Management of depression and referral of older people to psychological therapies: a systematic review of qualitative studies

Background: Depressive symptoms are common in later life and increase risk of functional and cognitive decline and use of healthcare services. Despite older people expressing preferences for talking therapies, they are less likely to be referred than younger adults, particularly when aged over 80 years.

Aim: To explore how healthcare professionals manage older people in relation to depression and referrals to psychological therapies.

Design and Setting: Systematic review and thematic synthesis of qualitative studies.

Method: We searched MEDLINE, EMBASE, PsychINFO, CINAHL and SSCI (inception-March 2018) and included studies exploring healthcare professionals’ views regarding management of late life depression across all settings. We excluded studies of older people’s views or depression management across all ages.

Results: We included 27 studies, predominately focussing on general practitioners’ and primary and community care nurses’ views. Many healthcare professionals felt late life depression was primarily attributable to social isolation and functional decline, but treatments appropriate for this were limited. Clinicians perceived depression to have associated stigma for older adults, which required time to negotiate. Limited time and complexity of needs in later life meant physical health was often prioritised over mental health, particularly in frailer people. Good management of late life depression appeared to depend more on the skills and interest of individual GPs and nurses than a structured approach.

Conclusion: Mental health needs to be a more prominent concern within the care of older adults, with greater provision of psychological services tailored to later life. This may facilitate future identification and management of depression.