Geriatrics

Nowadays, the management of depressive disorders in older people is a major public health issue. Whilst pharmacological treatment is still prescribed in all cases, the need to provide accessible psychotherapy to residents of care homes for older people with cognitive impairments presents an additional challenge. This narrative review of the literature assesses how virtual exercise bikes and virtual reality headsets can be integrated into structured non-pharmacological care pathways. Both tools are already widely used in care homes. The former is used for functional rehabilitation and the latter for the management of pain or anxiety. Their acceptability and the existing infrastructure make them realistic candidates for repurposing towards mental health care, particularly for the management of depression in older people with neurocognitive disorders. Indeed, studies conducted amongst the general elderly population have demonstrated the effectiveness of cognitive behavioural therapy (CBT) in combating depressive disorders and, more specifically, ‘next-generation’ CBT approaches that draw on digital technologies and virtual reality. These have demonstrated greater acceptability and yielded very promising results in recent years. However, the integration of these therapies into long-term care settings faces numerous challenges: acquisition and maintenance costs, a lack of infrastructure, the need to train already overburdened staff, and the absence of validated care protocols. This review examines the feasibility, safety and clinical value of using these readily accessible tools to treat depression in older people in care homes with cognitive impairment. However, it also emphasises the importance of conducting research that will lead to the development of evaluated, standardised and validated care protocols.

I read with great interest the recent article by Friedmann et al [...]

Background/Objectives: Older adults may cease leisure activities as physical function changes, but perceived mobility limitations and objectively measured muscle strength may capture different aspects of this process. We examined associations between changes in walking difficulty and grip strength and transitions to nonparticipation in travel, dining out, and hobbies or lessons. Methods: We analyzed the 2012 and 2017 waves of a nationwide panel survey of older adults in Japan. Activity-specific logistic regression models adjusted for baseline characteristics and changes in depressive symptoms and living circumstances. Common-sample and Firth regression analyses assessed sensitivity. Results: The activity-specific analytical samples ranged from 537 to 841 participants. Worsening walking difficulty was associated with increased odds of nonparticipation in the activities examined, whereas declining grip strength was most clearly associated with nonparticipation in hobbies (adjusted odds ratio per 5-kg decline, 1.74; 95% confidence interval, 1.19–2.55). Differences between activities were not robustly established in the primary analyses. Conclusions: Mobility difficulty and measured muscle strength may provide complementary information when assessing changes in older adults’ leisure participation. Their associations with nonparticipation should be interpreted alongside activity preferences and contextual barriers, without assuming a causal direction.