Collaborative depression care for the old-old: findings from the IMPACT trial

Abstract

Objectives: To compare the clinical outcomes of young-old patients (aged 60-74 years) and old-old patients (aged 75 years and older) who received collaborative care management for depression.

Design: Multisite randomized clinical trial.

Setting: Eighteen primary care clinics from eight healthcare organizations.

Participants: Nine hundred six patients (N = 606 young-old; N = 300 old-old) with major depression and/or dysthymia who were randomized to receive collaborative care in the Improving Mood: Promoting Access to Collaborative Treatment trial.

Intervention: Patients had access for 12 months to a depression clinical specialist who coordinated depression care with their primary care physician.

Measurements: Young-old and old-old patients were compared on process of care and outcome variables. Process of care was determined by the type of treatment and level of care received. Clinical outcomes included Symptom Checklist (SCL)-20 depression scores, treatment response (defined as a >or=50% decrease in the SCL-20 score from baseline), and complete remission (defined as a SCL-20 score <0.5) at 3-, 6-, 12-, 18-, and 24-month follow-up.

Results: The process of care variables did not significantly differ between the two age groups. Young-old patients had similar treatment responses at initial follow-up (3 months) but were significantly more likely to respond to treatment and meet complete remission criteria than old-old patients at 6-, 12-, 18-, and 24-months.

Conclusions: Young-old and old-old patients who receive collaborative depression care have a similar initial clinical response, but old-old patients may have a lower rate of long-term treatment response and complete remission in the long run.