Although the geriatric mental health field has developed a number of effective psychosocial interventions, most of these target patients with relatively straightforward conditions. In order to optimize the effectiveness and reach of psychosocial interventions, clinicians must be prepared to tackle hard cases. The presentations in this symposium will address difficult cases and issues: patients recovering from severe depression treated with ECT, patients with hoarding disorder, homebound older adults with significant medical comorbidity, and victims of elder abuse.

Dr. Kiosses will discuss a novel post-ECT psychosocial intervention aimed to reduce residual depression symptoms and disability in older and middle-aged adults with partial or full remission. REBUILD targets residual symptoms of depression by promoting medication adherence; helping the patient reconnect with family and friends after a long debilitating depression; increasing pleasurable and rewarding activities; identifying early signs of relapse and arranging quick consultation with the psychiatrist; and reducing the stigma of severe depression and ECT. Dr. Kiosses will present the design of the intervention and discuss preliminary pilot data.

Dr. Ayers will discuss a recent investigation utilizing a newly developed approach combining cognitive rehabilitation and exposure therapy (Cognitive Rehabilitation and Exposure/Sorting Therapy; CREST) for hoarding in older adults. Dr. Ayers will present the design of the intervention and discuss preliminary results from a randomized controlled trial comparing CREST to standard case management for geriatric HD.

Dr. Wetherell will address results of surveys of the mental health providers and Home-Based Primary Care (HBPC) Program Directors regarding the range and impact of mental health services in HBPC and describe the challenges and opportunities of providing interdisciplinary, collaborative mental health care in the home. The U.S. Department of Veterans Affairs (VA) Home-Based Primary Care (HBPC) program provides comprehensive, longitudinal primary care in the homes of Veterans with complex, chronic, disabling diseases.

Dr. Sirey will discuss a program, whose goal is to implement an evidence-based mental health approach embedded in an elder abuse service. The program is designed to detect and to improve mental health and promote the resolution of the mistreatment. This is critical because of the lack of elder abuse service that systematically assesses and provides services to address the mental health needs of older adult abuse victims. Integration of a skill-based mental health intervention into elder abuse services can uniquely improve mental health and promote abuse resolution for older adults in crisis.