Developing a Peer Support Intervention for Depression in SCD
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Project Summary Subjective cognitive decline (SCD) is self-reported concern about cognitive changes among persons without objective deficits on standardized cognitive testing, and may be a pre-clinical stage of Alzheimer’s Disease (AD). SCD is also closely linked to depression. Studies have reported 10-38% of older adults experience both depression and SCD. Depressive symptoms can precede, co-occur, or follow the onset of SCD, however, appropriate management of persons experiencing depression in SCD is undefined. An intervention study to understand the impact of decreasing depression on SCD has not been done. Such a study would clarify appropriate management and potentially alter the trajectory of cognitive decline. We have developed a community-based peer support intervention called Peer Enhanced Depression Care (Peers) for underserved older adults that we seek to adapt for older adults with depression and SCD. It is a manualized depression care program in which older adult peer coaches who have experienced depression provide 8 virtual weekly meetings in which social support, self-care skills, and linkage to community and clinical care are provided. Preliminary work has shown feasibility, acceptability, and potential mediators such as self-efficacy and loneliness. In this proposal our goal is to adapt Peer Enhanced Depression Care for older adults with depression and SCD, with particular emphasis on older adults of color. We will collaborate with the community-based organizations associated with the Massachusetts Alzheimer’s Disease Research Center. In Aim 1, we will conduct pre-intervention focus groups with older adults with depression and SCD to understand the experience, needs, and coping strategies associated with managing depression and SCD. We will conduct focus groups with other key stakeholders (e.g., community-based organization staff) to identify early stage barriers and facilitators to implementation of the intervention in community settings. Results will be used to adapt the intervention manual and training procedures to address the specific emotional and informational needs of ethnically diverse older adults with SCD in addition to depression. In Aim 2, we will assess the feasibility, acceptability, and fidelity of the adapted intervention, which we will call PeersSCD, consisting of 8 weekly video chats focused on emotional, appraisal, and informational support delivered by community-based older adult peer coaches to adults 50 years of age and older with depression and SCD. We will conduct pre- and post-intervention assessments and semi-structured interviews with participants, peer coaches, and community-based organization staff to assess feasibility and acceptability and identify facilitators and barriers to early-stage implementation of the intervention. The interviews will also be used to explore the potential mechanisms of action of the interventions from participants’ and peer coach perspectives. The preliminary data that we obtain will support a future randomized controlled trial to study the impact of depression care on SCD.
