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Limited evidence for meds, music, and massage to treat anxiety in residents of long-term care facilities
Clinical Question
What pharmacologic and nonpharmacologic measures are effective in managing anxiety in residents of long-term care facilities?
Bottom line
The data on managing anxiety in residents of long-term care facilities are limited to poor-quality studies but suggest that medications, music, and massage are effective. 1a-
Reference
Study design: Meta-analysis (randomized controlled trials)
Funding: Self-funded or unfunded
Setting: Nursing home/extended care facility
Synopsis
These authors systematically searched several databases, registries, and the gray literature* to identify randomized trials of therapies to reduce anxiety in persons who reside in long-term care facilities. They followed high-quality methodologic procedures and translated foreign language publications to allow for data extraction. Although they identified 80 eligible trials, only 10 were suitable for pooling of data. None of the studies were at low risk of bias. The studies ranged in size from 11 to 659 participants; most had fewer than 100 participants. The interventions were wide-ranging: medications, music, touch, multicomponent therapies, exercise or movement, robotic animals or therapy dolls, education, psychotherapy, cognitive behavioral therapy, reminiscence, and “other.” The comparison interventions included usual care, social interaction, another active intervention, and placebo. While all the studies included anxiety assessments, anxiety was the primary outcome in only 15 studies. The authors did not pool data for the 9 trials of pharmacologic interventions but found that antipsychotics and anxiolytics were more effective than their comparators in reducing anxiety. In the comparisons that allowed for pooling, the authors report medium to large effect sizes: music versus usual care (standardized mean difference [SMD] -0.82), music versus social interaction (SMD -0.41), and massage versus usual care (SMD -4.32). The authors found significant heterogeneity among these data. Finally, while the authors report that the nonpharmacologic therapies are low risk, they did not actually report any data on harms.
* Gray literature refers to unpublished studies, not studies of the elderly.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Poor evidence
Seniors anxiety is difficult to treat. Dog therapy is a good choice.
Managment of anxiety in long term care
The review is helpful more the ideas and approaches than the data. Residents in long term care require and individualized, person-centred approach for management of anxieity and related behaviours.
Gray Literature
Love the gray literature reference with the asterisk! 😃
LTC residents
limited evidence that music, meds and massage dec anxiety