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Objectives: Co‐occurring mood and anxiety disorders are common in older adult populations and are associated with worse long‐term outcomes and poorer treatment response than either disorder alone. This systematic review and meta‐analysis aimed to examine the efficacy and effectiveness of psychological interventions for treating co‐occurring mood and anxiety disorders in older adults. Method: The study was registered (PROSPERO CRD4201603834), databases systematically searched (MEDLINE, PSYCINFO, PubMed and Cochrane Reviews) and articles screened according to PRISMA guidelines. Inclusion: Participants aged ≥60 years with clinically significant anxiety and depression, psychological intervention evaluated against control in randomised controlled trial, changes in both anxiety and depression reported at post‐treatment. ResultsFour studies were included (total n = 255, mean age range 67–71 years). Overall, psychological interventions (cognitive behavioural therapy, mindfulness) resulted in significant benefits over control conditions (active, waitlist) for treating depression in the presence of co‐occurring anxiety (Hedges' g = −0.44), and treating anxiety in the presence of depression (Hedges' g = −0.55). However, conclusions are limited; the meta‐analysis was non‐significant, few studies were included, several were low quality and there was high heterogeneity between studies. Benefits at follow‐up were not established. Conclusion: Co‐occurring anxiety and mood disorders can probably be treated simultaneously with psychological interventions in older adults with moderate effect sizes, however, more research is needed. Given comorbidity is common and associated with worse clinical outcomes, more high‐quality clinical trials are needed that target the treatment of co‐occurring anxiety and mood disorders, and report changes in diagnostic remission for both anxiety and mood disorders independently. Key Points: Comorbid anxiety and mood disorders are common in older adults and are associated with worse outcomes than anxiety or mood disorders aloneFew psychological interventions have examined the efficacy of treating co‐occurring mood and anxiety disorders in older adults, and the quality of these studies is mixedLimited evidence suggests that psychological therapy can simultaneously target anxiety and mood disorders with moderate effect sizesSignificantly more research is needed to understand the efficacy of psychological interventions to target comorbid mood and anxiety disorders in older adults [ABSTRACT FROM AUTHOR]

Objective: Stepped care models are a possible solution to address service gaps in the provision of psychological therapies for anxiety and/or depression. The benefits may be particularly relevant for people in rural and remote areas and other under‐serviced and/or hard to reach populations, such as older adults. Design: Narrative literature review. Participants: Narrative literature review of the PubMed, Medline, and Psycinfo databases for studies reporting on the results of stepped care psychological interventions for older adults with anxiety and/or depressive symptoms. Main outcomes: Seventy‐seven papers were identified for evaluation of which nine papers met the study criteria (reporting on four individual trials). Results: We identified four controlled studies. Three of the four studies found stepped care intervention to be associated with significantly better clinical outcomes and cost‐effectiveness compared to treatment as usual. Studies primarily targeted subthreshold symptoms, mostly in primary care. Various interventions and stepping models were used. Conclusion: Stepped care has been associated with improved clinical outcomes and costs in older adults, particularly in primary care. There have been no rigorous studies of stepped delivery of psychological interventions to older depressed and anxious adults in alternative settings such as in specialist older adult mental health services or in private clinics. Although the evidence‐base for stepped care interventions is growing, it is not clear what evidence‐based treatment model should be adopted and in what services it could apply. More research is needed. However, the evidence to date is promising and suggests that stepped care approaches are feasible in older adults, and are likely to increase access to high quality interventions for older adults living in rural communities. [ABSTRACT FROM AUTHOR]