Unmet care needs of the oldest old with late-life depression: A comparison of patient, caring relative and general practitioner perceptions – Results of the AgeMooDe study

Stein, Janine; Pabst, Alexander; Weyerer, Siegfried; Werle, Jochen; Maier, Wolfgang; Miebach, Lisa; Scherer, Martin; Stark, Anne; Kaduszkiewicz, Hanna; Wiese, Birgitt; Moor, L; Bock, Jens‐Oliver; König, Hans‐Helmut; Riedel‐Heller, Steffi G.

doi:10.1016/j.jad.2016.07.001

Cited by 11 publications

(9 citation statements)

References 33 publications

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“…Depression is among the most common mental disorders in older populations. The prevalence rates of depression range from 4.6% to 9.3% in general populations aged 75 years and above (Luppa et al , ); in primary care settings, 10–12.5% of the elderly patients have been found to meet the criteria for major depressive disorder (Stein et al , ). In addition, the most recent estimates indicate that 10–20% of the elderly in the general population experience clinically significant depressive symptoms (Stein et al , ).…”

Section: Introductionmentioning

confidence: 99%

“…The prevalence rates of depression range from 4.6% to 9.3% in general populations aged 75 years and above (Luppa et al , ); in primary care settings, 10–12.5% of the elderly patients have been found to meet the criteria for major depressive disorder (Stein et al , ). In addition, the most recent estimates indicate that 10–20% of the elderly in the general population experience clinically significant depressive symptoms (Stein et al , ). Larger meta‐analyses, however, indicated higher prevalence rates of depressive disorders, ranging from 20.7% to 53.8%, in older and frailer populations (Luppa et al , ; Vaughan et al , ).…”

Section: Introductionmentioning

confidence: 99%

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Definition of a Geriatric Depression Scale cutoff based upon quality of life: a population‐based study

Laudisio

Incalzi

Gemma

et al. 2017

Int J Geriat Psychiatry

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Objectives: The cutoff scores for the Geriatric Depression Scale (GDS) commonly adopted in clinical and research settings are based upon other neuropsychological tests. However, any intervention for depression should aim at improving subjective quality of life (QoL). We searched for a GDS cutoff level that might identify a decrease in perceived QoL using a scale that also allows formal cost-effectiveness calculations. Methods: Quality of life was assessed by the Health Utilities Index, Mark 3 in all 344 residents of Tuscania (Italy) aged 75 years and above. Mood was assessed by both the 30-item GDS and the derived 15-item GDS. The association of GDS with low QoL was analyzed by multivariable logistic regression. Receiver operating characteristic curve analysis was adopted to estimate the overall predictive value and the best GDS cutoff for poor QoL. Results: The 30-item GDS score was associated with increased probability of a worse QoL (odds ratio (OR) = 1.07, 95% confidence (CI) = 1.02-1.12, p = 0.003); also, it was a fair predictor of worse QoL (area under the curve (AUC) = 0.72; 95% CI = 0.67-0.76). The best GDS score cutoff for identifying a poor QoL was above 9/30. Results were similar (OR = 1.07, 95% CI = 1.02-1.12, p = 0.003, and AUC = 0.72, 95% CI = 0.67-0.76) for the short GDS form for a cutoff above 5/15. Conclusions: Among older subjects, depressive symptoms are associated with reduced QoL; GDS scores above 9/30 or 5/15 best predict poor perceived health-related QoL. These cutoff scores could therefore identify subjects in whom treatment is more likely to improve QoL and to yield a favorable costeffectiveness ratio.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Definition of a Geriatric Depression Scale cutoff based upon quality of life: a population‐based study

Laudisio

Incalzi

Gemma

et al. 2017

Int J Geriat Psychiatry

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“…However, past research has identi ed some relevant factors in the underutilization of mental health services among older adults, such as patients negative stigma and beliefs associated with mental health and mental health care [12,23], negative self-perceptions of aging [16], personal beliefs of older adults [15], unmet needs [33], lack of professional training and knowledge in geriatrics and aging [34], and lack of organizational structures such as interdisciplinary approaches and collaborative care models [6,35,36]. The vastly lower levels of psychotherapy utilization in older adults relative to the younger cohorts are especially concerning as there are -in principal -plentiful of psychotherapy resources and no additional charges for the patients with the statutory health insurance system in Germany.…”

Section: Discussionmentioning

confidence: 99%

Perceived Need for Treatment and Non-utilization of Outpatient Psychotherapy in Old Age: Two Cohorts of a Nationwide Survey

Gellert

Lech

Kessler

et al. 2021

Preprint

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Objectives: Older adults with mental health problems may benefit from psychotherapy; however, their perceived need for treatment in relation with rates of non-utilization of outpatient psychotherapy as well as predisposing, enabling, and need factors proposed by Andersen’s Model of Health Care Utilization that account for these differences warrants further investigation.Method: We used two separate cohorts (2014 and 2019) of a German weighted nationwide telephone survey of German-speaking adults with N=12,197 participants. Across the two cohorts, 12.9% (weighted) reported perceived need for treatment for mental health problems and were selected for further analyses. Logistic Generalized Estimation Equations (GEE) was applied to model the associations between disposing (age, gender, single habiting, rural residency), enabling (education, general practitioner visit, general health status) non-utilization of psychotherapy (outcome) across cohorts in those with need for treatment (need factor).Results: In 2014/2019, out of 6,087/6,110 participants, 11.8%/14.0% reported perceived need for treatment due to mental health problems, which reflects a significant increase in prevalence from 2014 to 2019. Of those who reported perceived need for treatment, 36.4%/36.9% did not see a psychotherapist – where rates of non-utilization of psychotherapy were vastly higher in the oldest age (59.3/52.5%; 75+) category, than in the youngest (29.1/10.7%; 18-25 years). Concerning factors associated with non-utilization, multivariate findings indicated participation in the cohort of 2014 (OR 0.94), older age (Age 55-64 OR 1.02, Age 65-74 OR 1.47, Age 75+ OR 4.76), male gender (OR 0.83), lower educational status (OR 0.84), rural residency (OR 1.38), single habiting (OR 1.37), and seeing a GP (OR 1.39) to be related with non-utilization of psychotherapy; general health status was not significantly associated with non-utilization when GP contact was included in the model.Conclusion: There is a strong age effect in terms of non-utilization of outpatient psychotherapy. Individual characteristics of both healthcare professionals and patients and structural barriers may add to this picture. Effective strategies to increase psychotherapy rates in those older adults with unmet needs for treatment are required.

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“…At the same time, our findings also reflect the known mismatch of patients' preferences and treatment efficacy. For instance, electro-convulsive therapy (ECT) is known to be an effective way of treating severe depression in particular (Frazer et al, 2005;Spaans et al, 2015), but the stigma associated with ECT and concerns about its safety may keep patients from stating a preference for this treatment option (Brandt and Ugarriza, 1996;Stein et al, 2016b). Additionally, many countries have imposed mental health acts to overrule the patients' preference when it comes to acute selfendangerment.…”

Section: Discussionmentioning

confidence: 99%

“…Within this study, 1,230 patients aged 75 years and older were recruited from primary care practices in the cities of Leipzig, Bonn, Hamburg, and Mannheim. The recruitment process is described in detail elsewhere (Stein et al, 2016a(Stein et al, , 2016b. Figure 1 displays the sample flow chart for the present analysis.…”

Section: Samplementioning

confidence: 99%

Treatment preferences for depression in the elderly

Luck-Sikorski

Stein

Heilmann

et al. 2016

Int. Psychogeriatr.

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Depressive symptoms influence the preference for certain treatment options and also increase indecision in patients. The high preference for psychotherapy suggests a much higher demand for late-life psychotherapy in the future. Healthcare systems should begin to prepare to meet this anticipated need. Future studies should include previous experience with treatment methods as a confounding variable.

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Unmet care needs of the oldest old with late-life depression: A comparison of patient, caring relative and general practitioner perceptions – Results of the AgeMooDe study

Cited by 11 publications

References 33 publications

Definition of a Geriatric Depression Scale cutoff based upon quality of life: a population‐based study

Definition of a Geriatric Depression Scale cutoff based upon quality of life: a population‐based study

Perceived Need for Treatment and Non-utilization of Outpatient Psychotherapy in Old Age: Two Cohorts of a Nationwide Survey

Treatment preferences for depression in the elderly

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