Community-based treatment of late life depression an expert panel-informed literature review.
OBJECTIVE
To present findings from an expert panel-informed literature review on community-based treatment of late-life depression.


METHODS
A systematic literature review was conducted to appraise publications on community-based interventions for depression in older adults. The search was conducted between March and October 2005. An expert panel of mental health, aging, health services, and epidemiology researchers guided the review and voted on quality and effectiveness of these interventions.


RESULTS
A total of 3,543 articles were found with publication dates from 1967 to October 2005; of these, 116 were eligible for inclusion. Adequate data existed to determine effectiveness for the following interventions: depression care management, group and individual psychotherapy for depression, psychotherapy targeting mental health, psychotherapy for caregivers, education and skills training (to manage health problems besides depression; and for caregivers), geriatric health evaluation and management, exercise, and physical rehabilitation and occupational therapy. After reviewing the data, panelists rated the depression care management interventions as effective. Education and skills training, geriatric health evaluation and management, and physical rehabilitation and occupational therapy received ineffective ratings. Other interventions received mixed effectiveness ratings. Insufficient data availability and poor study quality prevented the panelists from rating several reviewed interventions.


CONCLUSIONS
While several well-described interventions were found to treat depression effectively in community-dwelling older adults, significant gaps still exist. Interventions that did not target depression specifically may be of benefit to older adults, but they should not be presumed to treat depression by themselves. Treating depressed elders may require a multifaceted approach to ensure effectiveness. More research in this area is needed.
Frederick
John T
JT
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98104, USA.
Steinman
Lesley E
LE
Prohaska
Thomas
T
Satariano
William A
WA
Bruce
Martha
M
Bryant
Lucinda
L
Ciechanowski
Paul
P
Devellis
Brenda
B
Leith
Katherine
K
Leyden
Kevin M
KM
Sharkey
Joseph
J
Simon
Gregory E
GE
Wilson
Nancy
N
Unützer
Jurgen
J
Snowden
Mark
M
D017668:Age of Onset; D000368:Aged; D000553:Ambulatory Care; D000928:Antidepressive Agents / Q000627:therapeutic use*; D003866:Depressive Disorder / Q000628:therapy*; D019468:Disease Management; D015577:Geriatric Assessment; D006699:Home Care Services; D006801:Humans; D011613:Psychotherapy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome