Complementary and alternative treatments for late-life depression, anxiety, and sleep disturbance: a review of randomized controlled trials.

OBJECTIVE

We reviewed randomized controlled trials of complementary and alternative medicine (CAM) treatments for depression, anxiety, and sleep disturbance in nondemented older adults.

DATA SOURCES

We searched PubMed (1966-September 2006) and PsycINFO (1984-September 2006) databases using combinations of terms including depression, anxiety, and sleep; older adult/elderly; randomized controlled trial; and a list of 56 terms related to CAM.

STUDY SELECTION

Of the 855 studies identified by database searches, 29 met our inclusion criteria: sample size >or= 30, treatment duration >or= 2 weeks, and publication in English. Four additional articles from manual bibliography searches met inclusion criteria, totaling 33 studies.

DATA EXTRACTION

We reviewed identified articles for methodological quality using a modified Scale for Assessing Scientific Quality of Investigations (SASQI). We categorized a study as positive if the CAM therapy proved significantly more effective than an inactive control (or as effective as active control) on at least 1 primary psychological outcome. Positive and negative studies were compared on the following characteristics: CAM treatment category, symptom(s) assessed, country where the study was conducted, sample size, treatment duration, and mean sample age.

DATA SYNTHESIS

67% of the 33 studies reviewed were positive. Positive studies had lower SASQI scores for methodology than negative studies. Mind-body and body-based therapies had somewhat higher rates of positive results than energy- or biologically-based therapies.

CONCLUSIONS

Most studies had substantial methodological limitations. A few well-conducted studies suggested therapeutic potential for certain CAM interventions in older adults (e.g., mind-body interventions for sleep disturbances and acupressure for sleep and anxiety). More rigorous research is needed, and suggestions for future research are summarized.