While many individuals maintain positive emotional wellbeing as they age, around half of older Australians living in residential aged care have significant levels of depression. Symptoms similar to low mood, lack of interest or pleasure in life and difficulty sleeping are common.
Rates of depression in aged care seem like increasingand without adequate treatment, symptoms will be enduring and significantly impair older adults’ quality of life.
But only a minority of aged care residents with depression receive services specific to the condition. Less than 3% of Australian aged care residents access Medicare-subsidised mental health servicessimilar to consultations with a psychologist or psychiatrist, annually.
Instead, residents are typically prescribed a medicine by their GP to administer their mental health, which they often take for several months or years. A recent study found six in ten Australian aged care residents take antidepressants.
While antidepressant medications may help many individuals, we lack robust evidence on whether or not they work for aged care residents with depression. Researchers have described “serious limitations of the present standard of care” in reference to the widespread use of antidepressants to treat frail older individuals with depression.
Given this, we wanted to seek out out whether psychological therapies may help manage depression on this group. These treatments address aspects contributing to people’s distress and supply them with skills to administer their symptoms and improve their day-to-day lives. But up to now researchers, care providers and policy makers haven’t had clear details about their effectiveness for treating depression amongst older people in residential aged care.
The excellent news is the evidence we published today suggests psychological therapies could also be an efficient approach for people living in aged care.
We reviewed the evidence
Our research team looked for randomised controlled trials published over the past 40 years that were designed to check the effectiveness of psychological therapies for depression amongst aged care residents 65 and over. We identified 19 trials from seven countries, including Australia, involving a complete of 873 aged care residents with significant symptoms of depression.
The studies tested several different sorts of psychological therapies, which we classified as cognitive behavioural therapy (CBT), behaviour therapy or reminiscence therapy.
CBT involves teaching practical skills to assist people re-frame negative thoughts and beliefs, while behaviour therapy goals to switch behaviour patterns by encouraging individuals with depression to have interaction in pleasurable and rewarding activities. Reminiscence therapy supports older people to reflect on positive or shared memories, and helps them find meaning of their life history.
The therapies were delivered by a variety of execs, including psychologists, social staff, occupational therapists and trainee therapists.
In these studies, psychological therapies were in comparison with a control group where the older people didn’t receive psychological therapy. In most studies, this was “usual care” – the care typically provided to aged care residents, which can include access to antidepressants, scheduled activities and help with day-to-day tasks.
In some studies psychological therapy was in comparison with a situation where the older people received extra social contact, similar to visits from a volunteer or joining in a discussion group.
What we found
Our results showed psychological therapies could also be effective in reducing symptoms of depression for older people in residential aged care, compared with usual care, with effects lasting as much as six months. While we didn’t see the identical effect beyond six months, only two of the studies in our review followed people for this length of time, so the info was limited.
Our findings suggest these therapies can also improve quality of life and psychological wellbeing.
Psychological therapies mostly included between two and ten sessions, so the interventions were relatively transient. This is positive by way of the potential feasibility of delivering psychological therapies at scale. The three different therapy types all gave the impression to be effective, in comparison with usual care.
However, we found psychological therapy is probably not more practical than extra social contact in reducing symptoms of depression. Older people commonly feel bored, lonely and socially isolated in aged care. The activities on offer are sometimes inadequate to satisfy their needs for stimulation and interest. So identifying ways to extend meaningful engagement day-to-day could improve the mental health and wellbeing of older people in aged care.
Some limitations
Many of the studies we found were of relatively poor quality, due to small sample sizes and potential risk of bias, for instance. So we’d like more high-quality research to extend our confidence within the findings.
Many of the studies we reviewed were also old, and necessary gaps remain. For example, we’re yet to grasp the effectiveness of psychological therapies for people from diverse cultural or linguistic backgrounds.
Separately, we’d like higher research to judge the effectiveness of antidepressants amongst aged care residents.
Ground Picture/Shutterstock
What must occur now?
Depression shouldn’t be considered a “normal” experience at this (or some other) stage of life, and people experiencing symptoms must have equal access to a variety of effective treatments. The royal commission into aged care highlighted that Australians living in aged care don’t receive enough mental health support and called for this issue to be addressed.
While there have been some efforts to offer psychological services in residential aged care, the unmet need stays very high, and rather more should be done.
The focus now must shift to learn how to implement psychological therapies in aged care, by increasing the competencies of the aged care workforce, training the following generation of psychologists to work on this setting, and funding these programs in an economical way.
