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Notepad A tool to keep notes and your questions to the health professional
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Physical Activity Tailored to Older Adults
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Studies description
Depressive symptoms are avoided by... 74% of older adults
72% of older adults
2% of older adults
With Without Impact Studies and referencesRhyner et al. [2016]. Journal of aging and physical activity, 24(2), 234-236.
Design: Systematic review and meta-analysis of 41 randomized controlled trials; Participants: 2,780 older adults with or without a clinical diagnosis of depression; Intervention: Physical activity including tai chi, strength exercises, aerobics, yoga, aerobics and strength combo, and qigong, compared to any non-active control group; Follow-up duration: Tested immediately after the intervention.
- reduced risk of chronic disease and premature death
- independence and mobility
- improved fitness and bone health
- reduced risk of heat disease
- improved mood and self-esteem
- reduced risk of falls
- improved sleep.
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Studies descriptionStudies and references
Nelson et al. [2007]. Med Sci Sports Exerc;39(8):1435-45.
Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association.
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Studies descriptionStudies and references
El-Khoury et al. [2013]. BMJ 2013, 347:f6234.
Design: Systematic review of 17 randomised controlled trials; Participants : 4 305 older people aged 60 years and more living at home; Intervention : Physical activity (eg. Tai chi, balance exercices, strength exercices) with the aim of preventing falls.
Liu, C.-j., & Latham, N. K. [2009]. Cochrane Database Syst Rev(3).
Design: Systematic review of 121 randomised controlled trials; Participants: 6700 older people aged 60 years and more; Intervention: Progressive resistance strength training; Follow-up duration: Varied from the end of the intervention to 1 year.
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Studies descriptionStudies and references
Rhyner et al. [2016]. Journal of aging and physical activity, 24(2), 234-236.
Design: Systematic review and meta-analysis of 41 randomized controlled trials; Participants: 2,780 older adults with or without a clinical diagnosis of depression; Intervention: Physical activity including tai chi, strength exercises, aerobics, yoga, aerobics and strength combo, and qigong, compared to any non-active control group; Follow-up duration: Tested immediately after the intervention.
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Psychotherapy
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Studies description
A decrease in depressive symptoms is experienced by... 73% of older adults
40% of older adults
33% of older adults
With Without Impact Studies and referencesCuijpers et al. [2014]. Maturitas, 79(2),160-169.
Design: Meta-analysis of 44 randomized controlled trials; Participants: 1,161 depressed older adults (50+); Intervention: Psychotherapy, including cognitive behavior therapy (CBT), interpersonal psychotherapy (IPT), behavioral activation therapy, problem-solving therapy (PST), psychodynamic therapy, non-directive counselling, dialectic behavior therapy, and life review, compared to any control group; Follow-up duration: 6 months.
Gelenberg AJ, Freeman MP, Markowitz JC, et al; American Psychiatric Association (APA). Practice guideline for the treatment of patients with major depressive disorder, Third edition.
Fournier, L., Roberge, P., Brouillet, H. (2012) – Faire face à la dépression au Québec. Protocole de soins à l’intention des intervenants de première ligne. Montréal : Centre de recherche du CHUM (www.qualaxia.org/ms/jalons). -
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Studies descriptionStudies and references
Swift et al. [2012]. J Consult Clin Psychol, 80(4), 547-559.
Design: Systematic review of 669 studies; Participants: 83,834 adults who engaged in psychological or psychosocial intervention; Intervention: Psychological interventions; Follow-up duration: Unspecified.
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Studies descriptionStudies and references
Ladwig et al. [2014]. Verhaltenstherapie, 24(4), 252-263.
Design: Cross-sectional survey; Participants: 195 adults who consulted for depression; anxiety; schizophrenia; or personality, food, or other disorders; Intervention: Psychotherapy; Follow-up duration: 0 to 12 years (range of time since end of therapy).
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Antidepressants
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Studies description
A reduction of depressive symptoms is experienced by... 50% of older adults
36% of older adults
14% of older adults
With Without Impact Studies and referencesKok et al. [2012]. Journal of affective disorders 141(2), 103-115.
Design: Systematic review and meta-analysis of 51 randomized controlled trials of pharmacotherapy for geriatric depression; Participants: 3,389 depressed older adults (55+) without dementia; Intervention: Pharmacotherapy, including tricyclic antidepressants, selective serotonin reuptake inhibitors, and all other antidepressants, compared to placebo; Follow-up duration: Unspecified.
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Studies descriptionStudies and references
Coupland et al. [2011]. BMJ 343 : d4551.
Design: Population-based cohort study; Participants: 60,746 depressed older adults, diagnosed between the ages of 65 and 100, included in the study between 1996 and 2007; Intervention: Any type of antidepressants; Follow-up duration: Until 2008
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Studies descriptionStudies and references
Coupland et al. [2011]. BMJ 343 : d4551.
Design: Population-based cohort study; Participants: 60,746 depressed older adults, diagnosed between the ages of 65 and 100, included in the study between 1996 to 2007; Intervention: Any type of antidepressants; Follow-up duration: Until 2008
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Studies descriptionStudies and references
Consumer Reports [2017] Best Treatments for Depression - Drug Side Effects:
https://www.consumerreports.org/cro/2013/09/best-treatments-for-depression/index.htm
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Massage therapy
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Studies descriptionStudies and references
Sharpe et al. [2007]. Complementary therapies in medicine, 15, 157-163.
Design: Randomized controlled trial; Participants: 49 older adults (60+) living in community and scoring within one standard deviation of an average frailty-risk score; Intervention: Massage therapy, compared to guided relaxation intervention; Follow-up duration: Tested directly after the intervention
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Studies descriptionStudies and references
Cambron et al. [2007]. J Altern Complement Med;13(8):793-6.
Design: Cross-sectional study; Participants: 91 clients who completed all survey questions, the average age was 46 (range 19-77); Intervention: Massage therapy clinic at a health sciences university; Follow-up duration: 2 to 7 days post-massage
Cherkin et al. [2001]. Arch Intern Med ;161(8):1081-8.
Design: Randomized trial study; Participants: 262 patients aged 20 to 70 years who had persistent back pain; Intervention: Study compared 3 treatments: traditional Chinese medical acupuncture, therapeutic massage, and self-care education; Follow-up duration: 4, 10, and 52 weeks after randomization
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Light therapy
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Studies description
Depressive symptoms are decreased for... 58% of older adults
41% of older adults
17% of older adults
With Without Impact Studies and referencesLieverse et al. [2011]. Arch Gen Psychiatry, 68(1), 61-70.
Design: Randomized controlled trial; Particpants: 88 depressed older adults (60+); Intervention: Light therapy, BLT (pale blue, approximately 7500 lux), compared to placebo (dim red light, approximately 50 lux); Follow up duration: Three weeks after the end of the treatment
- Temporary mild discomfort of their eyes (blurred vision, eye strain, glare, seeing spots, irritation)
- Infrequent and temporary hypomania, irritability, headache, or nausea
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Studies descriptionStudies and references
Terman & Terman. [2005]. CNS Spectr, 10(8), 647-663.
Design: Literature review and evaluation; Participants: Patients with seasonal and nonseasonal depression; Intervention: Light therapy; Follow-up duration: Unspecified
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Watchful waiting
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Studies descriptionStudies and references
Hegel et al. [2006]. Gen Hosp Psychiatry, 28(3), 205-212.
Design: One group pre-test/post-test trial; Participants: 111 adults with minor depression; Intervention: Watchful waiting (all the participants spent a month waiting before randomization for another study); Follow-up duration: Tested immediately after the intervention
Whiteford et coll. [2006]. Psychol Med, 43(8), 1569-1585.
Design: Systematic review and meta-analysis of 19 trials (2 randomized controlled trials: wait-list group and 1 observational cohort study for older adults); Participants: 94 depressed older adults; Intervention: Wait list or simply observation as a form of watchful waiting; Follow-up duration: 52 weeks
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Studies descriptionStudies and references
Fröjdh, Håkansson, Karlsson & Molarius. [2003]. Social Psychiatry and Psychiatric Epidemiology, 38 (10, 557-562).
Design: Cohort study, investigation of the progression of depression; Participants: 627 depressed older adults living in the community; Follow-up duration: 6 years
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Studies descriptionStudies and references
Woo et al. [2000]. The Journals of Gerontology: Series A, 55(2), M64-M69.
Design: Prospective cohort study, investigation of risk factors for institutionalization; Participants: 957 older adults living in the community and in institutions (but risk factors only calculated for participants in the community at baseline); Intervention: Watchful waiting; Follow-up duration: 3 years
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Physical Activity Tailored to Older Adults
Physical activity programs can be adapted to older adults. They may include walking, water exercises, balance or flexibility exercises, and weight training. They can be done at home or with other people. The activities should produce a sensation of warmth, and make you breathe harder. You should still be able to hold a conversation while partaking in the activity, but not to sing.
For every 100 older adults who are physically active, 2 feel a reduction of their depressive symptoms because they are physically active.
Regular physical activity has several additional benefits, for example:
Some older adults feel temporary muscle soreness after exercising. They can also experience muscle, bone or joints problems (for example minor strains, tendonitis, exacerbation of osteoarthritis, or joint pain).
To achieve an impact on their depressive symptoms, people must be physically active at least 3 weeks, either for 20 minutes 3 times a week, or for 2 hours once a week. Whatever the duration and frequency of the exercise, it takes time.
Psychotherapy
Psychotherapy aims to improve an individual's well-being and mental health by having them talk with a psychiatrist, psychologist, or other mental health provider. During psychotherapy, you learn about your condition and your moods, feelings, thoughts, and behaviours. Various psychotherapy techniques can treat depression, including cognitive-behavioral and interpersonal therapies. Psychotherapy may be delivered in person (one-on-one or with couples, or in groups), over the phone, via telephone counseling, or via the Internet.
For every 100 older adults who receive psychotherapy, 33 experience a decrease in their depressive symptoms due to psychotherapy.
For every 100 individuals who receive psychotherapy, 20 discontinue therapy due to costs, moving, lack of progress, dissatisfaction with therapy, stress during therapy.
People who receive psychotherapy may experience adverse effects. For every 100 individuals who receive psychotherapy: 16 report negative personal changes, 15 report stigmatization, 12 report negative impacts on their relationships, 3 report therapist abuse.
Patients require a referral from their physician to see a psychotherapist in the public system. Wait times are approximately one year, depending on the problem. Psychotherapy is also offered in the private sector, at a cost of approximately $100 per session.
Antidepressants
Antidepressants are drugs used to treat depressive disorders. There are various types, including selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors, tricyclic antidepressants, and monoamine oxidase inhibitors. Clinicians generally recommend they be introduced gradually and taken on a daily basis.
For every 100 depressed older adults without dementia who take antidepressants, 14 see their depressive symptoms reduced due to these medications.
Taking antidepressants increases an older adult's risk of dying.
Older adults taking antidepressants can experience adverse effects of these medications. For every 1,000 older adults taking antidepressants: 2 attempt suicide or self-harm, 30 experience a falls, 20 suffer fractures, 2 experience intestinal bleeding.
People who take antidepressants may experience other reversible adverse effects, such as diarrhea, dry mouth, fatigue, headache, nausea, loss of libido, sweating, or change in weight.
Antidepressants are generally partially covered by public insurance plans, but you may have to pay to get your prescription.
Massage therapy
Massage therapy consists of receiving massages from a qualified professional on a regular basis. In the studies reported here, the types of massage used included Swedish, neuromuscular, and myofascial techniques. According to the studies, massages were generally received twice a week for 4 weeks.
Massage therapy reduces depressive symptoms and stress in older adults. It also increases their well-being, vitality, and general health.
People who receive massage therapy may experience adverse effects. For every 100 individuals who receive massage therapy:
- 13 experience discomfort or pain
- 1 develops bruises
- 1 feels tired
- 1 has headaches after the session
Massage therapy requires the use of different types of oil, which may cause allergic reactions in some people.
One session of massage therapy costs approximately $60 to $100. While massage therapy is not covered by public insurance, some private insurance plans may refund it.
Light therapy
Light therapy consists of exposure to daylight or to an artificial light that mimics natural outdoor light. The exposure should last 30 to 120 minutes per day, for 1 to 10 weeks.
For every 100 depressed older adults who undergo light therapy, 17 experience a decrease in their depressive symptoms due to the light therapy.
People who undergo light therapy can experience:
To be effective, the person generally needs to undergo light therapy daily. This takes time. You also have to buy the equipment.
Watchful waiting
Consists of keeping an eye on your mood swings, without undertaking treatment or changing your lifestyle. For depressive symptoms, watchful waiting should comprise scheduled follow-ups with a professional, to monitor changes in your mood together.
For every 100 older adults who suffer minor depression, 13 recover within one month while doing nothing specifically to improve their mood.
For every 100 older adults who suffer major depression, 34 recover within one year, without taking any specific action.
Among people who make changes to reduce their depressive symptoms, a certain proportion will not improve. They may be disappointed that the steps they took did not allow them to reach their goals.
All the available options to improve mood can cause some inconveniences. These inconveniences are reviewed in the previous pages of this document. People who do not undertake any new treatment or changes to their lifestyle will not experience any of these inconveniences.
For every 100 older adults living with depression, 8 will die within 6 years due to their depression.
Older adults living with depression for three years are twice as likely to be admitted to a long-term care facility as older adults who do not suffer from depression.
Depression can impair a person's relationships with family and friends, as well as their generalfunctionning.
© Laval University, 2018 - Conflicts of interest - Credits
Any estimate of effect is very uncertain.
Downgraded because of risks of bias (lack of information on allocation concealment and random sequence generation) and heterogeneity in the estimate of effect.