Could psychotherapy ease depression in aged care?

With more than half of all Australian aged care residents currently experiencing depression, a team of researchers has called for the adoption of a new approach to treating elderly mental health.
 
According to a new Cochrane review, psychological therapies may be effective in reducing symptoms of depression, compared to antidepressants or access to activities within an aged care facility.
 
‘There’s also preliminary evidence suggesting psychological therapies may also improve residents’ quality of life and psychological wellbeing,’ researchers concluded.
 
‘Notably, most of these trials provided between just two and 12 psychotherapy sessions, which is promising from a feasibility perspective.’
 
For the study, the Australian researchers examined 19 clinical trials from seven countries, with the 873 older people analysed all showing significant symptoms of depression.
 
Each person had participated in behaviour therapy, cognitive behavioural therapy, or reminiscence therapy in the past.
 
With 60% of all Australians living in residential aged care currently prescribed an antidepressant medication, the researchers said psychotherapy offers a potential alternative.
 
However, they admitted that to do this, there must be a nationwide increase in the ‘competencies of the aged care workforce’, training for the next generation of psychologists to work in an aged care setting, and support to rollout these programs in a cost-effective way.
 
Dr Anthony Marinucci, Chair of RACGP Specific Interests Aged Care told newsGP any therapeutical changes cannot be done without this adequate funding.
 
‘In general, they are not widely used predominantly due to workforce shortages to be able to deliver this skilled intervention in an outreach setting,’ he said.
 
‘There is insufficient evidence to suggest a widespread rollout of psychological therapies for depression in aged care settings solely based on this study.
 
‘But I do think this study supports these forms of therapy as a potential adjunct for clinicians wishing to supplement their current therapeutic framework for depression.’
 
The review follows the damning royal commission into aged care report, which highlighted an urgent need for older Australians to have equitable access to high-quality mental healthcare.
 
The researchers say psychotherapy is one just tool which could be offered routinely to those who need it, rather than relying solely on antidepressants.
 
More broadly, Dr Marinucci said psychological based therapies have a place in aged care when the need is identified, but more study is required.
 
‘There is a large spectrum of needs within this patient population, including different levels of cognition and capacity which may impact on the effectiveness of any psychological intervention,’ he said.
 
‘Given this is a systematic review of randomised controlled trials, this is a high-quality study, but the evidence of effect is uncertain.
 
‘The study suggests cognitive behavioural therapy, behavioural therapy, and reminiscence therapy may reduce depressive symptoms compared with usual care, but with limited statistical significance.’
 
For more information, GPs can access the Focussed Psychological Strategies (FPS) skills training through the General Practice Mental Health Standards Collaboration.
 
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aged care antidepressants depression mental health