An intervention to improve depression care in older adults with COPD

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Abstract
Objective: To describe an intervention for older persons with Major Depressive Disorder (MDD) and Chronic Obstructive Pulmonary Disease (COPD) to improve adherence to psychiatric, medical, and rehabilitation recommendations. The intervention supplements antidepressant therapy for depression with an individualized care manager who targets psychological barriers that interfere with treatment participation.Method: Description of intervention development, training, and barriers to care, and illustration with case example.Results: Depression and its associated lack of motivation, helplessness, and lack of energy can obstruct active participation in rehabilitation exercises recommended for COPD. Additionally, depressed older adults perceive the benefits of depression treatment; however they also fear side effects, addiction to antidepressants and have concerns about stigma. The intervention elucidates individual attitudes and beliefs that may become barriers. The care manager works with the older adult to address the barriers and improve treatment participation.Conclusion: Augmentation of traditional pharmacotherapy for depression with a care manager can improve adherence to both depression and COPD treatment. This improved adherence may lessen the physical, psychological, and functional costs of both diseases. Copyright © 2006 John Wiley & Sons, Ltd.