Treatments for Depression for Older Adults Living in Long-Term Care: A Systematic Review and Network Meta-Analysis
Abstract
OBJECTIVE
To assess the comparative efficacy of interventions on depressive symptoms and disorders in older adults living in long-term care (LTC).
DESIGN
Systematic review and network meta-analysis.
SETTING AND PARTICIPANTS
Older adults living in LTC or equivalent settings.
METHODS
We searched 6 electronic databases and gray literature sources to identify randomized controlled trials describing pharmacologic or nonpharmacologic interventions. Studies had to measure depression as an outcome in persons living in LTC. Study inclusion and study quality were assessed in duplicate. Population characteristics, descriptions of intervention and control treatments, and end-point depression scores for each treatment were extracted from included studies. A network meta-analysis using the standardized mean difference (SMD) of depression scores was completed using a random effects model.
RESULTS
A total of 182 studies were included in the review. The network meta-analysis was completed with 147 studies and included 31 treatment conditions. Compared with usual care, horticulture therapy (SMD, -6.85; 95% Credibility Interval, -8.49 to -5.22) and cognitive behavioral therapy (SMD, -1.98; 95% Credibility Interval, -2.91 to -1.05) were the most efficacious treatments. Animal therapy, group reminiscence therapy, multicomponent nonpharmacologic treatments, exercise, and socialization interventions also significantly improved depressive symptoms compared with usual care.
CONCLUSIONS AND…
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Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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