Content area
Background
Using improved healthcare services has increased life expectancy in the ageing population, increasing physical and mental health burdens. Because of many limitations, older adults fail to attend mental health care services at the designated health centres. Thus, a community-based approach to dealing with mental health problems would have been ideal for this population, which has been tried in some high-income countries. This systematic review was conducted to find out the community-based mental health interventions to address some of the common mental health disorders among older adults in Lower Middle-income Countries.
Materials and methods
Based on PRISMA guidelines and registered in PROSPERO (CRD42024503470), the research question was split up into PICOS components. Three databases viz. PubMed, Scopus, and Cochrane Central were searched. AXIS, ROBINS I, and ROBINS II tools were used to assess the methodological quality of the included studies.
Results
A total of 9 eligible studies were included in this systematic review. Problem-solving therapy and Laughter therapy with physical exercise have been effective in reducing symptoms of depression among older adults. Reminiscence Therapy resulted in improvements in sleep quality. Daycare programs have been shown to enhance the overall mental well-being of older adults. No studies were identified addressing the community-based interventions for anxiety and substance use disorder.
Conclusion
Lastly, there is a need for urgent implementation of community-based mental health interventions, particularly among older adults in LMICs, since, at present, there are not enough focused interventions aimed at catering to their mental health needs.
Introduction
The use of enhanced, improved healthcare services and technology has increased life expectancy, in turn increasing the ageing population [1]. People aged 60 and older will rise from 1 billion in 2020 to 1.4 billion by 2030 [2], with most living in lower-middle-income countries (LMICs) by 2050 [3]. According to the findings, mental health issues are said to be more common among elderly people than people in other age groups [4, 5]. Studies in LMICs indicated a wide range of depression (0.5% to 62.7%) and generalised anxiety disorder (0.2% to 32.2%) among this demographic. The pooled prevalence of depression was found to be 10.5% among older adults [6]. Furthermore, insomnia is estimated to be one of the common mental health disorders in older adults, and that is associated with increased mortality and decreased quality of life [7, 8–9]. About 27.7% of older adults were estimated to have substance use disorders in India, out of which 4.07% had alcohol use disorders [10]. However, these mental health problems are often aggravated by poor access to mental health services, social isolation, stigma, lack of understanding about mental health and economic hardship [11, 12, 13–14].
According to WHO, there should be 3 psychiatrists for 100,000 people, but some LMICs, like India and Pakistan, fall short, with ratios of 0.75 [15] and 0.19 [16], respectively. The care for mentally ill patients in India and most of the LMICs is mainly confined to institutional-based care. Community-based mental health services and family-based care have gained popularity in some upper-middle income countries because of limited caregivers, decreased mobility and other ancillary factors [17, 18]. The effectiveness of such community-based mental health interventions has also been documented in the literature, and the beneficiaries have expressed their satisfaction and acceptability in accessing these services [19, 20, 21, 22–23]. Despite the launching of newer interventions for addressing mental health disorders in LMICs [24], initiatives for community-based interventions for older adults remain scarce, which further magnifies the deficits in care. The unequal accessibility of mental health services in LMICs is further aggravated by stigma and lack of knowledge. Thus, setting up community-based interventions for addressing mental health services towards older adults would be a welcome step. Moreover, it should have been culturally appropriate and properly monitored to have a sustainable impact in the long run. In this background, the present systematic review (SR) aimed to identify community-based mental health interventions for older adults in LMICs and offer suggestions for implementation in LMICs settings.
Materials & methods
This SR was registered in the PROSPERO database (CRD42024503470) [25]. The study followed the PRISMA 2020 guidelines [26] .
Literature search
The research question was initially deconstructed into five distinct components: P (Population/patient), I (Intervention), C (Comparator), O (Outcome), and S (Settings) format. Then, the components were further categorized into different concepts. The “Population (P)” component encompassed the concept of “old age”. The “Intervention (I)” component covered the “Community-Based Mental Health Intervention” concept. Concepts, i.e. “mental health,” “depressive disorders”, “anxiety”, “sleeping disorder,” and “substance use” were categorised as concepts under the “Outcome (O)” component. “Lower Middle-Income countries” were assigned to the “Settings (S)” component in the search strategy. Relevant “MeSH term” and text terms (tiab) were identified for each concept. The final search strategy was constructed by adding appropriate Boolean Operators such as “OR” and “AND” to link the concepts in search engines based on the research questions. The appropriate articles were then searched in three databases, viz. PubMed (Table 1s: Search Strategy in PubMed), Scopus, and Cochrane Central (Table 2s: Search Strategy in Cochrane Central).
Table 1. Characteristics of the selected studies (n = 9)
First author | Study area | Study period | Age of the study population (years) | Sample size | Study settings | Instruments used |
|---|---|---|---|---|---|---|
Jacob ME et al., 2007 [33] | India | -- | -- | 20 | Community | MMSE, WHO QoL BREF, CIS-R |
Safarina L et al., 2022 [34] | Indonesia | -- | -- | 29 | Community | GDS |
Marliana T et al., 2022 [35] | Indonesia | -- | -- | 106 | Community | DJG-11, ACPAST |
Aliyas Z, 2019 [36] | Iran | Sep 2018 – Dec 2018 | 65 and above | 912 | Community | RAND MOS SF-20 |
Sahragard F et al., 2019 [37] | Iran | -- | 60–67 | 72 | Community | MMSE, ISI |
Dias A et al., 2017 [38] | India | -- | -- | -- | Community | GHQ, WHO-DAS |
Sarkar S et al., 2017 [39] | India | Jan 2013 – Jan 2014 | 60 and above | 263 | Community | GDS, MMSE, WHO QoL |
Carandang RR et al., 2020 [40] | Philippines | 2017–2018 | 60 and above | 575 | Community | GDS, DSSI-10, UCLA, RAS |
Shahidi M et al., 2011 [41] | Iran | -- | 60–80 | 60 | Community | GDS, LSS |
MMSE Mini Mental State Examination,WHO QoL-BREF World Health Organization Quality ofLife-Brief,CIS-RClinical Interview Schedule-Revised,GDSGeriatric Depression Scale,DJG-11 De Jong Giervield-11,ACPAST Accepting Past Scale,RAND MOS SF-20 RAND MedicalOutcome Study Short Form-20,ISI Insomnia Severity Index,GHQ General Health Questionnaire,WHO-DAS World Health Organization-Disability Assessment Schedule,DSSI-10 Duke SocialSupport Questionnaire-10,UCLA University of California, Los Angeles,RAS ResilienceAppraisal Scale,LSS Life Satisfaction Scale
Table 2. Characteristics of community-based interventions (n = 9)
First author | Name of the intervention | Type of the intervention | Duration and frequency of intervention | Results | Others | |
|---|---|---|---|---|---|---|
Pre intervention score | Post intervention score | |||||
Jacob ME et al., 2007 [33] | Community-based Day care | Recreational activity, Occupational therapy, Counselling and Medical services and Lunch | -- | CISR: 11.35 ± 8.04 | CISR: 9.8 ± 6.4 | Follow up: After 3 months |
WHO QoL BREF: 56.20 ± 11.32 | WHO QoL BREF: 69.2 ± 10.2 | |||||
Safarina L et al., 2022 [34] | Laughter therapy | Intervene giving laugh therapy (humor) by giving one day once the film Sunda Sundanese comedy and Opera Van Java | 15 min/day; 6 consecutive days | Mild depression Score (Median): 7 ± 1.01 | Mild depression Score (Median): 6 ± 0.91 | -- |
Marliana T et al., 2022 [35] | MHPSS | Mental health and psychosocial support online based services | 8 weeks (56 days); Daily | MED: 48.1% (n = 26) | MED: 16.7% (n = 9) | Follow up: Immediately after intervention; After 28 days |
Aliyas Z, 2019 [36] | Blue/Green park access, park visitation, length of stay, physical activity level | Total 177 designed natural outdoor spaces have been categorized into play grounds, community parks, city parks have been considered in town. Off these 2 green and 3 blue spaces that are large in size are used by most of the residents | -- | -- | -- | -- |
Sahragard F et al., 2019 [37] | Reminiscence therapy | Expression of memories about special events of life, about celebration and travels in different periods of life, expression of memories about work experience and success, marriage | 2 times/week, 1.5 to 2 h/session, 4 weeks | Sleep Score: 16 ± 1.74 | Sleep Score: 11.38 ± 1.93 | Follow up: Immediately after intervention; After 1 month |
Dias A et al., 2017 [38] | PST into three steps: Problem, Solution, Action | Learning based psychotherapy | -- | GHQ Score: 5.4 ± 1.5 | GHQ Score: 3.3 ± 2 | -- |
Sarkar S et al., 2017 [39] | Day care facilities, Elderly homes, Work site and community level intervention | Group discussions, Physiotherapy, Health education, Psychological counselling, PST for depression and BI for substance abuse, Health camp for elderly at community level and conducted twice with speciality doctors, screening for depression by Psychiatrist | PST: 4 to 5 sessions, 20–30 min/session; BI: Once lasting for 7 to 10 min | -- | -- | Attendance at the day care reduces the probability of Depression by 51% |
Carandang RR et al., 2020 [40] | Peer counselling and Social engagement group | Establish strong working alliance, identify a client, define problems, engage behaviour change, and facilitate engagement with community; Health education about nutrition, physical activity, successful ageing, dealing with stress and depression, built problem solving and decision making capacity | Peer counselling: 1 h home visit/week for 3 months; Social engagement: elderlies joined 3 h/week for 3 months | -- | -- | -- |
Shahidi M et al., 2011 [41] | Laughter Yoga, Exercise therapy | Brief talk about something delightful, having positive attitude to everyday life, laughter exercises are mixed with deep breathing exercises (30–35 min each), 10 sessions of aerobic group exercise program (30 min) | -- | Laughter Therapy GDS Score: 16 ± 5.3 | Laughter Therapy GDS Score: 10 ± 6.9 | Only female participants were considered |
Exercise therapy GDS Score: 15.3 ± 5.4 | Exercise Therapy GDS: 11.1 ± 6.2 | |||||
CISR Clinical Interview Schedule Revised,WHO QoL BREF World Health Organization Qualityof Life Brief,MHPSS Medical Health and Psychosocial Support,MED Mental and EmotionalDisorder,PST Problem Solving Therapy,GHQ General Health Questionnaire,BI BriefIntervention,MBSR Mindfulness-based Stress Reduction,GDS Geriatric Depression Scale
The study focused on original articles such as Randomised Controlled Trials (RCTs), non-Randomised Controlled Trials (non-RCTs), and observational studies (cross-sectional study). Expert opinions, reviews, narratives, commentaries, conference proceedings, case series, and editorials were also included. The selection criteria were English-language publications that addressed community-based mental health interventions for older adults in LMICs, as classified by the World Bank for the 2023 fiscal year [27].
Data abstraction
Articles from three databases were imported into Rayyan for deduplication and further screening [28]. Two reviewers (DD and MK – first two authors) independently screened titles, abstracts, and full texts to identify eligible studies. In instances of disagreement between the two reviewers (DD and MK – first two authors), a third reviewer (AP) was consulted to resolve conflicts.
Assessment of methodological quality for each study
Data extraction used a customised form based on the Cochrane Data Extraction Form [29], capturing essential study details. The AXIS tool [30] assessed the quality of the articles of observational studies (cross-sectional and case-control designs), while the ROBINS-I [31] and ROBINS-II [32] tools were employed for non-RCTs and RCTs, respectively.
Results
A total of 963 articles were identified through searches in PubMed, Scopus, and Cochrane Central. After two stages of screening, 9 eligible studies were selected for analysis [33, 34, 35, 36, 37, 38, 39, 40–41], as described in a PRISMA flowchart (Fig. 1).
[See PDF for image]
Fig. 1
PRISMA flowchart of screening and selection of articles from databases
An equal number of studies originated from Iran (3 studies, 33.33%) [36, 37, 41] and India (3 studies, 33.33%) [33, 38, 39], followed by Indonesia (2 studies, 22.22%) [34, 35], and the Philippines (1 study, 11.11%) [40]. 3 studies were completed between 2013 and 2018, with others not mentioning specific periods. The longest study duration was 1 year. 4 studies included older adults aged 60 years or above, with 1 study targeting those aged 65 or older. 4 studies did not specify age groups. Sample sizes ranged from 20 to 912 participants, and the study settings of all the studies were community-based (9 studies) (Table 1: Characteristics of the selected studies).
Assessment tools for depression, anxiety, sleep-related problems, and substance use disorder included the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), and WHO Quality of Life Scale. Various instruments i.e. ACPAST, the UCLA Loneliness Scale, RAS, and ISI used were. All instruments were administered offline except for 1 study [35], which used an online format.
In the single cross-sectional study, objectives, sample size, and target population were clearly defined, though the study design was inappropriate. Data and methods were well-described, with ethics clearance and conflicts of interest reported (Table 2s: Quality Assessment of the selected articles by AXIS Tool for Observational (Cross-Sectional and Case-Control) Studies). Of the remaining 8 studies, 5 were non-randomised controlled trials (non-RCTs), and 3 were randomised controlled trials (RCTs). Among the non-RCTs, 20% had a moderate risk of bias, 20% had a serious risk, and 60% had a critical risk (Table 4s: Quality Assessment of the selected articles by RoB 1 Tool for non-Randomized Controlled Trial Studies) (Fig. 2). All RCTs (100%) showed an overall high risk of bias (Table 5s: Quality Assessment of the selected articles by RoB 2 Tool for Randomized Controlled Trial Studies) (Fig. 3).
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Fig. 2
Visual representation of Risk of bias of the included non-Randomized Controlled Trial Studies (n = 5)
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Fig. 3
Visual representation of Risk of bias of the included Randomized Controlled Trial Studies (n = 3)
Laughter therapy
This SR identified 2 studies (1 non-RCT & 1 RCT) that explored Laughter Therapy as a community-based intervention aimed at enhancing mental health outcomes among older adults. It was found to be effective in reducing mild depression scores and enhancing emotional well-being [34, 41]. Notably, 15-minute sessions encouraged the release of endorphins and serotonin, natural chemicals that promote a sense of serenity, given a reduction from 7 ± 1.01 to 6 ± 0.91 in mild depression scores (Table 2: Characteristics of community-based interventions) [34]. Of interest, Shahidi M et al. (2011) reported that Laughter Therapy resulted in a more significant enhancement in geriatric depression scores than Exercise Therapy. The GDS scores decreased from 16 ± 5.3 to 10 ± 6.9 following Laughter Therapy, while Exercise Therapy produced a more limited decline from 15.3 ± 5.4 to 11.1 ± 6.2. Also, this therapy substantially increased life satisfaction scores, rising from 19.2 ± 4.1 to 25.9 ± 5.6. In comparison, exercise therapy also improved life satisfaction but to a lesser extent, with scores increasing from 21.5 ± 6.8 to 24.3 ± 7.7 (Table 2: Characteristics of community-based interventions) [41].
Problem-Solving therapy (PST)
Among all the studies, 3 studies (non-RCTs) examined PST as a community-based intervention. One study combining PST with Brief Intervention (BI) in a program involving group discussions, physiotherapy, counselling, and health camps reported a 51% reduction in the risk of depression (Table 2: Characteristics of community-based interventions) [39]. Therapeutic interventions with PST were found to be beneficial for the psychological health as GHQ scores decreased significantly from 5.4 ± 1.5 to 3.3 ± 2 [38]. Another study incorporated PST into a program of peer counselling, social activity, weekly home visits, and community engagement, which enhanced physical activity, promoted successful ageing, and decision-making capacity among the elderly (Table 2: Characteristics of community-based interventions) [40].
Reminiscence therapy
A single RCT assessed the effect of Reminiscence Therapy on sleep quality. This therapy was focused on encouraging participants to recall and share memories of significant life events, such as celebrations, travels, and work experiences. Conducted twice weekly over four weeks, with each session lasting 1.5 to 2 h, the therapy led to a significant improvement in sleep quality, with sleep scores improving from 16 ± 1.74 to 11.38 ± 1.93 within one month of the intervention [37] (Table 2: Characteristics of community-based interventions).
Online-based services
One non-RCT conducted during the COVID-19 pandemic tested the effectiveness of Online-based Services to reduce loneliness [35]. This intervention led to a reduction in severe loneliness from 31.5% to 1.8%. Those who experienced moderate loneliness showed a notable decrease, with a significant increase in the percentage of individuals experiencing a reduction in loneliness from 11.9% after the intervention. Integrity increased from 46.3% to 87.1%, and despair decreased from 53.7% to 12.9% post-intervention (Table 2: Characteristics of community-based interventions).
Low-cost daycare programs
An RCT evaluated a Low-cost Daycare model that incorporated recreational activities, occupational therapy, and medical care, significantly enhancing the overall mental well-being of participants. In this study, the post-intervention scores indicated a reduction in psychological distress, as reflected in the CISR scores, which decreased from 11.35 ± 8.04 to 9.8 ± 6.4 after three months. Additionally, the quality of life, assessed using the WHOQoL-BREF scale, showed substantial improvement, with scores increasing from 56.20 ± 11.32 to 69.2 ± 10.2 over the same period [33].
Exposure to natural environment
One cross-sectional study investigated the influence of the availability of green and blue parks in urban settings, showed that regular access to natural spaces is linked to better physical health, though a direct relation to mental health was not identified. However, duration of exposure and activity of the participants correlated with enhanced physical and mental well-being (Table 2: Characteristics of community-based interventions) [36].
Discussion
As one of the fastest-growing population groups worldwide, older adults require adequate physical, mental and social support. However, barriers such as a lack of care support, loneliness, decreased mobility, and financial hardship, often prevent older adults from attending designated health centres at specified times. In this context, community-based mental health intervention emerges as a crucial strategy to address the mental health issues of older adults. Evidences suggest that such community-level interventions in LMICs have significantly improved the overall well-being of older adults, enhancing quality of life, happiness and life satisfaction [42, 43, 44–45]. These interventions promote social engagement, a sense of belonging, and active participation, contributing to emotional and psychological resilience.
The present SR identified 9 such articles encompassing 4 countries. Instead of focusing merely on one type of intervention, the included studies encompassed a mix of approaches including Low-cost Daycare Programs, Laughter Therapy, Online Mental Health Support, Problem Solving Therapy, Exposure to Natural Environments, Reminiscence Therapy, and Activity Programs, while highlighting conditions like depression, sleep problems, loneliness and general mental well-being (Fig. 4).
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Fig. 4
Summary of different community-based interventions and their targeted mental health domain
Laughter Therapy as a community-based interventions were found to be effective addressing depression among older adults in LMICs. Although Laughter Therapy alone has shown limited impact [34], its combination with exercise and breathing techniques yielded more substantial outcomes [41, 46]. The addition of Exercise likely amplified the therapeutic benefits by simultaneously improving both physical and mental health.
Furthermore, Community-based Daycare interventions have proven beneficial by providing social interaction alongside structured mental health support, resulting in improved quality of life and reductions in depression [39], as well as overall enhancements in mental health among older adults [33].
Regular Psychoeducational Programs in old age homes led to significant improvements in well-being. Prior to the intervention, 21.6% of participants exhibited mild depressive symptoms, but post-intervention, this figure increased to 60%, accompanied by a marked reduction in moderate and severe symptoms [47]. Peer counselling, social activities, and community participation further promoted physical activity, successful ageing, and decision-making among the elderly [40].
Religious Interventions, such as Qur’anic recitals among hospital patients at low resource setting significantly improved quality of life, as measured by WHO QoL scores, and reduced depression scores over a 12-week period. These recitals produced effects similar to relaxing music therapy, demonstrating the positive influence of auditory stimuli on mental health [48]. Music Therapy has also consistently shown benefits for older adults dealing with mental health disorders [49, 50]. Spiritual programs showed positive effects on life satisfaction and mental health among patients with heart disease [51].
Reminiscence Therapy emerged as an effective intervention for sleep disturbance and depression [37]. When combined with Psychoeducation, Reminiscence Therapy proved to be considerably more effective than the usual Reminiscence Therapy alone [52].
A 6-month Yoga Program that included exercise, relaxation techniques, controlled breathing, and ethical philosophy led to improvements in sleep scores and subjective well-being [53]. Additionally, an Activity Program in an old age home involving warm-up exercises, walking, cool-down, and relaxation three times a week resulted in a notable reduction in sleep disturbance [54]. Incorporating simple exercises, breathing techniques, and relaxation offers a holistic and adaptable approach suitable for older adults in community settings. Countries like Brazil and Malaysia have also shown significant improvements in depression and overall mental health scores following Group Exercise interventions [55, 56].
Online-based Mental Health and Psychosocial Support Services were found to be effective in reducing loneliness. There was a reduction in moderate emotional distress from 48.1% to 16.7% [35]. Follow-up results confirmed the effects of the low-cost, scalable intervention persist. However, a systematic review highlighted that multi-faceted interventions-enhancing social skills, support, opportunities, and cognition, reduce loneliness more effectively than single-objective approaches [57]. Nevertheless, a hybrid approach that combines digital tools with in-person support could maximize impact, especially in resource-constrained or digitally underserved settings. Telepsychiatry, which gained prominence during the COVID-19 pandemic, has also proven effective, with studies reporting high satisfaction among clinicians and positive outcomes in mental health care [58].
Additionally, therapeutic interventions like PST significantly reduced GHQ scores, indicating psychological improvements [38]. A research study from China indicated that Self-help Intervention, which consisted of a health lecture and training, promoted better outcomes in mental health [59]. Research on urban environments revealed that frequent Access to Parks and Natural Spaces was linked to better physical health, and exposure time correlated with improved mental well-being [36].
Despite evidence indicating that anxiety disorders are prevalent among older adults and can significantly impact their quality of life, leading to increased risks of cognitive decline, cardiovascular diseases, and functional impairment [60], no studies were identified that specifically focused on community-based interventions for anxiety among older adults in LMICs. Although studies conducted in upper and high-income countries have demonstrated the effectiveness of community-based interventions in alleviating anxiety symptoms [61, 62], this gap highlights a significant opportunity for future research in LMIC settings.
Although there is increasing evidence that substance use disorders in older adults negatively impact mental health, physical health, and add strain on healthcare systems [63], there is a notable lack of community-based intervention studies focused on this demographic. Furthermore, research on interventions for older adults across all countries is also limited. To address this issue, it is essential to consider the specific barriers that older adults face, such as stigma, shame, and social isolation, rather than merely introducing new programs. Connecting them to age-appropriate support groups and repeated community engagement sessions can help create a safe and welcoming environment [63].
Overall, the findings underscore the potential of various community-based strategies to enhance the mental health and overall well-being of older adults in LMICs. These strategies illustrate the value of readily accessible, cost-effective, and culturally relevant methods. By addressing both the psychological and social aspects of care, community-based frameworks provide a viable and sustainable approach to enhancing the quality of life for older individuals in resource-constrained settings.
Future initiatives should aim to develop community-led, relevant, affordable, and sustainable mental health interventions. Programs that engage community health workers have shown promise in improving access, acceptability, and involvement among older adults [64]. A key strategy to support such efforts is the WHO Task Shifting Model, which recommends delegating specific mental health care tasks from specialist providers to trained non-specialists. This approach is particularly beneficial in LMICs, where there is often a shortage of mental health professionals [65]. Community health workers can also facilitate the evaluation of the long-term effects of the interventions. Providing them with the flexibility to adapt interventions according to local contexts and cultures should be a central aspect of designing community-based interventions, as this enhances effectiveness and sustainability [66]. Approaches that incorporate community feedback are also vital as they ensure interventions remain contextually relevant and responsive. Family-centered collaborative care models which involve both older adults and their family members are particularly promising in LMICs for improving treatment outcomes and enhancing patient engagement [67]. But it should resolve the barriers, i.e. limited knowledge of family members about the mental health disorder, emotional exhaustion, unclear communication between the family members and healthcare providers [14, 18]. Additionally, improving mental health literacy among older adults and their family members is essential for enhancing the acceptance of interventions, reducing stigma, and fostering positive attitudes toward seeking mental health care [14, 68]. Interventions with religious significance, such as spiritual recitations and community-based spiritual initiatives, should be considered, as these methods have been proven effective in reducing mental health disorders and enhancing the quality of life in older adults within low-resource settings [48, 51, 69]. Exploring low-cost intervention models, including self-help groups and telepsychiatry, is urgently needed to support scalability and sustainability across diverse LMICs. Ongoing policy support and cross-sector collaboration are vital for integrating these interventions within healthcare systems and ensuring their long-term sustainability. Lastly, future studies should prioritize the involvement of underrepresented LMICs by enhancing regional research capabilities, developing local research expertise by offering training programs, research fostering international partnerships, and investing in infrastructure that supports large-scale mental health research and screenings of mental health disorders. Conducting robust RCTs and longitudinal research will be essential to assess the long-term effectiveness of mental health interventions among older adults in LMICs.
This SR has some limitations. It included nine studies, which restricts the generalizability of the outcomes. Most of the studies were carried out in four countries: India, Iran, Indonesia, and the Philippines, although the search strategy encompassed fifty-four LMICs. This limited geographical representation restricts the applicability of the findings to other LMICs and highlights the need for more regionally inclusive research. Considerable methodological variation was observed among the studies, including small sample sizes and differences in study design, intervention types, follow-up durations, as well as demographic factors like age and gender. Furthermore, inconsistencies in outcome measures, including the assessment tools used and different reporting formats, added to the overall heterogeneity. These factors, along with the absence of comparable quantitative data, prevented the pooling of results and consequently made a meta-analysis of pre and post-intervention scores unfeasible. A high risk of bias is present in all RCTs, and critical risk of bias in several included non-RCTs may influence the reliability of the results and limit the strength of the conclusion. Additionally, the exclusion of non-English studies, inaccessible full-texts, restricted database access, and the absence of grey literature may have further impacted the validity of the review.
Conclusion
This SR highlights the necessity for the implementation of community-based mental health interventions for older adults in LMICs. Interventions such as reminiscence therapy, laughter therapy, and structured daycare programs was found to be effective in enhancing mental health outcomes and overall well-being. However, the overall strength of this evidence is limited by the small number of studies, methodological shortcomings, limited geographical representation, restricting the generalizability of findings. Given these constraints, there is a urgent need for robust, high-quality research to validate and expand upon current findings.
Despite limited resources and the shortage of mental health professionals in LMICs, culturally sensitive interventions could efficiently fill the care gap among older adults. There is much to be explored regarding community engagement, family participation to ensure more holistic care that addresses physical, emotional, and social dimensions of well-being. Incorporating the training of community health workers can improve in the scalability of the intervention in low-resource setting.
Sustained funding and collaborative support from policymakers, healthcare providers, and community organizations will be crucial for the long-term success of these initiatives. In the long term, prioritising the mental health of older adults will make society more caring for its ageing population.
Acknowledgements
The authors acknowledge the support of the Indian Council of Medical Research for this project. The authors are grateful to the Director-in-Charge, ICMR- Centre for Ageing & Mental Health, Kolkata for his constant support.
Author contributions
1. Devi Das: Data curation, Methodology, Writing – original draft2. Madhurima Khasnobis: Data curation, Methodology, Writing – original draft3. Susmita Dutta: Data curation, Methodology, Writing – original draft4. Suchismita Hoda: Data curation, Methodology, Writing – original draft5. Arkaprovo Pal: Data curation, Methodology, Formal analysis6. Neha Dahiya: Formal analysis, Supervision, Writing – review & editing7. Asim Saha: Formal analysis, Supervision, Writing – review & editing8. Arun Kandasamy: Formal analysis, Investigation, Supervision, Writing – review & editing9. Martin Kraepelien: Conceptualization, Investigation, Supervision, Writing – review & editing10. Indranil Saha: Conceptualization, Formal analysis, Investigation, Supervision, Writing – review & editing11. Christopher Sundström: Formal analysis, Investigation, Supervision, Writing – review & editing12. Amit Chakrabarti: Conceptualization, Investigation, Supervision, Writing – review & editing.
Funding
This Systematic Review is a part of an Indo-Swedish collaborative project jointly funded by the Indian Council of Medical Research (ICMR), India and FORTE, Sweden.
Data availability
Data is available in the excel sheet and uploaded as supplementary file.
Declarations
Ethics approval and consent to participate
This Systematic Review is based on secondary data analysis, so Ethics approval is not applicable.
Competing interests
The authors declare no competing interests.
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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