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Peer Reviewed

Effects of Gender, Ethnicity, and Medical Illness on Drinking Cessation in Older Primary Care Patients

UC San Francisco Previously Published Works (2005)

Objective. This study examined the effects of gender, ethnicity, and medical illness on cessation of alcohol consumption in late life, by analyzing characteristics that distinguish current drinkers from former drinkers. Method. Participants were 211 medical patients aged 55-91, recruited from four public-sector primary care clinics. Respondents completed the Short Michigan Alcohol Screening Test (SMAST), and provided health and demographic data. A subset (n = 139) reported drinking history. Of these participants, 40% reported cessation of alcohol consumption at least one year prior to their participation in the study. Results. Older age, hypertension and heart problems were associated with drinking cessation among women but not among men. In logistic regression, drinking cessation was predicted by being unmarried, being a member of an ethnic minority group, heart problems and diabetes. Discussion. Physical illnesses may contribute to drinking cessation, especially in older women. Results have implications for alcohol interventions with older adults.

Cover page: Effects of Gender, Ethnicity, and Medical Illness on Drinking Cessation in Older Primary Care Patients

Article
Peer Reviewed

Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof‐of‐concept randomized trial

UC San Francisco Previously Published Works (2017)

Background

Existing treatments for depression are known to have only modest effects, are insufficiently targeted, and are inconsistently utilized, particularly in older adults. Indeed, older adults with impaired cognitive control networks tend to demonstrate poor response to a majority of existing depression interventions. Cognitive control interventions delivered using entertainment software have the potential to not only target the underlying cerebral dysfunction associated with depression, but to do so in a manner that is engaging and engenders adherence to treatment protocol.

Methods

In this proof-of-concept trial (Clinicaltrials.gov #: NCT02229188), individuals with late life depression (LLD) (22; 60+ years old) were randomized to either problem solving therapy (PST, n = 10) or a neurobiologically inspired digital platform designed to enhance cognitive control faculties (Project: EVO™, n = 12). Given the overlapping functional neuroanatomy of mood disturbances and executive dysfunction, we explored the impact of an intervention targeting cognitive control abilities, functional disability, and mood in older adults suffering from LLD, and how those outcomes compare to a therapeutic gold standard.

Results

EVO participants demonstrated similar improvements in mood and self-reported function after 4 weeks of treatment to PST participants. The EVO participants also showed generalization to untrained measures of working memory and attention, as well as negativity bias, a finding not evident in the PST condition. Individuals assigned to EVO demonstrated 100% adherence.

Conclusions

This study provides preliminary findings that this therapeutic video game targeting cognitive control deficits may be an efficacious LLD intervention. Future research is needed to confirm these findings.

Cover page: Improving late life depression and cognitive control through the use of therapeutic video game technology: A proof‐of‐concept randomized trial

Article
Peer Reviewed

Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program

Postprints from TRC (2004)

Aims This study compared 5-year treatment outcomes of older adults to thoseof middle-aged and younger adults in a large managed care chemical dependency program. We examined age group differences in individual, treatment and extra-treatment factors, which may influence long-term outcome. Design Seventy-seven per cent of original study participants completed a telephone interview 5 years after out-patient chemical dependency treatment at Kaiser Permanente. This sample (N = 925) included 65 patients aged 55-77, 296 patients aged 40-54 and 564 patients aged 18-39 (age at baseline). Measurements Measures at follow-up included alcohol and drug use, Addiction Severity Index (ASI), Alcoholics Anonymous Affiliation Scale, social resource and self-reported health questions. Mortality data were obtained from contact with family members of patients as well as automated health plan records. Findings Older adults were less likely to be drug-dependent at baseline than younger and middle-aged adults, and had longer retention in treatment than younger adults. At 5 years, older adults were less likely than younger adults to have close family or friends who encouraged alcohol or drug use. Fifty-two per cent of older adults reported total abstinence from alcohol and drugs in the previous 30 days versus 40% of younger adults. Older women had higher 30-day abstinence than older men or younger women. Among participants dependent only on alcohol, there were no significant age differences in 30-day abstinence. In logistic regression analysis, age group was not significant. Variables associated with greater age that independently predicted 30-day abstinence in the logistic regression model included longer retention in treatment and having no close family or friends who encouraged alcohol or drug use at 5 years: female gender was also significant. Conclusions Results indicate that older adults have favorable long-term outcome following treatment relative to younger adults, but these differences may be accounted for by variables associated with age such as type of substance dependence, treatment retention, social networks and gender. Age differences in these characteristics inform intervention strategies to support long-term recovery of older adults and provide direction for investigation of how age affects outcome.

Cover page: Five-year alcohol and drug treatment outcomes of older adults versus middle-aged and younger adults in a managed care program

Article
Peer Reviewed

Mobile phone–based interventions for mental health show promise of effectiveness, but what does the evidence tell us about what needs to come next?

UC Irvine Previously Published Works (2022)

The current manuscript is a commentary on "Mobile phone-based interventions for mental health: A systematic meta-review of 14 meta-analyses of randomized controlled trials". Although embedded within a nuanced discussion, one of the primary conclusions readers have taken from the meta-analysis was "we failed to find convincing evidence in support of any mobile phone-based intervention on any outcome", which seems to contradict the entirety of the evidence presented when taken out of context of the methods applied. In evaluating whether the area produced "convincing evidence of efficacy," the authors used a standard that appeared destined to fail. Specifically, the authors required "no evidence of publication bias", which is a standard that would be unlikely to be found in any area of psychology or medicine. Second, the authors required low to moderate heterogeneity in effect sizes when comparing interventions with fundamentally different and entirely dissimilar target mechanisms. However absent these 2 untenable criteria, the authors actually found highly suggestive evidence of efficacy (N > 1,000, p < .000001) in (1) anxiety; (2) depression; (3) smoking cessation; (4) stress; and (5) quality of life. Perhaps the appropriate conclusions would be that existing syntheses of data testing smartphone intervention suggests that these interventions are promising, but additional work is needed to separate what types of interventions and mechanisms are more promising. Evidence syntheses will be useful as the field matures, but such syntheses should focus on smartphone treatments that are created equal (i.e., similar intent, features, goals, and linkages in a continuum of care model) or use standards for evidence that promote rigorous evaluation while allowing identification of resources that can help those in need.

Cover page: Mobile phone–based interventions for mental health show promise of effectiveness, but what does the evidence tell us about what needs to come next?

Article
Peer Reviewed

A digital intervention targeting cognitive control network dysfunction in middle age and older adults with major depression

UC San Francisco Previously Published Works (2021)

Nonpharmacological interventions targeting putative network mechanisms of major depressive disorder (MDD) may represent novel treatments. This mechanistic study investigates how a video game-like intervention, designed to improve cognitive control network (CCN) functioning by targeting multitasking, influences the CCN of middle-aged and older adults with MDD. The sample consisted of 34 adults aged 45-75 with SCID-defined diagnosis of MDD, Hamilton depression rating scale scores ≥20, and a deficit in cognitive control. Participants were instructed to play at home for 20-25 min per day, at least 5 times per week, for 4 weeks. Evidence of target engagement was defined a priori as >2/3 of participants showing CCN improvement. CCN engagement was defined as a change in a Z score of ≥0.5 on functional magnetic resonance imaging (fMRI) in activation and functional connectivity of the CCN during task-based and resting-state fMRI, respectively. 74% of participants showed a change in activation of the CCN, and 72% showed an increase in resting-state functional connectivity. Sixty-eight percent demonstrated improved cognitive control function, measured as either improvement on sustained attention or working memory performance or reduced self-reported symptoms of apathy on the frontal systems behavioral scale (FrsBe). Participants also reported a significant reduction in mood symptoms measured by PHQ-9. A remotely deployed neuroscience-informed video game-like intervention improves both CCN functions and mood in middle-aged and older adults with MDD. This easily-disseminated intervention may rescue CCN dysfunction present in a substantial subset of middle-aged and older adults with MDD.

Cover page: A digital intervention targeting cognitive control network dysfunction in middle age and older adults with major depression

Article
Peer Reviewed

The feasibility, acceptability, and outcomes of PRIME‐D: A novel mobile intervention treatment for depression

UC San Francisco Previously Published Works (2017)

Background

Despite decades of research and development, depression has risen from the fifth to the leading cause of disability in the United States. Barriers to progress in the field are (1) poor access to high-quality care; (2) limited mental health workforce; and (3) few providers trained in the delivery of evidence-based treatments (EBTs). Although mobile platforms are being developed to give consumers greater access to high-quality care, too often these tools do not have empirical support for their effectiveness. In this study, we evaluated PRIME-D, a mobile app intervention that uses social networking, goal setting, and a mental health coach to deliver text-based, EBT's to treat mood symptoms and functioning in adults with depression.