Mental Health Services Use by Elderly Adults in a Primary Care Setting

Goldstrom, Ingrid D.; Burns, Barbara J.; Kessler, Larry G.; Feuerberg, Marvin; Larson, David B.; Miller, Nancy E.; Cromer, Ward J.

doi:10.1093/geronj/42.2.147

Cited by 69 publications

(33 citation statements)

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“…When first published, data such as these differed from the consensus of the day that mental health problems were highly prevalent among older adults (10). Of particular surprise was the prevalence estimate of 0.9% for MDE (8).…”

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confidence: 92%

The Epidemiology of Psychological Problems in the Elderly

2006

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Objective: To determine the prevalence of mood, anxiety, and other disorders in the population of Canadians aged 55 years and over. Method:We undertook an analysis of the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2).Results: There was a linear decrease for all disorders after age 55 years. This was true for men and women; for anglophones, francophones, and allophones; and for both people born in Canada and people who immigrated to Canada after age 18 years. Consistent with previous research, the prevalences were higher for women than men. Immigrants reported fewer problems than nonimmigrants, with the differences decreasing with age. Francophones of both sexes reported more mood disorder than anglophones, but francophone men had less anxiety disorder than anglophone men. Conclusions:Unlike other studies that have found an upturn in the prevalence of depression and anxiety in the elderly, our results indicate a steady decrease in these disorders. Our findings are discussed in terms of explanations for age-related differences in psychiatric disorders. Clinical Implications· Although people aged 55 years and over are more prone to suffer physical ailments and are more likely to face loss of loved ones, they appear to suffer less anxiety and depression than those aged of 55 years and under. · The low estimates of psychiatric disorders among the elderly, combined with the widely held belief that depression and other disorders are common in this population, suggest that there may be some risk of misattributing physical distress or impairment to psychological factors, leading to overmedication. Further research regarding the prevalence of mood and anxiety disorders among the elderly in institutions is required as this is an understudied group. Limitations· Although the CCHS 1.2 used a well-validated interview schedule, diagnoses are based on self-report of symptoms and were not confirmed by clinical interviews. · Not all depressive or anxiety disorders were included in the survey, although the most prevalent were. · The response rate was quite high for surveys, but those who did not participate may have refused because of psychological problems, possibly lowering the prevalence rates. · People in long-term care facilities and hospitals were not included.

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confidence: 92%

The Epidemiology of Psychological Problems in the Elderly

2006

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“…Among the one in 10 older primary care patients with depression,1 2 only a small fraction receives adequate treatment in primary care3 4 or sees a mental health specialist 2 5 6. Although treatment of depression in primary care has improved,7 – 13 few improvements deal with the specific needs of elderly patients.…”

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confidence: 99%

Long term outcomes from the IMPACT randomised trial for depressed elderly patients in primary care

Hunkeler

Katon

Tang

et al. 2006

BMJ

301

210

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Objective To determine the long term effectiveness of collaborative care management for depression in late life. Design Two arm, randomised, clinical trial; intervention one year and follow-up two years. Setting 18 primary care clinics in eight US healthcare organisations. Patients 1801 primary care patients aged 60 and older with major depression, dysthymia, or both. Intervention Patients were randomly assigned to a 12 month collaborative care intervention (IMPACT) or usual care for depression. Teams including a depression care manager, primary care doctor, and psychiatrist offered education, behavioural activation, antidepressants, a brief, behaviour based psychotherapy (problem solving treatment), and relapse prevention geared to each patient's needs and preferences. Main outcome measures Interviewers, blinded to treatment assignment, conducted interviews in person at baseline and by telephone at each subsequent follow up. They measured depression (SCL-20), overall functional impairment and quality of life (SF-12), physical functioning (PCS-12), depression treatment, and satisfaction with care. Results IMPACT patients fared significantly (P < 0.05) better than controls regarding continuation of antidepressant treatment, depressive symptoms, remission of depression, physical functioning, quality of life, self efficacy, and satisfaction with care at 18 and 24 months. One year after IMPACT resources were withdrawn, a significant difference in SCL-20 scores (0.23, P < 0.0001) favouring IMPACT patients remained. Conclusions Tailored collaborative care actively engages older adults in treatment for depression and delivers substantial and persistent long term benefits. Benefits include less depression, better physical functioning, and an enhanced quality of life. The IMPACT model may show the way to less depression and healthier lives for older adults.

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“…These problems are only compounded for the elderly. When identified in the primary care setting, older adults with mental disorders may be less likely than younger adults to be referred to mental health specialists (Goldstrom et al, 1987) and more likely to receive psychotropic drugs without a recorded diagnosis (Larson, Lyons, Hohmann, & Beardsley, 1991). The presence of mental disorders is also related to a greater risk of inappropriate medication prescription in older adults, especially benzodiazepines (Stuck et al, 1994).…”

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confidence: 99%