Do general practitioners "miss" depression in elderly patients?

MacDonald, A J

doi:10.1136/bmj.292.6532.1365

Cited by 134 publications

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“…The undertreatment of depression is a recognised phenomenon in both hospital (Lustman & Harper, 1988) and primary care settings (MacDonald, 1987;Crawford et al, 1998). However, it would appear that the high positive predictive value of depression for people given this provisional diagnosis by referrers in this study indicates a sizeable rate of detection.…”

Section: Discussionmentioning

confidence: 46%

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‘Sadly confused’: the detection of depression and dementia on medical wards

Rao

2001

Psychiatr. bull.

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Dementia and depression are common psychiatric diagnoses in older people, and are common reasons for referral to liaison psychiatry services. The present study examined the accuracy of physicians' diagnoses for both disorders in consecutive referrals to a liaison old age psychiatry service. RESULTSPositive predictive values for depression and dementia were high, but levels of treatment of depression and documentation of past psychiatric history were both poor. Alcohol misuse and stroke accounted for the commonest accompanying disorders. CLINICAL IMPLICATIONSThe findings have implications for the encouragement of physicians to treat depression when this is suspected. Educational programmes for this purpose may be useful, incorporating an exploration of attitudes and knowledge of physicians towards depression in older people.

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Section: Discussionmentioning

confidence: 46%

“…Most studies examining the recognition of depression have been confined to primary care settings, with some evidence that the detection of depression by general practitioners may be more adequate than both treatment and referral to specialist services (MacDonald, 1987).…”

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confidence: 99%

‘Sadly confused’: the detection of depression and dementia on medical wards

Rao

2001

Psychiatr. bull.

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“…In a British study, GPs' opinions on depression were compared with semi-structured assessments made by psychiatrists using explicit diagnostic criteria. Adequate recognition was observed, but treatment appeared to need improvement (6).…”

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confidence: 96%

Management of depression in elderly general practice patients

Marwijk

Bock

Jong

et al. 1994

Scandinavian Journal of Primary Health Care

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Objective -To describe general practitioners' (GP) management (i.e., recognition and treatment) of depression in elderly patients.Design -Two separate studies were performed: (a) to study recognition of depression, a postal survey was sent to GPs; (b) to evaluate the consistency of treatment, patients considered depressed by GPs were described.Setting -general practices in the West of The Netherlands. Subjects -65 GPs, and 44 patients of 7 GPs. Main outcome meusures -(a) degree of recognition of depression as described in major depression case-vignettes (b) consistency of treatment.Results -(a) On average 65% of the GPs recognized every depressive symptom in case-vignette one, while 52% of GPs recognized each symptom in case two. Most (39) doctors used a time criterion of less than 5 weeks for depressive disorder. (b) Depressed patients with at least three depressive symptoms all received treatment. Chronically depressed patients appeared to be treated somewhat inadequately. Conclusion -The results suggest some inadequate knowledge of criteria for major depression and some inconsistency in treatment. The management of depression in elderly GP patients appears to need improvement.

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“…7 Of significance is the discovery of a 'significantly depressed mental state' in almost two-fifths of residents in local authority homes. 8 Depressive disorders in old age often coexist with cerebral disease, with many studies excluding such cases.…”

Section: Epidemiologymentioning

confidence: 99%

Depression later in life—an approach for the family practitioner

Roos

2008

South African Family Practice

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Depressive disorder is the most common mental health problem in older people. Health professionals mainly come into contact with those who are most susceptible to depression, including older people who live in residential facilities and the frail with acute or chronic physical illness. Quite often, such individuals also exhibit multiple pathology. Under these circumstances, health professionals may have an exaggerated view of the extent of depression among the elderly, causing them to overlook depressive disorders that they may have developed. Organic factors, including alcohol and iatrogenic drugs, must be ruled out in the aetiology. Physical ill health must receive optimum treatment. The choice of antidepressant drug is based on the side-effect profiles and potential drug-drug interactions, rather than on the degree of therapeutic efficacy. Treatment should be multimodal and multidisciplinary, with the aim of complete recovery and not simple improvement. By using a range of treatments, most patients will recover, though keeping patients well is more difficult. Treatment should be continued for at least 12 months. Many patients who could benefit from long-term maintenance therapy do not receive it. With optimum management the prognosis is at least as good as that for any other stage of adult life.

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Do general practitioners "miss" depression in elderly patients?

Cited by 134 publications

References 0 publications

‘Sadly confused’: the detection of depression and dementia on medical wards

‘Sadly confused’: the detection of depression and dementia on medical wards

Management of depression in elderly general practice patients

Depression later in life—an approach for the family practitioner

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