Apr. 23, 2009 New research conducted by Dr. Philip Wilkinson (Department of Psychiatry, University of Oxford, Warneford Hospital Headington, Oxford) for a review published in the Cognitive Behaviour Therapist (Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies) has found that there are serious gaps in the treatments available to older patients experiencing later life problems associated with old age including depression, anxiety disorders, panic disorder and sleep disorders.
Dr. Philip Wilkinson states that despite a robust evidence base in support of the use of Cognitive Behavioural Therapy (CBT) in the treatment of mental disorders in younger adults, "trials with older people have generally been of poor methodological quality. Therefore, the potential of CBT to improve the outcome of late-life mental illness has not yet been adequately tested and demonstrated". There is, the author suggests, a strong case for retaining separate services for older people as their clinical needs may differ from younger adults.
Accessibility of services is another key issue that the article raises, although "CBT is one of the psychological therapies most frequently offered in the National Health Service, provision [to older patients] is patchy and relies on the availability of clinical psychologists". Moreover, "older adults have been severely under-represented" in GP referrals, hinting not only at a staff shortage of skilled clinical psychologists in the NHS but, even more worryingly, indicating an ageist bias in favour of younger cases on the part of GPs and clinical practitioners alike.
In a society that is rapidly getting older as a consequence of higher life expectancy brought about by medical advances and higher standards of living, this is indeed a major concern.
Dr. Wilkinson concludes that many of the randomized trials that served to give CBT the prominence it holds today apparently excluded older adults on the basis of age rather than more prognostic factors, such as the presence of dementia. "This reflects a failure to recognise that psychological treatments can indeed be relevant to older people and the problems they face. Data from trials that did include some older people indicate that age in itself does not affect outcome".
Despite recent increases in the range of CBT applications for older people, there appears to still be some prejudice in referring patients to these services and in inclusion of these patients in randomized clinical trials. Older people often have a preference for psychological treatments and presenting treatments as education rather than therapy can also increase their appeal.
According to Dr. Wilkinson, the lack of adequate CBT trials with older adults must be addressed, methodological limitations rectified, sample sizes increased to attain statistical validity, and the likelihood of bias minimized in order to tailor therapy to the particular problems of individuals, in this case older patient groups. For this reason, Dr. Wilkinson suggests developing standardized, reproducible CBT interventions and for these to be evaluated in large trials alongside medication or as part of case-management interventions.
Press coverage tends to highlight the problem of poor access to psychological treatments for older people; this review makes the case that development and evaluation of treatments are important too.
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