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(CESD) and anxiety (State Subscale from the State-Trait
Personality Inventory). Over the next 18 years, cognitive ability was assessed as many as five times. Cognitive
assessments included measures of attention (Digit Span),
processing speed (Symbol Digit and Figure Identification),
visuospatial functioning (Block Design, Card rotations,
Figure Logic), and memory (Thurstone Picture Memory).
Multivariate Cholesky decomposition models were fit.
Significant sex differences were found and the covariance
between each cognitive time point, anxiety and depression
were constrained to equality without degradation in model
fit. For males, anxiety and depression were associated with
significantly poorer performance on every test with correlations ranging from r = -0.18 (Symbol Digit) to -0.33 (Block
Design). Shared genetic influences explained between 36%
(Symbol Digit) to 80% (Block Design) of the correlation.
For females, anxiety and depression were only associated
with worse performance on Symbol Digit (ranx = -0.08
and rdep=-0.11) and Digit Span Forward (ranx=-0.02
and rdep=-0.03). Results suggest that for males emotional
distress is associated with worse cognitive performance
and this largely explained by shared genetic influences.
Longitudinal biometric models need to be fit to examine
this association over time.
THE EFFECT OF AN ADAPTIVE CBT INTERVENTION
ON OPTIMISM, SELF-EFFICACY, AND PERCEIVED
PSYCHOLOGICAL WELL-BEING IN A PILOT
INTERVENTION FOR DEPRESSED OLDER ADULTS
A. Sitt1, R. Zweig1, P. Marino2, 1. Clinical Psychology,
Ferkauf Graduate School of Psychology, New York, New
York, 2. Weill Cornell Medical College, New York, New
York
Older adults with disabilities are at higher risk for depression. Furthermore, factors associated with a disability place
older adults at risk for depressive symptoms. Older adults
with depression respond well to psychotherapy, however
few studies have focused on a treatment for both depression and physical disability in older adults. We conducted
an analysis of archival data derived from a pilot study on
an Adaptive CBT treatment for older adults with depression
and physical disability. Twenty-one homebound depressed
individuals with at least one self-reported medical illness
who were receiving nutritional services due to chronic illness
or physical disability were recruited from the community.
Validated instruments were used to assess depression, medical illness, perceived health, as well as changes in optimism,
self-efficacy, and psychological well-being following treatment. Assessments were conducted at baseline and postintervention. Perceived current and future health, endorsed
medical conditions, and depression were not found to be
related to optimism, self-efficacy, or psychological wellbeing at baseline. Participants who received Adaptive CBT
demonstrated increases in optimism and psychological wellbeing, but not in self-efficacy from baseline to post-intervention. Depression significantly decreased from baseline
to post intervention. Adaptive CBT appears to be a feasible
and promising intervention to improve optimism (p <.07)
and psychological well-being (p < .05) and decrease symptoms of depression (p < .01) in older adults with comorbid chronic illness or physical disabilities. If the efficacy of
The Gerontological Society of America
this approach is established, the results may have important
implications for the treatment of comorbid depression and
disability in older adults.
TESTING THE CHRONIC CARE MODEL FOR
DEPRESSION IN HOMEBOUND OLDER ADULTS
B. Getz, S. Meeks, Department of Psychological and Brain
Sciences, University of Louisville, Louisville, Kentucky
Homebound older adults are a unique population of
older adults with many chronic illnesses and complex
care needs, who are at increased risk for depression (Qui
et al., 2010). Many Chronic Care Models (CCMs) have
been developed to provide a better system of care to those
with chronic health conditions (Bodenheimer, Wagner, &
Grumbach, 2002; Wagner et al., 2001; Wagner, Austin, &
Von Korff, 1996a, 1996b). However, no CCM has been
developed specifically for use with depressed homebound
older adults. The CCM for Depressed Homebound Older
Adults is a model that was specifically designed for this
population, addressing many areas for improvement
of care. To examine aspects of this model in the current
home health care system we tested model-predicted relationships between home health system characteristics and
outcomes, using a sample of 3,000 depressed home health
patients from the Medicare Outcome and Assessment
Information Set (OASIS) and Master Beneficiary Summary
File. We hypothesized that in depressed homebound older
adults, more services offered by the home health agency
and more visits provided would be related to fewer hospitalizations and nursing home admissions. A regression
indicated that the number of services (β=0.332, p<0.001)
and visits (β=0.007, p<0.001) were significant predictors
(R2=0.059, F(5,2174)=27.34, p<0.001) of the number of
hospitalizations. This unexpected finding may indicate that
having more services is associated with more thorough
care, which may increase the likelihood that patients are
hospitalized if home health providers recognize a need for
it, or greater illness severity. Further analyses will explore
these possibilities.
DEPRESSION AND FRAILTY IN OLDER VETERANS
WITH HUMAN IMMUNODEFICIENCY VIRUS AND
HEPATITIS C VIRUS
C.J. Burant1,2, M. Pallaki1,2, D.M. Kresevic1,3, F. Kodama1,2,
R. Kalayjian1,4, M. Watanabe1, T.R. Hornick1,2, 1. Cleveland
VAMC, Cleveland, Ohio, 2. Case Western Reserve
University, Cleveland, Ohio, 3. University Hospitals Case
Medical Center, Cleveland, Ohio, 4. Metrohealth Medical
Center, Cleveland, Ohio
Depression has been associated with frailty, defined as a
vulnerability to declining health and increased morbidity and
mortality. Patients with chronic immune deficiency disorders
may be at a greater risk for depression and frailty, yet few
studies have identified prevalence. The purpose of this prospective pilot study of older veterans with HIV and HCV (n=
58) mean age = 59.2 (sd=6.7) was to identify the prevalence
and associated factors with depression and frailty. In this
study of a VA outpatient infectious disease clinic, patients
with HIV and HCV were screened for depression using the
PHQ-9 and for frailty using the Fried Frailty Criteria (weight
loss, exhaustion, physical activity, walk time, grip strength).