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

  • Rachael Frost (a1), Yehudit Bauernfreund (a1) and Kate Walters (a1)
Abstract
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.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence should be addressed to: Rachael Frost, Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK. Phone: 0207 830 2881. Email: rachael.frost@ucl.ac.uk.
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