13 Year Follow Up of Morbidity, Mortality and Use of Health Services Among Elderly Depressed Patients and General Elderly Populations

Djernes, Jens Kronborg; Gulmann, Nils Christian; Foldager, Leslie; Olesen, Frede; Munk‐Jørgensen, Povl

doi:10.3109/00048674.2011.589368

Cited by 48 publications

(14 citation statements)

References 37 publications

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“…Post-intervention effectiveness was well-documented, but follow-up periods of over one year were rare. Previous research suggests that depression is associated with faster physical decline and greater health service use (Djernes et al, 2011;Vaughan et al, 2015). Reducing depression may maintain physical functioning, rather than improve it, which may only be apparent in larger samples over longer follow up.…”

Section: Strengths and Limitations Of The Evidence Basementioning

confidence: 97%

“…difficulties carrying out activities of daily living due to physical health conditions, in addition to depression), have a four-fold increase in the risk of clinically significant anxiety or depression (Ni Mhaolain et al, 2012). Comorbid physical and mental health disorders increases the risk of greater frailty, mortality, and primary and secondary healthcare service use (Djernes et al, 2011;Vaughan et al, 2015). In an ageing population, demand for mental health services specific to later life is likely to increase.…”

Section: Introductionmentioning

confidence: 99%

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Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis

Frost

Bauernfreund

Walters

2019

International Psychogeriatrics

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Objective:To review the effectiveness of non-pharmacological interventions in older adults with depression or anxiety and comorbidities affecting functioning.Design:Systematic review and meta-analysis of randomized controlled trials, including searches of 10 databases (inception-Jul 2017).Setting:Home/community.Participants:People aged 60 and over experiencing functional difficulties from physical or cognitive comorbidities and have symptoms or a diagnosis of depression and/or anxiety.Interventions:Non-pharmacological interventions targeted at depression/anxiety.Measurements:We extracted outcome data on depressive symptoms, quality of life, functioning, and service use. We used random effects meta-analysis to pool study data where possible. Two authors assessed the risk of bias using the Cochrane Risk of Bias tool.Results:We identified 14 eligible trials including 2099 randomized participants and two subgroup analyses. Problem-solving therapy (PST) reduced short-term clinician-rated depressive symptoms (n = 5 trials, mean difference in Hamilton Depression Rating Scale score −4.94 [95% CI −7.90 to −1.98]) but not remission, with limited evidence for effects on functioning and quality of life. There was limited high-quality evidence for other intervention types. Collaborative care did not appear to affect depressive symptoms, functioning, or quality of life; and had mixed evidence for effects upon remission. No intervention consistently affected service use, but trials were limited by small sample sizes and short follow-up periods. No anxiety interventions were identified.Conclusion:PST may reduce depressive symptoms post-intervention in older people with depression and functional impairments. Collaborative care appears to have few effects in this population. Future research needs to assess cost-effectiveness, long-term outcomes, and anxiety interventions for this population.

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Section: Strengths and Limitations Of The Evidence Basementioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis

Frost

Bauernfreund

Walters

2019

International Psychogeriatrics

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“…The prognosis of LLD is typically poor and is characterized by chronicity, mortality, and increased risk for cognitive impairment and progression to dementia. 6 We aim to evaluate the clinical effects of using a transcranial direct current stimulation (tDCS) protocol -a non-invasive therapeutic strategy in terms of safety and clinical impact -on depressive symptoms. The rationale for using tDCS for depression is based on its properties of increasing (anodal) and decreasing (cathodal) cortical excitability.…”

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confidence: 99%

Transcranial direct current stimulation for depression in a 92‐year‐old patient: a case study

et al. 2014

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Dear Editor, The prevalence of clinically significant depressive syndromes in people 60 years and older (i.e. late-life depression (LLD)) ranges from 9% to 18%, with incidence rates of 19.3 per 1000 person years. 1,2 LLD has been linked to increased rates of suicide and premature mortality and more frequent use of health care with significantly higher health-care costs. 3 There is considerable heterogeneity in the clinical presentation of major depression across the life cycle. Younger patients may have clinical profiles characterized by high trait anxiety and variable patterns of circadian, sleep, energy, and appetite disturbance. 4 Those in midlife present the more stereotypic picture of anhedonia in combination with sleep disturbance, weight loss, and cognitive and motor impairments. In later life, clinical phenotypes are again more variable. 5 This may well reflect different neuropathological pathways to illness and largely differentiate those with earlier onset who have grown older from those experiencing clinical depression for the first time. The prognosis of LLD is typically poor and is characterized by chronicity, mortality, and increased risk for cognitive impairment and progression to dementia. 6 We aim to evaluate the clinical effects of using a transcranial direct current stimulation (tDCS) protocol -a non-invasive therapeutic strategy in terms of safety and clinical impact -on depressive symptoms. The rationale for using tDCS for depression is based on its properties of increasing (anodal) and decreasing (cathodal) cortical excitability. A larger study on depression and tDCS was recently published by Brunoni et al. 7 The authors performed a controlled trial involving 120 patients with major depression. The results of this factorial study, in which subjects were randomized to receive active or sham tDCS and verum or placebo sertraline, showed a significant improvement in depressive symptoms for tDCS alone or combined with sertraline. Favourable results have also been found by other groups studying major depressive disorder. 8 To the best of our knowledge, this has not yet been evaluated specifically for the old-old population.Mr J is a 92-year-old patient who has had major depression for the last 3 years. The patient presented no significant changes in complementary tests. Neuroimaging evaluation (magnetic resonance imaging) showed no volumetric or structural modifications other than age-related changes. At presentation, the patient was using escitalopram 10 mg/day without clinical response. Given the availability of tDCS device in our centre, it was decided the patient should undergo a tDCS protocol for major depression. The patient provided written informed consent in accordance with the requirements of Santa Casa Medical School's institutional review board. Intervention protocol was as follows: 10 sessions with 2 mA for 30 min (only on weekdays). The anode was placed over the left dorsolateral prefrontal cortex (F3 according to the 10/20 electroencephalogram system) and the cathode was placed ext...

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“…For example, Unützer et al (2000) found that primary care patients older than 65 and suffering from depression experience much lower quality of life than non-depressed persons, and several studies (e.g. Brown et al 2011;Djernes et al 2011) have found that depressed older people had higher mortality rate. Also studies have shown that the prognosis for depression amongst older patients in primary care is poorer than amongst younger patients (e.g.…”

Section: Introductionmentioning

confidence: 99%

Helpful approaches to older people experiencing mental health problems: a critical review of models of mental health care

Biering

2018

Eur J Ageing

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Despite growing concerns for the mental health of the older generation most studies focus on mental health care for younger people and there is a lack of knowledge about helpful treatment approaches and models of care for older people. Therefore, the purpose of this review was to answer the question what health care approaches are most helpful for older people experiencing mental health problems. Databases from 2000 to July 2017 were searched with focus on outcome studies, experts' opinions and treatment descriptions. Critical interpretive synthesis was used to analyse and interpret the findings. Four main models of care were found: the medical-psychiatric model which mostly focuses on antipsychotic medication for the treatment of symptoms. Psychotherapeutic and social interventions take into consideration the psychosocial perspectives of mental health problems, but little research has been done on their lasting effect. Research indicates that psychotherapy needs to be adapted to the special needs of older people. Few old people have access to psychotherapy which limits its usefulness. Holistic or integrated models of health care have emerged in recent years. These models focus on both physical and psychosocial wellbeing and have shown promising outcomes. To reduce antipsychotic medication older people need to be given better access to psychotherapy and social interventions. This presupposes training health care professionals in such treatment methods. The holistic models need to be developed and studied further and given high priority in health care policy.

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13 Year Follow Up of Morbidity, Mortality and Use of Health Services Among Elderly Depressed Patients and General Elderly Populations

Cited by 48 publications

References 37 publications

Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis

Non-pharmacological interventions for depression/anxiety in older adults with physical comorbidities affecting functioning: systematic review and meta-analysis

Transcranial direct current stimulation for depression in a 92‐year‐old patient: a case study

Helpful approaches to older people experiencing mental health problems: a critical review of models of mental health care

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