ContextFew depressed older adults receive effective treatment in primary care
settings.ObjectiveTo determine the effectiveness of the Improving Mood–Promoting
Access to Collaborative Treatment (IMPACT) collaborative care management program
for late-life depression.DesignRandomized controlled trial with recruitment from July 1999 to August
2001.SettingEighteen primary care clinics from 8 health care organizations in 5
states.ParticipantsA total of 1801 patients aged 60 years or older with major depression
(17%), dysthymic disorder (30%), or both (53%).InterventionPatients were randomly assigned to the IMPACT intervention (n = 906)
or to usual care (n = 895). Intervention patients had access for up to 12
months to a depression care manager who was supervised by a psychiatrist and
a primary care expert and who offered education, care management, and support
of antidepressant management by the patient's primary care physician or a
brief psychotherapy for depresssion, Problem Solving Treatment in Primary
Care.Main Outcome MeasuresAssessments at baseline and at 3, 6, and 12 months for depression, depression
treatments, satisfaction with care, functional impairment, and quality of
life.ResultsAt 12 months, 45% of intervention patients had a 50% or greater reduction
in depressive symptoms from baseline compared with 19% of usual care participants
(odds ratio [OR], 3.45; 95% confidence interval [CI], 2.71-4.38; P<.001). Intervention patients also experienced greater rates of
depression treatment (OR, 2.98; 95% CI, 2.34-3.79; P<.001),
more satisfaction with depression care (OR, 3.38; 95% CI, 2.66-4.30; P<.001), lower depression severity (range, 0-4; between-group
difference, −0.4; 95% CI, −0.46 to −0.33; P<.001), less functional impairment (range, 0-10; between-group
difference, −0.91; 95% CI, −1.19 to −0.64; P<.001), and greater quality of life (range, 0-10; between-group
difference, 0.56; 95% CI, 0.32-0.79; P<.001) than
participants assigned to the usual care group.ConclusionThe IMPACT collaborative care model appears to be feasible and significantly
more effective than usual care for depression in a wide range of primary care
practices.

https://jamanetwork.com/journals/jama/articlepdf/195599/JOC21093.pdf

Collaborative Care Management of Late-Life Depression in the Primary Care Setting: A Randomized Controlled Trial

Depression is perhaps the most frequent cause of emotional suffering in later life and significantly decreases quality of life in older adults. In recent years, the literature on late-life depression has exploded. Many gaps in our understanding of the outcome of late-life depression have been filled. Intriguing findings have emerged regarding the etiology of late-onset depression. The number of studies documenting the evidence base for therapy has increased dramatically. Here, I first address case definition, and then I review the current community- and clinic-based epidemiological studies. Next I address the outcome of late-life depression, including morbidity and mortality studies. Then I present the extant evidence regarding the etiology of depression in late life from a biopsychosocial perspective. Finally, I present evidence for the current therapies prescribed for depressed elders, ranging from medications to group therapy.

/pdf/depression-in-late-life-review-and-commentary-4a0bgmeam6.pdf

Depression in Late Life: Review and Commentary

Depression in the elderly

When choosing between delayed or uncertain outcomes, individuals discount the value of such outcomes on the basis of the expected time to or the likelihood of their occurrence. In an integrative review of the expanding experimental literature on discounting, the authors show that although the same form of hyperbola-like function describes discounting of both delayed and probabilistic outcomes, a variety of recent findings are inconsistent with a single-process account. The authors also review studies that compare discounting in different populations and discuss the theoretical and practical implications of the findings. The present effort illustrates the value of studying choice involving both delayed and probabilistic outcomes within a general discounting framework that uses similar experimental procedures and a common analytical approach.

/pdf/a-discounting-framework-for-choice-with-delayed-and-2di0vonnl8.pdf

A discounting framework for choice with delayed and probabilistic rewards.

OBJECTIVE: The goal of this study was to determine risk factors for depression among elderly community subjects. METHOD: MEDLINE and PsycINFO were searched for potentially relevant articles published from January 1966 to June 2001 and from January 1967 to June 2001, respectively. The bibliographies of relevant articles were searched for additional references. Twenty studies met the following six inclusion criteria: original research reported in an English or French publication, study group of community residents, age of subjects 50 years or more, prospective study design, examination of at least one risk factor, and use of an acceptable definition of depression. The validity of studies was assessed according to the four primary criteria for risk factor studies described by the Evidence-Based Medicine Working Group. Information about group size at baseline and follow-up, age, proportion of men, depression criteria, exclusion criteria at baseline, length of follow-up, number of incident cases of depression,...

Risk Factors for Depression Among Elderly Community Subjects: A Systematic Review and Meta-Analysis

DEPRESSION in the aging and the aged is a major public health problem. It causes suffering to many who go undiagnosed, and it burdens families and institutions providing care for the elderly by disabling those who might otherwise be able-bodied. What makes depression in the elderly so insidious is that neither the victim nor the health care provider may recognize its symptoms in the context of the multiple physical problems of many elderly people. Depressed mood, the typical signature of depression, may be less prominent than other depressive symptoms such as loss of appetite, sleeplessness, anergia, and loss of interest in, and enjoyment of, the normal pursuits of life. There is a wide spectrum of depressive symptoms as well as types of available therapies. Because of the many physical illnesses and social and economic problems of the elderly, individual health care providers often conclude that depression is a normal consequence

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=JAMA&articleId=399454&pdfFileName=jama_268_8_032.pdf

Diagnosis and Treatment of Depression in Late Life

Two of the most common psychological disorders of later life are dementia and depression. This text reviews up-to-date research on the diagnosis of dementia and depression and offers recommendations for evaluating this unique population. Test norms for older adults are also included.

Neuropsychological assessment of dementia and depression in older adults: A clinician's guide.

In the light of the fact that the fastest growing segment of the population consists of those over 85, this work asks whether psychology is ready to serve that ageing and aged population. A number of aspects of the question are addressed.

The Adult Years: Continuity and Change

The National Institutes of Health Consensus Development Conference on Diagnosis and Treatment of Depression in Late Life brought together biomedical and behavioral scientists, surgeons, and other health care professionals as well as the public to address the epidemiology, pathogenesis, pathophysiology, prevention, and treatment of depression in the elderly and to alert both the professional and lay public to the seriousness of depression in late life, to its manifestations and useful treatments, and to areas needing further study. Following 1 1/2 days of scientific presentations by experts and discussion by the audience, a consensus panel weighed the evidence and prepared their consensus statement. Among their findings, the panel concluded that (1) depression in late life occurs in the context of numerous social and physical problems that often obscure or complicate diagnosis and impede management of the illness; (2) because there is no specific diagnostic test for depression, an attentive and focused clinical assessment is essential for diagnosis; (3) depressed elderly people should be treated vigorously with sufficient doses of antidepressants and for a sufficient length of time to maximize the likelihood of recovery; (4) electroconvulsive therapy and psychosocial treatments also can be effective in the treatment of elderly depressed patients; and (5) estimates of the prevalence of depression vary widely, but the highest rates are in nursing homes and other residential settings, and staff in many of these facilities are not equipped to recognize or treat depressed patients. The full text of the consensus panel's statement follows.

Martha Storandt

Papers

Diagnosis and Treatment of Depression in Late Life

Neuropsychological assessment of dementia and depression in older adults: A clinician's guide.

The Adult Years: Continuity and Change

Diagnosis and Treatment of Depression in Late Life: The NIH Consensus Development Conference statement