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

2. 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 APHA Conference

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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
Strategic Plan Focus Areas:
Arts & Humanities
Healthcare
Housing
Community Connections – over-arching!

9. 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

10. 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

11. 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

12. Characteristics of the Healthy Aging I Sample (N = 61).%
Mean SD
Range
Age* 58
73.1
6.0
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
Self-rated health †
2.2
Number of health conditions
2.7
1.2
PHQ-9 Score
3.2
3.6
PHQ-9 severity score
0.3
0.7
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".

13. Table 1. Characteristics of the New Member Survey Sample (N = 166).%
Mean SD
Range
Age
163.0
68.8
6.6
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
Self-rated health†
3.0
1.0
Number of health conditions
3.8
2.4
PHQ-9 Score
164.0
2.7
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.Ҡ Median response reported = "good".

14. Table 1. Characteristics of the Healthy Aging II Sample (N = 153).%
Mean SD
Range
Age
153.0
72.8
7.8
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
Self-rated health† 3
Number of health conditions
5.5
2.8
PHQ-9 Score
3.1
3.8
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".

15. 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

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

17. 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)

18. 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

19. 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