Diagnosis and Treatment of Depression in the Elderly Medicare Population: Predictors, Disparities, and Trends

Crystal, Stephen; Sambamoorthi, Usha; Walkup, James; Akincigil, Ayşe

doi:10.1046/j.1532-5415.2003.51555.x

Cited by 218 publications

(174 citation statements)

References 48 publications

(48 reference statements)

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“…Thus, while there is evidence that primary care providers are increasingly diagnosing later-life depression and recommending treatment for older patients [49, 50], there need to be greater efforts to ensure that patients actually initiate and continue appropriate care throughout the course of their depressive illness. Poor adherence to depression treatment is an important source of drug exposure variability but is often inadequately measured in research trials and clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Kales

Nease

Sirey

et al. 2013

The American Journal of Geriatric Psychiatry

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Objective Although antidepressants are an effective treatment for later-life depression, older patients often choose not to initiate or to discontinue medication treatment prematurely. While racial differences in depression treatment preferences have been reported, little is known about racial differences in antidepressant medication adherence among older patients. Design Prospective, observational study comparing antidepressant adherence for older African-American and white primary care patients. Participants One hundred and eighty-eight subjects aged 60 and older, diagnosed with clinically significant depression with a new recommendation for antidepressant treatment by their primary care physician. Measurement Study participants were assessed at study entry and at four-month follow-up (encompassing the acute treatment phase). Depression medication adherence was based on a well-validated self-report measure. Results At four-month follow-up, 61.2% of subjects reported that they were adherent to their antidepressant medication. In unadjusted and two of the three adjusted analyses, African-American subjects (n=82) had significantly lower rates of four-month antidepressant adherence than white subjects (n=106). African-American females had the lowest adherence rates (44.4%) followed by African-American males (56.8%), white males (65.3%) and white females (73.7%). In logistic regression models controlling for demographic, illness, and functional status variables, significant differences persisted between African-American women and white women in reported four-month antidepressant adherence (OR 3.58, 95% CI 1.27-10.07, Wald Chi-square =2.42, df=1, p<0.02). Conclusions The results demonstrate racial and gender differences in antidepressant adherence in older adults. Depression treatment interventions for the older adults should take into account the potential impact of race and gender on adherence to prescribed medications.

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Section: Discussionmentioning

confidence: 99%

Racial Differences in Adherence to Antidepressant Treatment in Later Life

Kales

Nease

Sirey

et al. 2013

The American Journal of Geriatric Psychiatry

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“…Our study includes Medicare beneficiaries diagnosed with depression; however, depression is underdiagnosed in administrative claims data (48). This potential misclassification of exposure would cause our results to be biased toward the null.…”

Section: Limitations and Strengthsmentioning

confidence: 99%

Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease. The Role of Depression

et al. 2016

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Rationale: Among individuals with chronic obstructive pulmonary disease (COPD), depression is one of the most common yet underrecognized and undertreated comorbidities. Although depression has been associated with reduced adherence to maintenance medications used in other conditions, such as diabetes, little research has assessed the role of depression in COPD medication use and adherence.Objectives: The objective of this study was to assess the impact of depression on COPD maintenance medication adherence among a nationally representative sample of Medicare beneficiaries newly diagnosed with COPD. Methods:We used a 5% random sample of Medicare administrative claims data to identify beneficiaries diagnosed with COPD between 2006 and 2010. We included beneficiaries with 2 years of continuous Medicare Parts A, B, and D coverage and at least two prescription fills for COPD maintenance medications after COPD diagnosis. We searched for prescription fills for inhaled corticosteroids, long-acting b-agonists, and long-acting anticholinergics and calculated adherence starting at the first fill. We modeled adherence to COPD maintenance medications as a function of new episodes of depression, using generalized estimated equations.Measurements and Main Results: Our primary outcome was adherence to COPD maintenance medications, measured as proportion of days covered. The exposure measure was depression. Both COPD and depression were assessed using diagnostic codes in Part A and B data. Covariates included sociodemographics, as well as clinical markers, including comorbidities, COPD severity, and depression severity. Of 31,033 beneficiaries meeting inclusion criteria, 6,227 (20%) were diagnosed with depression after COPD diagnosis. Average monthly adherence to COPD maintenance medications was low, peaking at 57% in the month after first fill and decreasing to 35% within 6 months. In our adjusted regression model, depression was associated with decreased adherence to COPD maintenance medications (odds ratio, 0.93; 95% confidence interval, 0.89-0.98).Conclusions: New episodes of depression decreased adherence to maintenance medications used to manage COPD among older adults. Clinicians who treat older adults with COPD should be aware of the development of depression, especially during the first 6 months after COPD diagnosis, and monitor patients' adherence to prescribed COPD medications to ensure best clinical outcomes.

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“…3 Given the low rates of mental health services use among older adults, it is particularly important to understand the association between predisposing and need factors and obtaining men tal health care among older adults. 1,2 In light of re search suggesting that predisposing and need fac tors are associated with obtaining mental health care, and that these factors are associated with age, age was hypothesized as a moderator of the association between predisposing and need factors and obtaining mental health care.…”

Section: Overview Of the Present Studymentioning

confidence: 99%

“…For example, use of psycho therapy during a depressive episode was only 12% for adults between ages 65 and 69 and only 6.6% among adults over age 80. 1 Another study re ported the rate of mental health care as 6.7% for people over age 65, which was significantly low er than rates for both younger and middle-aged adults. 2 Because of the low rate of obtaining men tal health care among older adults, it is important to better understand how age interacts with other factors hypothesized to increase or decrease use of mental health services.…”

mentioning

confidence: 96%