The Utility or Futility of Treatment for Depression & Anxiety in Later Life: A Qualitative systematic review looking at older people’s attitudes and beliefs about whether depression and anxiety should be treated in later life and if so, how?

Problem

Symptoms of depression and anxiety are common in later life, but the evidence for successful medical treatments is limited and such treatments may not be accessed or even desired. We aimed to explore:1. Do older people think depression and anxiety in later life should be treated?2. What do older people think about the utility or futility of current available treatments for depression and anxiety in later life, and what might be better?

Approach

Systematic review of qualitative studies. We searched MEDLINE, EMBASE, CINAHL, ASSIA, PsychInfo, PsychExtra (October 2017). We included all qualitative studies exploring older people’s (mean age 65+) views regarding depression and anxiety in later life and whether and how it should be treated. We excluded studies focussing on people with severe mental health disorders or already receiving specific treatments. Two reviewers appraised quality using the CASP tool. Thematic synthesis is currently being undertaken.

Findings

(preliminary) We screened 7105 titles and abstracts and 37 full texts. We included 11 studies for thematic synthesis (7 US, 1 Canadian, 2 UK and 1 Netherlands).1. Older people’s ideas about whether depression and anxiety should be treated in later life? Preliminary themes indicate that many older people regard depression as a normal part of ageing, citing many reasons to be depressed in later life. There is a feeling that depression, like many other things in life, is something that will ‘pass with time’, without the need for treatment. Having inner strength, resilience and control over how you feel emerged as important themes. Denial of depression, seeing depression as a weakness and stigma also emerged as important barriers to seeking treatment.2. Older people’s preferences for treatments of depression and anxiety in later life? There was a strong preference for self-management of depression through non-medical behavioural strategies, such as getting out of the house, attending day centres, volunteering, prayer and seeing friends and family. Resilience and having a positive mental attitude were seen to be important coping strategies. There was more ambivalence towards medical interventions, such as antidepressants, counselling/psychological therapies and the role of the GP. Ethnicity was an influential factor on treatment preference, especially in African-American populations.

Consequences

The preliminary results from this review indicate that supporting older adults in self-management of depression and social interventions may be more acceptable in this age group than medication and talking therapies. It suggests that current medical interventions for older people need to be improved; by integrating them to a greater degree within older people’s social networks, these interventions might be made more relevant and accessible.