# Perioperative mental health intervention for older adults undergoing cardiac surgery

> **NIH NIH P50** · WASHINGTON UNIVERSITY · 2022 · $258,819

## Abstract

Abstract/Project Summary – PROJECT 3
Depression and anxiety are common but undertreated in older adults undergoing cardiac surgical procedures.
Approximately 400,000 older adults undergo cardiac surgery annually in the United States, and between a
quarter and a half of these individuals have symptoms of preoperative anxiety or depression. Each of these
individuals are at greater risk for depression/anxiety than the general older population. The perioperative
period is a particularly vulnerable time, as the patient is concurrently confronted with social, functional and
physical changes that accompany a major surgery. Most older adults with heart disease and depression or
anxiety do not receive appropriate mental health treatment, and if they do, it is typically limited to
pharmacologic interventions, further exacerbating already rampant polypharmacy. In this proposal, we will
optimize and test a pharmacological and behavioral intervention bundle for older patients undergoing cardiac
surgery, with clinically significant depressive and anxiety symptoms. We will institute a perioperative mental
healthcare intervention 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 invasive cardiac 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 cardiac 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 cardiac 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 medical complications, falls, delirium, and mortality. Thus,
medication optimization and deprescribing, in an intervention bundle with behavioral activation treatment of
depression and anxiety in older adults undergoing cardiac surgery, is expected to improve not only symptoms
of depression and anxiety but also other important post-o...

## Key facts

- **NIH application ID:** 10415141
- **Project number:** 5P50MH122351-02
- **Recipient organization:** WASHINGTON UNIVERSITY
- **Principal Investigator:** Michael Simon Avidan
- **Activity code:** P50 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $258,819
- **Award type:** 5
- **Project period:** 2021-06-01 → 2025-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10415141

## Citation

> US National Institutes of Health, RePORTER application 10415141, Perioperative mental health intervention for older adults undergoing cardiac surgery (5P50MH122351-02). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10415141. Licensed CC0.

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