Program to Encourage Active, Rewarding Lives for Seniors (PEARLS)
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Program to Encourage Active, Rewarding Lives for Seniors (PEARLS)

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Visit the PEARLS website.

Developed by: University of Washington Health Promotion Research Center
Program Administrator: Lesley Steinman
Year Program First Implemented: 2000


PEARLS is a highly effective method designed to reduce depressive symptoms and improve quality of life in older adults and in all-age adults with epilepsy. During six to eight in-home sessions that take place in the client's home and focus on brief behavioral techniques, PEARLS counselors empower individuals to take to action and make lasting changes so that they can lead more active and rewarding lives.

Supporting Evidence:

PEARLS was initially tested by the University of Washington using a randomized, controlled trial (RCT) in the community setting between 2000 and 2003. The study evaluated the impact of PEARLS on participants’ levels of depression, quality of life, and healthcare utilization. Participants in the study were 138 clients aged 60 years or older who received care from community senior service agencies in metropolitan Seattle; just over half (51.4%) had minor depression and the remainder had dysthymia (48.6%), a form of chronic, low-grade depression with symptoms lasting for more than two years. Half of all participants were randomly assigned to receive PEARLS, and half were randomly assigned to continue with their usual medical and mental health care. This study showed that over 12 months, individuals who received PEARLS were more likely than those who did not receive PEARLS to: 1) have a 50% or greater reduction in depression symptoms (43% of PEARLS recipients vs. 15% of the usual care group); 2) achieve complete remission from depression (36% of PEARLS recipients vs. 12% of the usual care group); and 3) have greater health-related quality-of-life improvements in both functional and emotional well-being. The study also demonstrated a trend toward lower hospitalization rates among those who received PEARLS compared to those who did not.

In a second RCT from 2007 through 2010, PEARLS was found to reduce depression severity to a significantly greater degree than usual care.  Eighty individuals with epilepsy with major depression, minor depression, and dysthymia were randomized to receive the PEARLS intervention (n=40) compared to usual care (n=40).  Participants had an average age of 44 years old and one in four belonged to a racial or ethnic minority group. Most (70%) were unemployed and 44% had a high school education or less. Half of the participants had visited the emergency room during the previous six months and 40% were taking an antidepressant at the start of the study.  At both twelve and eighteen months (or six to twelve months after the in-person visits), depression severity, thoughts of suicide, concentration, language, and emotional well-being were found to improve to a significantly greater degree in the PEARLS intervention arm as compared to usual care.

Exclusion of non-English speaking clients was recently identified as a major barrier to PEARLS program implementation. HPRC partnered with the local Area Agency on Aging to conduct a single group pilot study of PEARLS using language interpreters with Russian- and Somali-speaking older adults (N = 20). Interpreters received a brief training on PEARLS and study protocol. Standard PEARLS forms were translated for study purposes. 179 clients (55 Russian and 124 Somali) were screened for PEARLS eligibility and 20 clients (10 Russian and 10 Somali) were enrolled in PEARLS.  Of the 17 clients (85%) that completed the program, 76% significantly decreased their depressive symptoms and 82% no longer meet criteria for clinical depression (most of these clients began the program meeting criteria for major depression). Several processes and terminology were adapted for cultural appropriateness in the Russian and Somali communities. Clients were satisfied with the program and found the interpreter model acceptable. These findings suggest that delivering PEARLS with interpreters is effective for reaching clients with limited English proficiency. 


Ciechanowski P, Wagner E, Schmaling K, Schwartz S, Williams B, Diehr P, Kulzer J, Gray S, Collier C, LoGerfo J. Community-Integrated Home-Based Depression Treatment in Older Adults: A Randomized Controlled Trial. JAMA. (2004) 291 (13): 1569-1577. [Online]:

Ciechanowski P, Chaytor N, Miller J, Fraser R, Russo J, Unutzer J, Gilliam F. PEARLS depression treatment for individuals with epilepsy: a randomized controlled trial. Epilepsy Behav. (2010) 19 (3):225-31. [Online]:

Chaytor N, Ciechanowski P, Miller JW, Fraser R, Russo J, Unutzer J, Gilliam F. Long Term Outcomes from the PEARLS randomized trial for the treatment of depression in patients with epilepsy. Epilepsy Behav. (2011) 20 (3):545-9. [Online]:



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