Public health efforts toward reducing depression in older people

Abstract

Xie and colleagues (2020) conducted a study that investigated the relationship between biopsychosocial factors and symptoms of depression among 5791 primarily community-dwelling people older than 60 years in China. The results demonstrated a direct association of depressive symptoms with sociodemographic characteristics, poor health status, unhealthy habits (alcohol use and smoking), and sleep duration with the dominant predictor of depressive symptoms being poor health status. This study highlights an important concept in the treatment of depression in the elderly: the potential of lifestyle interventions to reduce symptoms of depression in the geriatric population. Currently, the treatments that have been most investigated in the geriatric population for depression are medications and psychotherapy. Antidepressants are the most studied and mainstay of treatment for depression. A meta-analysis of 15 randomized trials compared antidepressants with placebo in 4756 participants with Major Depressive Disorder, aged 55 years and older (mean age 70 years old) Xie et al. (2020). Results demonstrated antidepressants to be effective in treating depressive symptoms in the geriatric population (Tedeschini et al., 2011). However, for a subgroup of patients (age > 65 years), there was no significant difference between antidepressants and placebo. These analyses were limited by the heterogeneity, the limited number of trials with participants older than age 80, and exclusion of individuals with severe depression. These studies suggest that antidepressants may be limited as a treatment of depression among older adults, and that other interventions should be considered. Psychotherapy is cited as a useful, but underutilized treatment modality in the geriatric population. Ameta-analysis of 27 trials (n > 2000 patients) compared psychotherapy with control groups (waitlist, treatment-as-usual, attention, supportive therapy, placebo) and found a small-to-moderate clinical effect of therapy for reducing depressive symptoms. Due to lack of insurance coverage and availability of therapists, psychotherapy is currently limited as a treatment in the geriatric population (Huang et al., 2014). However, there have been a number of clinical trials integrating treatments of depression into primary care and home-based care settings, and utilizing non-doctoral level providers, such as nurses and lay health counselors as mental health care managers that demonstrate feasibility and effectiveness (Bruce and Sirey, 2018). Physical exercise has also been studied as a potential treatment modality for depression. A meta-analysis was performed of seven randomized trials (n = 519 patients) where exercise was defined as three to five sessions (30 to 45 min/ week) for 10 weeks to 6 months, compared to non-exercise controls. Analysis found a small, clinically significant impact of exercise for reducing depressive symptoms among older people (Bridle et al., 2012). Other studies have explored bright light therapy as a treatment for older adults. A meta-analysis of six trials (n = 359 patients) were studied to evaluate the effectiveness of light therapy in reducing depressive symptoms. Results demonstrated that light therapy has some effect on geriatric depression (Zhao et al., 2018). The Xie and colleagues’ (2020) manuscript suggests a number of additional interventions and/or preventive strategies for depression that might be considered. In that study, older people not living with their spouses were more likely to have higher levels of depressive symptoms in older people. Loneliness is one important factor that may be playing a role in the development and maintenance of depressive symptoms and other poor health and mental health outcomes. Efforts that promote strong emotion regulation and prosocial behaviors, which have been negatively correlated with loneliness, may reduce loneliness, and in turn, decrease the likelihood of depressive symptoms (Lee et al., 2020). Other efforts that promote good cardiovascular health (e.g. exercise, healthy diet) and high-quality sleep are also likely to prevent and/or reduce depressive symptoms in older people. Clinical trials at the community level that address promotion of such health behaviors on a International Psychogeriatrics (2021), 33:2, 115–116 © International Psychogeriatric Association 2021