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Cutting edge research on aging and mental health from Fellow Namkee Choi

Three Questions with Namkee Choi, Ph.D.
Steve Hicks School of Social Work, University of Texas at Austin

1. Given the baby boomer demographic in the US, aging research and mental health are highly topical. Can you tell us about some of your current research on videoconferencing and adult depression?

With rapidly increasing numbers of older adults, the need for mental health and substance use/misuse services in late life is also rising. For depression treatment, a significant proportion of older adults rely on pharmacotherapy prescribed by primary care physicians (PCPs). However, many low-income, homebound older adults have limited response to pharmacotherapy alone as it does not address multiple life stressors that these older adults have to contend with. Although evidence-based psychosocial treatments are recommended for late-life depression, low-income homebound older adults rarely receive them because of their homebound state and lack of transportation.

To improve these older adults’ access to depression treatments, we need to bring treatment to them in their own homes. In our research, my co-investigators and I have been using videoconferencing to provide short-term, evidence-based psychosocial treatments for low-income, homebound, largely racial/ethnic minority older adults. Starting in 2009, we first tested acceptability and efficacy of videoconferenced problem-solving therapy (Tele-PST) compared to in-person PST. We found out that Tele-PST was as acceptable as in-person PST and had better long-term outcomes than in-person PST. Older adults liked Tele-PST’s convenience. Built upon the success of Tele-PST, our current study (1R01MD009675) is testing real-world effectiveness of aging-service integrated Tele-PST delivered by licensed mental health clinicians and Tele-Behavioral Activation (Tele-BA) delivered by trained lay providers. Our treatment providers are co-located at Meals on Wheels Central Texas (MOWCTX), receive referrals from MOWCTX’s case managers, and coordinate care with the case managers. With current and projected shortage of professional mental health workforce, the Administration on Aging, SAMHSA, and the National Academies (formerly Institute of Medicine) recommend innovative approaches: integration of evidence-based treatment into aging services, use of technology in care delivery, and the expansion of clinical capacity by training lay mental health workers in screening and brief interventions. Our preliminary outcomes show that both treatment modalities are clinically effective. At the completion of the study, we will also examine cost-effectiveness. Although tele-delivery requires initial investment in equipment (as many low-income older adults do not have computers and the Internet access), the overall costs of tele-delivery is lower than in-person delivery owing to savings from travel time. Based on our study’s success, MOWCTX has already taken steps to integrate tele-mental health into its routine services for homebound older adults.

2. You have a great deal of research and scholarly material on the aging population. From your perspective, what’s the biggest issue that an aging US and possibly global population will face?

Aging is such a complex phase of human development that no one single issue trumps the other issues. As social workers, we must work on multiple issues that rapidly increasing numbers of older adults face. To name just a few, income security, access to preventive and treatment services for physical/functional, mental and cognitive health problems, access to affordable housing, and access to opportunities to continue to participate in meaningful activities are important. Low-income older adults face so many problems due to their lack of financial resources and lack of services. I have worked with many at risk of becoming homeless as low-income housing is scarce and utility bills are getting more expensive. Lack of transportation and digital divide (mostly due to unafforability of high Internet subscription fee) are also big risk factors for these older adults’ social isolation.

3. Meals on Wheels is an incredible program. You received an award for your service there a couple of years ago. Can you tell us about that and your involvement in the program?

The Founders’ Awards that I received from Meals on Wheels Central Texas twice in the past was for the most effective board member who made significant contributions to the agency.

I started volunteering as a driver delivering meals and a member of the Board of Directors of Meals on Wheels (MOW) programs more than two decades ago. I volunteered for MOWs in Buffalo, NY and Portland, OR before I joined MOWCTX in 2002. While most local MOWs funded by the Older Americans Act are small and focused on providing home-delivered meals, large MOWs have been providing more services than just home-delivered meals to better meet the complex needs of homebound older adults. Given that the competition for meal-delivery services from large-scale private-for-profit programs in recent years has begun to threaten the survivability of MOWs as only a meal-delivery program, MOWs all over the country will have to adopt a comprehensive service delivery model in the future. I see that these changes are already happening.

I have been very fortunate to work with MOWCTX located in Austin that has become a comprehensive aging service agency for thousands of homebound as well as mobile older adults in Central Texas and serves as a model for the other MOWs. In their expansion to become a comprehensive aging service agency, I have helped them expand their case management and mental health services and strengthen research and evaluation of their services. It has been a highly successful and mutually beneficial academic-community partnership that has advanced research and helped so many older adults at the same time. The agency board and administration recognized my contribution and awarded me as the recipients of the Founder’s Award twice in the past.

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