Effectiveness of Telehealth in Chronic Disease and Comorbid Mental Health Issues Among Older Adults: A Systematic Review and Meta-Analysis

Background: Telehealth is an innovative health service that uses electronic media such as telephone, video, internet, mobile, tablets, and monitoring devices. Studies have shown telehealth to be effective in treating and managing chronic illness, decreasing emergency visits and hospitalizations, and altering diet and exercise patterns (Wootton, 2012; Botsis & Hartvigsen, 2008). Yet, little is known about Telehealth service for comorbid depression, which is prevalent among older adults with chronic disease. This systematic review aims to review the effectiveness of interventions in studies using telehealth technology for geriatric mental health care.

Methods: The search was limited to peer-reviewed journal articles published between January 2001 and December 2014 from six databases. Articles met the following criteria: 1) randomized controlled trial; 2) participants’ mean age of 60 years or older; 3) telehealth intervention; 4) outcomes of depression, anxiety/distress, health-related quality of life; and patient self-efficacy of disease management. Telehealth intervention was defined as a treatment provided in the patient’s home and included counseling, health education, telemonitoring, video-based care, and/or web-based care. Seventeen studies were assessed using the Handbook of Cochrane Collaboration Review of Randomized Controlled Trials. Standardized effect sizes (Hedges) for mean differences in clinical outcomes were calculated to determine relative effectiveness of telehealth interventions. More than half of the studies reviews (55.6%) were conducted in the United States. A total of 4707 participants were included in the seventeen studies, and the sample sizes varied from 62 to 1573. The mean age of the participants ranged from 60 to 79 years (Mean=67.8). Of studies that provided race/ethnicity information, the proportion of Whites/Caucasians were high, ranging from 39% to 93%.

Results: Reviewed studies demonstrated moderate methodological quality (Mean: 5.9 out of 10) with almost 70% scoring at least 6 out of 10 on the Cochrane study methods quality scale. Telephonic plus telemonitoring interventions had the highest mean quality scores (7.0/10) while telemonitoring only interventions had the lowest (5.9/10). The majority of reviewed studies (88.9%) included an intervention protocol while 77.8% described the random allocation process. However, only two studies explained methods for addressing performance bias. A majority of studies (58.8%) used telephonic intervention while 11.8% used telemonitoring and 5.9% used web-based. Overall, telehealth interventions were more effective in improving depression, anxiety/distress, quality of life and self-efficacy in disease management than control interventions. Specifically, nine out of thirteen (69.2%) studies favored telehealth over controls on depression outcome measures. Meanwhile, six out of nine (66.6%) studies favored telehealth over control on anxiety measures, and two (40%) out of five studies favored telehealth over controls on health-related quality of life outcomes.

Implications: Findings of this systematic review suggest that Telehealth is likely effective in improving depression, distress, quality of life, and self-efficacy over controls in home-based geriatric populations, though, high quality trials are needed. This meta-analysis may assist health professionals in considering telehealth interventions for improving mental health among older adults.