Home-based collaborative care model for older adults shown to reduce depression symptoms.   

Background 

Depression affects all age groups, but in older adults, age-related physical and cognitive factors can worsen mental health and obscure symptoms. The Program to Encourage Active, Rewarding Lives model (PEARLS) is a home- and community-based collaborative care model to address depression in older adults, including those who are isolated, functionally impaired, or have multiple chronic conditions. PEARLS is a team-based model delivered in patients’ homes or over the phone by community-based organization staff (e.g., community health workers, social workers). PEARLS supports depression screening, symptom monitoring, and individualized strategies for improvement. This study assessed PEARLS’ impact on depression symptoms in adults aged 50 years and older across four Administration for Community Living-funded states.  

Findings  

1,155 older adults in Florida, Maryland, Texas, and Washington State participated in PEARLS between 2015–2021. The study assessed PHQ-9 depression screening scores during participants’ final PEARLS session as compared to baseline. There was statistically significant improvement in participants’ PHQ-9 scores, with an average decrease of 5.67 points. Following the intervention, approximately 35% of participants had depression remission, defined as a PHQ-9 score less than 5. Patients with mild depression were most likely to achieve remission. About 49% of participants experienced a clinical response to the intervention, defined as at least a 50% decrease in PHQ-9 score.  

Policy/Program Takeaways 

Home-based collaborative care models can support effective depression treatment for older adults. Providers, payers, and policymakers may explore how to build or support partnerships between providers and community-based organizations to enable such models.