RESUMEN
AIMS: Depression is common among dialysis patients and is associated with adverse outcomes. Problem-solving therapy (PST) is effective for treating depression in older patients with chronic illness, but its effectiveness has never been reported in hemodialysis (HD) patients. We investigated the feasibility and satisfaction of PST and its impact on depression scores among older HD patients. METHODS: Patients at least 60 years of age receiving maintenance HD at a single outpatient dialysis center were eligible for the study. Randomized patients received either 6 weeks of PST from a licensed renal social worker or usual care. This study modeled the staff-patient ratio standard of most dialysis clinics, and therefore only one social worker provided the interventions. Study outcomes included feasibility (successful completion of 6 weekly sessions) and patient satisfaction with PST as well as impact on depression scores (between-group comparison of mean Beck depression inventory (BDI) and Patient health questionnaire-9 (PHQ-9) scores at 6 weeks, and of mean change-from-baseline scores). RESULTS: The recruitment rate was 92% (35/38). All subjects randomized to the intervention arm (n = 17) and who initiated PST (n = 15) completed the study, and all reported overall satisfaction with the intervention. 87% reported that PST helped them to better solve problems and improved their ability to cope with their medical condition. At 6 weeks, there were no significant differences in mean BDI and PHQ scores between the usual care and the intervention group (BDI 11.3 vs. 9.3, p = 0.6; PHQ 5.7 vs. 3.3, p = 0.1). Mean change-from-baseline depression scores were significantly improved in the intervention group relative to the control group (change in BDI 6.3 vs.- 0.6, p = 0.004; change in PHQ 7.2 vs. 0.3, p < 0.001). CONCLUSIONS: The results demonstrate that PST is feasible in the dialysis unit setting, acceptable to patients, and may positively impact depression among maintenance hemodialysis patients.
Asunto(s)
Depresión/terapia , Enfermedades Renales/terapia , Solución de Problemas , Psicoterapia/métodos , Diálisis Renal/psicología , Servicio Social , Adaptación Psicológica , Factores de Edad , Anciano , Anciano de 80 o más Años , Atención Ambulatoria , Depresión/diagnóstico , Depresión/etiología , Depresión/psicología , Estudios de Factibilidad , Femenino , Humanos , Enfermedades Renales/diagnóstico , Enfermedades Renales/psicología , Masculino , Satisfacción del Paciente , Philadelphia , Proyectos Piloto , Escalas de Valoración Psiquiátrica , Diálisis Renal/efectos adversos , Encuestas y Cuestionarios , Factores de Tiempo , Resultado del TratamientoRESUMEN
Given the rise in the aging population and the increased use of health care services, there is a demand for awareness and training that targets underserved populations such as older lesbian, gay, bisexual, and transgender (LGBT) adults. Older LGBT adults are 5 times less likely to access health care and social services (King, 2009). Ethically responsible health service delivery is needed to capitalize on the strengths and capabilities of older LGBT adults and is vital for combating existing health disparities. Social workers aim to prevent ongoing gaps in care for older LGBT adults that can lead to negative individual and social consequences.