Recommendations for Treating Depression in Community-Based Older Adults

Objective

To present recommendations for community-based treatment of late-life depression to public health and aging networks.

Methods

An expert panel of mental health and public health researchers and community-based practitioners in aging was convened in April 2006 to form consensus-based recommendations. When making recommendations, panelists considered feasibility and appropriateness for community-based delivery, as well as strength of evidence on program effectiveness from a systematic literature review of articles published through 2005.

Results

The expert panel strongly recommended depression care management–modeled interventions delivered at home or at primary care clinics. The panel recommended individual cognitive behavioral therapy. Interventions not recommended as primary treatments for late-life depression included education and skills training, comprehensive geriatric health evaluation programs, exercise, and physical rehabilitation/occupational therapy. There was insufficient evidence for making recommendations for several intervention categories, including group psychotherapy and psychotherapies other than cognitive behavioral therapy.

Conclusions

This interdisciplinary expert panel determined that recommended interventions should be disseminated throughout the public health and aging networks, while acknowledging the challenges and obstacles involved. Interventions that were not recommended or had insufficient evidence often did not treat depression primarily and/or did not include a clinically depressed sample while attempting to establish efficacy. These interventions may provide other benefits, but should not be presumed to effectively treat depression by themselves. Panelists also identified primary prevention of depression as a much under-studied area. These findings should aid individual clinicians as well as public health decision makers in the delivery of population-based mental health services in diverse community settings.

Introduction

Depression is common among older adults, affecting almost 7 million Americans aged 65 and older.1, 2 In 1999, a landmark U.S. Surgeon General’s report on mental health found that 8% to 20% of older adults in the community, and up to 37% in primary care settings, suffer from depressive symptoms.³ Unfortunately, many of these older adults receive no or inadequate treatment,4, 5, 6 and this under-diagnosis and under-treatment of depression represents a serious public health problem.⁷ Preventing and treating late-life depression is also of significant public health importance because depression can increase symptom burden of other comorbid conditions (e.g., heart disease), disability, healthcare utilization, and mortality from suicide and cardiac disease.8, 9, 10, 11, 12

Community-based medical and social services settings (vs traditional mental health clinics), offer important opportunities for recognition and intervention of depression in older adults, since many depressed older adults typically present in these environments. Although a broad array of effective interventions exists for depression, there is no clear consensus on effective treatments to be recommended for community-based older adults specifically. This project aimed to identify effective interventions and to develop recommendations based on consensus from a panel of experts from public health, epidemiology, social services, and primary care.