Depression in Older People: What does the Future Hold?
01 Sep 1996-International Journal of Geriatric Psychiatry (John Wiley & Sons, Ltd.)-Vol. 11, Iss: 9, pp 831-835
TL;DR: In this article, a personal view from a United Kingdom perspective examines some demographic, economic and social changes and assesses the impact they may have on the prevalence and treatment of depression in older people.
Abstract: Demographic, economic and social changes over the next few decades are likely to have a significant effect on the care of the elderly. This personal view, from a United Kingdom perspective, examines some of these changes and assesses the impact they may have on the prevalence and treatment of depression in older people. Strategies for minimizing the marginalization of this group are discussed.
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TL;DR: The research on older people at risk of depression is summarized to identify important signs and symptoms which will help practitioners recognise it, consider the usual treatment approaches, outline effective psychosocial interventions and highlight important factors for therapists to consider in their work with older people.
Abstract: Depression as a clinical syndrome has been identified as the most significant mental health problem in later life. However, it is less likely to be recognised by health and social care practitioners than is depression among younger people. Even when depression is recognised, medical, psychological and social interventions are infrequent. Behaviour appears to be affected by negative beliefs about effectiveness despite evidence to the contrary. The purpose of this article is to summarise the research on older people at risk of depression, identify important signs and symptoms which will help practitioners recognise it, consider the usual treatment approaches, outline effective psychosocial interventions and highlight important factors for therapists to consider in their work with older people.
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TL;DR: Poor outcome was associated with severity of initial illness, those with depressive delusions having a particularly poor outcome, and there was no evidence that an intimate relationship protected against relapse in the face of continuing life stress.
Abstract: The paper describes a one year prospective study of 124 elderly depressed patients. Only one third of the group had a good outcome. Poor outcome was associated with severity of initial illness, those with depressive delusions having a particularly poor outcome. Outcome was also influenced by physical health problems and severe life events in the follow-up year. Social class differences in outcome were thought to be due to class differences in the experience of severe life events. There was no evidence that an intimate relationship protected against relapse in the face of continuing life stress.
546 citations
TL;DR: Oregon's final priority list was generated without reference to costs and is, therefore, more intuitively sensible than the initial list, but the utility of the final list is limited by its lack of specificity with regard to conditions and treatments.
Abstract: The Oregon Health Services Commission recently completed work on its principal charge: creation of a prioritized list of health care services, ranging from the most important to the least important Oregon's draft priority list was criticized because it seemed to favor minor treatments over lifesaving ones This reaction reflects a fundamental and irreconcilable conflict between cost-effectiveness analysis and the powerful human proclivity to rescue endangered life: the "Rule of Rescue" Oregon's final priority list was generated without reference to costs and is, therefore, more intuitively sensible than the initial list However, the utility of the final list is limited by its lack of specificity with regard to conditions and treatments An alternative approach for setting health care priorities would circumvent the Rule of Rescue by carefully defining necessary indications for treatment Such an approach might be applied to Oregon's final list in order to achieve better specificity ( JAMA 1991;265:2218-2225)
448 citations
TL;DR: Estimates of the direct costs associated with the treatment of patients in England and Wales amount to some £420 million annually, and pharmaceutical costs represent a relatively small proportion of this total.
Abstract: Depression is one of the commonest conditions seen by general practitioners. Conventional treatments are typically drug based, and usually involve one of the tricyclic preparations. The evaluation of new treatments requires an understanding of the costs and benefits of existing alternatives, to provide a comparative framework for general practitioners and others concerned with the treatment and management of depressed patients. This paper presents estimates of the direct costs associated with the treatment of patients in England and Wales. These amount to some 420 million pounds annually. Pharmaceutical costs represent a relatively small proportion of this total. Substantial indirect costs are generated through lost productivity, and these may exceed 3 billion pounds.
430 citations
TL;DR: The rise in the prevalence of dementia with age was further confirmed and the GMS AGECAT Package provides a method for standardising both the collection of data and the diagnostic process for comparative epidemiological studies and other research.
Abstract: A sample of 1070 elderly persons aged over 65 living in the Liverpool community was interviewed using the community version of the Geriatric Mental State (GMS) and the findings processed to provide a computerised diagnosis by AGECAT. Levels of organic disorder, probably dementia, reached 5.2%, intermediate between those of London and New York derived from previous studies. Levels for depressive illness overall were below those of other studies at 11.3% while levels for neurotic disorder were much the same at 2.4%. The rise in the prevalence of dementia with age was further confirmed. The GMS AGECAT Package provides a method for standardising both the collection of data and the diagnostic process for comparative epidemiological studies and other research.
404 citations