The prognosis of depression in older patients in general practice and the community. A systematic review

Abstract

Licht-Strunk E, van der Windt DAWM, van Marwijk HWJ, de Haan M, Beekman ATF. The prognosis of depression in older patients in general practice and the community. A systematic review. Family Practice 2007; 24: 168-180.Background. Little is known about the prognosis of depression in older patients in general practice or the community.Objectives. To summarize available evidence on the course and prognostic factors of depression in older persons.Methods. We conducted a systematic, computerized search of Medline and PsycINFO. Manual search of references of included studies were done. Studies potentially eligible for inclusion were discussed by two reviewers. Methodological quality was independently assessed by two reviewers. Data regarding selection criteria, duration of follow-up, outcome of depression and prognostic factors were extracted.Results. We identified 40 studies reporting on four cohorts in general practice and 17 in the community. Of all, 67% were of high quality. Follow-up was up to 1 year in general practice and up to 10 years in the community. Information on treatment was hardly provided. About one in three patients developed a chronic course. Five cohorts used more than two measurements during follow-up, illustrating a fluctuating course of depression. Using a best evidence synthesis we summarized the value of prognostic indicators. General practice studies did not provide strong evidence for any factor. Community studies provided strong evidence for an association of baseline depression level, older age, external locus of control, somatic co-morbidity and functional limitations with persistent depression. Conclusion.Within the older population, age seems to be a negative prognostic factor, while older people are more likely to be exposed to most of the other prognostic factors identified.

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“…To determine the strength of the scientific evidence, a rating system was applied which consists of five levels of evidence (strong, moderate, weak, inconclusive and inconsistent) based on the quality and the outcome of the studies, adapted from Licht-Strunk et al (Table 1). 13 Strong evidence could only be established by two high-quality studies showing consistent associations. Without a highquality study showing consistent associations, low-quality studies lead to weak evidence at best.…”

Psychosocial Predictors Of Depression In Elderly Patients Of A Brazilian Health Unit

“…According to Büchteman, Luppa, Bramesfeld and Riedel-Heller (2012), high depression rates in old age are not as high as the ones found in younger people. However, in this stage of the life cycle, depression has a bad prognostic because it has a floating and chronic course (Büchtemann et al, 2012;Licht-Strunk et al, 2007).…”

Cardiovascular risk factors in elderly : With special emphasis on atrial fibrillation, hypertension and diabetes

“…The prevalence for depression in old age is 12-15% [109,110], and the prognosis and outcomes are worse in older patients with depression compared to younger adults [111,112]. Late-life depression is defined as a major depressive disorder in adults 60 years of age or older [112], and depression is a risk factor for vascular and neurological illness such as DM, MI, stroke and Parkinson's disease [113].…”