Effective Treatments For Late Life Depression In Long-Term Care Facilities

Background: Nursing homes and assisted living facilities represent two types of long-term care environments commonly referred to as extended care facilities. Residents of long term care facilities suffer from a high rate of depression. However, few residents receive needed mental health services. Given high rate of depression diagnosed in older residents, knowledge of effective treatment is crucial. The aim of this study is to explore the effective treatments to reduce depression on older residents within the extant literature.

Design and Method: We analyze the extant literature (N=1,751) to identify the effective treatments to manage depression of older residents. After classifying the peer reviewed articles using Klein and Bloom's categories (i.e., empirical, technological, conceptual, valuable, and commentary), we use the Systematic Research Synthesis to investigate the effectiveness of various treatments on depression among older residents. We analyzed 18 articles from 1990 to 2004, which are met on the eligibility criteria. We analyzed the number of subjects, designs and methodologies, residential types, intervention types and duration of treatment, standardized measures, and findings.

Results: We found that 14 articles employed experimental design with random assignment to treatment condition. Three studies used quasi-experimental design with nonrandom assignment to treatment and control groups. 15 articles were group treatment and 3 were based on individual treatment or interview. The two major treatments are grouped into 7 biological intervention that used pharmacological treatment (i.e., antidepressant medication) and 8 psychological treatment that used cognitive-behavioral treatment, problem-solving treatment, or reminiscence therapy. 5 studies conducted pre- and post-test to compare the treatment effect. 2 studies used double blind manner to compensate the possibility of instrumentation threats to internal validity. One study used both semi-structured interview and structured clinical interview for diagnosis. One study conducted four evaluation sessions (i.e., nortriptyline and interpersonal psychotherapy, nortiptyline and clinical visits, placebo and psychotherapy, or placebo and clinical visits) to assess the depression symptomology. The results show that antidepressant medication treatment appears less efficacious in treating less severe depression. These findings reveal that minor depression should be treated initially with a nonpharmacologic intervention to avoid unnecessary medication risks.

Conclusion and Implications: The findings reveal that depression is a treatable symptomology by effective treatment and older people are more sensitive and very vulnerable to side effects. These findings suggest that the combined treatment with medication and psychotherapy might be considered to compare the effective interventions for depressed older adults in different residential conditions. The implication is that a nonpharmacologic intervention in long-term care settings, particularly in assisted living facilities, should be designed to meet the particular psychological challenges that residents face.