Treatment of depression in nursing home residents without significant cognitive impairment: a systematic review
Open accessAbstract
BACKGROUND: Depression in nursing facilities is widespread and has been historically under-recognized and inadequately treated. Many interventions have targeted depression among residents with dementia in these settings. Less is known about depression treatment in residents without dementia who may be more likely to return to community living. Our study aimed to systematically evaluate randomized control trials (RCTs) in nursing facilities that targeted depression within samples largely comprised of residents without dementia. METHODS: The following databases were evaluated with searches covering January 1991 to December 2015 (PubMed, PsycINFO) and March 2016 (CINAHL). We also examined national and international clinical trial registries including ClinicalTrials.gov. RCTs were included if they were published in English, evaluated depression or depressive symptoms as primary or secondary outcomes, and included a sample with a mean age of 65 years and over for which most had no or only mild cognitive impairment. RESULTS: A total of 32 RCTs met our criteria including those testing psychotherapeutic interventions (n=13), psychosocial and recreation interventions (n=9), and pharmacologic or other biologic interventions (n=10). Seven psychotherapeutic, six psychosocial and recreation, and four pharmacologic or other biologic interventions demonstrated a treatment benefit. CONCLUSIONS: Many studies had small samples, were of poor methodological quality, and did not select for depressed residents. There is limited evidence suggesting that cognitive behavioral therapies, reminiscence, interventions to reduce social isolation, and exercise-based interventions have some promise for decreasing depression in cognitively intact nursing home residents; little can be concluded from the pharmacologic or other biologic RCTs.
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Some previous reviews excluded participants with dementia despite the high prevalence of dementia in long-term care populations.
“Some reviews excluded participants with dementia (Gramaglia 2021;Simning 2017), despite the high prevalence of dementia in LTC populations (Seitz 2010).”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Simning 2017
The Introduction says this review focused on nursing-facility residents without moderate or severe cognitive impairment. But the Methods (Inclusion and Exclusion Criteria; page unavailable) required only that at least 50% of a trial’s sample have mild impairment or better, so the review did not categorically exclude participants with dementia. The high-prevalence clause is attributed to a different citation. (LLM, conf=0.88)
Experimental — accuracy not yet measuredPrior reviews excluded LTC residents with dementia, despite the high prevalence of dementia and cognitive impairment in LTC residents.
“Further limitations in prior reviews include the exclusion of LTC residents with dementia”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Simning 2017
The Methods (Inclusion and Exclusion Criteria; page unavailable) show that this review focused on nursing-home trials in which at least 50% of participants had mild cognitive impairment or better. That criterion could exclude studies predominantly involving residents with dementia, but it did not exclude all residents with dementia. The Introduction also says that some other prior reviews included residents with dementia. (LLM, conf=0.86)
Experimental — accuracy not yet measuredOne review focused only on nursing homes and excluded studies of assisted-living facilities.
“One review focused only on nursing homes and excluded studies of lower-level dependency facilities (assisted-living facilities; Simning 2017).”
From Psychological therapies for depression in older adults residing in long-term care settings (2024) · cites this paper as Simning 2017
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Gramaglia, C., Gattoni, E., Marangon, D., Concina, D., Grossini, E., Rinaldi, C., Panella, M., & Zeppegno, P. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.685860 · Cited by 38 · see citing works
Psychological therapies for depression in older adults residing in long-term care settings
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Background
- Authors
- Simning, A., & Simons, K. V.
- Affiliations
- University of Rochester Medicine (US)
- Corresponding author
- Simons, Kelsey V.
- Venue
- International Psychogeriatrics
- Publisher
- Elsevier BV
- Published
- 2017-02
- Volume
- 29
- Issue
- 2
- Pages
- 209-226
- ISSN
- 1041-6102 (ISSN-L)
- PMC
- PMC5469363
- OpenAlex
- W2538435461
- Cited by
- 47
- References
- 62
- Citations by year
- 2026: 5 · 2025: 1 · 2024: 12 · 2023: 4 · 2022: 7 · 2021: 6 · 2020: 6 · 2019: 3 · 2018: 3
- FWCI
- 0.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Psychogeriatrics (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (L30 AG051177)
- Topics
- Health Sciences › Health Professions › General Health Professions › Geriatric Care and Nursing Homes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Social Sciences › Psychology › Clinical Psychology › Health and Well-being Studies
- Keywords
- depression, nursing home residents, older adults, cognitive impairment, psychotherapeutic interventions, cognitive behavioral therapy, reminiscence therapy, social isolation, exercise intervention, psychosocial interventions, pharmacotherapy
- MeSH terms
- Aged, Dementia, Depression, Exercise Therapy, Homes for the Aged, Humans, Mental Health, Nursing Homes, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Cognitive Dysfunction
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