This site uses cookies to measure how you use the website so it can be updated and improved based on your needs and also uses cookies to help remember the notifications you’ve seen, like this one, so that we don’t show them to you again. If you could also tell us a little bit about yourself, this information will help us understand how we can support you better and make this site even easier for you to use and navigate.

Home-delivered problem adaptation therapy (PATH) for depressed, cognitively impaired, disabled elders: A preliminary study


Kiosses, Dimitris N., Arean, Patricia A., Teri, Linda, Alexopoulos, George S.


The American Journal Of Geriatric Psychiatry: Official Journal Of The American Association For Geriatric Psychiatry, Volume: 18, No.: 11, Pages.: 988-998

Year of Publication



Objectives: This preliminary study examines the efficacy of 12-week home-delivered problem adaptation therapy (PATH) versus home-delivered supportive therapy (ST) in reducing depression and disability in 30 depressed, cognitively impaired, disabled older adults.; Design: A 12-week randomized clinical trial. Research assistants were unaware of the participants’ randomization status. Assessments were conducted at baseline, 6 weeks, and 12 weeks.; Setting: Weill-Cornell Advanced Center for Interventions and Services Research.; Participants: Thirty elders with major depression, cognitive impairment, and disability were recruited through advertisement and the Home-Delivered Meals Program of the Westchester County Department of Senior Programs and Services.; Intervention: PATH is a home-delivered intervention designed to reduce depression and disability in depressed, cognitively impaired, disabled elders. PATH is based on problem-solving therapy and integrates environmental adaptation and caregiver participation. PATH is consistent with Lawton’s ecologic model of adaptive functioning in aging.; Measurements: Depression and disability were measured with Hamilton Depression Rating Scale-24 items and Sheehan Disability Scale, respectively. Client Satisfaction Questionnaire was used to assess patient satisfaction with treatment.; Results: Mixed-effects model analyses revealed that PATH was more efficacious than ST in reducing depression and disability at 12 weeks. Participants in both treatment groups were satisfied with treatment.; Conclusions: This preliminary study suggests that PATH is well accepted and efficacious in depressed elders with major depression, cognitive impairment, and disability. Because this population may not adequately respond to antidepressant medication treatment, PATH may provide relief to many patients who would otherwise remain depressed and continue to suffer.;

Bibtex Citation

@article{Kiosses_2010, doi = {10.1097/jgp.0b013e3181d6947d}, url = {}, year = 2010, month = {nov}, publisher = {Elsevier {BV}}, volume = {18}, number = {11}, pages = {988--998}, author = {Dimitris N. Kiosses and Patricia A. Arean and Linda Teri and George S. Alexopoulos}, title = {Home-Delivered Problem Adaptation Therapy ({PATH}) for Depressed, Cognitively Impaired, Disabled Elders: A Preliminary Study}, journal = {The American Journal of Geriatric Psychiatry} }


adaptation, adaptation psychological, aged, aged, 80 and over, cognition disorders, complications, depressive disorder major, disabled persons, female, geriatric assessment, home care services, humans, male, methods, patient acceptance of health care, problem, psychology, psychotherapy, statistics & numerical data, therapy

Countries of Study


Types of Dementia

Mild Cognitive Impairment (MCI)

Types of Study

Randomised Controlled Trial

Type of Outcomes

ADLs/IADLs, Depression and Anxiety, Satisfaction with care/services



Type of Interventions

Non-pharmacological Treatment

Non-Pharmaceutical Interventions

Behavioural Therapies