Community-based Rehabilitation Management for Patients With Remitted Geriatric Depression

This study intends to take patients with RGD as objects. Further construct a community-based rehabilitation management (CBRM) program with drug treatment, rehabilitation measures of education, psychology and exercise as its core content on the basis of evidence-based practice approach. Based on the cost-utility analysis of health economics, the health and economic benefits of the CBRM program will be evaluated, and a theoretical reference will be provided for community health institutions to carry out whole-course rehabilitation management practice and health policy formulation.

Inclusion Criteria:aged 60 years old or above at the time of enrollment;meet the diagnostic criteria for MDD without psychotic features according to DSM-5, and depressive symptoms have been improved and remained stable for at least 2 months after treatment with SSRIs;the total score of HAMD-17 is less than 7 at the time of enrollment;meet the diagnostic criteria for physio-cognitive decline: 1) the total score of ADL and IADL was less than 26; 2)cognitve decline: first, subjects with severe impairment of cognitive function will be excluded (years of education ≥ 6, MMSE scores <24；years of education <6 years, MMSE total score <14). After completing a neuropsychological task, cogintive declined will be confirmed when any aspects of cognitve function is 1.5 standard deviations lower than that of normal elderly; 3) the grip strength is weakened, and the domaint hand grip strength is < 28kg for males or <18kg for females; 4)slow step speed, that is, in a space of length >10 meters, the subjects walks 6 meters from the starting point at a normal and uniform pace, and the pace is <1m/s.comprehension, reading and writing skills to complete the measurements or complete them with assistance of the researchers with obstacles;voluntary participation and signed informed consent.Exclusion Criteria:meet the diagnostic of schizophrenia, bipolar disorder, dementia;comorbidity of physical diseases, such ascardiovascular and cerebrovascular diseases, rheumatoid arthritis, stroke and malignant tumors;history of alcohol or drug dependence;severe deformity of spine and limbs;complete or partial dependence on caregivers for daily life, such as long-term bedridden, wheelchair assisted;have received physical therapy or psychological treatment in the past three months;currently participating in other clinical research.