Remote psychological interventions for the treatment of anxiety and depression in older adults: a systematic review; and ‘it’s just life’s changed, that’s it.’ exploring lockdown experiences of older adults in the U.K. (March-May 2020)
Creators: name: Driscoll, Sarah Anne
Publisher: name: The University of Edinburgh
Year: 2021
Subjects: older adults
Covid-19
lockdown
confinement
psychological impact
iCBT
Telephone intervention
online
CBT-T

description: BACKGROUND: Extending the range of remote psychological interventions for older people and enhancing access routes to these have been long-standing ambitions of psychological services in the U.K. The direct impact of Covid-19 and the consequences of the accompanying mitigation measures have increased the urgency of developing creative, effective and patient centred models of remote service delivery for older peoples' mental health needs. “Lockdown” has been a core feature of the response to Covid-19 but research on the experiences (including the Information and Communication Technology experiences) of older adults isolating in their homes and of the psychological impact thereof is limited. OBJECTIVES: This thesis had two objectives. Firstly, to analyse the effectiveness and acceptability of remotely delivered CBT interventions for depression and anxiety for people aged 60+. A systematic review aimed to establish the quality of the evidence and provide a critical appraisal of the literature. Secondly, to explore the experiences of older adults (70+) during lockdown (March-May 2020) in the U.K. METHOD: A systematic literature search identified studies reporting the effectiveness and/or acceptability of CBT interventions delivered via online/telephone to individuals aged 60+ with anxiety and/or depression. Sixteen studies met the criteria for inclusion and relevant quality appraisal tools from the Joanna Briggs Institute were used to assess their quality. For the empirical project a qualitative design was adopted. Fifteen individuals were recruited and participated in in-depth semi-structured interviews about their experiences of lockdown in the U.K. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. RESULTS: Results of the systematic review supported the efficacy of remotely delivered interventions for the treatment of anxiety and depression in older people in that the majority of individuals reported improvement in the outcome measurements adopted by the studies. High levels of reported satisfaction and low attrition rates, were suggestive of high levels of acceptability of remote interventions. Potential bias arises from the extensive range of study designs and the non-exclusion of any study on the basis of quality. Results of the empirical project generated five superordinate themes and accompanying subthemes which were critically analysed and validation was sought from available participants. DISCUSSION AND IMPLICATIONS: The first paper of the thesis provides details of the evidence regarding the efficacy and acceptability of remotely delivered CBT interventions for the treatment of anxiety and depression in people aged 60+. Suggestions for the focus of additional research are proffered. The second paper indicates that participants found confinement to be challenging across a range of issues and that they experienced a variety of fluctuating emotions and cognitions. Nevertheless, many participants displayed a range of coping mechanisms and attributes, including adaptability, resilience and stoicism in the face of significant disruption to their routines and lifestyle.