OBJECTIVE: To review the effectiveness of non-pharmacological interventions in older adults with depression or anxiety and comorbidities affecting functioning. DESIGN: Systematic review and meta-analysis of randomized controlled trials, including searches of 10 databases (inception-Jul 2017). SETTING: Home/community. PARTICIPANTS: People aged 60 and over experiencing functional difficulties from physical or cognitive comorbidities and have symptoms or a diagnosis of depression and/or anxiety. INTERVENTIONS: Non-pharmacological interventions targeted at depression/anxiety. MEASUREMENTS: 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. RESULTS: 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. CONCLUSION: 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.
OBJECTIVE: To review the effectiveness of non-pharmacological interventions in older adults with depression or anxiety and comorbidities affecting functioning. DESIGN: Systematic review and meta-analysis of randomized controlled trials, including searches of 10 databases (inception-Jul 2017). SETTING: Home/community. PARTICIPANTS: People aged 60 and over experiencing functional difficulties from physical or cognitive comorbidities and have symptoms or a diagnosis of depression and/or anxiety. INTERVENTIONS: Non-pharmacological interventions targeted at depression/anxiety. MEASUREMENTS: 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. RESULTS: 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. CONCLUSION: 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.
Entities:
Keywords:
anxiety; depression; disability; medical comorbidity; meta-analysis
Authors: Martha L Bruce; Matthew C Lohman; Rebecca L Greenberg; Yuhua Bao; Patrick J Raue Journal: J Am Geriatr Soc Date: 2016-10-14 Impact factor: 5.562
Authors: Namkee G Choi; C Nathan Marti; Martha L Bruce; Mark T Hegel; Nancy L Wilson; Mark E Kunik Journal: Depress Anxiety Date: 2014-02-05 Impact factor: 6.505
Authors: Eric J Lenze; Alex Ramsey; Patrick J Brown; Charles F Reynolds; Benoit H Mulsant; Helen Lavretsky; Steven P Roose Journal: Am J Geriatr Psychiatry Date: 2016-07-29 Impact factor: 4.105
Authors: Dimitris N Kiosses; Lisa D Ravdin; James J Gross; Patrick Raue; Nabil Kotbi; George S Alexopoulos Journal: JAMA Psychiatry Date: 2015-01 Impact factor: 21.596
Authors: George S Alexopoulos; Patrick J Raue; Charles McCulloch; Dora Kanellopoulos; Joanna K Seirup; Jo Anne Sirey; Samprit Banerjee; Dimitris N Kiosses; Patricia A Areán Journal: Am J Geriatr Psychiatry Date: 2015-02-17 Impact factor: 4.105
Authors: Kate B Wolitzky-Taylor; Natalie Castriotta; Eric J Lenze; Melinda A Stanley; Michelle G Craske Journal: Depress Anxiety Date: 2010-02 Impact factor: 6.505
Authors: Zvi D Gellis; Jean McGinty; Amy Horowitz; Martha L Bruce; Elizabeth Misener Journal: Am J Geriatr Psychiatry Date: 2007-09-10 Impact factor: 4.105
Authors: Sanne Wassink-Vossen; Richard C Oude Voshaar; Paul Naarding; Rose M Collard Journal: Int J Ment Health Nurs Date: 2022-02-09 Impact factor: 5.100
Authors: Rachael Frost; Pushpa Nair; Su Aw; Rebecca L Gould; Kalpa Kharicha; Marta Buszewicz; Kate Walters Journal: Aging Ment Health Date: 2019-10-16 Impact factor: 3.658