Interventions for Improving Mental Health and Quality of Life of Older Adults with Mental Illness in Long-term Care: A Systematic Review and Meta-analysis

Abstract

         Various mental health interventions have been provided to older adults living in long-term care facilities, but the overall effectiveness of these interventions in improving mental health and quality of life remains inconclusive. This study is the first systematic review and meta-analysis to investigate and report interventions’ effects on improving mental health and quality of life among this population. A comprehensive search was conducted from January to February 2022 using PubMed, CINAHL, ProQuest, Web of Science, and Cochrane databases to identify eligible intervention studies published in English from December 2011 to December 2021. The inclusion criteria required studies to measure mental health and quality of life as outcomes in individuals aged 60 years and older with mental illness living in long-term care facilities. Studies that measured only mental health or quality of life were excluded. The PRISMA guidelines were used to guide the study’s method and report. Two reviewers independently evaluated the included studies’ methodological quality and extracted data. A third reviewer resolved discrepancies.          Six randomized controlled trials and two quasi-experimental studies were included for systematic review, of which five studies qualified for meta-analysis involving 658 participants. Due to high heterogeneity, subgroup analysis with a fixed effects model was conducted. The interventions integrating active social interactions reduced depressive symptoms (low certainty of the evidence). Additionally, reminiscence-based interventions improved the quality of life of older adults with mental illness (low certainty of evidence). Although the effectiveness of interventions remains inconclusive due to high heterogeneity, a limited number of studies in the meta-analysis, and low-quality evidence, this review suggested that nursing care and activities promoting active social interactions and reminiscence should be implemented in living in long-term care facilities to enhance the quality of life and mental health of older adults with mental illness. However, the types and components of interventions should be adjusted based on available resources and contextual factors. Further research with larger sample sizes and higher methodological quality is warranted to strengthen the evidence base in this area.