Objective-To investigate the efficacy of intervention by a psychogeriatric team in the treatment of depression in elderly disabled people receiving home care from their local authority.Design-Randomised controlled trial with blind follow up six months after recruitment.Setting-Community of south east London.Subjects-69 people aged 65 or over who received home care and were depressed according to criteria of the standardised automatic geriatric examination for computer assisted taxonomy (AGECAT). 33 were randomly allocated to an intervention group and 36 to a control group.Intervention-Members of the intervention group received an individual package of care that was formulated by the community psychogeriatric team in their catchment area and implemented by a researcher working as a member of that team. The control group received normal general practitioner care.Main outcome measures-Recovery from depression (AGECAT case at recruitment but non-case at follow up).Results-Data were analysed on an intention to treat basis. 19 (58%) of the intervention group recovered compared with only nine (25%) of the control group, a difference of 33% (95% confidence interval 10% to 55%/6). This powerful treatment effect persisted after controlling for possible confounders in logistic regression analysis, with members of the intervention group more likely than members of the control group to have recovered at follow up (odds ratio 9.0 (2.0 to 41.5)). This did not seem to be a simple effect of antidepressant prescription: use of antidepressants at follow up did not have a significant effect (multiply adjusted odds ratio 0.3 (0.0 to 1.9)).Conclusions-Depression is treatable in elderly people receiving home care. Therapeutic nihilism based on an assumed poor response to treatment in these socially isolated, disabled elderly people in the community is not supported. Section of Epidemiology and General Practice,
Fifty consecutive elderly patients undergoing emergency hip surgery were assessed shortly after operation and again one year later. Depressive symptoms, cognitive impairment, global physical ill-health and activity of daily living (ADL) function were assessed and their predictive effect on outcome investigated. Mortality was predicted by the presence of both depression and dementia as well as by physical ill-health. The effect of depression on mortality was independent of concurrent physical illness. Mortality was particularly high in subjects with both depression and dementia. Length of hospital stay was predicted by age and physical ill-health but not by psychiatric morbidity. ADL functioning at one year was predicted by increased age and the presence of dementia. Psychiatric evaluation may thus be relevant to the postoperative management of elderly patients undergoing emergency hip surgery.
2 Spence J. The need for understanding the individual as a part of the training and functions of doctors and nurses (speech delivered at a conference on mental health held in March 1949
Conclusions-This controlled trial of primary care physicians' attitudes towards patients with schizophrenia amounts to an empirical demonstration of medical discriminat ion against the sufferersof this and potentially of other long term psychiatricdisorders. Psychiatrists and general practitionersshould sharecare in the management of schizophrenia and try to overcome the prejudices against such patientsin an attempt to improvetheir overallclinicalcare.
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