Late-life depression and mental health services in primary care.

Mental health services in the treatment of late-life depression are critical in the primary care arena. A significant proportion of elderly patients experience depression, a problem causing a far-reaching impact on morbidity, mortality, and quality of life. A number of barriers may prevent effective depression treatment including negative physician and patient attitudes toward the stigma of depression, somatically focused clinical presentations, health care plan constraints, and competing medical demands, as well as gender and geographic isolation. Screening for depression in primary care settings is not always standard fare as physicians may feel confident in their diagnostic abilities. Research addressing effective depression treatment in the primary care setting has been limited to few clinical trials and physician-focused academic detailing. Future research should address real-world scenarios encountered by the primary care physician in their treatment of the "old-old" patient with complex medical comorbidities and functional decline.

Comparison of adult and geriatric psychiatric practice patterns: findings from the American Psychiatric Association's Practice Research Network.

OBJECTIVE: The authors explored diagnostic and treatment patterns for patients under and over age 65 seen by a nationally representative sample of psychiatrists participating in the American Psychiatric Association's Practice Research Network. METHODS: Detailed patient information, including demographic and financial characteristics, diagnoses, service utilization, and treatment, was collected by 383 psychiatrists on 1,026 patients to assess the impact of patient age on pharmacotherapy and psychotherapy service use as well as treatment outcomes. RESULTS: Approximately 15% of the patient sample was over age 65. Compared with patients ages 19-64, a lower percentage of geriatric patients had Axis I comorbidity, but a higher percentage had Axis III comorbidity. Geriatric patients were more often treated in hospital settings, and older patients were less likely to have their visits adversely affected by financial pressures of the healthcare system. Over 60% of patients in both age-groups received antidepressants, but there was a disproportionately increased use of antipsychotics and antianxiety/benzodiazepine medications among geriatric patients. Being age 65+ was a strong predictor for "improved" clinician rating on general assessment scores, but failed to be a predictor of receiving psychotherapy or pharmacotherapy. CONCLUSION: There were important differences between subject groups. Overall, American psychiatrists treat a complex group of geriatric patients suffering from major mental disorders complicated by medical comorbidity. Additional studies would further enhance our understanding of the delivery of mental health services to elderly patients and improve training of psychiatrists who help care for our aging population.