Characteristics and effectiveness of cognitive behavioral therapy for older adults living in residential care: a systematic review

Chan, Phoebe; Bhar, Sunil; Davison, Tanya E.; Doyle, Colleen; Knight, Bob G.; Koder, Deborah; Laidlaw, Ken; Pachana, Nancy A.; Wells, Yvonne; Wuthrich, Viviana M.

doi:10.1080/13607863.2019.1686457

Cited by 17 publications

(6 citation statements)

References 36 publications

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“…The relevance of these findings to older adults is unclear, given entirely different age-specific individual and systemic psychosocial contexts as well as cognitive comorbidities. However, CBT has been adapted for depression and suicide prevention in older adults (Bhar and Brown, 2012) and a systematic review of individual and group-based CBT to treat depression and anxiety in RACF residents showed some evidence of efficacy and good acceptability to residents and RACF staff (Chan et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

A systematic review of evidence-based aftercare for older adults following self-harm

Wand

Browne

Jessop

et al. 2022

Aust N Z J Psychiatry

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Objective: Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. Methods: Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. Results: Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. Conclusion: Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.

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Section: Discussionmentioning

confidence: 99%

A systematic review of evidence-based aftercare for older adults following self-harm

Wand

Browne

Jessop

et al. 2022

Aust N Z J Psychiatry

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“…The strongest evidence is for cognitive behavioral therapy (CBT), life review therapy, and problem-solving therapy (Jayasekara et al, 2015; Kanellopoulos et al, 2020; Lutz et al, 2021; Westerhof & Slatman, 2019). Most evidence on the effectiveness of psychotherapy for older adults with depression has come from samples of physically healthy, so-called “young–old” (55–75 years) home-living older adults (Cuijpers et al, 2014; Huang et al, 2015), or from samples of older adults living in long-term care facilities (Chan et al, 2021; Rabaioli-Fischer & Söder, 2021). There is some indication that psychotherapy is equally as effective for “old–old” (75+ years) adults as for young–old adults (Saunders et al, 2021).…”

Section: Older Adults With Long-term Care Needs Rarely Participate In...mentioning

confidence: 99%

Psychotherapists’ experiences providing at-home psychotherapy for home-living older adults with long-term care needs and depression.

Demmerle¹,

Gellert²,

Kessler³

2023

Journal of Counseling Psychology

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This study used qualitative methods to explore psychotherapists' experiences conducting at-home psychotherapy with older adults (60+ years) with long-term care needs and depression. We conducted semistructured interviews with 16 female psychotherapists (26-70 years old) who delivered at-home cognitive behavioral therapy to home-living older adults with long-term care needs and depression. We additionally conducted 10 patient case studies. Using an adaption of the methodology of grounded theory, we iteratively developed a hierarchical model. Results showed that psychotherapists experienced three dilemmas: (a) pushing for change versus acknowledging limitations, (b) providing help versus maintaining boundaries, and (c) being a guest in the patient's home versus the host of a psychotherapy session. The absence of a shared understanding of therapy and confrontation with patients' existential suffering intensified the experience of the dilemmas. The dilemmas generated professional self-doubt and negative emotions, which in turn triggered a reflexive process and ultimately participants' professional development. Participants found a way to integrate drives initially perceived as mutually exclusive, and further developed their professional self-image and therapeutic techniques. We interpret the dilemmas as reflecting difficulty reconciling the "curing" and "caring" treatment paradigms. Practice and support managing the three dilemmas along with reflection on the curing paradigm, views on old age, and fear of existential suffering should be part of qualifications for psychotherapists working with older adults in need of care. Cooperating with other care providers may relieve the pressure on psychotherapists to provide forms of support that could lead to overburden and impede therapeutic progress. Public Significance StatementOur study provides unique insight into psychotherapists' experiences conducting at-home therapy with home-living older adults (60+ years) with long-term care needs and depression. Psychotherapists experienced three dilemmas reflecting difficulty balancing the goals of "curing" and "caring." Addressing these dilemmas in clinical training and supervision may help prepare psychotherapists to work with homeliving older adults with long-term care needs.

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“…Behavioural strategies include activity scheduling, relaxation, problem solving and behaviour modification strategies [ 20 ]. Cognitive techniques assist individuals to identify and modify maladaptive patterns of thinking [ 21 , 22 ]. Reminiscence involves recounting and sharing memories of enjoyable experiences, important life events, and problem solving success [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Study protocol for ELders AT Ease (ELATE): a cluster randomised controlled trial of cognitive behaviour therapy to reduce depressive symptoms in aged care residents

Bhar,

Davison,

Schofield

et al. 2023

BMC Geriatr

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Background This protocol describes a study of the effectiveness of cognitive behaviour therapy (CBT) for reducing depressive symptoms in older adults living in residential aged care (RAC) facilities in Australia. Depressive symptoms are highly prevalent in this population, yet the benefits of CBT for reducing such symptoms in RAC facilities have not been widely investigated. Elders at Ease (ELATE) is a 16-session CBT intervention designed for implementation in RAC facilities. The intervention includes cognitive, behavioural and reminiscence strategies and is delivered by mental health trainees (MHTs) in collaboration with RAC facility staff and residents’ family. Methods and analysis ELATE will be evaluated using a cluster randomised trial comparing outcomes for residents who participate in the intervention with those living in usual care control facilities. The participants are RAC residents aged 65 years or above, with depressive symptoms (Patient Health Questionnaire-2 ≥ 3) and normal cognition or mild cognitive impairment (Standardised Mini Mental Status Examination ≥ 21). They are assessed at four time points: baseline prior to randomisation (T1), mid-treatment (T2; 2.5 months post randomisation), post-treatment (T3; 5 months post-randomisation) and 3-month follow-up (T4; 8 months post randomisation). The primary outcome is change in depressive symptoms between T1 and T3. Secondary outcomes are depressive symptoms at T4, anxiety, suicide ideation, sleep problems, quality of life, staff and family knowledge of late-life depression, stress levels and efficacy in caring for residents, and MHT levels of geropsychology competencies. Residents receiving the intervention are hypothesised to report a greater decrease in depressive symptoms between T1 and T3 compared to residents receiving usual care. The primary analysis is a regression, clustered over site to account for correlated readings, and independent variables are condition and depressive symptoms at T1. A cost-utility analysis is also undertaken. Discussion ELATE is a comprehensive CBT intervention for reducing depressive symptoms in RAC residents. It is designed to be implemented in collaboration with facility staff and residents’ families, individually tailored to residents with normal cognition to mild cognitive impairment and delivered by trainee therapists. ELATE offers a model that may be widely applicable across the RAC sector. Trial registration Trial registered with the Australian and New Zealand Clinical Trial Registry (ANZCTR) Number ACTRN12619001037190, prospectively registered on 22 July 2019.

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Characteristics and effectiveness of cognitive behavioral therapy for older adults living in residential care: a systematic review

Cited by 17 publications

References 36 publications

A systematic review of evidence-based aftercare for older adults following self-harm

A systematic review of evidence-based aftercare for older adults following self-harm

Psychotherapists’ experiences providing at-home psychotherapy for home-living older adults with long-term care needs and depression.

Study protocol for ELders AT Ease (ELATE): a cluster randomised controlled trial of cognitive behaviour therapy to reduce depressive symptoms in aged care residents

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