Why Late-life Depression Matters

Depression has a profound effect on the health and quality of life of seniors, as well as on their ability to live independently.

Depressed older adults are less likely to follow their health care provider's treatment guidelines or engage in healthy practices to self-manage chronic health conditions to maintain health and function.

Minor and chronic depression affects between 15 to 20% of older adults, especially those who are socially isolated and in frail health.

Doctors and their older patients often incorrectly assume depression is an unavoidable consequence of aging, and only about half of depressed older adults receive treatment.

PEARLS Program Description

PEARLS is a counseling program that teaches depression management techniques to seniors with depression. It consists of in-home counseling sessions followed by a series of phone calls. The counseling covers the following three behavioral approaches to managing depression

1. The PEARLS counselor teaches the participant to recognize symptoms of depression and understand the strong link between unsolved problems and depression. They then teach a structured set of steps the participants can employ to solve their problems, ranging from clearly defining the problem to implementing the chosen solution(s).
2. The counselor helps the participant to meet recommended levels of social and physical activity by steering him/her towards community settings that offer an array of opportunities, such as senior centers, community centers, and faith communities. Involvement in social and physical activities has been shown to improve the mood of people with depression.
3. The PEARLS counselor also helps participants identify and participate in personally pleasurable activities. People who are depressed generally stop doing enjoyable things. Engaging in pleasurable activities has been found to be successful in helping people manage their depression.

In addition, the PEARLS program ensures that other potential factors contributing to depression, such as untreated or partially treated chronic medical conditions, are adequately assessed and treated. An important part of the comprehensive PEARLS program is the potential use of antidepressant medications, which is decided upon and administered within the context of the client's relationship with his/her medical health care provider.

Summary of Research Results

In 2003, the University of Washington's Health Promotion Research Center, in collaboration with the City of Seattle's Aging and Disability Services and Senior Services, conducted a study of the effectiveness of the PEARLS Program. Study participants who received the PEARLS intervention were three times more likely than non-participants to significantly reduce their depressive symptoms (43% vs. 15%) or completely eliminate their depression (36% vs. 12%). There were improvements in participants' functional and emotional well-being, and they reduced their utilization of health care services.

JAMA article reporting findings of the PEARLS study

Current efforts are focused on replicating the PEARLS program, making it available to a broader range of older adults,and other adults with chronic medical conditions.