Frost and colleagues1 bring up an important — often under-recognised — topic and its associated challenges to our attention.
With the continuity of care allowed, and the knowledge of both a patient’s social context and their comorbidities that influence treatment options, there is little doubt that primary care has a central role in the management of older people with depression.
Individualising a treatment plan based on the circumstances of a person is crucial;2 assumptions on an older person’s preferences are likely to be detrimental. Several factors need to be kept in mind when deciding on a treatment strategy: both clinician and patient preferences; manual dexterity; eyesight issues; access to technology; mobility; previous history of anxiety and/or depression (and previous successful treatment options); comorbidities; and polypharmacy.
Exploring all of the above is invariably difficult within the standard 10-minute consultation as the review points out. It is only by investing the time and effort in longer appointments that we can hope to address this often neglected area. Moreover, being attentive to the possibility of depression presenting differently in older people (for example, with somatic symptoms) will help to prevent multiple initial attendances.3,4 A cursory assessment ending in a prescription for antidepressants is unlikely to be helpful in most instances.
Appropriate services need to exist locally to cater for the needs of the older population. Primary care networks have the potential to help deliver more effective care to patients with mental health problems by locating mental health therapists within primary care and by having practice pharmacists help with medications and pharmacology.5,6 Patients are likely to appreciate the familiarity and proximity of treatment ‘under one roof’. Because of the complex interplay between one’s social situation and mental wellbeing, signposting from social prescribers can also help, for example, befriending services, Age UK, U3As, volunteering activities, and bibliotherapy.
Closer cooperation between psychiatry, geriatrics, and primary care can also lead to more effective outcomes.2 In care home settings, the training of staff by experienced mental health nurses can also increase the confidence in identifying and dealing with mental health issues.4,7
- © British Journal of General Practice 2019
