AIDElong—acute illness and depression in elderly: sustained improvement after group psychotherapy in geriatric patients, a follow-up of longterm effects in a randomized controlled trial

TL;DR

Group cognitive behavioral therapy for elderly patients with depression and acute illness leads to lasting improvements in mental and physical health.

Contribution

Demonstrates sustained long-term benefits of early group CBT in elderly patients with depression and acute medical illness.

Findings

Immediate CBT group showed significant and sustained improvement in depression symptoms over 12 months.

Delayed intervention group improved after starting therapy, with better functional outcomes compared to the waiting period.

Patients receiving early CBT had lower rates of nursing home admission and mortality.

Abstract

Comorbid depression is highly prevalent in very old adults hospitalized for acute medical illness. We have previously shown that immediate intervention with cognitive behavioral therapy (CBT) effectively reduces symptoms of depression and anxiety. The present study examines the long-term course and the effect of delayed intervention.

Randomized, controlled cross-over trial of group CBT.

We recruited in-patients of a geriatric university department ≥ 65 years with depression (Hospital Anxiety and Depression Scale HADS ≥ 7). Intervention took place after hospital discharge in a day care setting.

Patients were randomized to an immediate active intervention group (II) or a waiting list control group with delayed intervention (DI). II patients were invited immediately after discharge to 10 to 15 weekly behavioral group therapy sessions. After 4 months (T1), DI patients switched to active intervention, while II were followed under control conditions. Final evaluation took place after 12 months (T2). Primary endpoint was improvement in HADS.

56 patients (82.0 ± 6.2 years, HADS 18.8 ± 7.0) were randomized to II, 99 patients (81.9 ± 5.9 years, HADS 18.1 ± 8.3) to DI. II patients improved significantly at T1 (HADS 10.4 ± 5.2). Improvement was sustained under control conditions at T2 (11.9 ± 7.8). DI patients did not improve on waiting list (T1 22.9 ± 8.3), but after initiation of active treatment (T2 16.0 ± 8.5) (ANOVA: F = 3.75, p = 0.026). Concomitantly, functional parameters such as Barthel Index and Timed-Up-and-Go differed significantly between groups with better courses in DI patients. Among II patients, 4 (7.1%) deceased and 2 (3.6%) were newly admitted to a nursing home, among DI, 15 (15.2%) and 10 (10.1%) respectively.

Cognitive behavioral group therapy yields sustained improvement of depressive symptoms in very old geriatric patients, if administered in a multimodal approach immediately following hospitalization for acute medical illness. Concomitant with improvement of depressive symptoms, patients benefit in terms of functional status and medical outcome.

www.germanctr.de; DRKS 00004728; February 12, 2013.

The online version contains supplementary material available at 10.1186/s12877-026-06983-0.

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