Training Older Adults to Use Telemedicine for Mental Health may have Limited Impact

Treatment resistant late-life depression: A narrative review of psychosocial risk factors, non-pharmacological interventions, and the role of clinical phenotyping

BACKGROUND

Treatment resistant depression (TRD) is a subset of major depressive disorder (MDD) in which symptoms do not respond to front line therapies. In older adults, the assessment and treatment of TRD is complicated by psychosocial risk factors unique to this population, as well as a relative paucity of research.

METHODS

Narrative review aimed at (1) defining TRLLD for clinical practice and research; (2) describing psychosocial risk factors; (3) reviewing psychological and non-pharmacological treatments; (4) discussing the role of clinical phenotyping for personalized treatment; and (5) outlining research priorities.

RESULTS

Our definition of TRLLD centers on response to medication and neuromodulation in primary depressive disorders. Psychosocial risk factors include trauma and early life adversity, chronic physical illness, social isolation, personality, and barriers to care. Promising non-pharmacological treatments include cognitive training, psychotherapy, and lifestyle interventions. The utility of clinical phenotyping is highlighted by studies examining the impact of comorbidities, symptom dimensions (e.g., apathy), and structural/functional brain changes.

LIMITATIONS

There is a relative paucity of TRLLD research. This limits the scope of empirical data from which to derive reliable patterns and complicates efforts to evaluate the literature quantitatively.

CONCLUSIONS

TRLLD is a complex disorder that demands further investigation given our aging population. While this review highlights the promising breadth of TRLLD research to date, more research is needed to help elucidate, for example, the optimal timing for implementing risk mitigation strategies, the value of collaborative care approaches, specific treatment components associated with more robust response, and phenotyping to help inform treatment decisions.

Digital literacy during the coronavirus pandemic in older adults: Literature Review and Research Agenda

Demographic change in the developed world is leading to a higher proportion of older adults and longer life expectancy. Measures to control the coronavirus disease have affected older adults the most. Social isolation and access to remote health services has been a problem for many people. We have used the method of scientific literature review. The selection of articles was made in accordance with the following inclusion criteria: accessibility, scientificity, content relevance and topicality. After selection, the results were analysed by qualitative content analysis. With the content analysis of twenty scientific articles, we gained an insight into digital literacy of older adults during the COVID-19 pandemic. Three content categories were identified: (1) poor digital literacy of older adults, (2) inequality in ICT access, (3) use of ICT reduces the negative impact of social isolation. We note that there is a large digital divide in digital literacy and competences among older adults which expanded during the coronavirus disease pandemic. Several factors, including socio-economic status, internet access and the poor adaptation of ICT for older adults affect digital literacy. Rapid development of remote health and social care, poor digital literacy of older adults and the poor adaptation of ICT for older adults dictate that the problem must be tackled systemically.