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Posttraumatic stress disorder in older adults: an overview of characteristics and treatment approaches
- Authors:
- BÖTTCHE Maria, KUVERT Philipp, KNAEVELSRUD Christine
- Journal article citation:
- International Journal of Geriatric Psychiatry, 27(3), March 2012, pp.230-239.
- Publisher:
- Wiley
Research on posttraumatic stress disorder (PTSD) in older adults can be assigned to 2 categories based on the period of life in which the trauma occurred. The first category covers older adults who were traumatised decades ago, such as veterans of World War II. The second category covers older adults traumatised more recently, such as victims of violence. The aim of this article is to review the available data on how the timing of the trauma impacts the prevalence and symptoms of late-life PTSD and to review the current treatment approaches. It demonstrates that the course and severity of PTSD symptoms in older adults depends on the time the trauma occurred. In the case of acute traumatisation, lower prevalence rates and symptom severities are generally observed in older than in younger populations. In the case of early-life traumatisation, a decline in PTSD symptom severity can be observed over the life course. Research on treatment approaches has produced promising results, indicating that disorder-specific interventions, such as trauma confrontation and cognitive restructuring, can be effectively combined with an age-specific narrative life-review approach.
Depression in older adults
- Authors:
- RODDA Joanne, WALKER Zuzana, CARTER Janet
- Journal article citation:
- British Journal of General Practice, 1.10.11, 2011, pp.683-687.
- Publisher:
- Royal College of General Practitioners
This clinical review draws on recent systematic reviews, meta-analyses, and randomised controlled trials to provide an overview of current approaches to the diagnosis and management of patients who develop late life depression. It covers older people at risk, the diagnosis of depression in older adults, how late life depression is managed, and drug and psychological therapies.
Psychotherapy with lesbian, gay, bisexual, and transgender older adults
- Authors:
- DAVID Steven, CERNIN Paul A.
- Journal article citation:
- Journal of Gay and Lesbian Social Services, 20(1/2), 2008, pp.31-49.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
There has been no research specifically addressing psychotherapy with older LGBT adults, and this review integrates findings from research on psychotherapy with LGBT people and with older people to identify evidence-based treatments. The areas discussed include adult development, coping, stigmatisation, social context and the effects of cohort membership. The findings suggest that evidence-based therapies can be adapted to a variety of issues encountered by older LGBT adults, and these modifications to therapeutic techniques are noted throughout. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Effects of psychotherapy and other behavioral interventions on clinically depressed older adults: a meta-analysis
- Authors:
- PINQUART M., DUBERSTEIN P. R., LYNESS J. M.
- Journal article citation:
- Aging and Mental Health, 11(6), November 2007, pp.645-657.
- Publisher:
- Taylor and Francis
The goal of the present study was to assess the effects of psychotherapy and other behavioural interventions on depressive symptoms in clinically depressed older patients. Meta-analysis was used to examine the effects of 57 controlled intervention studies. On average, self-rated depression improved by d=0.84 standard deviation units and clinician-rated depression improved by d=0.93. Effect sizes were large for cognitive and behavioural therapy (CBT) and reminiscence; and medium for psychodynamic therapy, psychoeducation, physical exercise and supportive interventions. Age differences in treatment effects were not observed. Weaker effects were found in studies that used an active control group and in studies of physically ill or cognitively impaired patients. Studies of samples comprised exclusively of patients suffering from major depression (versus other mood disorders) also yielded weaker intervention effects. On average, 18.9% of participants did not complete the intervention, with higher dropout rates reported in group (versus individual) interventions and in longer interventions. It is concluded that cognitive-behavioural therapy and reminiscence are particularly well-established and acceptable forms of depression treatment. Interventions with 7-12 sessions may optimize effectiveness while minimizing dropout rates. For physically and cognitively impaired patients, modifications in treatment format and/or content might be useful, such as combining psychotherapy with social work interventions and pharmacotherapy.
Non-pharmacological interventions for older adults with depressive symptoms: a network meta-analysis of 35 randomized controlled trials
- Authors:
- CHEN Ya-Ling, et al
- Journal article citation:
- Aging and Mental Health, 25(5), 2021, pp.773-786.
- Publisher:
- Taylor and Francis
Objective: To assess the effectiveness of non-pharmacological interventions for seniors with depressive symptoms. Methods: A comprehensive literature search was performed. We conducted network meta-analysis in two ways, intervention classes (psychosocial, psychotherapy, physical activity, combined, treatment as usual) and individual intervention (11 categories). Whenever included studies used different scales, the different instruments were converted to the units of the scale most frequently used (the Geriatric Depression Scale), such that the effect size was reported as a mean difference (MD) with 95% confidence interval (CI). The risk of bias of RCTs included in this review was assessed according to the Cochrane Handbook. Bayesian NMA was conducted using R-3.4.0 software. Results: A total of 35 RCTs with 3,797 enrolled patients were included. Compared to conventional treatment, physical activity and psychotherapy resulted in significant improvements in depressive symptoms (MD: 2.25, 95%CrI: 0.99–3.56; SUCRA = 86.07%; MD: 1.75, 95% CrI: 0.90–2.64; SUCRA = 66.44%, respectively). Similar results were obtained for music (MD: 2.6; 95% CrI: 0.84–4.35;SUCRA = 80.53%), life review (MD:1.92; 95% CrI:0.71–3.14; SUCRA = 65.62%), cognitive behavioral therapy (MD: 1.27; 95% CrI: 0.23–2.38; SUCRA = 45.4%), aerobic (MD: 1.84; 95% CrI: 0.39-3.36; SUCRA = 63%) and resistance training (MD: 1.72; 95% CrI: 0.06-3.42; SUCRA = 59.24%). Network meta-regression showed that there were no statistically significant subgroup effects. Conclusions: Physical activity and psychotherapy demonstrated statistically significant superiority over conventional treatment. Music and life review therapy proved the most promising individual interventions. However, conclusions are limited by the lack of sufficient sample size and consensus regarding intervention categories and so an adequately powered study is necessary to consolidate these findings. (Edited publisher abstract)
Anxiety and related symptoms in older persons with dementia: directions for practice
- Authors:
- MCCLIVE-REED Kimberly P., GELLIS Zvi D.
- Journal article citation:
- Journal of Gerontological Social Work, 54(1), January 2011, pp.6-28.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Anxiety disorders and related symptoms commonly occur in older people with cognitive impairment or dementia, thus significantly decreasing their functional abilities and reducing their quality of life. This evidence-based review of the literature outlines the extent of the problem, and focuses on current best practices in psychosocial interventions for anxiety in persons with dementia. A wide variety of non-pharmacological interventions are examined, including emotion-oriented therapies, behavioural modification and cognitive-behavioural therapy programmes, structured activity programmes, and sensory stimulation therapies, including multisensory approaches. The approaches that appear to show clinical promise for successful treatment of anxiety and related symptoms in dementia include behavioural and cognitive-behavioural therapies, music therapies, animal-assisted therapy (AAT), exercise therapy, and touch therapies. The need for more rigorous research to establish the validity and safety of non-pharmacological interventions in persons with cognitive impairment is discussed.
Counselling older people: what can we learn from research evidence?
- Authors:
- HILL Andy, BRETTLE Alison
- Journal article citation:
- Journal of Social Work Practice, 20(3), November 2006, pp.281-297.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This paper reports on a systematic review aimed at providing a reliable overview of the effectiveness, appropriateness and feasibility of counselling older people. Papers were located from a wide range of sources to ensure comprehensive coverage of the literature and 47 papers were included in the final review. The review concluded that counselling is efficacious with older people, particularly in the treatment of anxiety, depression and in improving subjective well-being. Evidence indicates that individual, as opposed to group counselling, is the psychological treatment of choice among the community-dwelling elderly and that this may be the more effective modality with this population. Group counselling for nursing home residents and home-based individual counselling for community-dwelling older people are both feasible modes of service delivery. A pro-active approach to the identification of psychological problems among residential and community-dwelling older people is necessary to ensure problems are not left untreated.
Review of assessment and treatment of PTSD among elderly American armed forces veterans
- Authors:
- OWENS Gina P., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 20(12), December 2005, pp.1118-1130.
- Publisher:
- Wiley
This review summarizes the available research related to difficulties in assessment with the elderly American Armed Forces veteran population. In addition, both psychotherapeutic and pharmacological treatment interventions for PTSD are discussed. A literature search was conducted using PsycINFO, Medline, and the National Center for PTSD's PILOTS database. Evidence suggests that elderly veterans generally present more somatic symptoms of PTSD. Medical and psychological comorbodities, such as depression, substance abuse, or cognitive deficits can further complicate the assessment process. Cut-scores for existing instruments need to be further established with elderly veterans. Use of exposure therapies with the elderly has not been adequately researched and mixed results have been obtained for supportive therapy for treatment of PTSD. Controlled research investigating pharmacological interventions for PTSD with the elderly is also limited. The evidence suggests that some psychotherapeutic and pharmacological interventions already utilized with younger individuals may be useful with the elderly veteran population. However, research indicates that modifications may be required for working with the elderly population and further research in the areas of assessment and treatment are necessary.
Presentations and management of Post Traumatic Stress Disorder and the elderly: a need for investigation
- Author:
- BUSUTTIL Walter
- Journal article citation:
- International Journal of Geriatric Psychiatry, 19(5), May 2004, pp.429-439.
- Publisher:
- Wiley
With an aging population increasing presentations of cases of Post Traumatic Stress Disorder (PTSD) can be expected to old age services. While progress has been made in recent years in relation to the understanding and development of aetiological theories, classification, assessment and management strategies and protocols in the adult population, similar advances have lagged behind for the elderly. The aim was to review the adult literature regarding PTSD and discuss how this might apply to an elderly population. An attempt is made to highlight a better awareness of the field of psychological trauma in the elderly in the hope of stimulating debate and research. A review of the adult literature is conducted relating to classification, aetiology, demographic features, vulnerability, assessment, clinical management including psychotherapy and medications and how these may apply to the elderly. Little has been published in this field that directly relates to the elderly. The adult literature allows insight into understanding how PTSD may present in the elderly, and how they may be managed. Further specific research is needed in the elderly in order to facilitate a better understanding of PTSD that present in this unique population. This will lead to better clinical assessment, management and treatment provision.
Advancing psychological therapies research in Northern Ireland
- Authors:
- IRVINE Mandy, et al
- Publisher:
- Public Health Agency
- Publication year:
- 2011
- Pagination:
- 191p.
- Place of publication:
- Belfast
One of a series of rapid research reviews following the Bamford Review to contribute to a needs led research programme for psychological therapies. First the paper reviews existing national and international literature regarding psychological therapies. It then outlines the findings of a regional survey into the current provision of psychological therapies and research programmes being delivered across statutory and third sector services in Northern Ireland. The findings of the presented by the four main client groups of: adults; older adults; children and young people; and learning disabilities. Conditions covered include: depression, anxiety, post traumatic stress disorder, suicide, Autistic Spectrum Disorders, Attention Deficit Hyperactivity Disorder, schizophrenia, bipolar disorder, and challenging behaviour. Finally the authors offer a model for prioritising future needs-led research in the psychological therapies in Northern Ireland.