Specialisation: Older Adults

Efficacy of Telehealth Interventions in Treating Depression Among Older Adults

Provisioning care that optimizes outcomes requires the use of evidence-based nursing practice. Nurses utilize their experiences in the care process and leadership to identify issues that can be addressed and improved with evidence-based interventions. Depression disorder (MDD) is one of the most prevalent and impactful health disorders among older adults. According to the World Health Organization (2023), an estimated 3.8% of the population experience depression, including 5% of adults (4% among men and 6% among women) and 5.7% of adults older than 60 years. The number sums to approximately 280 million people in the world who have depression. However, health insurance unavailability/lack of funds, inadequate providers and access, transit problems, shame, and suffering from mental ailment may lead to barriers to care. These challenges can be worse for the aged due to diminished cognitive and or sensory impairments, being alone socially as well as physical sicknesses.

In recent years, telehealth is increasingly used for synchronous provision of behavioral health services. Telepsychology and telepsychiatry delivered via technology simultaneously promise to improve access to care and overcome barriers to treatment (Guaiana et al., 2020). Factors such as stigma and practical issues like lack of transport or difficulty in taking time off from work hinder individuals from accessing care. Telehealth improves healthcare accessibility for remote service members, offers flexible appointment times, and eliminates the need for constant presence in mental health clinics. This paper explores telehealth interventions as a potential solution and proposes an evidence-based practice change.

PICOT question

In older adults aged diagnosed with depression (P), does the implementation of telehealth interventions (I) compared to traditional in-person therapy (C), lead to a significant reduction in depressive symptoms (O) over a 12-week intervention period (T)?

Method of Studies

Bellanti et al. (2021) utilized a rapid review methodology to investigate the effectiveness of behavioral health treatments delivered in person compared to telehealth. The methods included a systematic search of the PubMed database, hand-searching of relevant systematic reviews, dual screening, single-person data abstraction verified by a second person, and dual risk of bias assessment. The study involved 22 RCTs, of which eight evaluated the efficacy of TH among populations with PTSD, depression, or mixed diagnoses using non-inferiority trials. Quantitative analyses were not conducted because of variations in heterogeneity among the studies. This methodology provides a strong base for comparing the efficiency of telehealth programs for mental health disorders. It gives useful ideas regarding how it can be employed to treat depression among the elderly.

Schiller et al. (2023) tested online depression therapies. The study used systematic reviews and meta-analyses of 2010–2021 RCTs. Remission, responsiveness, and depression severity following treatment had varying outcomes. Reporting followed PRISMA standards, The Cochrane Handbook, and AHRQ recommendations for systematic reviews. The study examines virtual depression interventions using a broad search strategy, inclusion criteria, and consistent data extraction. It addresses all research questions in evidence-based practices by identifying bias sources, improving trial quality, and adjusting for heterogeneity.

Belanger and Winsberg (2022) compare telepsychiatric care for depression in older and younger persons. Psychiatric care was provided to 12,908 U.S. adults aged 18–82 from October 2018 to January 2022. With 23 covariates, propensity matching created two comparable groups, older and younger. Repetition ANOVA was used to assess PHQ-9 results. Using real-world data from a telehealth platform improved internal validity and revealed the age-specific effectiveness of telepsychiatric therapy. Propensity matching and repeated measurements ANOVA improve the study’s likelihood of answering the research topic.

Guaiana et al.’s (2020) systematic study analyzes telepsychiatry for unipolar depression. The review covered randomized controlled trials (RCTs) of persons 18 or older with unipolar depression in diverse clinical settings and healthcare practitioners. Between 1946 and 2019, studies have to employ teletechnology and be published in English. The review eliminated trials with substantial medical comorbidities, children under 18, non-video treatments, and non-RCT designs. A systematic literature search across several databases examined acceptability, patient satisfaction, efficacy, and cost-effectiveness. The review covers 1946–2019, offering a complete overview of depression telepsychiatry therapies.

Results of Studies/Key Findings

Bellanti et al. (2021) found 22 main RCTs assessing telepsychiatry in depression. Moreover, non-inferiority was demonstrated by telehealth modalities using telephone and video teleconferencing over in-person interventions across various psychotherapies. In relation to depression, telephone-based cognitive behavioral therapy (CBT) was found to be as effective as face-to-face CBT, with the added benefit of improved treatment attendance. As regards PTSD, video teleconferencing based on EBTs was generally no different from face-to-face therapies, although some studies had higher drop-out rates amongst telehealth groups. Satisfaction and therapeutic alliance were similar between telepsychiatry and in-person options, thus indicating its feasibility and acceptance in diverse populations such as veterans. This research report highlights that mental health care can be made less expensive and more accessible through a telemental health approach.

Guaiana et al. (2020) found telepsychiatry preferred by patients as the best alternative to direct physician contact or compared favorably with it regarding treatment acceptability and patients’ attitudes. The efficacy evaluations revealed even better outcomes connected with telepsychiatry interventions than comparable treatments using conventional systems. Few of them excluded the cost implications of reduced travel, while others did not find any telemedicine expenses reduction. In contrast, some research articles reported on the cost-effectiveness of telemedicine more than those for traditional care. These findings confirm the viability, satisfaction, effectiveness, and potential savings related to depression treatment through telemedicine services.

Belanger and Winsberg (2022) showed substantial baseline differences between the four age groups in an initial sample of 12,908 individuals. Older adults have fewer fully employed individuals, higher incomes, more graduate degrees, chronic medical conditions, and diverse mental health histories compared to younger adults. However, there were similar groups after propensity matching was done despite such variances. Both age groups had a reduction in depression severity over time with telepsychiatric care, as shown by repeated measures analysis. Therefore, virtual modalities utilized by older adults produce equal depression outcomes as in younger adults, thereby challenging assumptions about older adults’ technology aversion.

According to Schiller et al. (2023), virtual interventions, primarily cognitive-behavioral therapy (CBT), demonstrated superior outcomes compared to waitlist and TAU regarding remission, response, and depression severity. Specifically, virtual interventions had higher odds of remission than waitlist (OR 10.30) and TAU (OR 2.27). Depression severity reduction was greater with virtual interventions than waitlist (SMD 0.81) and TAU (SMD 0.59). Virtual CBT outperformed attention control in remission (OR 1.92) and depression severity (SMD 0.25).

Outcomes Comparison

The anticipated outcomes for the PICOT question involve expecting a significant reduction in depressive symptoms among older adults diagnosed with depression over a 12-week intervention period when telehealth interventions are compared to traditional in-person therapy.

Comparison with selected articles

According to Bellanti et al. (2021), various psychotherapies yielded non-inferiority with online interventions, such as telephone and video teleconferencing. Cognitive Behavioral Therapy (CBT) delivered over the phone was found to be as effective as it’s in–person counterpart but with better treatment contact rates. The finding is consistent with the expectation of substantial decreases in depressive symptoms through telehealth.

Schiller et al. (2023) found that Internet-based anxiety and depression treatments like CBT are more effective than conventional treatments or no treatment in terms of remission, response, and depression severity. It implies that virtual therapies may improve remission and depression severity reduction to satisfy telehealth intervention goals. Telepsychiatric care reduces depression severity with time, according to Belanger and Winsberg (2022). The PICOT results were as expected, demonstrating that virtual modalities can produce depression effects comparable to traditional therapy. Guaiana et al. (2020) found that patients preferred telepsychiatry to medical visits. Moreover, telepsychiatry interventions outperformed comparable treatments. This supports previous predictions about telemedicine therapy for depressed older individuals.

Proposed Evidence-Based Practice Change

Effective interventions for the treatment of depression among older adults are the focus of the PICOT question. The research articles indicate that telehealth solves this problem by overcoming access barriers and yielding satisfactory results. Various barriers hinder the optimization of depression care for older adults in nursing practice. The proposed evidence-based practice change is integrating and promoting telehealth interventions like telepsychiatry as well as virtual interventions such as cognitive behavioral therapy to enhance patient care for depression in older adults. The practice will enhance accessibility, reduce barriers, and ensure effective management of depression. The effectiveness of this practice change requires a comprehensive evaluation, including monitoring depressive symptom severity, treatment adherence, patient satisfaction, and follow-up rates. There should also be constant feedback from patients and healthcare providers for continuous improvement.

Conclusion

The evidence-based practice change of incorporating telehealth interventions for depression in older people is supported by the chosen articles. Expected results correspond with the affirmative findings from the study that stress the efficiency of telepsychiatry and virtual interventions. The recommended alteration solves not just nursing practice trouble but also encourages patient-centered care, aiming at better access and contentment in providing depression treatment to elderly people. The success of this practice change will require continuous assessment of outcomes.

References

Belanger, H. G., & Winsberg, M. (2022). Do older adults benefit from telepsychiatric care: Comparison to younger adults. Frontiers in Psychiatry13. https://doi.org/10.3389/fpsyt.2022.998401

Bellanti, D. M., Kelber, M. S., Workman, D. E., Beech, E. H., & Belsher, B. E. (2021). Rapid review on the effectiveness of telehealth interventions for the treatment of behavioral health disorders. Military Medicine187(5-6), e577–e588. https://doi.org/10.1093/milmed/usab318

Guaiana, G., Mastrangelo, J., Hendrikx, S., & Barbui, C. (2020). A systematic review of the use of telepsychiatry in depression. Community Mental Health Journal57(1), 93–100. https://doi.org/10.1007/s10597-020-00724-2

Schiller, C. E., Prim, J., Bauer, A. E., Lux, L., Lundegard, L. C., Kang, M., Hellberg, S., Thompson, K., Webber, T., Teklezghi, A., Pettee, N., Gaffney, K., Hodgins, G., Rahman, F., Steinsiek, J. N., Modi, A., & Gaynes, B. N. (2023). Efficacy of virtual care for depressive disorders: systematic review and meta-analysis. JMIR Mental Health10, e38955. https://doi.org/10.2196/38955

World Health Organization. (2023, March 31). Depressive disorder (depression). World Health Organization. https://www.who.int/news-room/fact-sheets/detail/depression#:~:text=An%20estimated%203.8%25%20of%20the

Depression in Older Adults

Chronic melancholy, a lack of optimism, and a lack of interest in previously pleasurable activities are hallmarks of depression in older people. It is a frequent problem that can seriously affect someone’s physical and mental health and quality of life. Both patients and medical professionals need to be aware of the signs and symptoms of depression in the elderly, as this population is prone to being undiagnosed and untreated. Sleep disturbances, feelings of sadness that do not go away, difficulty focusing, an overwhelming sense of guilt or worthlessness, and a loss of interest in formerly pleasurable activities are commonly associated with depression. Alterations in physical characteristics, such as weariness, gastrointestinal distress, and a loss of appetite, may also be present. Many things can contribute to depression in older adults, including physiological and psychological stresses, environmental shifts, and loneliness (Maier et al.,2021). Many of these concerns are not exclusive to the elderly, and depression can strike people of any age. Medication, counseling, and behavioral modifications are only some options for treating depression in the elderly. Psychotherapy can help treat various conditions.

The article “Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association” by Agüera-Ortiz et al. (2020) reports on a consensus on geriatric depression promoted by the Spanish Psychogeriatric Association. This study employs the Delphi technique to reach a consensus on various topics related to treating depression in the elderly and then conduct two separate analyses using those findings. One discusses picking the right antidepressant medication for a person based on their other medical conditions. The other looks at ways to better spot and treat depression in the older population. The study indicates that despite the frequency and significance of depression in the elderly, the topic is still understudied and often contentious. Important findings and suggestions for spotting and treating depression in the elderly are provided in this article.

Maier et al. article comprehensively analyze the factors that increase or decrease the likelihood of developing depression in persons aged 65 and up. Physical health issues, mental retardation, social isolation, and stressful life experiences were all recognized as risk factors for the development of depression in this population by the review. Strong social support, regular exercise, and engagement in worthwhile endeavors all help protect older persons from developing depression (Maier et al.,2021). The authors stress the importance of therapies that focus on these protective and risk factors to combat depression and improve the emotional health of the elderly. In sum, the study is a helpful resource for understanding the causes and risk factors for depression in the elderly and potential solutions to this serious public health problem.

“Prevalence and Determinants of Depression among Old Age” article does a meta-analysis and systematic review of the prevalence and causes of depression in the elderly. Seventy studies that satisfied the authors’ inclusion criteria were found after a comprehensive search of electronic databases. Estimates for depression in the elderly ranged from 5% to 63% (Zenebe et al.,2021). The study also found that women, the poor, the uneducated, those with physical sickness, and those with cognitive disabilities all had a higher risk of developing depression than men. The authors conclude that older persons’ rates of depression are high enough that preventative measures and outreach programs aimed at this demographic are warranted.

Depression is a severe problem that needs to be addressed, especially among the elderly. It is worth noting that indicators of depression in this age group could look different than in others. Physical signs of depression, such as weariness, discomfort, and digestive disorders, may be more common in the elderly than the typical psychological symptoms of depression. Loved ones and medical professionals must recognize these shifts and manage the elderly accordingly. Older folks can take charge of their mental health and quality of life with the correct amount of encouragement and tools.

Works Cited

Agüera-Ortiz, Luis, et al. “Depression in the Elderly. Consensus Statement of the Spanish Psychogeriatric Association.” Frontiers, Frontiers, 16 Apr. 2020, https://www.frontiersin.org/articles/10.3389/fpsyt.2020.00380/full.

Maier, Alexander, et al. “Risk Factors and Protective Factors of Depression in Older People 65+. A Systematic Review.” PLOS ONE, Public Library of Science, 13 Apr. 2021, https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0251326.

Zenebe, Yosef, et al. “Prevalence and Determinants of Depression among Old Age: A Systematic Review and Meta-Analysis – Annals of General Psychiatry.” BioMed Central, BioMed Central, 18 Dec. 2021, https://annals-general-psychiatry.biomedcentral.com/articles/10.1186/s12991-021-00375-x.