title: Geriatric characteristics in randomised controlled trials on antidepressant drugs for older adults: a systematic review.
abstract: Meta-analyses of antidepressant drug treatment trials have found that increasing age is associated with a less favourable outcome. Because the prevalence of geriatric characteristics, like disability, medical co-morbidity, malnutrition, cognitive (dys)function and frailty increase with age and are associated with depression, these characteristics are likely to modify the treatment outcome of antidepressant drugs in late-life depression. This review examines how these five characteristics are taken into account in randomised controlled trials (RCTs) with antidepressant drugs for major depressive disorder in patients aged 60 years or above.
  
  
  
  A systematic search in PubMED, PsychInfo and EMBASE, from the year 2000 onwards, yielded 27 RCTs, with a total of 6356 subjects with a median age of 71 years. Two reviewers independently assessed whether each characteristic was considered as inclusion or exclusion criterion, descriptive variable, stratification variable, co-variable, outcome measure, or in adverse effect monitoring.
  
  
  
  Malnutrition and frailty were not taken into account in any study. Disability was used as an outcome measure in five studies. Two studies explicitly included a population with possibly serious medical co-morbidity. Cognitive status was the only condition taken into account as co-variable (n = 3) or stratifying variable (n = 1) and was used as outcome measure in seven studies.
  
  
  
  We conclude that geriatric characteristics are rarely taken into account in RCTs on antidepressant drugs in late-life depression, and studies including the oldest adults are underrepresented. This warrants recruitment of the oldest adults and adjustment of treatment strategies in future studies. Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: Department of Geriatrics/Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.|Department of Old Age Psychiatry and Geriatrics, Pro Persona Mental Health Care, Nijmegen, The Netherlands.
authors.forename: Carolien E M
authors.initials: CE
authors.lastname: Benraad
authors.affiliation: Department of Old Age Psychiatry and Geriatrics, Pro Persona Mental Health Care, Nijmegen, The Netherlands.
authors.forename: Floor
authors.initials: F
authors.lastname: Kamerman-Celie
authors.affiliation: Department of Old Age Psychiatry and Geriatrics, Pro Persona Mental Health Care, Nijmegen, The Netherlands.|Department of Internal Medicine, Section of Geriatrics, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Barbara C
authors.initials: BC
authors.lastname: van Munster
authors.affiliation: Department of Old Age Psychiatry, University Medical Center, Groningen, The Netherlands.
authors.forename: Richard C
authors.initials: RC
authors.lastname: Oude Voshaar
authors.affiliation: Program for Mood Disorders, Pro Persona Mental Health Care, Nijmegen, The Netherlands.|Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: Spijker
authors.affiliation: Department of Geriatrics/Radboudumc Alzheimer Center, Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Marcel G M
authors.initials: MG
authors.lastname: Olde Rikkert
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use*; D060825:Cognitive Dysfunction; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000188:drug therapy*; D006233:Persons with Disabilities; D000073496:Frailty; D006801:Humans; D044342:Malnutrition; D017063:Outcome Assessment, Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000928:Antidepressive Agents
keywords: aged; antidepressant drug; co-morbidity; cognitive function; disability; frailty; geriatric syndrome; major depressive disorder; malnutrition