What Matters Most: A Needs Assessment of Older Adults

Introduction With aging, comes a myriad of new experiences and adversities. One theme that continuously presents itself, especially in mental health clinics, is loneliness and isolation. The lack of social connections and the hinderance it plays only became more apparent during the COVID-19 pandemic and prompted the idea of creating a psychotherapeutic intervention to help combat these experiences in older adults. Group interventions foster social connections while reducing cost and the limited access to clinicians;the overall aim of this project was to conduct a program evaluation of an innovative, rotating psychological wellness group for older adults. In keeping with this, a needs assessment of what matters most in older adults was performed. Methods This pilot program includes a psychological wellness group offering for older adults with 6 modules covering a collection of topics that support optimal psychological wellness and promote health and resilience (i.e. digital tools and mobile apps, value-based behavioral activation to improve your mood, eating for a healthy brain, introduction to mindfulness, improving your sleep and strategies for managing anxiety) that are be held weekly, ranging in duration from 2-6 weeks, over the next 6 months. Participants were referred from outpatient psychiatry clinics, geriatric medicine providers in medical center, and local community organizations servicing older adults. To be included, patients had to be 65+ years old, English speaking, open to group treatment, and without a diagnosis of dementia. Once participants were triaged and selected, a questionnaire was sent that addressed multiple aspects of their past medical history as well as their goals of care, prompting patients to identify what matters most to them in the domains of functionality, enjoyment, and connectivity as well as an open text question allowing them to expand on which three matter the most above all. Results Older adults (N=21) were enrolled in the psychological wellness group, including 6 males and 15 females. Seven of the participants lived alone and 3 were caregivers. Survey results indicated that older adults greatly prioritize maintaining cognitive status as their greatest health priority. The perceived importance of maintaining social connectivity via relationships with family and friends was rated equally if not higher than physical functionality. The following representative direct patient quotes encapsulate this sentiment well with "[I] just can't seem to connect. I spend most of my days alone trying to make meaningful connection.” "Spend time with family and friends (personal connections, they are important to me).” Relatedly, patients who indicated that mental cognition was not one of their most important health goals tended to respond positively to priorities centered around personal independence, such as travel, preserved sensory function, and ability to complete iADLs. However, ability to care for self and others was globally the least important priority. Conclusions Insights in the health priorities of older adults may allow for a better understanding of their treatment goals, allowing for greater alignment in the therapeutic alliance. Of the neurocognitive domains, social cognition is not routinely tested;this preliminary data underscores the importance of this domain to older adults. Future work includes collecting additional surveys to create datasets large enough for cluster analysis and predictive modeling, which may be informative for directing targeted modules in expected areas of need and in initial intake triage. This research was funded by Psychiatry Innovator Grants Program- Grant #1266204-705-KAVGS Department of Psychiatry and Behavioral Sciences, Stanford University (PI: Cassidy-Eagle).

Scoping Review of Geriatric Depression and Behavioral Activation

Introduction A substantial proportion of older adults will experience depression (including major depressive disorder and subsyndromal depressive symptoms), yet depression remains underdiagnosed and undertreated among older adults. Behavioral Activation is an effective, empirically-validated, first-line treatment for mild to moderate depression. Behavioral activation is a patient-centered intervention designed to decrease depressive behavior (e.g. social isolation, physical inactivity) and increase engagement in pleasurable activities (e.g. hobbies, family time). The objective of this scoping review is to evaluate the gaps in the literature and knowledge base regarding the implementation contexts, target populations, delivery modalities, assessment methods, and effectiveness of behavioral activation as a treatment for depression and/or anxiety among older adults, including both inpatient and outpatient settings. Methods We performed a scoping review and searched for peer-reviewed articles published from 1990 to 2020. The keywords and their combinations (e.g., depression, anxiety, elder(s), elderly, geriatric, older adult(s), age, aged, aging, behavio(u)ral activation) were used in search engines including the following but not limited to PubMed, PsycINFO, and Cochrane. Our search strategy identified 423 results;after removing duplicates, 232 results remained. Currently, we are evaluating the titles and abstracts using broad inclusion criteria to ensure that all relevant behavioral activation relevant to geriatric depression and/or anxiety are included. All types of studies and publications (e.g. randomized clinical trials, cohort studies, case controls, reviews, etc.) that focus on behavioral activation as an intervention or primary focus are being included in this comprehensive search. Studies have to include participants > 50 years old with either clinically diagnosed depression and/or anxiety at or above a pre-defined cut-point on a validated symptom scale (e.g., PHQ-9: >5 and GAD-7: >5). Results This scoping review will chart the landscape of literature relevant to behavioral activation for older adults with depression and/or anxiety. The literature will be reviewed in terms of study setting (e.g., community or outpatient settings, inpatient psychiatric units, assisted living facilities);study type (including randomized clinical trials, as well as observational studies, cohort studies, case controls, cross sectional, etc.);mode, frequency, and duration of intervention delivery;type and training of providers;assessment methods;and outcomes. Reviews will be examined for themes and consistency in synthesis of findings. Particular attention will be paid to identifying gaps in the literature where further work is needed to broaden the reach and impact of this promising intervention. Conclusions Scoping reviews represent a compelling method for evaluating existing literature and identifying gaps for future study. The present scoping review will synthesize the identified literature, in the hope of helping not only clinicians who work closely with older adults, but also researchers wishing to pursue studies in this area. Given a burgeoning older adult population and a paucity of geriatric mental health providers, clinical guidelines offering alternative nonpharmacologic therapy can be effective and cost-effective for clinicians and healthcare systems. Given the COVID-19 pandemic and the consequent escalation in social isolation among older adults, it is also hoped that this scoping review will identify promising avenues and methods for adapting behavioral activation in myriad ways—i.e., through implementation via telehealth platforms—to the older adult population. Funding Not applicable