Behavioral Activation and Medication Optimization In Older Adults Undergoing Cardiac Procedures

The Washington University

Status: Completed

Conditions: Cardiac Surgery; Older Adults; Depression; Anxiety

Treatments: Behavioral: Behavioral activation; Other: Medication optimzation; Other: Care as usual

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT05575128

202209033

P50MH122351 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

This Hybrid 1 Study will test the effectiveness of a bundled intervention comprised of behavioral activation and medication optimization in reducing symptoms of depression and anxiety in older adults undergoing cardiac surgery (compared with usual care), while examining implementation outcomes.

Enrollment: 102 patients

Sex: All

Ages: 60+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults ≥ 60 years
• Scheduled major cardiac procedure
• PHQ-ADS ≥ 10, indicating clinically significant depression or anxiety symptoms

Exclusion criteria

• Barrier to communication (Unable to read, speak, and understand English)
• Severe cognitive impairment screened by the SBT (Short Blessed Test) >10
• Acutely suicidal
• Previous participation in this study or CPMH feasibility study 202101103.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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102 participants in 2 patient groups

Behavioral activation and medication optimization

Experimental group

Description:

Behavioral activation (BA) will begin perioperatively and will span across 3 months postoperatively, with sessions approximately weekly or biweekly, depending on patient preference \& health condition. Medications will be reviewed by a team of interventionists to minimize brain-toxic medications and optimize doses of antidepressants and other mental health medications. In-hospital and after discharge, the interventionists' role will include coordinating with the care teams to ensure that medication changes that were introduced preoperatively are maintained.

Treatment:

Other: Medication optimzation

Behavioral: Behavioral activation

Control (treatment as usual)

Other group

Description:

Participants in control arm will continue care as usual. They will receive printed resources for supporting sleep hygiene, stress reduction, cognitive and mental health exercises, as well as community resources for older adults.

Treatment:

Other: Care as usual