Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis.

Rachael Frost,Kate Walters,Yehudit Bauernfreund

doi:10.1017/s1041610218001564

Rachael Frost, Kate Walters + Show 1 more

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https://doi.org/10.1017/s1041610218001564

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Journal: International psychogeriatrics	Publication Date: Nov 27, 2018
Citations: 24	License type: CC BY 4.0

Affiliation: University College London

Abstract

To review the effectiveness of non-pharmacological interventions in older adults with depression or anxiety and comorbidities affecting functioning. Systematic review and meta-analysis of randomized controlled trials, including searches of 10 databases (inception-Jul 2017). Home/community. People aged 60 and over experiencing functional difficulties from physical or cognitive comorbidities and have symptoms or a diagnosis of depression and/or anxiety. Non-pharmacological interventions targeted at depression/anxiety. We extracted outcome data on depressive symptoms, quality of life, functioning, and service use. We used random effects meta-analysis to pool study data where possible. Two authors assessed the risk of bias using the Cochrane Risk of Bias tool. We identified 14 eligible trials including 2099 randomized participants and two subgroup analyses. Problem-solving therapy (PST) reduced short-term clinician-rated depressive symptoms (n=5 trials, mean difference in Hamilton Depression Rating Scale score -4.94 [95% CI -7.90 to -1.98]) but not remission, with limited evidence for effects on functioning and quality of life. There was limited high-quality evidence for other intervention types. Collaborative care did not appear to affect depressive symptoms, functioning, or quality of life; and had mixed evidence for effects upon remission. No intervention consistently affected service use, but trials were limited by small sample sizes and short follow-up periods. No anxiety interventions were identified. PST may reduce depressive symptoms post-intervention in older people with depression and functional impairments. Collaborative care appears to have few effects in this population. Future research needs to assess cost-effectiveness, long-term outcomes, and anxiety interventions for this population.

Highlights

Late-life mental health is becoming an increasingly important issue
Problem-solving therapy (PST) reduced short-term clinician-rated depressive symptoms (n = 5 trials, mean difference in Hamilton Depression Rating Scale score −4.94 [95% CI −7.90 to −1.98]) but not remission, with limited evidence for effects on functioning and quality of life
DEPRESSIVE SYMPTOMS Modified PST significantly reduced clinicianrated Hamilton Depression Rating Scale (HAM-D) scores post-intervention

Summary

Introduction

Late-life mental health is becoming an increasingly important issue. It is estimated that 37%–43% of older adults have symptoms of anxiety or depression (Braam et al, 2014; Rodda et al, 2011), while 9%–14% have a diagnosed anxiety or major depressive disorder (Rodda et al, 2011; Wolitzky-Taylor et al, 2010). Anxiety or depression in later life is associated with an increased risk of cognitive decline, functional decline, and increased use of healthcare services (Meeks et al, 2011; Wolitzky-Taylor et al, 2010). Commonly experiencing physical or cognitive comorbidities affecting functioning (i.e. difficulties carrying out activities of daily living due to physical health conditions, in addition to depression), have a four-fold increase in the risk of clinically significant anxiety or depression (Ni Mhaolain et al, 2012).

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