Aging is a physiological, individual, and heterogeneous process influenced by social, health-related, economic, and cultural factors (Congreso General de los Estados Unidos Mexicanos, 2024). Mexican legislation and international organizations define older adults (OAs) as individuals aged 60 years or older (Estebsari et al., 2020). Projections indicate that the global geriatric population will double by 2050 (United NationsDepartment of Economic and Social AffairsPopulation Division, 2019). In Mexico, the OAs population is projected to reach 20.6 million by 2030, representing 15% of the total population (Instituto Nacional de las Personas Adultas Mayores, 2024). However, this demographic shift contrasts sharply with the limited availability of specialized care, as in 2025, there was only one certified geriatrician per 13,000 OAs (Consejo Mexicano de Geriatría, 2025). The marked heterogeneity of aging increases vulnerability to developing affective disorders, with reported prevalence rates of anxiety and depression of 28% and 39%, respectively (Estebsari et al., 2020; De la Vega Martínez et al., 2023).

These conditions are closely associated with functional decline, frailty, worsening of comorbidities, and a consequent reduction in quality of life (Coveñas et al., 2024). Furthermore, substantial gaps in healthcare coverage, infrastructure, medication supply, and mental health service availability persist for OAs in Mexico (Juárez et al., 2020). As a result, up to 96.8% of this population does not receive treatment. This gap is closely linked to low health service utilization, largely driven by structural barriers such as geographic distance and limited access to transportation (Guzmán-Olea et al., 2018).

In this context, non-pharmacological interventions (NPIs) emerge as a particularly relevant strategy, given their demonstrated benefits on emotional wellbeing, functional capacity, and quality of life, as well as their favorable cost-effectiveness, safety profile, sustainability, and replicability (Gramaglia et al., 2021; Apóstolo et al., 2016). Evidence from systematic reviews and meta-analyses indicates that a broad range of NPIs, including physical activity, horticulture, cognitive behavioral therapy, positive reminiscence, mindfulness-based interventions, and others, may be more effective than pharmacological treatment in reducing depressive symptoms (Gramaglia et al., 2021; Apóstolo et al., 2016; Chen et al., 2021; Frost et al., 2019). These interventions have been associated with reductions of 20%–30% in depressive symptoms and improvements of 10%–20% in life satisfaction, with sustained benefits lasting up to six to 12 months, while avoiding adverse effects, pharmacological dependence, and constraints related to medication availability or economic factors.

Due to the steady increase in the geriatric population and disparities in the availability of and access to mental health services, implementing evidence-based policies, particularly NIPs, is a fundamental public health strategy to mitigate these deficiencies among OAs in Mexico. This review aims to identify NIPs implemented in Mexico to promote, maintain, and improve OAs mental health. Additionally, it will examine the main challenges and opportunities for replicating these policies.

Two studies were randomized controlled trials, and five were quasi-experimental. The mean scores were 5.5 (maximum 13) and 6.8 (maximum 9), respectively (See Tables 2, 3).

To our knowledge, this is the first systematic review conducted in the Mexican population to evaluate the comprehensive impact of NPIs on OAs mental health. Overall, our findings indicate that structured physical exercise programs are consistently associated with reductions in depressive symptoms and improvements in resilience (Borbón-Castro et al., 2020; Cantón-Martínez et al., 2024; Ortiz-Ortiz et al., 2019). These effects appear to be modulated by baseline depressive severity and participants’ cognitive and functional status, with greater benefits observed in group-based interventions tailored to OAs’ preferences and delivered under multidisciplinary supervision. Intervention adherence, duration, and individualization emerged as critical determinants of effectiveness, underscoring the importance of adaptive program design in this population (Niclasen et al., 2018; Gramaglia et al., 2021; Athanasiou et al., 2023; Santoyo-Sánchez and Reyes-Morales, 2024).

Beyond descriptive associations, emerging mechanistic evidence provides a coherent biological and conceptual framework to explain the mental health benefits of exercise-based NPIs. Recent integrative studies indicate that physical activity enhances neural connectivity and neurogenesis, modulates stress-regulatory systems by reducing cortisol and other stress-related hormones, and promotes the release of neurotransmitters involved in mood regulation and emotional resilience. In parallel, exercise promotes muscle regeneration and attenuates systemic inflammation and oxidative stress. Collectively, these mechanisms help explain why exercise-based NPIs may be more effective in improving mood, attention, executive function, memory, quality of life, reducing depressive symptoms, and suicidal ideation than psychotherapy or antidepressant treatment alone (Athanasiou et al., 2023; Kanani et al., 2025; Chen et al., 2021; Mazumder et al., 2023). Compared with conventional pharmacological treatments, these interventions demonstrate feasibility, safety, and cost-effectiveness profiles, reinforcing their potential for implementation in resource-constrained public health systems. Their delivery by trained multidisciplinary teams further supports their scalability and sustainability at the community level (Santoyo-Sánchez and Reyes-Morales, 2024; Apóstolo et al., 2016; Chen et al., 2021; Borbón-Castro et al., 2020; Cantón-Martínez et al., 2024; Ortiz-Ortiz et al., 2019).

In addition to exercise-based strategies, positive reminiscence interventions have consistently been shown to enhance life satisfaction, mood, social engagement, and cognitive outcomes (Apóstolo et al., 2016). Evidence from Mexico indicates reductions in depressive symptoms and improvements in the recall of specific positive memories following reminiscence-based programs, whereas other approaches, such as cognitive stimulation therapies, primarily contribute to maintaining or improving cognitive function (Villasán-Rueda et al., 2023; Sánchez-Nieto et al., 2019).

In contrast, evidence supporting video game–based and mental stimulation interventions remains limited and inconclusive (Gramaglia et al., 2021), with pilot studies in Mexico failing to demonstrate clear intervention-specific reductions in depressive symptomatology (Gómez-Miranda et al., 2019; Sánchez-Nieto et al., 2019). These heterogeneous findings highlight the need to critically differentiate between cognitively engaging activities and interventions capable of producing clinically meaningful emotional outcomes.

Globally, mental disorders affect approximately 15% of the geriatric population (Instituto Nacional de las Personas Adultas Mayores, 2024), yet access to adequate mental healthcare remains limited even in high-income countries. International evidence reveals a marked scarcity and uneven distribution of NPIs, with relatively few interventions identified over extended periods across Europe, North America, and low- and middle-income countries (Apóstolo et al., 2016; Xu et al., 2023; Wuthrich et al., 2024; Niclasen et al., 2018; Mazumder et al., 2023).

While several nations have implemented diverse, integrated strategies including mind–body practices, psychosocial stimulation, intergenerational learning, and nature-based or animal-assisted interventions (Gramaglia et al., 2021; Apóstolo et al., 2016; Xu et al., 2023; Reangsing et al., 2021; Frost et al., 2019; Niclasen et al., 2018; Mazumder et al., 2023; Wuthrich et al., 2024), Mexican programs remain largely concentrated on face-to-face modalities focused on physical exercise, cognitive stimulation, and reminiscence (Villarreal-Ángeles et al., 2016; Borbón-Castro et al., 2020; Cantón-Martínez et al., 2024; Gómez-Miranda et al., 2019; Ortiz-Ortiz et al., 2019; Sánchez-Nieto et al., 2019; Villasán-Rueda et al., 2023).

This limited diversity reflects structural constraints, including limited infrastructure, shortages of specialized human resources, and the absence of formal public policies that integrate NPIs into geriatric care models (Juárez et al., 2020; Guzmán-Olea et al., 2018).

Nevertheless, NPIs developed in Mexico demonstrate methodological rigor comparable to international studies, employing experimental or quasi-experimental designs and validated instruments to assess depression and life satisfaction (Gramaglia et al., 2021; Apóstolo et al., 2016; Xu et al., 2023; Niclasen et al., 2018; Mazumder et al., 2023; Wuthrich et al., 2024; Reangsing et al., 2021; Frost et al., 2019).

Most interventions in Mexico and around the world target non-institutionalized OAs, are of relatively short to moderate duration, and involve small sample sizes, highlighting persistent challenges related to scalability, long-term follow-up, and inclusion of more vulnerable subpopulations (Gramaglia et al., 2021; Reangsing et al., 2021; Frost et al., 2019; Niclasen et al., 2018; Mazumder et al., 2023; Apóstolo et al., 2016; Xu et al., 2023; Wuthrich et al., 2024; Ortiz-Ortiz et al., 2019; Villasán-Rueda et al., 2023).

In light of this evidence, the findings highlight the need to move beyond descriptive analyses toward policy-relevant, mechanism-informed frameworks. The integration of exercise-based and psychosocial NPIs into national aging and mental health strategies represents an opportunity to reduce treatment gaps and enhance emotional wellbeing and quality of life among OAs in Mexico.

Despite ample evidence supporting the benefits of NPIs on OA mental health (Gramaglia et al., 2021; Apóstolo et al., 2016; Xu et al., 2023; Reangsing et al., 2021; Frost et al., 2019; Villarreal-Ángeles et al., 2016; Borbón-Castro et al., 2020; Cantón-Martínez et al., 2024; Gómez-Miranda et al., 2019; Ortiz-Ortiz et al., 2019; Sánchez-Nieto et al., 2019; Villasán-Rueda et al., 2023; Niclasen et al., 2018; Mazumder et al., 2023; Wuthrich et al., 2024), significant challenges remain. The primary issue is the limited territorial coverage of NPIs, which are currently present in only 4 of Mexico’s 32 states (12.5%). Epidemiological evidence from Mexico indicates that only 12.7% of OA with depressive symptoms are detected, and merely 8.5% receive treatment. Moreover, increasing levels of municipal marginalization are associated with a widening gap between the prevalence of depressive symptoms and access to diagnosis and treatment. Consistent with the findings of the present review, these disparities are more pronounced in southern regions of the country than in Mexico City, suggesting insufficient institutional commitment to healthcare in rural and marginalized areas (Cerecero-García et al., 2020).

The present review identifies clear opportunities to strengthen the implementation of NPIs in Mexico, supported by national clinical guidelines that endorse a biopsychosocial approach to depression in OAs (Instituto Mexicano del Seguro Social & Centro Nacional de Excelencia Tecnológica en Salud, 2010). Community, academic, and institutional settings may serve as scalable, cost-effective platforms for integrating culturally adapted, evidence-based NPIs. However, current implementation remains constrained by weak interdisciplinary coordination (Consejo Mexicano de Geriatría, 2025; Santoyo-Sánchez and Reyes-Morales, 2024). To maximize impact, future efforts should prioritize inclusive models that address OAs with functional dependence or chronic conditions, ensuring continuity of care across home-based and institutional settings. Such an approach underscores the need for immediate action to prioritize equitable, inclusive, and wellness-centered models of geriatric care.

The findings of this review should be interpreted in light of several limitations related to both the primary studies and the review process itself. Regarding the included evidence, the methodological quality was variable. Two studies were randomized controlled trials (Villarreal-Ángeles et al., 2016; Borbón-Castro et al., 2020), and five were quasi-experimental (Cantón-Martínez et al., 2024; Gómez-Miranda et al., 2019; Ortiz-Ortiz et al., 2019; Sánchez-Nieto et al., 2019; Villasán-Rueda et al., 2023). The mean quality scores were 5.5 (maximum 13) and 6.8 (maximum 9), respectively.

The most frequent contributors to methodological limitations were a lack of blinding, small sample sizes, short intervention duration, and limited control of confounding variables. While blinding is inherently difficult in physical interventions (Adams et al., 2021), these scores indicate a moderate risk of bias, warranting cautious interpretation of efficacy. Consequently, the observed effects should be interpreted as suggestive rather than definitive. Overall confidence in the magnitude of the reported benefits is moderate. Furthermore, most interventions target non-institutionalized OAs, are of short duration, and involve small sample sizes, highlighting persistent challenges related to long-term follow-up and inclusion of vulnerable subpopulations (Gramaglia et al., 2021; Reangsing et al., 2021; Frost et al., 2019; Niclasen et al., 2018; Mazumder et al., 2023; Apóstolo et al., 2016; Xu et al., 2023; Wuthrich et al., 2024; Ortiz-Ortiz et al., 2019; Villasán-Rueda et al., 2023).

Regarding the review process, two specific limitations must be acknowledged. First, the search strategy was restricted to PubMed, Scopus, and the Virtual Health Library. While these databases provide comprehensive coverage of high-impact medical literature, their exclusion of other databases (e.g., Embase, PsycINFO) and grey literature may have led to the omission of relevant local reports or unpublished dissertations. Second, the search algorithm used English and Spanish terms but may have introduced linguistic bias by excluding studies published in indigenous languages or in journals not indexed in major repositories (Dobrescu et al., 2021). Moreover, Dobrescu et al. note that restricting systematic reviews to English-language publications minimally affects estimates and conclusions for most medical topics (Dobrescu et al., 2021).

Taken together, the findings of this review suggest that NPIs constitute a promising yet underutilized strategy to promote, maintain, and improve mental health among OAs in Mexico. Their limited and uneven implementation reflects persistent structural gaps within the health system and broader societal neglect of geriatric care. Addressing these challenges requires the development of robust, inclusive, and sustainable public policies that support the integration of culturally relevant, non-pharmacological psychosocial interventions into routine care. Future research must move beyond pilot studies to prioritize larger, nationally representative samples and explicitly include OAs with multimorbidity, functional dependence, or sensory impairments. Only through such rigorous and scalable approaches can geriatric mental healthcare evolve from a privilege into a standardized, essential component of the national health system.