Comparing Two Ways to Treat Serious Worry among Older Adults from Underserved, Racial or Ethnic Minority Communities

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What was the research about?

Serious worry is a problem for up to 30 percent of adults age 55 or older. Serious worry is worry about everyday problems that happens often and is hard to control. It may make people feel restless, tired, or tense. Serious worry can be part of another anxiety condition or a problem on its own.

Compared with other older adults, those adults with serious worry are more likely to have poor physical health, and they often have depression and sleep problems. They are also more likely to have trouble thinking clearly. Doctors don’t always recognize or treat serious worry, especially in older adults who live in neighborhoods with few resources. Compared with white adults, African American adults are less likely to be diagnosed and treated for serious worry.

In this study, the research team compared two treatments for older adults who had serious worry. People received one of two treatments from social workers or community health workers, or CHWs. CHWs are trained to teach about health and link people in their community with health and social services.

• In one approach, called Calmer Life, people received up to 12 training sessions for three months to learn healthy ways of thinking and acting. They also learned how to get help with needs such as food or housing. Social workers and CHWs matched trainings to each adult’s needs. They included religion or spirituality if requested. The trainers followed up by phone every month for another three months.
• In the other approach, enhanced community care, social workers and CHWs gave each person a customized list of food, housing, mental health, and other services. The social workers or CHWs also called clients every month or more often to offer support and check on symptoms.

What were the results?

Both treatments worked about the same. At the end of the study, people receiving either treatment had

• Less worry
• Less anxiety
• Fewer symptoms of depression
• Better sleep
• More ability to do social activities
• More ability to do daily activities despite disability
• Better quality of life related to mental health

Physical health stayed the same with either treatment.

More people in Calmer Life than in enhanced community care had hospital stays during the second three months of the study. People in Calmer Life were more satisfied with their program six months after the study began than were adults who got enhanced community care. There was no difference at nine months.

Who was in the study?

The study included 148 adults, age 50 and older, with significant worry who lived in neighborhoods with few resources. Of these adults, 76 percent were African American, 17 percent were white, 5 percent were Hispanic, and 2 percent were other races. The average age was 67, and 82 percent were women.

What did the research team do?

The research team assigned the older adults to one of the two groups by chance. At the start of the study and six and nine months later, the team surveyed the adults about worry, anxiety, depression, and other symptoms.

Clients, counselors, and managers from social service and faith-based agencies helped plan, design, and conduct the study.

What were the limits of the study?

The study compared two treatments to each other, but not to usual care. The research team can’t be sure the changes in the study are a result of those treatments.

Future research could look at whether these treatments could be delivered to groups instead of one-on-one. Studies could also look at whether the treatments work for people who speak Spanish.

How can people use the results?

Social service agencies or health systems can consider using either Calmer Life or enhanced community care or both approaches to help older adults with serious worry.

Objective

To compare an evidence-based cognitive behavioral therapy intervention with enhanced community care to treat worry among older adults from underserved communities with members predominantly of racial or ethnic minority groups

Study Design

This randomized controlled trial compared two methods for treating significant worry in adults age 50 and older: Calmer Life, an evidence-based cognitive behavioral therapy intervention, and enhanced community care. Community health workers (CHWs) or social workers led the interventions, each of which lasted six months.

In Calmer Life, CHWs or social workers held up to 12 one-on-one skill-building sessions for three months with each client in person or by phone. Calmer Life included

• Culturally and individually tailored training to reduce worry using cognitive behavioral therapy techniques and incorporating religion or spirituality if requested
• Resource counseling to target basic needs such as food or housing
• Help establishing connections to primary care to address urgent needs and facilitate communication about worry symptoms and treatment

For three months after the skill-building sessions ended, the trainers provided brief check-in calls to help clients practice their skills.

In enhanced community care, CHWs or social workers provided information, emotional support, and symptom monitoring during 15- to 30-minute phone calls biweekly for three months and then monthly for three months. Each participant also received a custom list of local mental health and social service resources, including locations, fees, and types of insurance accepted.

Working with social service and faith-based organizations, researchers recruited 148 adults, age 50 and older, with clinically significant worry identified through screening with anxiety scales. Participants were primarily from underserved communities. Of these adults, 76% were black, 17% were white, and 5% were Hispanic. The average age was 67, and 82% were female.

Researchers randomly assigned participants to Calmer Life or enhanced community care. At baseline, six months, and nine months, researchers surveyed participants about worry- and anxiety-related symptoms, depression, sleep difficulties, social function and disability, quality of life, patient-reported use of health or mental health services, and patient satisfaction with the program.

Patients, counselors, and managers of social service and faith-based agencies helped plan, design, and conduct the study.

Results

The two groups did not differ significantly on most study outcomes. Participants in both groups averaged moderate to severe worry and moderate anxiety at baseline. At six months, participants in both groups showed statistically (p<0.0001) and clinically significant reductions in worry and anxiety. Worry scores dropped below the clinical cutoff, and anxiety scores averaged in the mild range.

Participants’ physical health did not change during the study.

Compared with participants who received enhanced community care, more participants in the Calmer Life intervention reported at least one hospital admission during the second three months of the study (p=0.04). Participants in Calmer Life reported higher satisfaction with their intervention at six months (p=0.003) but not at nine months.

Limitations

The study did not compare the interventions against a less active control; changes observed may be a result of other factors, not the interventions.

Conclusions and Relevance

Older adults from underserved, predominantly minority communities showed reduced worry and anxiety at the end of either intervention. Social service providers and health system administrators can consider either approach for addressing worry for these older adults.

Future Research Needs

Future research could examine whether providers could deliver Calmer Life and enhanced community care as group interventions and whether the interventions are effective for older adults who speak Spanish.