Treatments for Depression for Older Adults Living in Long-Term Care: A Systematic Review and Network Meta-Analysis

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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 outcomes 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 IMPLICATIONS: Many nonpharmacologic treatments for depression in LTC have been studied and are found to be efficacious. The low-risk and cost-effective nature of many of the nonpharmacologic treatments makes them ideal for use in LTC. More studies of pharmacologic treatments are needed to inform prescribing for depression in the LTC population. The range of treatments available for depression may help clinicians select therapies individualized to resident needs.

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