Abstract
Older home-living vulnerable adults often suffer from chronic conditions accompanied by restrictions in mobility, social participation and reduced independence. Among this rapidly growing population depression is a common and serious health problem; however, there are shortcomings in the diagnosis of depression and provision of psychotherapy. Despite growing evidence in treating depression among the group of nursing home residents or the “young-old”, there is a research gap regarding needs-oriented healthcare strategies for very old, frail or care-dependent older adults living at home. The present article provides an overview of different outpatient psychotherapeutic treatment approaches for vulnerable older adults with depression, in particular adaptations tailored to those who are homebound or in need of care. Based on the current state of research, this article derives recommendations for psychotherapy in this special setting to consider the physical and psychosocial resources of this patient group. Furthermore, healthcare strategies for embedding psychotherapy in collaborative, telehealth or home-delivered healthcare services are described and their applicability as psychosocial support for older adults during the coronavirus disease 2019 (COVID-19) pandemic is discussed. Psychotherapy is an efficacious treatment for depression in home-living vulnerable older adults. Further implementing telehealth or home delivered settings, individually tailored psychotherapeutic approaches as well as collaborative and stepped care approaches can increase utilization and medical supply of this patient group. More research and innovative programs are needed to improve access to and provision of psychotherapeutic care as well as their social inclusion.
Highlights
Analogous to this shortage of research, patients in this population are almost always excluded from psychotherapeutic services even in regions with high availability of psychotherapeutic resources such as Germany [15]
The lack of barrier-free and accessible healthcare institutions, shortage of psychotherapists qualified to work with older adults or difficulties with arranging home visits are examples of structural barriers that may in part reflect negative views towards psychotherapy in old age [26]
The search terms included words related to older adults with depression, need of care and psychotherapy as well as coronavirus disease 2019 (COVID19)
Summary
Christina Tegeler1 · Ann-Kristin Beyer2 · Fee Hoppmann1 · Valentina Ludwig1 · Eva-Marie Kessler. The limitations of antidepressant medication (e.g. reduced response and adherence rates, drug-drug interactions and adverse side effects [37]) in older adults and evidence for a strong preference for psychotherapy [28] indicate a higher need for psychotherapeutic services for homebound and vulnerable older adults with depression. The described deficiencies in research and healthcare supply and lack of reliable evidence result in largely unmet psychotherapeutic needs of home-living older vulnerable patients. The present article provides an overview of the current status of international programs, healthcare strategies and clinical recommendations relating to psychotherapy for home-living vulnerable older adults with depression. 19) pandemic on the mental health of older adults [4], we discuss how psychosocial support could be realized for vulnerable older adults in the current situation and beyond
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