https://orcid.org/0000-0002-0860-3717
Figures
Abstract
Objective
Mental health problems among older adults are becoming a growing public health concern in South Asia due to continued changes in population dynamics caused by declining fertility rates and increasing life expectancy. This scoping review aimed to explore and summarize evidence about mental health interventions and their impacts on geriatric mental health and highlight gaps and areas for future research.
Methods
We searched six electronic databases and additional sources for experimental/non-experimental studies evaluating the effectiveness of geriatric mental health interventions in eight countries in the South Asia region from the date of inception of each database up to August 5, 2022. Following the preliminary screening, we extracted data from the eligible articles using a Microsoft Excel data extraction worksheet. We followed Joanna Briggs Institute (JBI) guidelines for this scoping review and reported evidence adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist.
Results
From a total of 3432 potential articles retrieved, 19 were included in this review following pre-determined eligibility criteria. Across studies, mental health interventions can be broadly categorized into the following types– 1) traditional Yoga, Tai chi, or other meditative movements; 2) behavioral, occupational, or learning-based interventions; 3) tech-based interventions; 4) music therapy; and 5) new healthcare model. The evidence was predominantly based on India (n = 16), whereas three articles were identified from Pakistan. No article was found from six other South Asian countries. Depression and anxiety were the most frequent mental health outcomes, followed by quality of life, cognitive function, self-esteem, physical performance, and many more.
Conclusion
Although limited, this review found various interventions that have varying effects on different geriatric mental health outcomes. A handful of evidence on mental health intervention in South Asia indicates a lack of acknowledgment that may develop a serious paucity of geriatric mental health practice. Therefore, future researchers are encouraged to conduct empirical studies to understand disease burden, including associated factors of geriatric mental health, which may help to construct contextually appropriate mental health interventions in this region.
Citation: Mazumder H, Faizah F, Gain EP, Sharmin Eva I, Ferdouse Mou K, Saha N, et al. (2023) Effectiveness of mental health interventions for older adults in South Asia: A scoping review. PLoS ONE 18(7): e0287883. https://doi.org/10.1371/journal.pone.0287883
Editor: Qin Xiang Ng, Singapore General Hospital, SINGAPORE
Received: November 28, 2022; Accepted: June 14, 2023; Published: July 7, 2023
Copyright: © 2023 Mazumder et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All data associated with this paper are retrieved from published materials available in the referred journal articles and has been presented as a part of this review.
Funding: The authors received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Population aging has been evolving worldwide unprecedently since the 20th century [1]. Older adults contributed to 962 million of the world’s population in 2017, projected to double by approximately 2.1 billion by 2050 [2]. The growing elderly population is an imminent concern in low-and middle-income countries, including South Asia, which is home to nearly a quarter (23%) of the global population [3]. A drastic drop in fertility rates and increasing life expectancy during the late 20th and 21st centuries have eventually been impacting the age structure of South Asian countries, shifting towards consistently burgeoning group of older adults [1]. As a result, the substantial growth of the elderly population in the South Asia region will take place over the next couple of decades, likely contributing to 334 million of the total population in 2050 [4]. As life expectancy grows, older people frequently encounter various physical, mental, functional, and psychosocial challenges that can seriously affect their quality of life and contribute to a higher family and social burden.
According to the World Health Organization (WHO), developing countries constitute 80% of the global non-communicable disease (NCD) burden [5], where older adults share the most [6]. Mental health among older adults is one of the predominant contributors to the NCD burden. Of adults, approximately 15% aged 60 and over experience a mental disorder attributed to 6.6% of all disabilities globally [7]. However, it is discussed on a limited scale in developing country-context, including South Asia, due to pre-existing stigma, lack of resources, limited healthcare access, and absence of effective health management systems. The prevalence of self-reported depression over 50 years was 47.7%, 40.3%, 40.4%, and 11.4% in Bangladesh, India, Nepal, and Sri Lanka, respectively [8]. A systematic review estimated the prevalence of depression as 34.4% among older people in India [9]. Elderly depressive and anxiety disorders are highly prevalent in Bangladesh, estimated at 55.5% and 55.7%, respectively [10,11]. In Nepal, the prevalence was 15.4% for depression, 18.1% for anxiety, and 12.1% for stress among community-dwelling older adults [12].
While evidence about geriatric mental health disorders in South Asia is highly scarce, continually growing older adults creates a high demand for understanding their complex physical, mental, functional, and other psychosocial problems and associated health and social needs. Mental health deeply encompasses all aspects of human lives, including social, cultural, religious, spiritual, and historical, which may incur stressors of varying extents [13]. Older adults in South Asia share all these psychosocial stressors, possibly more frequently due to declining capacities, co-morbidities, functional disabilities, frailty, bereavement, financial hardship, and family/social neglect [7]. These stressors can result in social alienation, loneliness, and psychosocial distress among older adults that may eventually lead to various mental and behavioral disorders, thereby impacting the overall geriatric quality of life [7]. Moreover, the intersection of geriatric mental and physical health issues in South Asian countries is critical to address because of the lack of integrated policies, legislation, strategic plans, programs, implementation, and other related measures [3,14]. Higher social stigma, taboos, and lack of awareness are frequently associated with underreporting of geriatric mental illnesses [3]. Also, the lack of skilled human resources affects the timely screening, diagnosis, treatment, and prevention of elderly mental health problems [3,15].
Although pharmacological interventions play a critical role in addressing mental disorders; non-pharmacological or psychosocial interventions such as cognitive behavioral therapy [16], group therapy [17], occupational therapy [18], narrative therapy [19], and culturally appropriate healing practices [20] can be profoundly helpful in improving mental health at the community and population level. Hence, psychosocial interventions refer to a range of interpersonal or informational activities, techniques, or approaches that focus on various aspects such as physical, behavioral, cognitive, emotional, interpersonal, social, or environmental factors in order to improve health outcomes [21]. Many prior research has shown the beneficial impact of psychosocial interventions in fostering post-traumatic growth [22], enhancing the quality of life for people with chronic diseases [23,24], and improving cognitive function, social interaction, and overall well-being among older adults [25–27]. Though addressing geriatric mental disorders requires diverse interventions; however, there is a dearth of empirical and summarized evidence about elderly mental health interventions at the South Asian country or regional level. Also, the epidemiology of geriatric mental disorders is not well-studied, limiting the contextual knowledge and insights about aging mental health burdens, which may affect the development and implementation of appropriate mental health services for older adults.
Moreover, it is necessary for health and social policymakers and practitioners to find high-quality evidence on geriatric mental health interventions for effective policymaking and adopting standard practices in the health system. Hence, socioeconomic and cultural dimensions of growing geriatric mental health problems [28] warrant different psychosocial and community-level interventions that are contextually appropriate to develop an older-friendly environmental and social support network. Therefore, adopting a mental health promotion perspective, this scoping review aimed to examine the nature and extent of existing evidence on non-pharmacological or psychosocial interventions relevant to community geriatric mental health practices in South Asia.
2. Materials and methods
2.1 Data sources and guidelines
We conducted this scoping review according to the Joanna Briggs Institute (JBI) guidelines for scoping reviews and reported evidence adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist (S1 Checklist). For scholarly data, we systematically searched Medline, American Psychological Association (APA) PsycInfo, Academic Search Ultimate, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Policy Reference Center, and the Web of Science databases from the date of inception of each database up to August 5, 2022, using the specific set of keywords applied with Boolean operators (i.e., “OR,” “AND”). The search queries were used across titles, abstracts, subject-specific keywords, and topic fields in respective databases without using any filter option (Table 1). A complete search strategy for selected databases is provided in the supplementary section (S1 File). The protocol of this review was not registered in any review repository; however, it is available from the authors upon request.
2.2 Eligibility criteria
We included articles that met all the following criteria:
- Original articles reporting mental health interventions (e.g., experimental, non-experimental, quasi-experimental, randomized, pre-post evaluation, etc.),
- Studies that recruited older participants (age 50 years or over) were included in this review, consistent with previous research involving older adults in this region to make this review more inclusive [29–32]. Hence, we considered the author’s perspective of the included studies in defining the aging population,
- Studies that evaluated psychosocial, behavioral, or non-pharmacological interventions for addressing geriatric mental health problems. It also encompasses interventions if they involve a combination of psychosocial therapies along with any pharmacological treatment, as well as studies that compared the effectiveness of psychosocial interventions with pharmacological medications,
- Studies that reported at least one mental health outcome, including mental disorders and psychological problems within the scope of the International Classification of Diseases (ICD) or Diagnostic and Statistical Manual (DSM) for mental disorders,
- Studies that focused on older people living in any of the South Asian countries,
- Studies that were published in scholarly journals as peer-reviewed articles,
- The full text of the articles was available in the English language.
This set of comprehensive criteria allowed the potential inclusion of any article that described the effectiveness of mental health interventions for older adults in South Asia. However, articles not published as peer-reviewed pieces (e.g., editorials, commentaries, preprints) or those without intervention (e.g., descriptive papers without outcome evaluation, reviews, case studies) were considered ineligible. Also, citations without full texts or those published in languages other than English were excluded from this review.
We used a cloud-based systematic review management portal (rayaan.ai) to evaluate all retrieved citations. Two reviewers independently reviewed all entries, and a third reviewer assisted them in resolving potential conflicts about eligibility through discussion. All citations eligible for full-text review were examined using the same process and included for data extraction and synthesis.
2.3 Data extraction
We used a pre-designed data extraction form that included items on study characteristics (e.g., study design, methods, samples, recruitment strategies), interventions and their contents, and mental health outcomes following the interventions. Three reviewers participated independently in the data extraction process, and a fourth author reviewed all the extracted data to ensure consistency and accuracy. Later, all reviewers participating in data extraction discussed discrepancies and reached a consensus.
2.4 Data synthesis
Scoping review provides an evidence map and informs potential gaps by evaluating the collective body of evidence. We narratively summarized the key findings on major study variables, interventions, and all mental health outcomes of interest. These findings were arranged in separate groups and presented in a tabulated form that informed the overview of existing intervention studies and their outcomes.
3. Results
Fig 1 illustrates the detailed literature search and selection process adhering to the PRISMA flowchart. The systematic search of electronic databases and other sources yielded 3088 citations. Following deduplication, 1094 citations were included for the preliminary title and abstract screening using pre-determined eligibility criteria. Also, 344 citations were identified and screened from additional sources, including Google Scholar, reference searching, and others. We initially found 26 potential citations for full-text evaluation and finally included 19 articles in this scoping review [31–49].
3.1 Characteristics of the included studies
An overview of the included studies is provided in Table 2. The vast majority of studies, 84% (n = 16), were conducted in India [32–45,48,49], and the remaining studies (n = 3) were conducted in Pakistan [31,46,47]. No studies were identified from Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, and Sri Lanka. Most studies (n = 17) were published during 2011–2022. Studies mainly conducted in institutional settings (n = 8) that include old homes, residential homes, and hospices [34,35,38,40,44,45,47,49]; five were conducted in hospital settings [31,36,37,39,41], five in the community [32,33,43,46,48], and the rest recruited samples from both healthcare and community settings [42]. The age range of recruited older adults was 50 years and over, but the mean age of all studies was over 60. Except for one [49], all studies included male and female participants.
Ninety-five percent were intervention studies (n = 18) with sample sizes ranging from 7 to 181. Eleven of them had experimental study design with both intervention and control groups [32–35,38,39,42–44,48,49], and seven studies followed the pre-post design [31,36,40,41,45–47] applied to the same sample population before and after the intervention. For instance, Dias et al., 2018 randomly assigned lay-provider-led mental health intervention to a group while the control group received usual care [42], whereas Chobe et al., 2022 assigned three yoga and/or ayurveda-based interventions to three different elderly groups with mild cognitive disorders and assessed pre-and post-outcomes of each intervention group [48]. Five intervention studies used randomized techniques to assign participants to the intervention and control arm [34,35,42,43,49]. The only comparative secondary analysis assessed one-year records of mental health access in a newly implemented community-based mental health program compared to a tertiary-facility-based (MCH) mental health service [37]. This secondary analysis assessed the healthcare access of older people in the mental health community outreach clinics compared to a traditional tertiary healthcare facility using past one-year health records (216 vs. 187). Over half of the included studies in this review (53%, n = 10) recruited sample populations from a convenient setting, either a hospital or old-age home/residential home/hospice [31,34,36,38–41,45,47,49].
3.2 Mental health interventions and their outcomes
Although limited, various interventions evaluated their impact on mental health disorders among South Asian elderlies. Since India is the home of meditative movements and many other traditional practices, most studies have assigned these practices as interventions to examine their effectiveness on various geriatric mental disorders. In total, 53% (n = 10) of included studies evaluated yoga, meditation, Tai chi, and mindfulness-based stress reduction as mental health interventions [32,34–36,38,41,43,44,48,49]. Hence, some studies assigned ayurveda/herbal medication as a comparator or applied a combination of yoga and ayurveda intervention. For example, Chobe et al. 2022, a controlled trial, evaluated the efficacy of an 8-weeklong yoga module, ayurveda treatment, and a combination of yoga and ayurveda in three different intervention groups to evaluate their comparative effects on older adults with mild cognitive impairment [48].
Two studies evaluated two different comprehensive packages of behavioral interventions. First, Dias et al., 2018, assessed the effectiveness of a lay counselor-led behavioral and learning-based intervention for older people with depression that comprised of problem-solving therapy, brief behavioral insomnia treatment, self-care education, and assistance in assessing medical and social programs [42]. Another one, Kumar et al., 2014, assigned a 5-week-long novel occupational therapy targeting older adults with mild to moderate dementia consisting of relaxation, physical exercise, personal activities, cognitive exercise, and recreational activities [39].
Among the included articles, two studies evaluated in-built community/health system intervention programs. Jacob et al., 2006 assessed the effectiveness of a community-based daycare center program on geriatric mental health and quality of life; the other one assessed healthcare utilization of a new model designed as decentralized community-based mental health outreach clinics [33]. Very few studies (n = 2) evaluated technology-oriented interventions such as virtual reality (VR) based environmental enrichment and brain training among older people with mental disorders [31,46]. Some studies (n = 2) assigned learning-based interventions [45,47]. Jafree et al., 2021 evaluated intergenerational learning activities consisting of a broad thematic area such as language, history, civic awareness, music, religious and spiritual dialogue, etc. [47]. The other one assigned a psycho-educational intervention comprising several topics related to health education, sleep hygiene, daily routine, pain management, self-esteem, self-medication, and many more [45]. Interestingly, a 21-day-long instrumental and classical music-based therapy was undertaken as an intervention to explore its effect on geriatric depression [40].
The geriatric mental health outcomes across all these interventions were widely varied. Most meditative or yoga-based interventions significantly reduced geriatric depression and anxiety symptoms. In addition, the yoga-based interventions were highly effective in improving stress, mindfulness, and sleep [48]. Both yoga and a combination of yoga and ayurveda intervention improved the cognitive abilities of the elderly with mild cognitive impairment. Several domains of elderly cognitive function, such as learning, attention, recalling memories, processing speed, and working memories, were significantly improved following the intervention of yoga or combined yoga-ayurveda [32]. Moreover, these meditative interventions significantly improved concentration, mood, self-esteem, stress, and many other psychosocial, physical, and environmental spheres of geriatric quality of life.
Music therapy was found to be effective in reducing mild-to-moderate depression among older adults [40]. The behavioral and learning-based interventions significantly improved geriatric quality of life, physical performance, self-esteem, life enjoyment, and reduced mental disorders such as depression, stress, and anxiety [33,39,45]. Another behavioral intervention led by lay counselors reduced the progression to severe depression among older people with mild depressive symptoms [42]. The technology-based experiments were mainly applied to improve cognitive abilities in older adults. In a longitudinal study, Riaz et al., 2021 assigned a virtual reality (VR)- based environmental enrichment technique to older adults with mild cognitive impairment. After 6-months of intervention, no change was observed in geriatric cognitive function, except for a trend toward improved mental well-being [46]. Another quasi-experimental study assigned a brain training game as an intervention for six weeks on older participants with mild cognitive impairment [31]. This “Body and Brain Exercise” intervention significantly improved the cognitive abilities of older adults. A significantly higher proportion (16.5%) of the elderly sought mental health care at community-based mental health outreach clinics compared to the psychiatry outpatient service in a medical college hospital (9.5%) [37]. This study was implemented to evaluate mental healthcare access at the community-based mental health outreach centers–a flagship government program piloted in a district of Karnataka state in India to decentralize mental health services at the community level.
Intervention studies or implementation research in mental health substantially contribute to identifying contextually appropriate evidence-based approaches for promoting geriatric mental health status. However, despite a growing elderly population, such a paucity in geriatric mental health research in South Asia highlights a research disparity, possibly associated with its less priority at the public health research and policy level, lack of research investment, inadequate institutional capacities, and other health system/ context-specific factors. Also, inadequate evidence regarding the community-based mental healthcare approach indicates a lack of integration of geriatric mental health services with local stakeholders at the community level, which may limit elderly healthcare access, including social support. Moreover, while growing evidence in developed regions informs health benefits of using digital or technology-based geriatric mental health interventions, we found scanty evidence reflecting serious negligence in advancing geriatric mental health practice beyond the traditional healthcare approach.
4. Discussion
This scoping review offered an overview of the information available in the literature about the effectiveness of mental health interventions for older adults in South Asia. Most studies were conducted in India and a few in Pakistan; however, no studies were identified in the other six South Asian countries (Afghanistan, Bangladesh, Bhutan, Nepal, Maldives, and Sri Lanka). Yoga, Tai chi, and other meditative movements have historically been practiced in many countries in South and Eastern Asia [50–52]. Hence, included studies predominantly assigned these meditative movements as interventions to explore their effectiveness on geriatric mental disorders. Moreover, some behavioral or learning-based approaches were evaluated on how physical and psychological aspects of geriatric health were impacted following such interventions. A few papers undertook community-based behavioral interventions to improve geriatric mental health and overall quality of life. Additionally, we found scanty articles in South Asia that employed tech-oriented/ digital mental health interventions for older adults.
Exploring and summarizing evidence about the effectiveness of mental health interventions on various geriatric mental disorders in South Asia revealed a wide range of methodological heterogeneity. The majority were intervention studies; some followed the pre-post design, some applied randomized or non-randomized approaches, and others were quasi-experimental. Primary studies recruited in this review were conducted in diverse settings, including communities, health facilities, and institutions (nursing homes/residential homes/hospices); however, most studies enrolled participants conveniently. The current review observed various study differences, including sample size, population characteristics, sampling strategy, and instruments used in measuring geriatric mental illnesses or quality of life. Most studies were conducted on a small scale, while 44% (n = 8) had a sample size of ≤ 50. Hence, notably, study variability can be greater even after simple randomization if the study participants are old and small in number. Small sample sizes also can cause less statistical power, leading to misinterpretation of the intervention results [53]. However, several studies lacked methodological explanations regarding sample selection, recruitment, and sampling strategies, which were likely to increase the risk of bias. Additionally, intervention studies with low or non-significant effectiveness are less likely to suffer from publication bias or file-drawer syndrome. Therefore, any such studies that were not published and indexed in databases were beyond the scope of the review, which could have provided further insights about the effectiveness on mental health outcomes.
Our review also identified a paucity of research on geriatric mental health interventions in this region. The available evidence was primarily hospital or institution-focused traditional or behavioral interventions, while community-based, digital, or tech-based interventions were highly limited. These interventions mainly focused on geriatric mental health outcomes, where associated physical, psychological, socioeconomic, and cultural factors remained largely un-specified. Prior research highlighted a wide range of interventions such as group-based therapy [54], occupational therapy [55], self-guided therapy [56], physical exercise [57], cognitive training [58], digital or tech-based interventions [59], home-based interventions [60–62], lifestyle improvements [63], community-based intervention [64], nutrition [65], intergenerational program [66], social participation [67], horticulture therapy [68], etc. are found to be effective in improving geriatric mental health and overall quality of life.
The rapid technological advancement in medical sciences since the 20th century has created different avenues in preventive, promotive, and curative healthcare [69], continually emerging as a practical approach offering direct services to people with mental disorders worldwide [70–72]. Unlike institutional healthcare, digital or tech-based geriatric mental health services can bring a significant improvement in implementing evidence-based practices by overcoming a geographic or physical barrier [70,73]. It can also improve the process of screening, assessment, treatment, and follow-up of patients with mental disorders [73]. However, a limited number of studies applied tech-based interventions given the geographic and population scope of this review. Hence, brain training significantly improved geriatric cognitive abilities [31], whereas virtual reality-based intervention showed no cognitive improvement except a trend of positive mental well-being [46]. Such varying effectiveness of tech-based mental health interventions to improve geriatric mental health outcomes suggests the need for further studies with large sample sizes and rigorous experimental designs.
Community-based healthcare is considered viable in delivering- preventive and therapeutic health services in South Asia [74]. Hence, community-based mental health interventions can improve healthcare accessibility, social participation, and physical and cognitive function and promote a social support network for older adults [75]. However, it has been evident that mental health care utilization among older people is low [76–78]; hence, assessing geriatric mental health, especially in low- and middle-income countries, including South Asia, becomes critical [79]. Moreover, a lack of contextual evidence regarding the dynamics of elderly mental health, including its determining factors, may introduce inappropriate measures at the policy level and can cause the demands of older adults to be unmet. Hence, it is essential to establish an integrated healthcare approach encompassing associated physical, psychosocial, cognitive, socioeconomic, cultural, and environmental factors of geriatric mental health.
Designing a mental health intervention for a specific group in a particular context warrants more profound knowledge and insights regarding respective cultural, socioeconomic, environmental, and other psychosocial dimensions. These mental health determinants may directly or indirectly impact geriatric physical, behavioral, and psychological health outcomes. Allen and colleagues discussed how cumulative stress obtained throughout life-course in different contexts, associated with social inequalities, serves as a mechanism that can seriously affect individual/ group mental health conditions [80], which may have a trans-generational impact [81]. They have found a poor and socially disadvantaged group of people disproportionately affected by mental disorders [80] than their counterparts. Older people in South Asia frequently experience low income or financial insecurity; therefore, they are likely to encounter poverty and a relative decline in family support [82] that eventually may impact elderly mental health conditions and quality of life [83]. Likewise, the cultural impact on geriatric mental health is critical in South Asia, especially in light of this region’s rampant political and socioeconomic transition since the last century. For example, the cumulative impact and early-life stressors caused by post-colonial sociocultural reforms in India and Pakistan [84,85], post-independence socio-political shifting in Bangladesh [86], the impact of internal conflicts, and political regime changes in Nepal and Sri Lanka [87,88] have exposed older adults to an experience of large-scale socio-political transformation that may have different physical and psychosocial consequences.
Furthermore, continually increasing socioeconomic and demographic transition in South Asia led to substantial changes in family structure, lifestyle, and living patterns, which compelled older adults to live independently. Hence, family and community act as a source of informal financial and social support systems for older adults, exposing them to economic hardship and a dearth of social support and care, along with an existing lack of social connectedness and poor quality of living, which may cause additional psychosocial distress. Therefore, rather than focusing on clinical or other temporary mental health interventions, these critical psychosocial concepts need to be examined regarding their impact on mental health outcomes and should be considered in future intervention designs and deliveries. Therefore, this review calls for extensive research on geriatric mental health, both epidemiological and intervention studies, to understand sociocultural determinants and their impacts on elderly psychosocial health may offer profound contextual understanding to design and implement appropriate interventions.
Finally, we identified little published work on mental health interventions regarding their effectiveness on geriatric mental health outcomes, indicating a serious gap in evidence-based mental health practice in South Asia. Most studies explicitly investigated the effect of interventions on different geriatric mental health outcomes; however, limited evidence made it impossible to identify the most effective intervention. Moreover, there were limitations in the several study methodologies that can introduce bias and inaccurate estimation; therefore, we encourage future researchers to adopt more robust methodological approaches in designing intervention studies. The absence of representative studies from six South Asian countries highlighted research disparity and knowledge gap in this region, which may associate with inadequate mental health policies and programs, low emphasis on scientific evidence at the policy level, a lack of research investment, and limited institutional capacities and collaboration.
There are several limitations in this review. Firstly, this review focused on non-pharmacological interventions; however, we recognize the importance of studying pharmacological mental health interventions. Therefore, the findings of this study alone may not be helpful unless pharmacological and other forms of medical treatment are considered, particularly for patients with severe mental illness. Secondly, critical appraisal or risk of bias assessment is not recommended according to the adhering guidelines; therefore, we did not conduct any methodological quality/ risk of bias assessment of included studies. Thirdly, our approach of retrieving literature from leading selected databases facilitated the inclusion of peer-reviewed articles, whereas unpublished interventions and studies from unselected databases remained beyond our scope. Finally, including articles only in English appeared to be a limitation, which may cause a loss of evidence related to geriatric mental health interventions.
5. Conclusion
Mental health disparities among older adults are a critical public health concern in South Asia. The continuous growth of the aging population in this region contributes to the higher disease burden, including co-morbidities and disabilities that may associate with elevating mental disorders. In addition, many other stressors derived from co-existing socioeconomic, cultural, and environmental factors may have a cumulative psychosocial impact on older adults that can cause substantial psychological and behavioral changes. Our scoping review has summarized evidence about the effect of psychosocial, behavioral, or other non-pharmacological interventions on a broad range of geriatric mental health outcomes. However, limited research on geriatric mental health, including psychosocial epidemiology, warrants further research to bring contextual evidence and insights in order to establish integrated, evidence-based mental health services in South Asia.
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