Psychological Interventions With Older Adults During Inpatient Postacute Rehabilitation: A Systematic Review

Objective: Older adults in inpatient postacute care settings report high rates of depression and anxiety. Psychological interventions address these symptoms through educational, cognitive, behavioral, relaxation, and/or psychosocial approaches. The purpose of this study was to systematically evaluate the quality of existing literature on psychological interventions for depression and/or anxiety among older adults during an inpatient postacute care stay. Method: Medline, Embase, Cochrane Library, CINAHL, PsycINFO, and Google Scholar were searched for key concepts. Studies were included that (a) sampled skilled nursing facility or inpatient rehabilitation facility patients, (b) evaluated a psychological intervention, (c) measured depression and/or anxiety symptoms before and after interventions, and (d) had a mean or median age of 65+. Two raters assessed articles for inclusion and risk of bias. Results: Search strategies identified 7,506 articles for screening; nine met inclusion criteria. Included studies varied by study design, intervention type, and methodological quality. Only one study had low overall risk of bias. Four studies demonstrated preliminary treatment benefits for depression symptoms; none reported benefits for anxiety symptoms. Conclusions: Most of the included studies were limited by small sample size and high risk of bias. Thus, currently, there is insufficient evidence to support the effectiveness of psychological interventions for depression or anxiety among older adults during an inpatient postacute care stay. The authors offer a detailed discussion of methodological limitations, empirical gaps, and future directions to develop this body of literature. Impact and ImplicationsSources of bias, including poorly controlled confounders, inconsistent intervention adherence, and lack of available a priori protocols, prohibit conclusions regarding effectiveness of psychological interventions for depression or anxiety among older adults in inpatient postacute care settings. Even though high-quality evidence is lacking, preliminary findings suggest that psychological interventions may be acceptable for addressing depressive symptoms among older adults during an inpatient postacute care stay; thus, the need for future rigorous research is justified. No study reported treatment benefits for anxiety symptoms, suggesting the need for more conceptual work to understand the appropriateness of psychological interventions for anxiety among older adults