scholarly journals Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies

2019 ◽  
Vol 69 (680) ◽  
pp. e171-e181 ◽  
Author(s):  
Rachael Frost ◽  
Angela Beattie ◽  
Cini Bhanu ◽  
Kate Walters ◽  
Yoav Ben-Shlomo
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Older People ◽  
Functional Decline ◽  
Late Life ◽  
Later Life ◽  
Healthcare Services ◽  
Qualitative Studies ◽  
Late Life Depression ◽  
Psychological Therapies

BackgroundDepressive symptoms are common in later life and increase both the risk of functional and cognitive decline and the use of healthcare services. Despite older people expressing preferences for talking therapies, they are less likely to be referred than younger adults, particularly when aged ≥80 years.AimTo explore how healthcare professionals (HCPs) manage older people in relation to depression and referrals to psychological therapies.Design and settingSystematic review and thematic synthesis of qualitative studies.MethodMEDLINE, Embase, PsycINFO, CINAHL, and the Social Sciences Citation Index (inception–March 2018) were searched for studies exploring HCPs’ views regarding management of late-life depression across all settings. Studies of older people’s views or depression management across all ages were excluded.ResultsIn total, 27 studies, were included; these predominantly focused on the views of GPs and primary and community care nurses. Many HCPs felt that late-life depression was mainly attributable to social isolation and functional decline, but treatments appropriate for this were limited. Clinicians perceived depression to have associated stigma for older adults, which required time to negotiate. Limited time in consultations and the complexity of needs in later life meant physical health was often prioritised over mental health, particularly in people with frailty. Good management of late-life depression appeared to depend more on the skills and interest of individual GPs and nurses than on any structured approach.ConclusionMental ill health needs to be a more-prominent concern in the care of older adults, with greater provision of psychological services tailored to later life. This may facilitate future identification and management of depression.

scholarly journals Characteristics of Cognitive Behavioral Therapy for Older Adults Living in Residential Care: Protocol for a Systematic Review (Preprint)

2018 ◽  
Author(s):  
Phoebe Chan ◽  
Sunil Bhar ◽  
Tanya E. Davison ◽  
Colleen Doyle ◽  
Bob G. Knight ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Cognitive Behavioral Therapy ◽  
Residential Care ◽  
Behavioral Therapy ◽  
Late Life ◽  
Aged Care ◽  
Residential Aged Care ◽  
Late Life Depression ◽  
Residential Settings

BACKGROUND The prevalence rates of depressive and anxiety disorders are high in residential aged care settings. Older adults in such settings might be prone to these disorders because of losses associated with transitioning to residential care, uncertainty about the future, as well as a decline in personal autonomy, health, and cognition. Cognitive behavioral therapy (CBT) is efficacious in treating late-life depression and anxiety. However, there remains a dearth of studies examining CBT in residential settings compared with community settings. Typically, older adults living in residential settings have higher care needs than those living in the community. To date, no systematic reviews have been conducted on the content and the delivery characteristics of CBT for older adults living in residential aged care settings. OBJECTIVE The objective of this paper is to describe the systematic review protocol on the characteristics of CBT for depression and/or anxiety for older adults living in residential aged care settings. METHODS This protocol was developed in compliance with the recommendations of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P). Studies that fulfill the inclusion criteria will be identified by systematically searching relevant electronic databases, reference lists, and citation indexes. In addition, the PRISMA flowchart will be used to record the selection process. A pilot-tested data collection form will be used to extract and record data from the included studies. Two reviewers will be involved in screening the titles and abstracts of retrieved records, screening the full text of potentially relevant reports, and extracting data. Then, the delivery and content characteristics of different CBT programs of the included studies, where available, will be summarized in a table. Furthermore, the Downs and Black checklist will be used to assess the methodological quality of the included studies. RESULTS Systematic searches will commence in May 2018, and data extraction is expected to commence in July 2018. Data analyses and writing will happen in October 2018. CONCLUSIONS In this section, the limitations of the systematic review will be outlined. Clinical implications for treating late-life depression and/or anxiety, and implications for residential care facilities will be discussed. CLINICALTRIAL PROSPERO 42017080113; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=80113 (Archived by WebCite at http://www.webcitation.org/70dV4Qf54) REGISTERED REPORT IDENTIFIER RR1-10.2196/9902

scholarly journals Personality disorders in later life: epidemiology, presentation and management

2020 ◽  
Vol 26 (4) ◽  
pp. 208-218
Author(s):  
Ayesha Bangash
Keyword(s):  
Older Adults ◽  
Personality Disorder ◽  
Older People ◽  
Medical Care ◽  
Personality Disorders ◽  
Late Life ◽  
Later Life ◽  
Enormous Amount ◽  
Expected Increase ◽  
Growing Population

SUMMARYDespite the enormous amount of literature on medical care of older people, personality disorders in late life have been given little attention. Clinicians tend not to assign this diagnosis to older adults in view of limited research into, and therefore limited awareness of, this topic. This article aims to promote better understanding of this subject in view of the growing population of older people and hence an expected increase in the number of personality disorder cases.

Origins of depression in later life

2005 ◽  
Vol 35 (9) ◽  
pp. 1241-1252 ◽  
Author(s):  
DAN G. BLAZER ◽  
CELIA F. HYBELS
Keyword(s):  
Older Adults ◽  
Stressful Life Events ◽  
Cognitive Distortions ◽  
Late Life ◽  
Later Life ◽  
Late Life Depression ◽  
Younger Adults ◽  
Social Risks ◽  
Clinically Significant ◽  
The Many

Background. Despite the burden of depression in late life, its origins present a paradox to investigators and clinicians alike.Method. We review biological (genetics and heredity factors, neurotransmitter dysfunction, endocrine changes, vascular disorders, and medical co-morbidities), psychological (personality attributes, neuroticism, cognitive distortions, and the lack of emotional control and self-efficacy) and social (stressful life events, bereavement, chronic stress or strain, socio-economic disadvantage and impaired social support) origins of late-life depression based upon an extensive though not exhaustive review of the extant literature. In addition, modifying psychological and social factors are discussed.Results. Older adults appear to be at greater risk for major depression biologically, such as depression resulting from vascular changes, yet the frequency of depression is lower compared to younger adults. Older adults may be protected psychologically due to factors such as socio-emotional selectivity and wisdom, compared to younger adults, and perhaps relatively protected from social risks.Conclusions. A biopsychosocial approach to evaluating the origins of late-life depression is heuristically valuable, a continual reminder of the many factors that contribute to the onset and persistence of clinically significant symptoms in late life.

scholarly journals Preventing Late-Life Depression: Lessons in Intervention Development From Goa, India

2017 ◽  
Vol 1 (3) ◽  
Author(s):  
Charles F Reynolds ◽  
Amit Dias ◽  
Alex Cohen ◽  
Jennifer Morse ◽  
Stewart J Anderson ◽  
...  
Keyword(s):  
Older Adults ◽  
Behavioral Treatment ◽  
Intervention Strategy ◽  
Case Series ◽  
Late Life ◽  
Later Life ◽  
Late Life Depression ◽  
Depression Prevention ◽  
Medical Disorders ◽  
Subsyndromal Symptoms

Abstract We describe the development of an intervention strategy for the indicated prevention of depression in older adults living in Goa, India. Of particular novelty, the intervention is deliverable by lay health counselors and is grounded in problem solving therapy for primary care and brief behavioral treatment for insomnia. We have named the intervention “DIL” (the Hindi word for “heart” and an acronym for “depression in late life.”) Additional DIL strategies include psychoeducation in self-management of co-occurring medical disorders such as diabetes mellitus, together with assistance in navigation to needed social and economic resources. We present the results of a preliminary open-trial case series involving 21 participants with subsyndromal symptoms of depression, demonstrating feasibility, acceptability, and benefit to participants. We then present the design of a larger confirmatory trial into which 181 participants have been enrolled. “DIL” is a novel and large depression prevention trial conducted with lay health counselors in a low-resource country. Its results are likely to have implications for depression prevention in older adults in other low- and middle-income countries and to inform contemporary models of the staging of depressive illness in later life.

A Systematic Review and Comparison of Neurocognitive Features of Late-Life Attention-Deficit/Hyperactivity Disorder and Dementia With Lewy Bodies

2020 ◽  
pp. 089198872094425
Author(s):  
Jennifer L. Prentice ◽  
Morgan J. Schaeffer ◽  
Alexandra K. Wall ◽  
Brandy L. Callahan
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Attention Deficit Hyperactivity Disorder ◽  
Attention Deficit ◽  
Dementia With Lewy Bodies ◽  
Lewy Bodies ◽  
Late Life ◽  
Later Life ◽  
Qualitative Synthesis ◽  
Hyperactivity Disorder

Objective: Attention-deficit/hyperactivity disorder (ADHD) in adulthood and dementia with Lewy bodies (DLB) share many cognitive and noncognitive similarities. The overlapping features between both disorders complicate differential diagnosis. The aim of the current systematic review was to compare patterns of neuropsychological profiles in older adults with ADHD and DLB. Method: Of the 1989 ADHD-related articles and 1332 DLB-related articles screened, 3 ADHD and 25 DLB articles were retained for qualitative synthesis and review. Results: A synthesis of individual study findings revealed isolated working memory deficits for late-life ADHD, and performance deficits in areas of attention, memory, language, and visuoperceptual abilities for DLB. Results were limited by small samples and absence of data in some cognitive domains. Conclusion: These initial findings support potentially unique neurocognitive profiles for ADHD in later life and DLB that would enable practitioners to differentially diagnose and appropriately treat older adults presenting with these phenotypically similar disorders.

scholarly journals The association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults: systematic review and meta-analysis

2019 ◽  
Vol 215 (2) ◽  
pp. 449-455 ◽  
Author(s):  
Jingkai Wei ◽  
Ruixue Hou ◽  
Xiaotao Zhang ◽  
Huiwen Xu ◽  
Liyang Xie ◽  
...  
Keyword(s):  
Systematic Review ◽  
Older Adults ◽  
Cardiovascular Mortality ◽  
Meta Analysis ◽  
Late Life ◽  
Community Dwelling ◽  
Late Life Depression ◽  
Prospective Cohort Studies ◽  
Community Dwelling Older Adults

BackgroundLate-life depression has become an important public health problem. Available evidence suggests that late-life depression is associated with all-cause and cardiovascular mortality among older adults living in the community, although the associations have not been comprehensively reviewed and quantified.AimTo estimate the pooled association of late-life depression with all-cause and cardiovascular mortality among community-dwelling older adults.MethodWe conducted a systematic review and meta-analysis of prospective cohort studies that examine the associations of late-life depression with all-cause and cardiovascular mortality in community settings.ResultsA total of 61 prospective cohort studies from 53 cohorts with 198 589 participants were included in the systematic review and meta-analysis. A total of 49 cohorts reported all-cause mortality and 15 cohorts reported cardiovascular mortality. Late-life depression was associated with increased risk of all-cause (risk ratio 1.34; 95% CI 1.27, 1.42) and cardiovascular mortality (risk ratio 1.31; 95% CI 1.20, 1.43). There was heterogeneity in results across studies and the magnitude of associations differed by age, gender, study location, follow-up duration and methods used to assess depression. The associations existed in different subgroups by age, gender, regions of studies, follow-up periods and assessment methods of late-life depression.ConclusionLate-life depression is associated with higher risk of both all-cause and cardiovascular mortality among community-dwelling elderly people. Future studies need to test the effectiveness of preventing depression among older adults as a way of reducing mortality in this population. Optimal treatment of late-life depression and its impact on mortality require further investigation.Declaration of interestNone.

The Role of Community- and Home-Based Interventions in Late-Life Depression

2014 ◽  
Author(s):  
Laura N. Gitlin
Keyword(s):  
Older Adults ◽  
Depressive Disorders ◽  
Treatment Guidelines ◽  
Underserved Populations ◽  
Functional Decline ◽  
Late Life ◽  
Evidence Base ◽  
Late Life Depression ◽  
Home Based

Depressive disorders are highly prevalent and among the most debilitating conditions in late life. If untreated, depression has profound effects on quality of life and health; it also increases the risk for dementia, other comorbidities, functional decline, and mortality. Although primary care is the principal setting for the detection and treatment of depression, older adults and particularly, minorities do not always receive evidence-based treatment guidelines. Thus, new care models are urgently needed. This chapter considers the role of community- and home-based approaches to depression care, their theoretical underpinnings and advantages, and exemplary programs. Twenty-three rigorously tested community- and home-based interventions with positive depression outcomes are identified, suggesting a robust and growing evidence base. Community- and home-based approaches may overcome persistent mental health disparities by reaching underserved populations, minimizing stigma by normalizing depression detection and delivering treatments at home, and increase access to nonpharmacological approaches—such as psychosocial and behavioral approaches—f or older adults who are at risk for or have late-life depression.

scholarly journals Late-Life Depression: Portuguese Research Trends over the last Decade (2007-2017)

2018 ◽  
Vol 1 (1) ◽  
pp. 29
Author(s):  
Gabija Kisieliūtė ◽  
Oscar Ribeiro ◽  
Constança Paúl
Keyword(s):  
Older Adults ◽  
Older People ◽  
Help Seeking ◽  
Population Aging ◽  
Late Life ◽  
Health Concern ◽  
Geriatric Depression ◽  
Late Life Depression ◽  
Help Seeking Behaviors ◽  
Mental Health Concern

Background: Depression is the second major mental health concern in older people and it is generally accepted that it highly contributes to diminished wellbeing and worse general health. Population aging has raised the need to enlarge depression research in older adults so that it may be properly prevented, diagnosed and treated. In Portugal, the extent of research conducted on geriatric depression is unknown. Goals: This study aims to explore the scope of depression research with elderly population in Portugal, and to provide insights on the prevailing research topics that have been considered, highlighting possible trends and research gaps.Methods: A scope review was conducted. Research papers having “older people” (or similar words) AND “Portugal” AND “Depression” in their title, abstract or keywords were screened across main international scientific databases (SCOPUS, Web of Science, PsycINFO and PUBMED) for a ten-year period [2007-2017]. Results: A total of 50 papers were selected and analysed. Six main categories were distinguished: depression, health status and social conditions; late life depression and its characteristics; assessment of late life depression; intervention outputs; attitudes towards depression and help seeking behaviors; and sociodemographic characteristics of people with depression. Discussion: The considerable expressiveness of geriatric depression in our country and the lack of attention it is given as a primary research topic (rather than as an associated variable to other conditions) suggest the need for a greater investment by Portuguese researchers in order to improve accurate diagnosis and adequate psychological interventions.Keywords: Depression; Systematic review; Geriatric; Older adults; Portugal.

Refining Evidence-Based Treatments for Late-Life Depression

GeroPsych ◽  
2015 ◽  
Vol 28 (2) ◽  
pp. 67-76
Author(s):  
Grace C. Niu ◽  
Patricia A. Arean
Keyword(s):  
Older Adults ◽  
Mental Illness ◽  
Brain Plasticity ◽  
Late Life ◽  
Aging Population ◽  
The United States ◽  
Future Research ◽  
Evidence Based ◽  
Late Life Depression ◽  
Evidence Based Treatments

The recent increase in the aging population, specifically in the United States, has raised concerns regarding treatment for mental illness among older adults. Late-life depression (LLD) is a complex condition that has become widespread among the aging population. Despite the availability of behavioral interventions and psychotherapies, few depressed older adults actually receive treatment. In this paper we review the research on refining treatments for LLD. We first identify evidence-based treatments (EBTs) for LLD and the problems associated with efficacy and dissemination, then review approaches to conceptualizing mental illness, specifically concepts related to brain plasticity and the Research Domain Criteria (RDoc). Finally, we introduce ENGAGE as a streamlined treatment for LLD and discuss implications for future research.

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