Depression is common amongst older people, with one in seven meeting the criteria for full-blown depresssion. Older people at the greatest risk of depression are those who suffer from loneliness and long-term illnesses, both of which affect this age group disproportionately.
Being depressed can also make health problems worse and older people with depression are at an increased risk of dying. The CASPER clinical trial focussed on older people with lower-severity symptoms who are at the highest risk of becoming clinically depressed.
We developed an innovative treatment for older people (aged 65 or over) with depression symptoms. This treatment, Collaborative Care, involved a case manager co-ordinating different aspects of a person's care and working with them for an average of six sessions over 7-8 weeks, mainly over the telephone. We designed the treatment to be a simple and low cost way of helping people with depression symptoms. Each participant also received usual care from their GP.
We then tested the treatment by comparing it with usual GP care alone. Each person taking part was given one type of care. This was decided by chance, like the roll of a dice. We then compared how people who received Collaborative Care fared, compared to those who received usual GP care alone.
The trial took place in the North of England and 705 older adults took part for up to a year. We showed that Collaborative Care reduced the symptoms of depression in older people.
Those who received the treatment were also less likely to be more severely depressed after a year. Older people were also less anxious and had improved quality of life compared to people who just received care from their GP.
CASPER was funded by the National Institute for Health Research (NIHR). The NIHR is the research arm of the NHS. Its formal title is the CollAborative care and active surveillance for Screen-Positive ElderRs with subthreshold depression (CASPER) trial. Its funder reference number is 08/19/04. We received ethics approval from Leeds East Ethics Research Committee. CASPER is registered with the ISRCTN Registry and its number is ISRCTN02202951.
The full report can be read at https://www.journalslibrary.nihr.ac.uk/hta/hta21080#/abstract. A summary of the trial has also been published in JAMA: The Journal of the American Medical Association (http://jamanetwork.com/). The original trial plan was published here https://trialsjournal.biomedcentral.com/articles/10.1186/1745-6215-12-225. A sub-study of the trial was published at http://www.jad-journal.com/article/S0165-0327(15)30098-7/fulltext.
We are now planning to train NHS therapists in Collaborative Care to ensure that older people all over the UK can benefit from this intervention. We are also planning to conduct a one-off extended follow-up with participants in the trial.