Complicated Grief Treatment in Elderly Adults

Columbia Univ New York Morningside, New York NY

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): This application is the second revision of an application that responds to PA-03-014 inviting grant applications for older adults. The application is modified to address reviewers concerns and to add additional pilot data. Seniors are the demographic group most likely to be bereaved. According to the National Council on Aging (http://www.aoa.gov/prof/ Statistics/ profile/2Q03/2003profile.pdf), in 2002, more than 10 million older Americans were widowed. These people are at risk for a debilitating reaction called Traumatic or Complicated Grief (CG: the term now used for this condition). Studies confirm that Complicated Grief can be reliably identified and occurs in about 10-20% of bereaved individuals. CG appears to carry much of the risk for negative outcomes of bereavement. CG can affect health status and influence decisions about personal health care. The risk of hypertension is 10 times greater among widowed subjects who meet consensus criteria for CG compared to those who do not, while subjects with CG are 17 times less likely to have visited a physician in the months since the death. Despite its high prevalence and significant morbidity, there are no proven efficacious treatments. The PI of this application developed a novel psychotherapy called Complicated Grief Treatment (CGT), and has now completed a study (MH60783) comprised of adults over age 18, that confirmed efficacy of this approach. However, most participants were less than 60 years old. Participants >age 60 (n=29) were less likely to be employed and more likely to live alone. CGT and IPT produced similar results in older and younger adults, with better response to CGT in both groups. However, confirmation of efficacy among seniors is important, since older people have different vulnerabilities and different problems in adjusting to grief than younger adults. We thus assembled a group of highly experienced geriatric researchers skilled in assessment and management of problems in older people, e.g. physical infirmity, cognitive dysfunction, social isolation, disruption of daily routine. We propose to conduct a randomized controlled study of CGT v IPT in individuals >65 years of age. Our specific aims are: 1) To compare results of 16 sessions of either CGT or standard IPT. We hypothesize that CGT will produce a higher response rate and shorter time to response than IPT, and that responders will show significantly greater