Editor’s note: The John A. Hartford Foundation, the Administration for Community Living (ACL) and The SCAN Foundation fund the Aging and Disability Business Institute, led by USAging. The mission of the Aging and Disability Business Institute is to build and strengthen partnerships between aging and disability community-based organizations (CBO) and the healthcare system. As partners in the Institute, ASA and USAging are collaborating on a series of articles and case studies in Generations Now that highlight community-based integrated care networks.
People often come about their geriatric specialty in a roundabout fashion, but it’s even more common that once they’ve settled on a topic or a population they are so eager to do the work that they take on multiple projects at the same time. Brenna N. Renn, PhD, is one of those people.
A licensed psychologist and assistant professor in the Department of Psychology at the University of Nevada–Las Vegas (UNLV), she always knew she wanted to be in a health or helping profession and became mesmerized by psychology in an advanced placement course in high school. A mentor at the University of Washington strongly advocated for the role of psychology in improving behavior or intervening in behavior in mental and physical health outcomes, which planted another seed in Renn’s head about the possibilities of psychology.
Three years as a research coordinator at the University of Washington in the Veterans Administration hospital conducting Alzheimer’s research nourished that seed.
Renn was intrigued by the diversity of the aging experience and went on to get her doctorate in psychology with a focus on geropsychology.
Studying Depression and Cognitive Impairment
Now she and her family are ensconced in a suburb of Las Vegas, where she runs the TREATment Lab at UNLV. The lab straddles two paths, said Renn, one on geropsychology and issues of older adulthood related to mental health, which looks at how to better treat depression in older adults. Specifically older adults who also have mild cognitive impairment.
The second path involves doctoral students analyzing the scientific literature to better understand if psychotherapy trials historically have included individuals with any sort of cognitive impairment or not. The answer unfortunately is mostly not.
Renn has connected with senior centers and recreation centers and partnered with physical therapy colleagues to offer depression and cognitive screening.
Renn also conducts provider trainings in the community, as she has realized that although many medical professionals are confident in their ability to treat depression, and feel they can diagnose cognitive impairment, when the two conditions co-occur, both mental health and medical providers tend to think there’s just nothing more they can do at that point.
When most clinical trials have excluded those two co-occurring conditions it leaves providers in this black hole regarding how to best treat this population, Renn said.
“Depression is relatively treatable, or at least amenable to a lot of our behavioral techniques, but there’s not really good literature to inform the treatment of depression in those instances,” Renn said.
So, she has a study running on that topic. But recruiting participants has been difficult, as the people who show up to community events tend not to be depressed, which has led her to more novel recruitment strategies, particularly in marginalized communities. Since Renn moved to the city in 2020, she has been testing ways of getting Las Vegas’s overworked providers to recruit study subjects. Hopefully this recruitment will ramp up as UNLV’s new medical school gains traction.
Renn has connected directly with senior centers and recreation centers, too, as well as partnering with physical therapy colleagues to offer depression and cognitive screening.
Task-sharing Intervention
A third area of interest for Renn is improving access to mental health care for older adults, particularly marginalized older adults. Currently in trial she has a study on non-specialist providers—coaches, psychology majors, or recent graduates—to be trained in a structured intervention, in which she’ll supervise them closely and they will deliver the mental and behavioral health interventions directly to older adults who are depressed with co-occurring cognitive impairment.
An older clinical interest of Renn’s is depression in the context of chronic disease, as it is often comorbid with diabetes, heart failure and coronary disease. Some of her previous work looked at how to better assess chronic disease with depression and recognize the interplay that occurs between the two conditions, making it harder for folks to manage their chronic disease. People with both are less likely to do what’s required for treatment, such as exercise, diet management, and showing up at health appointments. Conversely chronic disease can exacerbate depression. “This is all still a passion of mine, too,” Renn said.
‘We need to take a lifespan approach [to mental and physical health] but we’re not quite there yet.’
Diabetes, high cholesterol, cardiac issues, even Alzheimer’s can be decades in the making, not showing up until people are in their 70s or 80s, but it’s likely that what one does in one’s 30s or 40s matters. “We need to take a lifespan approach [to mental and physical health] but we’re not quite there yet in our healthcare system,” Renn said.
For now, in her aim to involve communities, providers and potential trial subjects, Renn is out in Las Vegas giving talks at independent living communities, guest-lecturing at UNLV’s Osher Lifelong Learning Institute, and partnering with a senior center in an underserved area of the city. “These are all the folks who historically are not represented and don’t necessarily think about going to a university to participate in research,” she said.
“I’m excited to partner with them and go out to their senior center to do roundtable discussions around what they see as the mental health needs of their community, specific to the senior center but also in their neighborhoods.
“Can we then work together to co-develop something where perhaps my team goes to their senior center twice a week to offer whatever services they see as relevant?” Renn asked. “Maybe that’s caregiver support groups, maybe that’s my depression trial and we just do it there, maybe it’s cognitive screening, or other brief ways of identifying dementia or depression. That’s one of my next initiatives,” said the woman who seems to have so very many already.
She’s also trying to launch an official collaboration with the VA hospital in Southern Nevada and she retains an affiliation with the University of Washington School of Medicine in which they partnered with Premera Blue Cross to implement a trial of collaborative care, where psychiatry is embedded in healthcare at primary care clinics to treat depression. Premera funded the University of Washington to roll out the collaborative across about 8 clinics over the span of a couple years. Her lab is evaluating the outcomes data.
“It’s less that we’re examining patient outcomes because we know these sorts of models generally work, and patients generally improve, but what we’re looking at is what were the markers of implementation success, what helped that program really take off in certain clinics and why did it gain less traction in others? How can we better partner with clinics?” Renn asked. Seems very likely she’ll figure out a way.
Alison Biggar is ASA’s editorial director.
Photo caption: Brenna Renn addresses the audience at the Washington Mental Health Summit.
Photo credit: Courtesy University of Washington
