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Winter 2025
Winter 2025 Issue Mental Health: Giving Older Adults the Tools to Face Depression PEARLS empowers older adults to live happier, healthier lives. Many older adults, according to various studies and research, experience depression. Even so, they’re sometimes less likely to report depressive feelings than younger people. Finding viable solutions to treat depression in the geriatric population was the catalyst for the formation of PEARLS—a Program to Encourage Active, Rewarding Lives. This evidence-based program educates older adults about depression and empowers them with the skills they need to combat it. Mark B. Snowden, MD, MPH, a geriatric psychiatrist and professor at the department of psychiatry and behavioral sciences at the University of Washington, says that PEARLS was formed by community-based organizations working in partnership with researchers at the UW Health Promotion Research Center. These organizations included Aging and Disability Services, the Area Agency on Aging (AAA) for the Seattle/King County region, and partners from senior centers and Catholic Community Services. “They wanted a program that could serve a wider range of depression severity, particularly those with milder forms of depression often ineligible for treatment in the public mental health system or some primary care clinic programs focused on patients with major depression,” Snowden explains. “Minor depression is more prevalent in older adults, and for those older adults facing multiple chronic conditions and social isolation, [it] can be a major deterrent to healthy habits like exercising and compliance with treatments for chronic medical conditions.” PEARLS coaches meet with older adults for six to eight 50-minute sessions. This can be done in person at home, in person in community settings, on the telephone, or remotely. This flexibility is important to making the program accessible to more older adults. Snowden says that since the goal was to have a program that community organizations could ultimately run, PEARLS was designed to use the types of staff these organizations already employed as opposed to requiring them to hire certified/licensed mental health professionals. “Because of this, the program needed to be simple to understand, require brief training, and be acceptable to the older adult clients,” he continues. “Since there was no evidence that treatment of minor depression required extensive antidepressant use, the role of the psychiatrist was shifted from being a direct care provider to one supervising the care delivered by the PEARLS coaches. The program focuses on teaching clients to use problem-solving therapy and behavioral activation [increasing physical activity, social activities, and pleasant events]. To make the program more acceptable to its clients, PEARLS emphasizes that it’s the client, not the coach or supervisor, that gets to determine what problems are most responsible for depression in the client’s opinion, and these are the ones that the client is coached in solving using problem-solving therapy.” According to Snowden, the initial randomized controlled trial was successful, and the AAA was able to continue offering the program without support from the UW because it was, as desired, simple and easy to administer. “Additional research has demonstrated that [the program] can be extended to the treatment of clients with major depression as long as the clients are open to the possibility of taking an antidepressant and have a primary care provider to prescribe the medication if needed,” he adds. Learning From Experience PEARLS, Snowden says, falls in the family of “collaborative care treatments for depression,” which involve a patient-centered approach to treating mental health conditions in the primary care setting. He adds that it was preceded by a primary care clinic program that focused on major depression in primary care patients, as reported in trials such as the Improving Mood through Providing Access to Collaborative Treatment (IMPACT) and the Prevention of Suicide in Primary Care Elderly-Collaborative Trial (PROSPECT). “These programs used clinic staff to identify and treat primary care older patients suffering from major depression,” Snowden explains. “The staff were supervised by a psychiatrist who did not see the patients directly but did provide consultative medication recommendations to the patients’ primary care providers. PEARLS is the community-based organization version of this model in that it works with aging network provider agencies like AAAs or senior centers to treat the patients in their homes, where many AAAs already were providing services, or in the community settings like senior centers.” PEARLS fills a gap in the treatment system, particularly for those older adults who are ineligible for treatment in many primary care clinic models or the public mental health system focused on major depression, not minor depression, Snowden says. “It’s also important for homebound elders who may not be able to leave the home often enough to complete treatment in traditional behavioral health settings or primary care clinics or who simply would prefer to be in treatment with a worker from a community-based organization they already know,” he adds. “It aims to teach clients how to recognize the symptoms of depression, identify problems they feel contribute to their depression, and use concrete approaches to solve those problems and to become more active physically and socially while resuming pleasant events they often have stopped because of feeling depressed.” Hope for the Future In addition to measurement-based improvement in depression, research shows that older adults treated in PEARLS by the PEARLS coach/counselors report improved quality of life, experience less social isolation and loneliness, and show significant trends toward needing fewer medical hospitalizations for their medical conditions and fewer nursing home days. “Qualitative research with PEARLS clients reveals they often feel empowered and better able to manage their lives, to have better relationships with family and peers, and more able to work with their health care providers,” Snowden says. It’s important that primary care physicians, geriatricians, and others involved in the medical care of older adults take the time to address their depression—even when it’s considered mild. “Mental health conditions continue to be associated with much stigma in our society, so individuals involved in the medical care of older adults can play an important role in making it clear that mental health conditions are much like other medical conditions—treatable and not a sign of personal or moral weakness or failure,” Snowden says. “To the extent that many primary care settings have yet to adopt and implement a clinic-based model for collaborative care treatment of depression, it would be great if they could identify and support community organizations that have created PEARLS programs by establishing referral mechanisms and ways to collaborate in the care of their patients.” — Lindsey Getz is an award-winning freelance writer in Royersford, Pennsylvania.
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