Treating depression in older adults in long-term care

Wednesday 24 April 2024

Vanessa Jordan

PEARLS No.

743

Clinical question

Are psychological therapies effective for treating depression in older people living in long-term care facilities?

Bottom line

Compared with non-therapy comparators, psychological therapies (including cognitive behavioural therapy, behavioural therapy and reminiscence therapy) may be more effective for reducing depressive symptoms in older adults who live in LTC facilities, with large effect sizes at end of intervention and up to three months after intervention. However, there is currently no evidence to show this effect was maintained long term.

In the short term, psychological therapies were also effective for improving quality of life and psychological wellbeing in older adults who live in LTC facilities. Due to insufficient evidence, the broader benefits of psychological therapies, and longer-term effects, are unclear.

Caveat

Most studies included small numbers of participants and used unreliable methods. Thus, the evidence was of very low certainty, limiting confidence in the findings.

There were also several common participant exclusion criteria used in these studies, including hearing, vision or communication difficulties; a range of comorbid conditions or physical inability to participate in therapy; and recent admission to the LTC facility. Thus, the findings of effectiveness of psychological therapies may not apply equally to LTC residents with more complex presentations.

Context

Depression is common among older people residing in LTC facilities. Currently, most residents treated for depression are prescribed antidepressant medications, despite the potential availability of psychological therapies that are suitable for older people and often preferred by those wanting a non-pharmacological treatment approach.

Cochrane Systematic Review

Davison TE, et al. Psychological therapies for depression in older adults residing in long-term care settings. Cochrane Database Syst Rev 2024;3:CD013059. This review contains 19 trials with a total of 873 participants.

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