Regular Research Articles
Community-Based Outreach and Treatment for Underserved Older Adults With Clinically Significant Worry: A Randomized Controlled Trial

https://doi.org/10.1016/j.jagp.2018.07.011Get rights and content

Highlights

  • The main question addressed by this study was whether two evidence-based interventions created by a community-academic partnership for improving worry and generalized anxiety disorder-related symptoms in older participants from underserved, low-income, mostly minority neighborhoods who had significant worry and were interested in psychosocial treatment were effective at 6 and 9 months.

  • The main finding was that both interventions (one a cognitive behavioral therapy with resource counseling to address basic unmet needs, facilitation of communication with primary care providers about worry/anxiety, integration of religion/spirituality, person-centered flexibility in skill content and delivery and nontraditional community providers and the other an enhanced model of standard community-based information and resource counseling that addressed both basic unmet needs and mental health needs) resulted in similar and significant improvements.

  • The meaning of the finding is that community-based outreach and worry/anxiety screening are needed in underserved populations and that either or a combination of these interventions might be suitable for older adults with identified worry/anxiety.

Objective

To determine whether Calmer Life (CL) improved worry, generalized anxiety disorder-related (GAD-related) symptoms, anxiety, depression, sleep, trauma-related symptoms, functional status, and quality of life better than Enhanced Community Care with Resource Counseling (ECC-RC) at 6 months and 9 months.

Methods

A randomized, controlled, comparative-effectiveness study involving underserved, low-income, mostly minority neighborhoods in Houston, Texas, looked at individuals ≥50 with significant worry and interest in psychosocial treatment. Interventions were CL, cognitive behavioral therapy with resource counseling, facilitation of communication with primary care providers about worry/anxiety, integration of religion/spirituality, person-centered skill content and delivery and nontraditional community providers, ECC-RC, and enhanced standard community-based information/ resource counseling addressing basic unmet and mental health needs. Primary outcomes were worry and GAD-related symptom severity. Secondary outcomes were anxiety, depression, sleep difficulties, trauma-related symptoms, functional status, quality of life, service use and satisfaction.

Results

Similar, moderate improvements followed CL and ECC-RC on worry, GAD-related symptoms, anxiety, depression, sleep, trauma-related symptoms, and mental health quality of life at 6 and 9 months, but with symptoms at both times and higher satisfaction with CL at both. Fewer ECC-RC participants reported a hospital admission in the prior 3 months than those in CL at 6 and 9 months; at 9 months, fewer reported a visit with a provider in the previous 3 months.

Conclusion

Both interventions showed similar improvements at 6 and 9 months, but symptoms remained that might require care. Either intervention or a combination may be useful for low-income older adults with identified worry/anxiety.

Section snippets

METHODS

Institutional review boards at Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center approved the study. Participants provided informed consent and received $25 for each assessment at baseline and at 6 and 9 months.

Participant Flow and Characteristics

Figure 1 shows participant flow and reasons for dropout. Total study attrition was 22.3% (33 of 148 included), with 9.5% (14 of 148) dropping before baseline assessment and 12.8% (19 of 148) dropping after randomization. Demographic variables were comparable for included participants dropping out before baseline and those completing baseline assessment who were randomized (Table 2). Among 134 randomized participants, attrition rates were similar in CL (15.7%, 11 of 70) and ECC-RC (12.5%, 8 of

DISCUSSION

To our knowledge, this is the first clinical trial of late-life worry/anxiety interventions among underserved, low-income, mostly minority older adults. In the context of a solid community-academic partnership, we successfully recruited a sample of mostly African American, low-income older adults with clinically significant worry, almost all of whom had at least one Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, psychiatric disorder. These data highlight the need for

CONCLUSION

CL and ECC-RC produced similar and moderate improvements in worry/anxiety and related symptoms, albeit with remaining symptoms that may require ongoing care. Given the significant attention to resource counseling in both of these interventions, improvements may reflect the central role of case management and community service use for improving depression in older, low-income, underserved populations. Community agencies and faith-based organizations may choose to use either CL or ECC-RC, or a

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