PEARLS Helps End Depression for Seattle’s Filipino Elders

PEARLS Helps End Depression for Seattle’s Filipino Elders

Story tools

A A AResize



Photo: Counselor Lenlen Tayao conducts a PEARLS session with ex-Marine Gino Ragudos.

SEATTLE, Wash.— Gino Ragudos says he felt "suicidal at times" after his stormy divorce and final separation from Carlota, his wife of 35 years.

One summer evening, the Filipino American ex-Marine drove around Puget Sound where "I found a little church, but I just sat in the parking lot." Ragudos, though, fended off those most dire thoughts and attributed his bleak outlook to his isolation.

"I didn't have any confidence," said the 67-year-old Vietnam combat veteran. "I couldn't decide, couldn’t think straight. Actually, I was miserable. The apartment duplex was nice, but I often just sat there at the dining table. I couldn't do anything.”

Ragudos continued, “I knew I had a problem, I didn't know where to go, who to contact, where to begin. I thought after you part with a mate of 35 years, the mother of your kids, you're supposed to enjoy freedom."

His feelings of helplessness increased when he met old friends. Some seemed cold and indifferent, he said.

Treating Depression—Before It Becomes Major

Then Ragudos happened to see a flier for PEARLS (Program to Encourage Active and Rewarding Life for Seniors) and wondered if it was for him.

Developed at the University of Washington (UW) School of Public Health in the late 1990s, the nationally adopted program uses a problem-solving approach to help people 55 or older overcome minor depression--before it can become major—and remain independent.

The PEARLS flier Ragudos saw was for one of its Seattle-area programs specifically designed for Filipino American veterans—and he made a call.

Depression affects one in five elders, mental health researchers have established. Minor depression, or treatable depression with fewer symptoms, is a big deal for elders because it can affect how they feel, whether they leave the house and engage with others, and how they handle problems that inevitably come up with aging.

Treatable depression has an impact on elders across the board, such as older retirees, aging boomers, first-generation immigrant elders, senior veterans and their spouses.

In the summer of 2008, the City of Seattle awarded the nonprofit senior center, the International Drop-In Center (IDIC), where I serve as executive director, with a multi-year grant for the PEARLS project to address the need for aging veterans and their spouses or widows to combat minor depression.

Health-service researchers at UW developed PEARLS working with local community providers. A King County health-and-human-services levy was passed in 2008 to fund the effort for veterans and their spouses or widows. The effort included a special emphasis on elderly Filipino immigrants.

In the program’s first year, IDIC hired counselors who were trained in recruitment, counseling and tracking of each client's progress. Within the initial weeks after training, the counselors were able to recruit aging Filipino veterans, many who were in World War II, and their spouses and widows.
Counseling Resistance in Asian Cultures

Working with Seattle-King County’s Aging and Disability Services, PEARLS specialists and the university's community mental health services guided the counselors in penetrating the inner circle of the local Filipino American elders population.

Moving cautiously at first was important because the old soldiers and their spouses, as expected, resisted joining the program. They typically denied having problems and displayed outright indifference to any effort to address concerns of emotional health.

In most Asian cultures, it is a no-no to openly share one's personal worries and problems. Resistance had to do with cultural sensitivities that included one’s face value, honor, public embarrassment, or weakness of character.

IDIC staffers work hard to overcome challenges in recruiting immigrant elders to the program. Minor depression is common among the target population of first-generation elders, often from isolation and lack of social contacts. Research has shown that if recognized and treated early, depression can be turned around. But if left untreated, it can deepen into serious mental illness.

Understandably, due to their age and difficulty in adjusting to western culture, most Filipino elderly immigrants simply stay home. To reach most of the homebound elders, regulars at the senior center had to be recruited first.

Much-needed coaching from PEARLS project adviser Mark Snowden, of the University of Washington and medical director for Geriatric Psychiatry Service at Harborview Medical Center, gave the IDIC counselors the confidence and knowledge to complete the first year of the program. In that year alone, they enrolled 36 veterans and spouses, 20 of whom graduated from the program.

A New Place, New Friends, a New Outlook

As a counselor in the program, Lenlen Tayao visits seniors like Ragudos every day, listens to their problems, and helps them figure out solutions.

Ragudos related that Tayao’s first visit felt like school. There was paperwork, such as going over lists of possible worries and concerns. He thought he probably wouldn't go through with the program.

But after Tayao left, he sat at his kitchen table and started reading the material she had left for him and filling out the program’s form, which asked about his concerns. "I felt a warm flash across my chest," he said. "I thought maybe there is something to this."

For instance, Ragudos jotted down that he was living on a meager pension and could not afford his rising rent. He needed a more affordable place. He also wrote that he needed to socialize more – and he needed more exercise to help control his diabetes.

By simply writing down his list of problems, Ragudos felt they seemed more manageable.
Tayao also referred him to a case manager at the senior center, who helped canvas possible apartment sites. Ragudos found a new place in West Seattle, a building with many seniors. The apartment complex is near a bus stop, so he got rid of his car. He also walks around the new neighborhood.

"Here in the building lobby,” Ragudos said, “we socialize. We sit and talk. My best friend down the hall is a retired teacher."

Ragudos also joined a socio-cultural group called "Young Once," which reaches out to first-generation elderly immigrants. Through that group he met folkdance and fitness instructor Dolly Castillo, who is the senior center’s cultural activities coordinator.

Soon, he also became a constant volunteer at the senior center, packing and distributing food-bank bags for low-income families. And he joined fitness sessions held in conjunction with congregate lunch programs. Eventually, Ragudos became close friends with senior center officers, who presented him with an appreciation plaque for dedicated volunteer work.

Not for the Mentally Deficient

Because so many who might benefit lacked knowledge and understanding of what PEARLS was about, IDIC conducted focus sessions with Filipino seniors to discuss their concerns. Even then, many IDIC clients thought that the project was centered only on the mentally deficient.

They become more accepting of PEARLS only after several graduates of the program shared their experience and demonstrated how positively the sessions had helped them gain self-confidence and the capability to solve their own problems.

By the following year, PEARLS gained enough of a reputation in local community circles that more elders and their children stepped forward to ask about the program.

At the University of Washington, Snowden is continuing research to further refine ways of dealing with minor depression in older adults. He noted that cultural sensitivity and age-old ethnic traditions are factors that pose challenges in understanding older immigrants’ needs. These must be analyzed and reckoned with if PEARLS is to help elevate the quality of life of the elderly population in the City of Seattle.

Sluggo Rigor wrote this story for Seattle’s Filipino-American Bulletin through the MetLife Foundation Journalists in Aging Fellows program, a collaboration of New America Media and the Gerontological Society of America. He is also executive director of the nonprofit International Drop-In Center for seniors.