# Perioperative mental health intervention for older adults undergoing hip and knee arthroplasty for osteoarthritis

> **NIH NIH P50** · WASHINGTON UNIVERSITY · 2022 · $229,320

## Abstract

Abstract/Project Summary – PROJECT 1
By 2030, 4 million older adults will undergo elective total hip or knee arthroplasty (THA/TKA), the most
common elective surgical procedures intended to mitigate pain and physical disability in this age group. Mental
health problems are highly prevalent in these patients, with 20-30% reporting substantial symptoms of anxiety
and depression both pre- and post-operatively. Depression and anxiety worsen THA/TKA outcomes by (i)
reducing participation in rehabilitation, thereby impeding recovery, (ii) heightening susceptibility to pain which
increases the risk of revision surgery and increases the likelihood of prolonged opioid use, and (iii) raising the
risk for delirium and delayed neurocognitive recovery. Despite the documented impact on individuals and our
health care system, effective interventions that treat anxiety and depression have not been applied to and
evaluated for older adults undergoing THA/TKA. In this proposal, we will optimize and test a pharmacological
and behavioral intervention bundle for older patients undergoing total joint arthroplasty for osteoarthritis, with
clinically significant depressive and anxiety symptoms. In this proposal, we will institute a perioperative mental
healthcare bundle including: (1) applying a proven behavioral intervention, behavioral activation (BA), with
strategies based on patient preferences and needs; and (2) medication optimization and deprescribing (MOD),
targeting to optimize dosages of anti-depressant medications, and stopping harmful or ineffective medications.
Aim 1 (Adaptation): Informed by a collaborative planning approach, we will adapt, develop and implement an
optimal perioperative mental health intervention bundle for older adults undergoing major orthopedic
procedures. Through stakeholder input, we will develop and iteratively adapt a behavioral and medication
optimization intervention bundle for implementation in this population. Following initial protocol development,
through treatment development trials, we will iteratively optimize the intervention through interactive feedback
from patients over the age of 65 undergoing major orthopedic intervention, and other stakeholders, noting
barriers and facilitators to program completion. Aim 2 (Testing): Using a hybrid Type 1 randomized controlled
trial design, we will compare the effectiveness of the intervention bundle with usual care in reducing symptoms
of depression and anxiety in older patients undergoing orthopedic surgery. For this aim, 100 patients with
symptoms of depression and anxiety will be randomly assigned to the pharmacological and behavioral
intervention bundle or usual care. Pre-operative depression and anxiety are associated with a host of adverse
outcomes after surgery, including complications, falls, delirium, and pain. Thus, medication optimization,
deprescribing, and behavioral treatment of depression and anxiety in older adults undergoing total joint
arthroplasty may improve symp...

## Key facts

- **NIH application ID:** 10415139
- **Project number:** 5P50MH122351-02
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Eric J Lenze
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $229,320
- **Award type:** 5
- **Project period:** 2021-06-01 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10415139

## Citation

> US National Institutes of Health, RePORTER application 10415139, Perioperative mental health intervention for older adults undergoing hip and knee arthroplasty for osteoarthritis (5P50MH122351-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10415139. Licensed CC0.

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