Detection and management of depression in the elderly physically ill patient

✍ Scribed by Mavis Evans

• Publisher: John Wiley and Sons
• Year: 1995
• Tongue: English
• Weight: 617 KB
• Volume: 10
• Category: Article
• ISSN: 0885-6222
• DOI: 10.1002/hup.470101007

✦ Synopsis

Depression is common in the elderly especially the elderly physically ill. It is a condition with high morbidity and mortality, especially if untreated. Depression at all ages costs society many millions of pounds for drug, GP and hospitalisation costs. In the elderly these costs can be compounded by the increased strain on patient and relatives leading to admission into residential care.

The diagnosis is often missed as medical staff assume symptoms are understandable, due to the physical problems, or d o not ask suitable questions during physical assessment. A short screening scale for depression in this population (ELDRS) was developed and validated against structured questionnaires and psychiatric interview. A prevalence of 20% depressed was found in a population of acute geriatric medical inpatients.

An open treatment trial of fluoxetine in patients diagnosed with the aid of the scale (n= 72) showed a significant response to treatment (p<O.O3) and a marked reduction in death rate. Advent of the SSRIs which are well tolerated by the elderly including those with multiple physical problems and concomitant medication have increased the importance of correct diagnosis in this population. Such patients can now be safely and effectively treated with consequent reduction in associated morbidity and mortality.