Pathway to psychiatric care of the elderly with depression

Cole, Martín G.; Yaffe⃰, Mark J.

doi:10.1002/(sici)1099-1166(199602)11:2<157::aid-gps304>3.0.co;2-s

Cited by 63 publications

(31 citation statements)

References 31 publications

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“…Even elderly persons with prescription benefits may be unable to cover increased cost sharing because of their generally fixed incomes (37). High costs may particularly curtail antidepressant use because of the stigma associated with mental health treatments among seniors (10,(43)(44)(45)(46)(47). Older patients also frequently take multiple regimens for comorbid conditions and may decide to limit their antidepressant use so that they can pay for their other medications (22).…”

Section: Discussionmentioning

confidence: 99%

The Impact of Cost Sharing on Antidepressant Use Among Older Adults in British Columbia

Wang¹,

Patrick²,

Dormuth³

et al. 2008

Psychiatric Services

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Objective-Antidepressant therapies are underused among older adults and could be further curtailed by patient cost-sharing requirements. The authors studied the effects of two sequential costsharing policies in a large, stable population of all British Columbia seniors: change from full prescription coverage to $10-$25 copayments (copay) in January 2002 and replacement with incomebased deductibles and 25% coinsurance in May 2003.Methods-PharmaNet data were used to calculate monthly dispensing of antidepressants (in imipramine-equivalent milligrams) among all British Columbia residents age 65 and older beginning January 1997 through December 2005. Monthly rates of starting and stopping antidepressants were calculated. Population-level patterns over time were plotted, and the effects of implementing costsharing policies on antidepressant use, initiation, and stopping were examined in segmented linear regression models.Results-Implementation of the copay policy was not associated with significant changes in level of antidepressant dispensing or the rate of dispensing growth. Subsequent implementation of the income-based deductible policy also did not lead to a significant change in dispensing level but led to a significant (p=.02) decrease in the rate of growth of antidepressant dispensing. The copay policy was associated with a significant (p=.01) drop in the frequency of antidepressant initiation among persons with depression. Income-based deductibles reduced the rate of increase in antidepressant This research was presented in a poster session at the 22nd

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Section: Discussionmentioning

confidence: 99%

The Impact of Cost Sharing on Antidepressant Use Among Older Adults in British Columbia

Wang¹,

Patrick²,

Dormuth³

et al. 2008

Psychiatric Services

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“…The main reason is that many elderly persons somatise their depression in physical symptoms. 20 In a similar fashion, older people are often reluctant to report falls to their primary care physician, or they simply forget about their occurrence. 21 It may be more feasible to identify the risk factors for depression and falls than the conditions themselves.…”

Section: Discussionmentioning

confidence: 99%

Depression and falls among community dwelling elderly people: a search for common risk factors

Biderman

Cwikel²,

Fried³

et al. 2002

Journal of Epidemiology &Amp; Community Health

196

140

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Study objectives: Depression and falls are two common conditions that impair the health of older people. Both are relatively underdiagnosed and undertreated problems in primary care. The study objective was to investigate whether there was a common set of risk factors that could predict an increased risk of both falls and depression. Design: This was a cohort study drawn from a primary care clinic, with a one year follow up. Dependent measures included: reporting two or more falls in the past year and a score of 7 or over on the S-GDS (Short Geriatric Depression Scale). A parsimonious set of risk factors was selected that predicted both outcomes based on a series of discriminant function analyses. Participants and setting: The setting was a primary care clinic serving a mixed socioeconomic population, in Beer Sheva, Israel. The sample included 283 General Sick Fund members, aged 60 and over, who completed both baseline assessments and one year follow up interviews. Main results: At the one year follow up, 12% of the sample reported frequent falls in the past year and 25.5% of the sample screened positive for depressive symptoms. A set of five risk factors that included: poor self rated health, poor cognitive status, impaired ADL, two or more clinic visits in the past month, and slow walking speed (>10 seconds over five metres) was successful at discriminating between fallers and non-fallers (86% discrimination) and between those with and without depressive symptoms (76%). For every risk factor added, there was a significant increase in the proportion of respondents who had depressive symptoms. A similar result was found for falls. Conclusions: These results show that there is a common set of risk factors that increase the risk of two common outcomes in geriatric medicine, falls and depression. For a general practitioner or a geriatric physician, it might be easier to detect these risk factors than to diagnose depression or high risk for falls. When these risk factors are detected in patients the physician can then be more active in direct probing about depression and falls. F alls and depression are common problems in the elderly that generally escape detection and therefore go untreated in primary care.1 2 There is a consensus, however, that their prevention and treatment could greatly benefit the health and wellbeing of the elderly population.3 The development of a clearer understanding of their causes would help to formulate more effective means of prevention and treatment.The reported prevalence of mild depressive symptoms among community dwelling elderly people over the age of 65 is between 15%-20% 4 5 although prevalence of major depressive disorders is only 2%-5%. 4 The vast majority of elderly people, an estimated 80%, who suffer from symptoms of depression will not receive any treatment. 6Falls are also a common problem among elderly people; approximately 30% of those over 65 will fall each year, with rates rising with increasing age reaching about 40% in those over age 80.7 While most falls do not resu...

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“…4 Depression among elderly individuals is a serious problem, and fewer than 20% of cases are detected or treated. 5,6 There is mounting interest in searching for risk factors that affect depression in the elderly, and the relationship between hypertension and depression has been highlighted. 7,8 Considering the fact that hypertension and depression are the major constituents of health-related burden worldwide, 9 the identification of any association between these two highly common diseases would be beneficial in both public health and clinical contexts.…”

Section: Introductionmentioning

confidence: 99%

Hypertension and risk of depression in the elderly: a meta-analysis of prospective cohort studies

et al. 2014

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The objective of the study was to assess the relationship between hypertension and risk of depression. The relationship between hypertension and depression has been discussed for a long time, but the results are controversial. Studies were searched from PubMed and Cochrane up to 24 March 2014. Any prospective cohort study, which possibly reported the relationship between hypertension and depression, was included. The random effect model was used to calculate the pooled relative risk (RR). Finally, five prospective cohort studies were included for analysis, with a total of 9647 participants involved. Our meta-analysis does not support that hypertension is probably a risk factor of depression. The pooled RR was 1.16 (95% confidence interval: 0.91, 1.42) when those exposed to hypertension were compared with those who were not. Subgroup analysis, sensitivity analysis and publication bias test suggested that the overall result of this analysis was robust. Further studies are needed to exclude the effects of other confounding factors.

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Pathway to psychiatric care of the elderly with depression

Cited by 63 publications

References 31 publications

The Impact of Cost Sharing on Antidepressant Use Among Older Adults in British Columbia

The Impact of Cost Sharing on Antidepressant Use Among Older Adults in British Columbia

Depression and falls among community dwelling elderly people: a search for common risk factors

Hypertension and risk of depression in the elderly: a meta-analysis of prospective cohort studies

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