Interventions to Reduce Depression in Nursing Home Residents: A Systematic Review

Background and Purpose: Depression is considered one of the most prevalent mental illnesses in older adults globally. Depression is also experienced more frequently by older adults living in nursing homes. Based on recent studies, it is estimated that depression affects up to 78% of adults living in nursing homes. Yet, depression is still considered to be commonly underdiagnosed and inadequately treated in nursing homes. While medication is a common intervention to treat depression, there are alternative interventions which can help in the treatment of depression without the need of pharmacological treatments. These alternative interventions usually target patients’ emotional and behavioral state. The primary objective of this systematic review aimed to evaluate the current interventions used to treat depression without the use of medication in adults 65+ living in nursing homes.

Methods: The Cochrane Handbook for Systematic Reviews was used to do a systematic search of published studies regarding interventions for depression in adults 65+ living in nursing homes. The following databases were consulted in March 2021: PubMed, Pro Quest and Age Line in search of articles published in English. Articles were selected according to the inclusion criteria which consisted of a depression intervention on adults 65+, living in nursing homes in the last 5 years. Pharmacological interventions were excluded as well as residents with dementia.

Results: A total of 6 studies met the search criteria. The search did not yield any studies in the United States. All the studies utilized a version of the Geriatric Depression Scale (GDS) to conduct pretest and posttest evaluations of the participants in control and intervention groups. All the studies resulted in a larger decrease in GDS scores for the intervention groups than the control groups indicating various levels of effectiveness in the interventions. Effect sizes between groups ranged from large negative to small negative sizes except for one study which resulted in a positive effect size. The limitation on the study with the positive effect size was that the pretest GDS scores of the control group were significantly lower than those of the intervention group.

Conclusions and Implications: This systematic review revealed that there is international recognition that depression in adults over the age of 65 living in nursing facilities is an item of concern. The effects of non-pharmacological interventions to treat depression for this population has been studied in multiple countries over the last five years but none of these studies were found in the United States. There is promising data that suggests that interventions that engage older adults in nursing homes, improve their depressive symptoms.