The Promise of Behavioral Activation to Treat Depression in Nursing Homes

Abstract

Hundreds of randomized trials have shown that psychological interventions are effective in the treatment of depression. 1 Cuijpers P Quero S Noma H et al. Psychotherapies for depression: a network meta-analysis covering efficacy, acceptability and long-term outcomes of all main treatment types. World Psychiatry. 2021; 20: 283-293 Crossref PubMed Scopus (46) Google Scholar That is also true in older adults. Although the effects of psychological treatments are significantly less effective in children and adolescents, there are no significant differences in effects between age groups when patients have reached adulthood. 2 Cuijpers P Karyotaki E Eckshtain D et al. Psychotherapy for depression across different age groups: a meta-analysis. JAMA Psychiatry. 2020; 77: 694-702 Crossref PubMed Scopus (79) Google Scholar Psychotherapy is as effective in older adults as it is in younger adults, and there is now enough evidence that it also works equally well in older old adults (75 and older). Most patients with depression also prefer psychotherapy over treatment with antidepressants. 3 McHugh RK Whitton SW Peckham AD et al. Patient preference for psychological vs pharmacologic treatment of psychiatric disorders: a meta-analytic review. J Clin Psychiatry. 2013; 74: 595-602 Crossref PubMed Scopus (427) Google Scholar Behavioral Activation in Nursing Homes to Treat Depression (BAN-Dep): Results From a Clustered, Randomized, Single-Blinded, Controlled Clinical TrialThe American Journal of Geriatric PsychiatryVol. 30Issue 12PreviewDepression is a common clinical syndrome among older adults living in residential aged care facilities (RACFs). Clinically significant symptoms of depression, as measured by the Geriatric Depression Scale (GDS-15), were present in 49 (50.5%) of 97 older adults recently admitted to an aged care facility in Australia,1 with data from the US National Nursing Home Survey suggesting that a depressive disorder affects at least 1 in every 3 residents.2 Despite its high prevalence, the presence of depression among aged care residents may go unnoticed, so that appropriate treatment may not be made available. Full-Text PDF The Problem With Maslow's HammerThe American Journal of Geriatric PsychiatryVol. 30Issue 12PreviewSomewhere between 15% and 65% of elders living in nursing homes and residential care facilities have significant depression and anxiety1 and these symptoms have only intensified during the COVID-19 pandemic.2 Depression and anxiety are major contributors to decreased quality of life for older adults and are associated with poor health outcomes, social isolation, functional decline including premature death and increasing the burden on nursing home staff and caregivers.3,4 Mood disorders in late life are also often unrecognized clinically and more likely to have a complicated clinical course and incomplete recovery and. Full-Text PDF