Understanding and treating OCD in older adults

Background: Despite the proliferation of research into Obsessive Compulsive Disorder (OCD) in youth and adults, OCD in older adults has been a largely neglected area. With an internationally ageing population, the number of affected older individuals is set to more than double by 2050, and there is little information available to guide the management of this area of growing clinical need. Accommodation (typically by family members) is almost ubiquitous among paediatric and adult samples with OCD, and is associated with greater OCD symptom severity, impairment and poorer treatment outcome. Treatment protocols that incorporate family members and target accommodation mechanisms are becoming mainstays of OCD treatment, with emerging evidence that adjunctive or family-focused interventions may improve outcomes for affected individuals. Despite this evidence in younger samples, changes in later life are likely to affect the phenomenology of OCD symptom presentation, including accommodation, and the implementation of these modified treatment protocols. For example, comorbid cognitive or physical health issues may complicate efforts to stop family accommodation, and require age-appropriate considerations of the demarcation of accommodation versus appropriate functional support. Similarly, the relationship between affected individuals and supporters can be more diverse in older samples (i.e., includes adult children, neighbours or residential aged care staff in comparison to the predominantly parent or romantic partner relationships among younger samples). These differences require stakeholder engagement about the best way to involve supporters in treatment for late-life OCD and the development and evaluation of age-appropriate treatment protocols.
Aims: This two-phase project aims to examine 1) the nature and impact of symptom presentation and accommodation in late-life OCD in mixed method study, and 2) utilise patient, supporter and clinician feedback in the development and evaluation of an age-appropriate treatment protocol for late-life OCD that incorporates supporters and the reduction of accommodating behaviours.
Method: Phase 1 will involve a mixed-method study incorporating quantitative data collection on accommodation, patient and supporter characteristics, and qualitative interviews with patients, supporters and clinicians about treatment for OCD in older adults. Patients and supporters will complete questionnaire and clinician-administered measures of OCD, accommodation, anxiety and depression, health-related impairment and disability, cognitive ability, and relationship quality. Patients, supporters and clinicians specialising in the treatment of OCD and/or older adults will provide information about accommodation in late-life and the development of a treatment protocol that incorporates supporters. Phase 2. Information from Phase 1 will be used to develop an older-adult specific treatment protocol for late-life OCD that incorporates supporters and targets accommodation behaviours. This treatment protocol will be evaluated in a pilot open trial.
Outcomes: These results will improve understanding of the clinical picture and treatment of OCD among older adults. Using a consumer-informed process, the development and pilot evaluation of this age-appropriate treatment protocol will represent an important step towards improving treatment for older adults with OCD. Information gained during this pilot phase will help to refine the treatment protocol and provide pilot data for a fully powered NHMRC grant investigating efficacy and associated intervention mechanisms in a randomised control trial.