Jefferson Center for Applied Research on Aging and Health (CARAH) Center in the Park Senior Center

In Touch: Mind, Body & Spirit A Collaborative Model of Inquiry and Practice in Support of African American Elders' Mental Health Nancy L. Chernett & Laura N. Gitlin (PI) CARAH Lynn Fields Harris (Co-PI) Marie-Monique Martol Center in the Park 2009 APHA Conference

Depression in Older Adults Depression is the most prevalent mental health condition in older adults (over 7 million 65+) Though depression is most frequently identified in Primary Care setting Remains under-recognized and under-treated 50% diagnosed, 10% of whom have treatment RX Depression stigma among patients, families & providers may contribute to diagnosis & treatment disparities in older adults Older adults respond favorably to treatment when identified and treatment options are accepted (pharmacologic and non-pharmacologic) Debilitating but treatable condition Exacerbates chronic illness physical symptoms Contributes to more functional decline & ADL/IADL capacity

Depression in African American Older Adults African American’s are at greater risk higher prevalence of chronic conditions negative impact of socio-economic influences Depression prevalence in older African Americans is similar to that of Whites Older African American’s benefit equally from treatment Culturally influenced values, attitudes and beliefs influence willingness to accept diagnosis and treatment options (stigma, reliance on family and self, spiritual beliefs and prayer, preference for non-pharmacologic treatments) Prevalence rates for AA are higher for homebound, urban dwellers with co-morbidity Previous discrimination, negative health care experiences (Tuskegee), Contributes to reduced trust of health care system, providers & treatment

New Models of Depression Prevention and Treatment Holistic approaches which support positive mental health and address the cultural attitudes, beliefs and preferences of diverse older adult populations Collaborative care models which meet the complex social and emotional needs of older adults (e.g. IMPACT, PEARLS) Utilize trusted resources to identify and intervene late-life depression—especially for vulnerable groups such as African Americans

The Role of Senior Centers in Depression Care Represent a trusted community resource Provide ongoing contact & services in a non-threatening, non-medicalized setting Provide recreation, education and social support services which support mental well-being The Challenge: Building senior center capacity and infrastructure to provide evidenced-based mental health prevention and treatment services

The In Touch Partners Jefferson Center for Applied Research on Aging & Health (CARAH) Expertise in applied community-based research in depression, dementia and family caregiving, QoL Center in the Park Nationally accredited senior center founded in 1968 6,000+ members ~ 1,000 of whom are homebound 92% AA, 83% female 55 – 98 years old (1/3 75+) Urban, low SE status

CIP Programs and Services Life Long Learning Opportunities - Piano, Bible study, Crocheting/Knitting, Computer classes etc Arts & Humanities - Pottery, Crazy Quilting, Art: mixed media, Exploring Color Health & Fitness - Tap Dancing, Line Dancing, Harvest Health, Yoga, Tai Chi Social Services - Programs for homebound older adults, caregivers, and older adults with housing issues 2003-2006 Strategic Plan Focus Areas: Arts & Humanities Healthcare Housing Community Connections – over-arching!

In Touch: Mind, Body & Spirit In Touch Goal: Develop a sustainable infrastructure in a Senior Center to advance research, training and programming which is responsive to the social and cultural tenets of urban African American older adults to enhance healthy aging and mental well-being In Touch Objectives: Survey CIP membership to identify risks of late-life depression Evaluate impact of Center’s current programs on health & well-being Identify research questions which enhance knowledge for mental health service needs and preferences of older African Americans Provide training and experience for health professional students in cultural considerations in provision of health care services

Framework to Identify Late-Life Depression Risk Factors Demographic characteristics Female Single/living alone Low income Social determinants Physical environment/safety Housing Social networks Historical and current discrimination Physical health & function Poor self-rated health Chronic/severe pain Functional impairment/vulnerabilty Psycho-social status Social isolation Cognitive decline Caregiving Family conflict Bereavement Symptoms of depression/anxiety

Utility of Conceptual Framework Categorize existing Center Programs Identify areas not being addressed evaluate impact of current programming on mental health/well-being Informs new program development in areas of concern that may not be addressed Caregiving programs Brain health workshops Men’s programming

Characteristics of the Healthy Aging I Sample (N = 61). % Mean SD Range Age* 58   73.1 6.0 60.0 - 88.0 Gender 61 Male 31 50.8 Female 30 49.2 Marital status Single 32 52.5 Married 29 47.5 Education <HS 7 11.5 HS 17 27.9 >HS 37 60.6 Level of financial difficulty* 2.0 1.0 - 4.0 Self-rated health † 2.2 0.0 - 4.0 Number of health conditions 2.7 1.2 0.0 - 5.0 PHQ-9 Score 3.2 3.6 0.0 - 16.0 PHQ-9 severity score 0.3 0.7 0.0 - 3.0 Minimal/no depression 47 77 Mild depression 9 14.8 Moderate depression 4 6.6 Moderately severe depression 1 1.6 Severe depression PHQ-9 score >=5 23.0 * Median response reported = "some difficulty paying for basics like food, shelter, etc. † Median response reported = "good".

Table 1. Characteristics of the New Member Survey Sample (N = 166). % Mean SD Range Age 163.0   68.8 6.6 57.0 - 92.0 Gender 166.0 Male 16.3 Female 83.7 Marital status 165.0 Single 75.2 Married 24.8 Education <HS 21.0 12.7 HS 52.0 31.3 >HS 93.0 56.0 Level of financial difficulty* 2.0 1.0 - 4.0 Self-rated health† 3.0 1.0 1.0 - 5.0 Number of health conditions 3.8 2.4 0.0 - 11.0 PHQ-9 Score 164.0 2.7 0.0 - 19.0 PHQ-9 severity score Minimal/no depression 130.0 79.3 Mild depression 19.0 11.6 Moderate depression 13.0 7.9 Moderately severe depression 1.2 Severe depression 0.0 PHQ-9 score >=5 20.5 * Median response reported = "some difficulty paying for basics like food, shelter, etc.“† Median response reported = "good".

Table 1. Characteristics of the Healthy Aging II Sample (N = 153). % Mean SD Range Age 153.0   72.8 7.8 60.0 - 93.0 Gender Male 56.0 36.6 Female 97.0 63.4 Marital status Single 112.0 73.2 Married 41.0 26.8 Education <HS 31.0 20.3 HS >HS 66.0 43.1 Level of financial difficulty* 1.0 0.0 - 3.0 Self-rated health† 3 1.0 - 5.0 Number of health conditions 5.5 2.8 0.0 - 16.0 PHQ-9 Score 3.1 3.8 0.0 - 19.0 PHQ-9 severity score Minimal/no depression 116.0 75.8 Mild depression 26.0 17.0 Moderate depression 7.0 4.6 Moderately severe depression 4.0 2.6 Severe depression 0.0 PHQ-9 score >=5 24.2 * Median response reported = "not very difficult paying for basics like food, shelter, etc. † Median response reported = "good".

In Touch Exploratory Studies African Americans older adults (Total N = 380) Healthy Aging I: N = 61, 60 + yrs, mixed methods interview (50/50 men & women, mean age 73 years, 89% > HS ed) New member survey: N = 166, 55 + yrs, 84% female, mean age 69 yrs, 87% > HS ed) Healthy Aging II: N = 153; 60 yrs +, 64% women, mean age 73 yrs, 80% > HS ed) – involved more participants outside of CIP member community

In Touch Risk Factor Data Self-rated health Health conditions Financial difficulty Depression screen

In Touch Outcomes Depression screening protocol embedded in Senior Center in take processes Intervention study—Beat the Blues (NIMH) Programs which address memory/cognition concerns (Brain health workshop, challenge your brain game, program on memory loss) Ask the Doc (facilitating communication between physicians & older AA) Men’s programming (IT, fishing, sports activities, camaraderie) Program Evaluation findings (from Renee)

Ongoing Process of Inquiry TJU Academic Research Center Center in the Park (CIP) Senior Center Ongoing Process of Inquiry Community Advisory Network Literature Reviews Key Informant Interviews CIP Focus Groups Exploratory Studies Program Evaluation CIP Programming CIP Infrastructure: Sustaining Programs and Processes to Support Positive Mental Well-Being

The Future: Supporting Senior Centers’ Role in Promoting Mental Health Depression prevention/treatment continuum Enhanced depression education and literacy training (de-stigmatizing depression) Building the aging network’s capacity for systematic depression identification, referral and linkage within community service settings Senior Center-based programming Education/support programming Evidence-based programming to reduce risks and support self-management (BTB) Building relationships with PCP’s and mental health providers for referral and linkage to appropriate services