Assessment and treatment of geriatric depression in primary care settings
M. Glasser and J. A. Gravdal
Department of Family and Community Medicine, University of Illinois College of Medicine at Rockford, 61107, USA.
OBJECTIVE: To examine primary care physicians' practices relating to the
diagnosis and management of geriatric depression, attitudes regarding
responsibilities for and barriers to management, self-assessments of their
needs in providing this care, and physician characteristics that correlate
with attitudes and practices. DESIGN: Descriptive and analytic needs
assessment. SETTING: A midwestern city and surrounding county and the
suburb of another midwestern city. MEASUREMENTS: A self-administered survey
consisting mainly of close-ended, Likert scale questions. PARTICIPANTS: One
hundred forty-one family physicians and general internists (53.2%)
responded. Respondents were 75.4% male and 50.8% general internists and
ranged in age from 29 to 75 years (mean, 43 years; SD, 11 years). RESULTS:
No standard test to screen for depression was used by 66.7% of respondents.
The 2 most common laboratory studies ordered were thyroid studies (41.1%)
and chemistry panels (37.6%). Selective serotonin reuptake inhibitors were
most commonly prescribed for depression (53.2%). Although 98.6% of
respondents agreed that treatment of depression in elderly patients was
important, 29.0% reported that depressed elderly patients frustrated them,
and 24.2% were too pressured for time to routinely investigate depression
in the elderly. The most frequently identified needs in caring for these
patients were increased time with patients (97.1%); increased reimbursement
for counseling (87.8%); greater emphasis in medical training on the link
between physical and mental health (85.6%); improved patient compliance
with treatment (84.3%); and more training and attention to depression in
residency (82.1%). In general, family physicians were more active and
positive in their approach toward geriatric depression. CONCLUSIONS:
Potential interventions to improve the diagnosis and management of
geriatric depression include the following: use of screening instruments in
a more efficient and timely manner; increased reimbursement for counseling
of patients; more educational programs at the undergraduate, graduate, and
continuing medical education levels; and clinical practice guidelines
specific to geriatric depression.
