A home-based program that includes social and physical activity significantly reduces symptoms of depression in older adults who are chronically ill and have minor depression, according to an article in the April 7th issue of The Journal of the American Medical Association.

Clinically significant depression affects 15 to 20 percent of elderly individuals in the United States, according to background information in the article. Older adults with social isolation, multiple illnesses, and physical impairment are more likely to be depressed but may be less able to seek appropriate care for depression compared with other older adults.

Paul Ciechanowski, MD, MPH, and his American colleagues conducted a randomized controlled trial comparing a specific program for treating minor depression and dysthymia, the Program to Encourage Active, Rewarding Lives for Seniors (PEARLS), with usual care in medically ill, low-income, mostly homebound older adults. The study included 138 participants (51.4 percent with minor depression, and 48.6 percent with dysthymia) aged 60 years or older, recruited through community senior service agencies in one metropolitan area from January 2000 to May 2003. Seventy-two percent of the participants lived alone, 58 percent had an annual income of less than $10,000, and 69 percent received some form of home assistance.

Patients were randomly assigned to the PEARLS intervention (n = 72) or usual care (n = 66). The PEARLS intervention consisted of visits and phone calls from a therapist. In addition, patients received a form of brief psychotherapy known as problem-solving treatment, modified to emphasize physical activity and increased socialization. There were also potential recommendations regarding antidepressant medications.

The researchers found that at 12 months, compared with the usual care group, patients receiving the PEARLS intervention were about 5 times more likely to have at least a 50 percent reduction in depressive symptoms (43 percent vs. 15 percent), nearly 5 times more likely to achieve complete remission from depression (36 percent vs. 12 percent), and to have greater health-related quality-of-life improvements in functional well-being and emotional well-being.

"This is one of the first studies to show that by partnering with community agencies, it is possible to target and effectively treat depressed, frail, elderly adults using primarily nonpharmacological treatments such as psychotherapy," the authors wrote. "Dissemination of PEARLS within existing community social service programs has the potential to significantly improve the well-being and function of depressed older adults served by these programs."

In an accompanying editorial, Jeffrey M. Lyness, MD, wrote that the findings in the current study provide evidence-based hope for the millions of elderly persons living in the "dark tunnel" of major depression or the only slightly less "dim tunnels" of lesser depressions that practical home-based programs can improve mental health and overall quality of life.