Third-wave CBT on late-life depression in patients living alone or in dual-aging families in Hong Kong

BackgroundLate-life depression affects around 10% of older adults in Hong Kong and is linked to increased morbidity, mortality, frailty, dementia, and healthcare utilisation. Older adults who live alone or in dual-aging families are at particularly high risk due to social isolation, caregiving burden, and limited access to centre-based mental health services, yet no trials have specifically evaluated third-wave CBT in this underserved group. Emerging evidence suggests that age-adapted mindfulness- and acceptance-based CBT (MBCT, ACT, MBSR) can significantly reduce depressive symptoms in older adults across diverse settings.​ObjectiveThis project aims to evaluate the feasibility and effectiveness of an age- and culturally adapted third-wave CBT intervention, delivered by community nurses, in reducing depressive symptoms among older adults living alone or in dual-aging families in Hong Kong. MethodsA quasi-experimental or randomized controlled design will be employed with community-dwelling adults aged 60 years or above who live alone or in dual-aging family arrangements and present with mild to moderate depressive symptoms as identified by the Geriatric Depression Scale (GDS). Participants will be allocated to either (1) an age-adapted third-wave CBT program (MBCT/ACT-informed) delivered in small groups or near-home/community settings by trained community nurses, or (2) an active control condition consisting of usual nursing care. The intervention will consist of 8–12 weekly sessions incorporating mindfulness practice, acceptance, values clarification, and behaviour change strategies, with adaptations for physical limitations, cognitive load, and cultural relevance. Primary outcome will be change in depressive symptoms (GDS), with secondary outcomes including quality of life and psychological flexibility, measured at baseline, post-intervention, and short-term follow-up. Expected ResultsIt is hypothesised that participants receiving the third-wave CBT intervention will show greater reductions in depressive symptoms and improvements in quality of life and psychological flexibility compared with those in the active control group. The study will also assess feasibility, acceptability, and fidelity of a community nurse-led delivery model in this high-risk population.​ConclusionsBy targeting older adults living alone or in dual-aging families and integrating screening, brief assessment, and structured third-wave CBT within community nursing services, this project aims to address critical service gaps in the detection and treatment of late-life depression in Hong Kong. Findings will provide locally relevant evidence to inform future scaling of home- and community-based third-wave CBT interventions within advanced nursing practice and integrated geriatric mental health care.