Improving Mood in Assisted Living Settings



Status:Active, not recruiting
Conditions:Depression
Therapuetic Areas:Psychiatry / Psychology
Healthy:No
Age Range:55 - Any
Updated:1/16/2019
Start Date:February 2013
End Date:June 2019

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Improving Mood in Assisted Living Settings Using a Cognitive Training Intervention

Late-life depression levels are escalating, and include 24% of all tenants of Assisted Living
(AL) settings. A promising, novel intervention is a computerized visual speed of processing
training program known as Road Tour. Road Tour has been show to reduce depressive symptom
levels and the risk of onset of clinical depression in community dwelling older adults. The
investigators hypothesize that similar benefits will accrue to residents in AL settings.

To evaluate this the investigators will use a two-arm, parallel, randomized controlled trial
(RCT) comparing Road Tour training to attention control using computerized crossword puzzles
among 370 adults 55 years old or older who reside in 15-30 AL settings that are partnering
with the investigators.

The investigators hypothesize that Road Tour participants will have improved cognitive
processing speed, lower levels of depressive symptoms, lower likelihood of the onset of
clinical depression, less anxiety, lower levels of pain symptoms, and better health-related
quality of life. These outcomes will be assessed at baseline, post-training, six months, and
one year.

Late-life depression is a large, escalating public health problem that often interacts with
other health conditions and leads to spiraling disability that simultaneously threatens
independence and health-related quality of life (HRQoL), and increases health care costs.
Depression affects 24% of older adults in AL settings, but rates of recognition and treatment
are low and underscore the need for alternative depression prevention and treatment methods
in AL. A novel and promising intervention is a computerized cognitive training program known
as Road Tour, which has shown serendipitous benefits for reducing depression symptoms and the
onset of suspected clinical depression consistent with Beck's model of cognitive depression.
As a self-directed, user-friendly "game", Road Tour overcomes common attitudinal and
resource-related barriers that impede treatment in AL settings, and holds considerable
promise for interrupting the potential downward spiral of depression-related disability for 1
million AL elders.

The purpose of this study is to evaluate the effect of Road Tour on processing speed,
depressive symptoms and suspected clinical depression, and depression-related comorbidities
among AL residents in Iowa. The investigators will use a two-arm, parallel, RCT comparing
Road Tour training to attention control using computerized crossword puzzles among 370 adults
55 years old or older. The investigators will actively engage 15-30 AL settings and their
associated facilities as study partners who implement the training at their sites and assist
with the evaluation process. The investigators will help each AL setting develop AL-specific
recruitment and enrollment protocols, educate AL staff about the study, and oversee
computerized training by participating residents, as well as their family members and AL
staff.

The investigators' three specific aims are to: (1) establish the effect of Road Tour on
improving cognitive processing speed in AL; (2) evaluate the effect of Road Tour on reducing
depressive symptoms and the risk of onset of suspected clinical depression in AL; and, (3)
evaluate the effect of Road Tour on the depression-related health outcomes of anxiety, pain,
and HRQoL in AL.

Participants will receive 10 hours of computerized training over 5-6 weeks, and 4 hours of
booster training at months 5 and 11, for a total of 18 hours of training. Outcomes are
changes in the Useful Field of View (UFOV) test for speed of processing (Aim 1), changes in
the 12-item Centers for Epidemiologic Studies Depression scale (CESD-12) and the 9-item
Patient Health Questionnaire (PHQ-9) for depressive symptoms and suspected clinical
depression (Aim 2), and changes in the Short Form 36-item Health-Related Quality of Life
(HRQoL) Questionnaire (SF-36) for HRQoL, the Brief Pain Inventory (BPI) for pain, and 7-item
Generalized Anxiety Disorder questionnaire (GAD-7) for anxiety (Aim 3). Data will be
collected using telephone interviews at baseline, post-training (6-8 weeks), and at 26-weeks
and 52-weeks. Linear mixed effect models that adjust for the clustering within AL settings
will be used with main effects specified for treatment group and time, as well as their
two-way interaction. This study is the first step in evaluating depression-related outcomes
of using Road Tour in AL settings.

Inclusion Criteria:

- 55 years old or older

- reside in one of the participating AL settings or affiliated sites

- capable of providing informed consent

Exclusion Criteria:

- self-reported insufficient visual acuity (with glasses) to use a computer

- self-reported physical inability to use a computer mouse and keyboard

- non-English speaking
We found this trial at
32
sites
West Liberty, Iowa 52776
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West Liberty, IA
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Amana, Iowa 52203
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Amana, IA
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Bettendorf, Iowa 52722
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Bettendorf, IA
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Carlisle, Iowa 50047
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Carlisle, IA
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Cedar Falls, Iowa 50613
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Cedar Falls, IA
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Cedar Rapids, Iowa 52401
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Cedar Rapids, IA
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Cedar Rapids, Iowa 52402
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Cedar Rapids, IA
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Cedar Rapids, Iowa 52405
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Cedar Rapids, IA
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Cedar Rapids, Iowa 52405
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Cedar Rapids, IA
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Clinton, Iowa 52732
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Clinton, IA
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Clive, IA
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Davenport, IA
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Davenport, Iowa 52806
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Davenport, IA
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Davenport, Iowa 52807
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Davenport, IA
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Davenport, IA
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Des Moines, Iowa 50317
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Des Moines, IA
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Des Moines, Iowa 50312
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Des Moines, IA
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Fort Madison, Iowa 52627
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Fort Madison, IA
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Iowa City, Iowa 52246
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Iowa City, IA
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Iowa City, Iowa 52240
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Iowa City, IA
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Iowa City, Iowa 52246
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Iowa City, IA
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Iowa City, Iowa 52246
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Iowa City, IA
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Iowa City, IA
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Johnston, Iowa 50131
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Johnston, IA
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Marion, Iowa 52302
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Marion, IA
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Marion, Iowa 52302
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Marion, IA
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Marshalltown, Iowa 50158
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Marshalltown, IA
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Muscatine, Iowa 52761
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Muscatine, IA
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Sigourney, Iowa 52591
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Sigourney, IA
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Tipton, Iowa 52772
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Tipton, IA
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Waterloo, IA
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Williamsburg, Iowa 52361
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Williamsburg, IA
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