How do young-old and old-old adults benefit from cognitive-behavioral therapy compared to working-age adults? A large multicenter naturalistic study

Background

Although meta-analyses suggest comparable efficacy of cognitive-behavioral therapy (CBT) in older adults compared to working-age adults, little is known about its effectiveness in naturalistic settings across different age groups. Hence, this study compared symptom change, attrition rates, and treatment duration in outpatient CBT between working-age adults (18–64 years), young-old adults (65–74 years), and old-old adults (≥ 75 years).

Methods

We analyzed a large naturalistic dataset comprising 9081 patients between 18 and 96 years receiving outpatient CBT in Germany. Using propensity score matching, we examined differences in treatment response, remission, attrition, and duration between comparable groups of working-age, young-old, and old-old adults.

Results

Response and remission rates did not differ between the three age groups in terms of the Brief Symptom Inventory (BSI-53) and patient- and clinician-rated subjective improvement (CGI-I). Young-old and old-old adults showed lower rates of response and remission on the Beck Depression Inventory (BDI-II). These differences were limited to items assessing somatization, which may be related to normal aging. Treatment duration was shorter in young-old and old-old adults compared to working-age adults. Attrition rates did not differ.

Limitations

The samples of older adults were relatively small and probably selective. Especially, home-bound, vulnerable older adults may be underrepresented. Further, the observational study design limits interpretability of findings.

Conclusions

Young-old and old-old adults seem to benefit from outpatient CBT to a similar extent as working-age adults. Potential bias in outcome measures due to age-related somatic complaints should be acknowledged in practice and future research.