IMPORTANCE: Problem adaptation therapy (PATH) is a treatment for older adults with @entity308 , @entity73 (from mild @entity73 to moderate @entity303 ), and disability. Antidepressants have limited efficacy in this population and psychosocial interventions are inadequately investigated. OBJECTIVE: To test the efficacy of 12-week PATH vs supportive therapy for @entity73 @entity1 (ST-CI) in reducing @entity308 and disability in 74 older adults with @entity308 , @entity73 , and disability. DESIGN, SETTING, AND @entity1 : A randomized clinical trial at the Weill Cornell Institute of Geriatric Psychiatry from April 1, 2006, to September 31, 2011. Interventions were administered at the @entity1 ' homes. @entity1 included 74 older individuals (age >=  65 years) with @entity308 and @entity73 to the level of moderate @entity303 . They were recruited through collaborating community agencies of Weill Cornell Institute of Geriatric Psychiatry and were randomly assigned to 12 weekly sessions of PATH or ST-CI (14.8% attrition rate). INTERVENTIONS: Home-delivered PATH vs home-delivered ST-CI. Problem adaptation therapy integrates a problem-solving approach with compensatory strategies, environmental adaptations, and caregiver participation to improve @entity1 ' emotion regulation. Supportive therapy for @entity73 @entity1 focuses on expression of affect, understanding, and empathy. MAIN OUTCOMES AND MEASURES: Mixed-effects models for longitudinal data compared the efficacy of PATH with that of ST-CI in reducing @entity308 (Montgomery-Asberg Depression Rating Scale) and disability (World Health Organization Disability Assessment Schedule II) during 12 weeks of treatment. RESULTS: @entity1 in PATH had significantly greater reduction in @entity308 (Cohen d, 0.60; 95% CI, 0.13-1.06; treatment * time, F(1,179) = 8.03; P =   .005) and disability (Cohen d, 0.67; 95% CI, 0.20-1.14; treatment * time, F(1,169) = 14.86; P =   .001) than ST-CI @entity1 during the 12-week period (primary outcomes). Furthermore, PATH @entity1 had significantly greater @entity308 remission rates than ST-CI @entity1 (37.84% vs 13.51%;   (2) = 5.74; P =   .02; number needed to treat = 4.11) (secondary outcome). CONCLUSIONS AND RELEVANCE: Problem adaptation therapy was more efficacious than ST-CI in reducing @entity308 and disability. Problem adaptation therapy may provide relief to a large group of @entity73 older adults who have few treatment options. TRIALS REGISTRATION: Clinicaltrials.gov Identifier: NCT00368940.

Problem adaptation therapy for older adults with @entity308 and XXXX : a randomized clinical trial.

@entity303 :: ('MESH:D003704', 'Disease') :: ['dementia'] @entity73 :: ('MESH:D003072', 'Disease') :: ['cognitively impaired', 'cognitive impairment', 'cognitive deficits', 'depressed and cognitively impaired'] @entity1 :: ('9606', 'Species') :: ['participants', 'patients', 'Participants', 'PARTICIPANTS'] @entity308 :: ('MESH:D003866', 'Disease') :: ['depression', 'major depression']
@entity73 :: (MESH:D003072,Disease) :: ['cognitive impairment']
