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Telemedicine-based interventions can improve depressive symptoms in isolated older adults

Goodarzi Z, Watt J, Kirkham J, Seitz D, Ismail Z, Tricco A, et al. Depression in community residing elders (DIRE): A rapid review of depression telemedicine interventions for older adults living in the community Canadian Institutes for Health Research. 2020.

Review question

•      What is the effectiveness of telemedicine and remote interventions for community-dwelling older adults (over 60 years of age) who experience depressive symptoms or depressive disorders?

Background

•      The infection prevention and control measures enacted during the COVID-19 pandemic have disproportionately affected older adults and put them at a higher risk for social isolation and depression.

•      Many effective interventions such as psychotherapy are available for older adults with depression. However this population often experiences barriers to accessing mental health services.

•      This has resulted in an urgent need to understand the effectiveness, acceptability and cost of telemedicine-based interventions for treating depression in older adults.

How the review was done

•      A detailed search of five electronic databases was conducted to identify studies published up to May 25, 2020. Studies that compared the effectiveness of telemedicine to usual care for reducing depressive symptoms in community-dwelling older adults were included. Telemedicine includes any remote intervention conducted over telephone, videoconferencing, or the internet.

•      A total of 1,966 studies were identified in the initial searches, and 14 were included in the review after assessing their eligibility.

•      This rapid review was funded by the Canadian Institutes of Health Research Knowledge Synthesis: COVID-19 in Mental Health and Substance Use.

What the researchers found

•      Telemedicine interventions described in the included studies were conducted over the telephone or the internet. Telephone interventions were administered by counsellors, social workers, nurses or psychologists whereas internet interventions combined self-guided cognitive behavioural therapy (CBT) with guidance from a clinician.

•      CBT is an effective form of psychotherapy for treating depression and anxiety in adults and adapts well to a virtual setting. Several included studies added a component of clinician guidance to allow for ongoing feedback and reinforcement to mirror the components of in-person CBT.

•      Changes in mean depression scores suggest that these telemedicine-based interventions may be effective in older adults. 

Conclusion

•      Since many healthcare providers are trained to conduct CBT, remote delivery could be offered to older adults during the COVID-19 pandemic.

•      As this was a rapid review, a more comprehensive search should be conducted to identify any further literature on this topic.

•      More evidence on costs and effectiveness is needed before making firm recommendations.