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

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.

SUBMITTER: Frost R 

PROVIDER: S-EPMC6398582 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature