Effectiveness of continuity of care in reducing depression symptoms in elderly: A systematic review and meta‐analysis

Abstract

Background Depression affects 10%–20% of older adults worldwide. The course of late‐life depression (LLD) is often chronic, with a poor long‐term prognosis. Lower treatment adherence, stigma, and suicide risk lead to significant challenges in the continuity of care (COC) for patients with LLD. Elderly patients with chronic diseases can benefit from COC. As a common chronic disease of the elderly, whether depression can also benefit from COC has not been systematically reviewed. Methods Systematic literature search in Embase, Cochrane Library, Web of Science, Ovid, PubMed and Medline. Randomized Controlled Trials (RCTs) on the intervention effects of COC and LLD, published on 12 April 2022, were selected. Two independent researchers made research choices based on consensus. An RCT with COC as an intervention measure for the elderly with depression 60 years old was the inclusion criteria. Results A total of 10 RCTs involving 1557 participants were identified in this study. The findings showed that: (1) COC significantly reduced depressive symptoms compared to usual care (standardized mean difference [SMD] = −0.47, 95% confidence interval: −0.63 to −0.31), with the best improvement at 3‐ to 6‐month follow‐up; (2) The reduction in depressive symptoms was more pronounced for patients with comorbid chronic conditions with LLD (SMD = −0.93, 95% CI: −1.18 to −0.68); (3) COC was more effective than other regions for LLD in Europe and the Americas (SMD = −0.84, 95% CI: −1.07 to −0.61); and (4) COC had a positive impact on the quality of life of patients with LLD (SMD = 0.21, 95% CI: 0.02–0.40). Limitations The included studies included several multi‐component interventions with widely varying methods. Therefore, it was almost impossible to analyze which of these interventions had an impact on the assessed outcomes. Conclusions This meta‐analysis shows that COC can significantly reduce depressive symptoms and improve quality of life in patients with LLD. However, when treating and caring for patients with LLD, health care providers should also pay attention to timely adjustments of intervention plans according to follow‐up, synergistic interventions for multiple co‐morbidities, and actively learning from advanced COC programs at home and abroad to improve the quality and effectiveness of services.

The Wall of Evidence for Continuity of Care: How Many More Bricks Do We Need?

“…43 The evidence base for continuity of care continues to grow, giving rise to multiple systematic reviews for various outcome measures. 9,10,12,16,17,24,34,37 Also, study results have been reproduced and replicated-using different continuity measures in both comparable and different populations, leading to an increasingly robust wall of evidence.Despite this wall of evidence, continuity of care in family practice has been in sharp decline over the past decadesboth in the United Kingdom and the United States, [44][45][46] negatively affecting health outcomes for patients, doctors, and society. Previously, this decline was mainly explained qualitatively or narratively: eg, patients and doctors are increasingly mobile, solo practice is becoming rare, the number of patients with chronic diseases-and corresponding multiple professionals employed by different organizations-is rising, family…”

“…43 The evidence base for continuity of care continues to grow, giving rise to multiple systematic reviews for various outcome measures. 9,10,12,16,17,24,34,37 Also, study results have been reproduced and replicated-using different continuity measures in both comparable and different populations, leading to an increasingly robust wall of evidence.…”

Low Functional network integrity in cognitively unimpaired and MCI subjects with depressive symptoms: results from a multi-center fMRI study

“…With appropriate recognition, diagnosis, and treatment, the symptoms of depression can be effectively managed and alleviated, although treatment resistance is prevalent [11,12]. Early intervention can prevent worsening depressive symptoms, reduce disability, enhance cognitive function, and improve overall health outcomes in older adults [13][14][15].…”