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Improving Treatment of Depression in Older Adults

Expanding the MARPEH Model
Improving Treatment of Depression in Older Adults

Identifying and effectively treating older patients who suffer from depression continues to be a challenge. Primary care providers (PCPs) tend to screen for and treat depression, and although well-intentioned, treatment in a primary care setting does not always yield the best outcome for older patients.

PCPs actually now screen patients for depression more often than they used to, however increased screening has not always led to better treatment. Depression in older adults can present differently than in younger patients, and PCPs who aren’t aware of that may underestimate the severity of depression in their older patients.

Even when depression is diagnosed, primary care practices aren’t set up well to follow patients who are started on treatment. For example, a patient may start an anti-depressant, develop side effects and just stop taking it, or not know that when they feel better they are supposed to stay on their medication. A PCP may start a patient on a medication dose and not adjust the dose if not effective, again because of inadequate follow-up. And finally, patients treated in the primary care setting tend not to get psychotherapy, which is often an important component of effective treatment.

So to address all of those problems, a model that is referred to as integrated treatment of depression has been developed, and Hebrew SeniorLife’s MARPEH (Making Real Progress in Emotional Health) is an adaptation of that model. HSL offers the MARPEH program to residents in its supportive senior living communities. And, thanks to recent grants from The James and Sarah Dyer Charitable Fund and Blue Cross and Blue Shield of Massachusetts Foundation, MARPEH will be expanding the program into the community through Hebrew SeniorLife Home Care.

The MARPEH program provides:

  • Education to primary care providers to help them better recognize depression in older patients and apply state-of-the-art treatment
  • Training to non-clinical staff to help them recognize signs and symptoms of depression in the elderly
  • A depression care manager (DCM). A patient who is identified as having depression is referred to the DCM, who provides treatment, including psycho-therapy, and sees the patient on a regular basis reporting back to the patient’s PCP. The DCM also meets weekly with a psychiatrist to discuss cases.

The MARPEH Program has been very successful in the HSL senior living communities. But most seniors live in the greater community so expanding MARPEH into HSL Home Care is a significant move. Depression screening is already incorporated into the process for admitting patients into home health care, but the problem has been what do you do then if the patient screens positive?

We’re applying the MARPEH concept to HSL Home Care, aimed at improving lines of communication between home care providers and PCPs, and also to provide home care staff, who already have experience with disease management, with tools that allow them to add depression to the conditions they can treat.

My hope is that we will be able to bring the same quality psychiatric care that we’ve been able to offer to HSL residents with the MARPEH program to many older adults in Greater Boston’s communities.

This blog is the third in a three part series on mental health and older adults, read Part I and Part II

Hebrew SeniorLife Home Care
Often, there’s no place like home to recover after a hospital stay, take charge of chronic illness, or learn to live with a disability that may limit mobility but need not limit quality of life. HSL Home Care offers a comprehensive range of services to assist seniors in the Greater Boston area with their recovery following surgery, illness or hospital stay or to manage chronic illness. HSL Home Care is staffed by seasoned professionals who specialize in the needs of older adults and are available 24 hours a day, seven days a week. We will work closely with you to set personal goals for care and wellness, respecting your choice every step of the way.

Eran Metzger, M.D.'s picture

About the Blogger

Medical Director of Hebrew SeniorLife Psychiatry

Eran D. Metzger, M.D., is the medical director of psychiatry at Hebrew SeniorLife. Board certified in psychiatry, neurology and forensic psychiatry, Dr. Metzger's clinical interests focus on the interfaces between medical illness and emotional disorders, as well as medical ethics. He is a graduate of the Pennsylvania State University College of Medicine and completed his internship at Brockton Hospital and his residency and fellowship at Beth Israel Deaconess Medical Center. An assistant professor of psychiatry at Harvard Medical School, Dr. Metzger's research interests include...

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Both my wife(age 78) and I(age 79), would like some information to assist and help us through these, Life Changing challenges that getting old brings to us. Memory for me(husband) is one of my biggest challenges, I have issues remembering topics that my wife and I have discussed, she seems to much better at remembering than I do. If you can suggest anything that we can do to make us better as we age regarding memory issues, please respond. Thanking you in advance, tom leblanc, Florida.
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My husband (age 75) is experiencing considerable short-term memory loss and seems to be afflicted with noticeable depression. Is there a good natural remedy to treat depression?? He will never relent to prescription meds. Thanks for your input.
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