DOI: 10.5176/2315-4330_WNC15.48
Authors: Dr Rasika S. Jayasekara, Professor Nicholas Proctor
Abstract:
Background: The objective of this systematic review was to examine the effects of cognitive behavioural therapy (CBT) for older adults with depression. Method: This review considered only randomised controlled trials (RCTs) assessing the effectiveness of CBT as a treatment for older adult with major depression when compared to standard care, specific medication, other therapies and no intervention. The review included trials in which patients were described as elderly, geriatric, or older adults, or in which all patients were aged 55 or over. The Joanna Briggs Institute’s systematic review process was used for this review including detailed search strategy, critical appraisal, data collection and analysis. A comprehensive search using all identified keywords and index terms was undertaken in major databases (MEDLINE; CINAHL; Cochrane Central Register of Controlled Trials; Controlled Trials; EMBASE; Current Contents; PsycINFO; TRIP). Each paper was assessed by two independent reviewers for methodological quality prior to inclusion in the review using The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Meta-analyses were performed using Review Manager 5 software (2011). Results: A total of seven randomised controlled trials (RCT) were included in the review. Two trials involving 159 older adults with depression compared CBT versus treatment as usual (TAU) using Beck Depression Inventory (BDI) and the pooled data of two trials found no statistically significant differences in reduction of depression after 3-4 months of the intervention (Weighted mean differences [WMD] -2.61, 95{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} CI -5.82 to -0.6) and 6-10 month follow-up (WMD -3.05, 95{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} confidence interval [CI] -6.41 to -0.32). Three trials involving 97 older adults with depression compared CBT and TAU in reduction of depression using Geriatric Depression Scale (GDS) and found a significant difference between CBT and control groups (WMD -2.83, 95{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} CI -4.02 to -1.64), however significant heterogeneity was observed (chi-square 10.09, df=2, I2=80{6e6090cdd558c53a8bc18225ef4499fead9160abd3419ad4f137e902b483c465} p=0.006) in both fixed and random effects models. Individually, four trials that compared the CBT with TAU found that CBT is an effective treatment for older adults with depression. Conclusion: The key finding of this review is that cognitive-behavioural therapies are likely to be efficacious in older people when compared to treatment as usual. This finding is consistent with the findings of several systematic reviews and meta-analyses undertaken across a wider age range. However, the small size of included trial, the nature of the participants, and the heterogeneity of the interventions has considerable implications with regard to generalising these findings to clinical populations.
Keywords: Cognitive behavioural therapy, Depression, Older Adult, Systematic review
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