Our results suggest possible avenues for building more effective partnerships between palliative care consult services and referring physicians and highlight the need for interventions designed to facilitate physician-patient communication about palliative care.

Objective Colocation of mental health screening, assessment, and treatment in primary care reduces stigma, improves access, and increases coordination of care between mental health and primary care providers. However, little information exists regarding older adults’ attitudes about screening for mental health problems in primary care. The objective of this study was to evaluate older primary care patients’ acceptance of and satisfaction with screening for depression and anxiety. Methods The study was conducted at an urban, academically affiliated primary care practice serving older adults. Study patients (N = 107) were screened for depression/anxiety and underwent a post-screening survey/interview to assess their reactions to the screening experience. Results Most patients (88.6%) found the length of the screening to be “just right.” A majority found the screening questions somewhat or very acceptable (73.4%) and not at all difficult (81.9%). Most participants did not find the questions stressful (84.9%) or intrusive (91.5%); and a majority were not at all embarrassed (93.4%), upset (93.4%), or uncomfortable (88.8%) during the screening process. When asked about frequency of screening, most patients (72.4%) desired screening for depression/anxiety yearly or more. Of the 79 patients who had spoken with their physicians about mental health during the visit, 89.8% reported that it was easy or very easy to talk with their physicians about depression/anxiety. Multivariate results showed that patients with higher anxiety had a lower positive reaction to the screen when controlling for gender, age, and patient–physician communication. Conclusions These results demonstrate strong patient support for depression and anxiety screening in primary care.

The authors' results suggest that a demand exists for high-quality electronic and portable learning tools that are relevant to medical student education in psychiatry. Psychiatry educators are usefully positioned to be involved in the development of such resources.

Late-life depression is a leading cause of disability in older adults and is associated with significant economic burden. This article draws from the existing literature and publicly available databases to describe the relative importance of the indirect costs associated with late-life depression. The authors found that unpaid caregiver costs represent the largest component of the indirect costs of late-life depression, with the highest level of economic burden attributed to the majority of care recipients who have fewer depressive symptoms. Other indirect costs, such as productivity losses related to early retirement, reduced ability to fulfill work and family functions and diminished financial success were mostly under-appreciated in the literature. Also, mortality cost estimates provided little clarity, employing variable methodologies and revealing mixed results. With respect to late-life suicide studies, studies approximated both economic costs and savings. More rigorous efforts to evaluate the indirect costs of late-life depression would afford a better understanding of the social and economic toll of this disorder and could influence the allocation of resources for research and treatment.

This cross-sectional observational study examined the frequency of older patient–physician discussions about exercise, who initiates discussions, and the quality of questioning, informing, and support about exercise. The study used a convenience sample of 396 follow-up visits at 3 community-based practice sites, with 376 community-dwelling older patients and 43 primary-care physicians. Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis coding system. Results demonstrate that exercise was discussed in 13% of visits and the subject was raised equally by patients and physicians. Exercise was significantly more likely to be discussed in dyadic visits (14.7%) than in triadic visits (4.1%). Patient level of education, patient overall physical health, and the physician’s being female were significant predictors of the occurrence of exercise discussion. Given the importance of exercise for maintaining health and independence in older adults, more clinical and research attention is needed to address barriers to effective discussions in this area.