine, Durham, North Carolina††Division of Research, Kaiser Permanente, Oakland, California‡‡University of California at Los Angeles, Los Angeles, California.
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  • Hugh C. Hendrie MB, ChB,

    1. From the *Indiana University Center for Aging Research, Indianapolis, IndianaRegenstrief Institute, Inc. Indianapolis, IndianaDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana§University of Washington School of Medicine, Seattle, WashingtonGroup Health Cooperative of Puget Sound, Seattle, WashingtonSouth Texas Veterans Health Care System, San Antonio, Texas#University of Texas Health Science Center at San Antonio, San Antonio, Texas**Duke University School of Medicine, Durham, North Carolina††Division of Research, Kaiser Permanente, Oakland, California‡‡University of California at Los Angeles, Los Angeles, California.
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  • Anthony J. Perkins MS,

    1. From the *Indiana University Center for Aging Research, Indianapolis, IndianaRegenstrief Institute, Inc. Indianapolis, IndianaDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana§University of Washington School of Medicine, Seattle, WashingtonGroup Health Cooperative of Puget Sound, Seattle, WashingtonSouth Texas Veterans Health Care System, San Antonio, Texas#University of Texas Health Science Center at San Antonio, San Antonio, Texas**Duke University School of Medicine, Durham, North Carolina††Division of Research, Kaiser Permanente, Oakland, California‡‡University of California at Los Angeles, Los Angeles, California.
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  • Wayne Katon MD,

    1. From the *Indiana University Center for Aging Research, Indianapolis, IndianaRegenstrief Institute, Inc. Indianapolis, IndianaDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana§University of Washington School of Medicine, Seattle, WashingtonGroup Health Cooperative of Puget Sound, Seattle, WashingtonSouth Texas Veterans Health Care System, San Antonio, Texas#University of Texas Health Science Center at San Antonio, San Antonio, Texas**Duke University School of Medicine, Durham, North Carolina††Division of Research, Kaiser Permanente, Oakland, California‡‡University of California at Los Angeles, Los Angeles, California.
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  • Polly Hitchcock Noel PhD,

    1. From the *Indiana University Center for Aging Research, Indianapolis, IndianaRegenstrief Institute, Inc. Indianapolis, IndianaDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana§University of Washington School of Medicine, Seattle, WashingtonGroup Health Cooperative of Puget Sound, Seattle, WashingtonSouth Texas Veterans Health Care System, San Antonio, Texas#University of Texas Health Science Center at San Antonio, San Antonio, Texas**Duke University School of Medicine, Durham, North Carolina††Division of Research, Kaiser Permanente, Oakland, California‡‡University of California at Los Angeles, Los Angeles, California.
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  • Linda Harpole MD, MPH,

    1. From the *Indiana University Center for Aging Research, Indianapolis, IndianaRegenstrief Institute, Inc. Indianapolis, IndianaDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana§University of Washington School of Medicine, Seattle, WashingtonGroup Health Cooperative of Puget Sound, Seattle, WashingtonSouth Texas Veterans Health Care System, San Antonio, Texas#University of Texas Health Science Center at San Antonio, San Antonio, Texas**Duke University School of Medicine, Durham, North Carolina††Division of Research, Kaiser Permanente, Oakland, California‡‡University of California at Los Angeles, Los Angeles, California.
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  • Enid M. Hunkeler MA,

    1. From the *Indiana University Center for Aging Research, Indianapolis, IndianaRegenstrief Institute, Inc. Indianapolis, IndianaDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana§University of Washington School of Medicine, Seattle, WashingtonGroup Health Cooperative of Puget Sound, Seattle, WashingtonSouth Texas Veterans Health Care System, San Antonio, Texas#University of Texas Health Science Center at San Antonio, San Antonio, Texas**Duke University School of Medicine, Durham, North Carolina††Division of Research, Kaiser Permanente, Oakland, California‡‡University of California at Los Angeles, Los Angeles, California.
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  • Jürgen Unützer MD,

    1. From the *Indiana University Center for Aging Research, Indianapolis, IndianaRegenstrief Institute, Inc. Indianapolis, IndianaDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana§University of Washington School of Medicine, Seattle, WashingtonGroup Health Cooperative of Puget Sound, Seattle, WashingtonSouth Texas Veterans Health Care System, San Antonio, Texas#University of Texas Health Science Center at San Antonio, San Antonio, Texas**Duke University School of Medicine, Durham, North Carolina††Division of Research, Kaiser Permanente, Oakland, California‡‡University of California at Los Angeles, Los Angeles, California.
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  • for the IMPACT Investigators

    1. From the *Indiana University Center for Aging Research, Indianapolis, IndianaRegenstrief Institute, Inc. Indianapolis, IndianaDepartment of Psychiatry, Indiana University School of Medicine, Indianapolis, Indiana§University of Washington School of Medicine, Seattle, WashingtonGroup Health Cooperative of Puget Sound, Seattle, WashingtonSouth Texas Veterans Health Care System, San Antonio, Texas#University of Texas Health Science Center at San Antonio, San Antonio, Texas**Duke University School of Medicine, Durham, North Carolina††Division of Research, Kaiser Permanente, Oakland, California‡‡University of California at Los Angeles, Los Angeles, California.
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  • This study was supported by grants from the John A. Hartford Foundation, the California Healthcare Foundation, the Hogg Foundation, and the Robert Wood Johnson Foundation.

Christopher M. Callahan, MD, Indiana University Center for Aging Research, Regenstrief Institute, Inc. 1050 Wishard Blvd, RG6, Indianapolis, IN 46202. E-mail: ccallaha@iupui.edu

Abstract

Objectives: To determine the effect of collaborative care management for depression on physical functioning in older adults.

Design: Multisite randomized clinical trial.

Setting: Eighteen primary care clinics from eight healthcare organizations.

Participants: One thousand eight hundred one patients aged 60 and older with major depressive disorder.

Intervention: Patients were randomized to the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) intervention (n=906) or to a control group receiving usual care (n=895). Control patients had access to all health services available as part of usual care. Intervention patients had access for 12 months to a depression clinical specialist who coordinated depression care with their primary care physician.

Measurements: The 12-item short form Physical Component Summary (PCS) score (range 0–100) and instrumental activities of daily living (IADLs) (range 0–7).

Results: The mean patient age was 71.2, 65% were women, and 77% were white. At baseline, the mean PCS was 40.2, and the mean number of IADL dependencies was 0.7; 45% of participants rated their health as fair or poor. Intervention patients experienced significantly better physical functioning at 1 year than usual-care patients as measured using between-group differences on the PCS of 1.71 (95% confidence interval (CI)=0.96–2.46) and IADLs of −0.15 (95% CI=−0.29 to −0.01). Intervention patients were also less likely to rate their health as fair or poor (37.3% vs 52.4%, P<.001). Combining both study groups, patients whose depression improved were more likely to experience improvement in physical functioning.

Conclusion: The IMPACT collaborative care model for late-life depression improves physical function more than usual care.

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