Research articleRecommendations for Treating Depression in Community-Based Older Adults
Introduction
Depression is common among older adults, affecting almost 7 million Americans aged 65 and older.1, 2 In 1999, a landmark U.S. Surgeon General’s report on mental health found that 8% to 20% of older adults in the community, and up to 37% in primary care settings, suffer from depressive symptoms.3 Unfortunately, many of these older adults receive no or inadequate treatment,4, 5, 6 and this under-diagnosis and under-treatment of depression represents a serious public health problem.7 Preventing and treating late-life depression is also of significant public health importance because depression can increase symptom burden of other comorbid conditions (e.g., heart disease), disability, healthcare utilization, and mortality from suicide and cardiac disease.8, 9, 10, 11, 12
Community-based medical and social services settings (vs traditional mental health clinics), offer important opportunities for recognition and intervention of depression in older adults, since many depressed older adults typically present in these environments. Although a broad array of effective interventions exists for depression, there is no clear consensus on effective treatments to be recommended for community-based older adults specifically. This project aimed to identify effective interventions and to develop recommendations based on consensus from a panel of experts from public health, epidemiology, social services, and primary care.
Section snippets
Methods
In the first stage of this project, a panel of 14 academics in public health and geriatric depression systematically reviewed 3543 peer-reviewed studies published from 1967 to 2005 to identify effective interventions for treating depression in non-institutionalized older adults. The panel operationalized “depression” as either a clinical DSM-IV13 depression diagnosis (e.g., major depression, dysthymia) or as a symptom severity score from a standardized assessment instrument. The literature
Results
A summary of the recommendations is provided in Table 1. Further details on the programs and points to consider are provided in the following section. Consensus was reached for all recommendations.
Discussion
This work addresses the urgent need for effective prevention and treatment of depression in older adults. More information can be found on our project’s website.30 We strongly recommended home-based DCM for people with minor depression or dysthymia; although home-based DCM for major depression has not been studied. DCM is also strongly recommended in primary care settings for major depression and dysthymia, although it was not more effective than usual primary care for minor depression. Primary
Conclusion
This recommendation process identified DCM and CBT for effective community-based treatment for late-life depression, based on their strength of evidence and applicability in these settings. The panel felt that these recommended programs should be disseminated throughout public health and aging networks while acknowledging the challenges and obstacles involved. Other interventions were not recommended, often because available studies did not target depressed subjects specifically or the number
References (52)
- et al.
Community-based treatment of late life depression: an expert panel–informed literature review
Am J Prev Med
(2007) - et al.
Developing an evidence-based Guide to Community Preventive Services—methods
Am J Prev Med
(2000) - et al.
Evidence-based pharmacologic interventions for geriatric depression
Psychiatr Clin North Am
(2005) - et al.
Depression and service utilization in elderly primary care patients
Am J Geriatr Psychiatry
(2001) - et al.
Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale)
Am J Prev Med
(1994) - et al.
Development and validation of a geriatric depression screening scale: a preliminary report
J Res
(1983) - et al.
Funding mechanisms for depression care management: opportunities and challenges
Gen Hosp Psychiatry
(2006) - Narrow WE. One-year prevalence of depressive disorders among adults 18 and over in the U.S.: NIMH ECA prospective data....
Mood disorders
Mental health: a report of the Surgeon General
(1999)
Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial
JAMA
Care for depression in HMO patients aged 65 and older
J Am Geriatr Soc
Community-integrated home-based depression treatment in older adults: a randomized controlled trial
JAMA
Psychiatric status and 9-year mortality data in the New Haven Epidemiologic Catchment Area Study
Am J Psychiatry
Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study
Am J Psychiatry
Depression and diabetes: impact of depressive symptoms on adherence, function, and costs
Arch Intern Med
Depression as a risk factor for ischaemic heart disease in men: population based case–control study
BMJ
Quality adjusted life years in older adults with depressive symptoms and chronic medical disorders
Int Psychogeriatr
Diagnostic and statistical manual of mental disorders: DSM-IV-TR
Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial
JAMA
Cognitive therapy of depression
Antidepressants for depressed elderly
Cochrane Database Syst Rev
Pharmacotherapy of depression in old age
Acta Clin Belg
Longitudinal study of depression and health services use among elderly primary care patients
J Am Geriatr Soc
Persons with depression symptoms and the treatments they receive: a comparison of primary care physicians and psychiatrists
Int J Psychiatry Med
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