Comparative Efficacy of Various Interventions to Reduce Perceived Stress Among Older Adults: A Systematic Review and Network Meta-Analysis

BACKGROUND: Existing interventions targeting perceived stress in older adults exhibit a diverse range of types and inconsistent effectiveness. It remains unclear which interventions are most effective for older adults in terms of perceived stress, anxiety, depression, and cortisol levels. AIMS: This study aimed to assess the effectiveness of interventions targeting perceived stress in older adults for perceived stress, depression, anxiety, and cortisol levels. METHODS: A systematic search was conducted using PubMed, EMBASE, Web of Science, Cochrane, CINAHL, PsycINFO, CNKI, SinoMed, VIP, and WanFang databases on January 9, 2024 for randomized controlled trials (RCTs). Pairwise meta-analysis and network meta-analysis (NMA) were conducted using Review Manager v.5.4 and Stata v.16.0. RESULTS: A total of 23 RCTs were included. The reminiscence therapy had the highest probability (98.6%) of being the most promising intervention to reduce perceived stress, followed by exercise (68.1%) and yoga (56.1%). The included interventions had benefits on cortisol levels (SMD = -0.30; 95% CI [-0.54, -0.06]; p = 0.01). Moreover, exercise showed positive effects on reducing depression (SMD = -1.84; 95% CI [-3.69, 0.01]; p = 0.05), and it was ranked as the most promising method for depression or anxiety. Health education also reduced anxiety symptoms compared to control group (SMD = -0.77; 95% CI [-1.27, -0.26]; p = 0.03). LINKING EVIDENCE TO ACTION: Interventions targeting perceived stress had overall benefits in reducing perceived stress in older adults, especially reminiscence therapy and exercise. Exercise and health education each had potential benefits for alleviating depression and anxiety, respectively. More high-quality RCTs are needed to obtain more robust conclusions.