An improved understanding of how older adults view loneliness in relation to depression, derived from multiple methods, may inform clinical practice.

PURPOSE We wanted to understand concordance and discordance between physicians and patients about depression status by assessing older patient's views of interactions with their physicians. METHODSWe used an integrated mixed methods design that is both hypothesis testing and hypothesis generating. Patients aged 65 years and older, who identifi ed themselves as being depressed, were recruited from the offi ces of primary care physicians and interviewed in their homes using a semistructured interview format. We compared patients whose physicians rated them as depressed with those whose physicians who did not according to personal characteristics (hypothesis testing). Themes regarding patient perceptions of their encounters with physicians were then used to generate further hypotheses. RESULTSPatients whose physician rated them as depressed were younger than those whose physician did not. Standard measures, such as depressive symptoms and functional status, did not differentiate between patients. Four themes emerged in interviews with patients regarding how they interacted with their physicians; namely, "My doctor just picked it up," "I'm a good patient," "They just check out your heart and things," and "They'll just send you to a psychiatrist." All patients who thought the physician would "just pick up" depression and those who thought bringing up emotional content would result in a referral to a psychiatrist were rated as depressed by the physician. Few of the patients who discussed being a "good patient" were rated as depressed by the physician. CONCLUSIONSPhysicians may signal to patients, wittingly or unwittingly, how emotional problems will be addressed, infl uencing how patients perceive their interactions with physicians regarding emotional problems. Ann Fam Med 2006;4:302-309. DOI: 10.1370/afm.558. INTRODUCTIONT he primary health care setting plays a key role for older adults with depression and other psychiatric disturbances, because older persons in the community are unlikely to receive mental health care from a mental health care specialist.1-3 Nevertheless, evidence on the quality of care for older adults with depression in primary care suggests that often their depression is not diagnosed or actively managed. 4 Although much attention has been focused on understanding physician-based reasons for underdiagnosis of depression, primary care physicians believe that barriers to depression treatment are most often patient centered and related to patient attitudes and beliefs about depression care. 5 Several previous studies have linked patient-physician communication to important health outcomes and adherence to treatments. Our study focuses on the patient's view of the interactions with their physicians and is based on an integrated mixed methods design that includes elements derived from both quantitative and qualitative traditions, 10,11 alternating hypothesis-testing and hypothesis-generating strategies. This design allowed us to link the themes regarding how patients talk to their physicians wi...

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Background This study’s objectives were to describe community oncologists’ beliefs about and confidence with geriatric care and to determine whether geriatric-relevant information influences cancer treatment decisions. Methods Community oncologists were recruited to participate in two multi-site geriatric oncology trials. Participants shared their beliefs about and confidence with caring for older adults. They were also asked to make a first-line chemotherapy recommendation (combination vs. single-agent vs. no chemotherapy) for a hypothetical vignette of an older patient with advanced pancreatic cancer. Each oncologist received one randomly-chosen vignette that varied on three variables: age (72/84 years), impaired function (yes/no), and cognitive impairment (yes/no). Other patient characteristics were held constant. Logistic regression models were used to identify associations between oncologist and vignette-patient characteristics with treatment decisions. Results Oncologist response rate was 61% (n=305/498). The majority of oncologists agreed that “the care of older adults with cancer needs to be improved” (89%) and that “geriatrics training is essential” (72%). However, less than 25% were “very confident” in recognizing dementia or conducting a fall risk or functional assessment, and only 23% reported using the geriatric assessment (GA) in clinic. Each randomly varied patient characteristic was independently associated with the decision to treat: younger age (adjusted OR: 5.01; 95% CI: 2.73–9.20), normal cognition (5.42; 3.01–9.76), and being functionally intact (3.85; 2.12–7.00). Accounting for all vignettes across all scenarios, 161 (52%) said they would offer chemotherapy. All variables were independently associated with prescribing single-agent over combination chemotherapy (older age: 3.22; 1.43–7.25; impaired cognition: 3.13, 1.36–7.20; impaired function: 2.48; 1.12 –5.72). Oncologists’ characteristics were not associated with decisions about providing chemotherapy. Conclusion Geriatric-relevant information, when available, strongly influences community oncologists’ treatment decisions.

Simvastatin has statistically significant effects on affect and affective processes in elderly volunteers. The decrease in positive affect may be significant clinically and relevant to the quality of life of many patients.