Profiles of met and unmet care needs in the oldest-old primary care patients with depression - results of the AgeMooDe study.

BACKGROUND: Unmet care needs have been associated with an increased risk of depression in old age. Currently, the identification of profiles of met and unmet care needs associated with depressive symptoms is pending. Therefore, this exploratory study aimed to identify profiles of care needs and analyze associated factors in oldest-old patients with and without depression. METHODS: The sample of 1092 GP patients aged 75+ years is based on the multicenter study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)". Depression (i.e. clinically meaningful depressive symptoms) was determined using the Geriatric Depression Scale (GDS) (cutoff score ≥ 4). Needs of patients were assessed using the Camberwell Assessment of Need for the Elderly (CANE). Associated sociodemographic and clinical factors were examined, and latent class analysis identified the need profiles. RESULTS: The main result of the study indicates three need profiles: 'no needs', 'met physical needs', and 'unmet social needs'. Members of the 'met physical needs' (OR = 3.5, 95 %-CI: 2.5-4.9) and 'unmet social needs' (OR = 17.4, 95 %-CI: 7.7-39.7) profiles were significantly more likely to have depression compared to members of the 'no needs' profile. LIMITATIONS: Based on the cross-sectional design, no conclusions can be drawn about the causality or direction of the relationships between the variables. CONCLUSIONS: The study results provide important insights for the establishment of needs-based interventions for GPs. Particular attention should be paid to the presence of unmet social needs in the oldest-old GP patients with underlying depressive symptoms.

Categorical and dimensional perspectives on depression in elderly primary care patients - Results of the AgeMooDe study.

An accurate diagnosis is essential for the management of late-life depression in primary care. This study aims to (1) provide information on the agreement on depression diagnoses between general practitioners (GPs), dimensional tools (Geriatric Depression Scale [GDS], Hospital Anxiety and Depression Scale [HADS]) and a categorical tool (Structured Clinical Interview for DSM-IV criteria [SCID]) and (2) identify factors associated with different diagnoses. As part of the multicenter study "Late-life depression in primary care: needs, health care utilization and costs (AgeMooDe)" a sample of 1113 primary care patients aged 75 years and older was assessed. The proportion of depression was 24.3% according to GPs, 21.8% for the GDS, 18.9% for the HADS and 8.2% for the SCID. Taking GDS, HADS and SCID as reference standards, recognition of GPs was 47%, 48% and 63%. Cohen's Kappa values indicate slight to moderate agreement between diagnoses. Multinomial logistic regression models showed that patient related factors of depression were anxiety, intake of antidepressants, female gender, a low state of health, intake of medication for chronic diseases and functional impairment. GPs performed better at ruling out depression than ruling in depression. High levels of disagreement between different perspectives on depression indicate that they may be sensitive to different aspects of depression.

The Impact of Depressive Symptoms on Healthcare Costs in Late Life: Longitudinal Findings From the AgeMooDe Study.

OBJECTIVE: To examine whether depressive symptoms affect healthcare costs in old age longitudinally. DESIGN: Multicenter prospective observational cohort study (two waves with nt1 = 1,195 and nt2 = 951) in Germany. SETTING: Community. PARTICIPANTS: Participants aged 75 years and older recruited via general practitioners. MEASUREMENTS: Depressive symptoms were assessed by the Geriatric Depression Scale (GDS). The health-related resource use was measured retrospectively from a societal perspective based on a questionnaire, covering outpatient services, inpatient treatment, pharmaceuticals, as well as formal and informal nursing care. Hybrid regression models were used to determine the between- and within-effect of depressive symptoms on healthcare costs, adjusting for important covariates. RESULTS: Six-month total cost increased from €3,090 (t1) to €3,748 (t2). The hybrid random effects models showed that individuals with more depressive symptoms had higher healthcare costs compared with individuals with less depressive symptoms (between-effect). Moreover, an intra-individual increase in depressive symptoms increased healthcare costs by €539.60 (within-effect) per symptom on GDS. CONCLUSIONS: Our findings emphasize the economic importance of depressive symptoms in old age. Appropriate interventions to treat depressive symptoms in old age might also be a promising strategy to reduce healthcare costs.

Treatment preferences for depression in the elderly.

BACKGROUND: If patients are treated according to their personal preferences, depression treatment success is higher. It is not known which treatment options for late-life depression are preferred by patients aged 75 years and over and whether there are determinants of these preferences. METHODS: The data were derived from the German "Late-life depression in primary care: needs, health care utilization, and costs (AgeMooDe)" study. Patients aged 75+ years (N = 1,230) were recruited from primary care practices. Depressive symptoms were determined using the Geriatric Depression Scale (GDS-15). Support for eight treatment options was determined. RESULTS: Medication, psychotherapy, talking to friends and family, and exercise were the preferred treatment options. Having a GDS score ≥ 6 significantly lowered the endorsement of some treatment options. For each treatment option, the probability of choosing the indecisive category "I do not know" was significantly increased in participants with moderate depressive symptoms. CONCLUSIONS: 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.

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.

BACKGROUND: Research showed that the perception of unmet needs may differ between patients, caregivers and professionals. Lacking agreement with regard to unmet needs between raters involved may have a negative impact on treatment of late-life depression. METHODS: As part of the multicenter German study "Late-life depression in primary care: needs, health care utilization and costs" (AgeMooDe), n=1188 primary care patients aged 75-98 with and without depression, relatives (n=366) and general practitioners (GPs, n=1152) were assessed using the German version of the Camberwell Assessment of Need for the Elderly (CANE) in order to identify patients' unmet needs from different perspectives. Kappa coefficients were computed to determine level of agreement between perspectives. Penalized likelihood logistic regression models were run in order to assess the association between depression severity and disagreement between perspectives with regard to unmet needs. RESULTS: The prevalence of unmet needs was higher in depressive patients. Kappa coefficients were on average higher for depressive patients ranging from poor to substantial. Severity of depression was significantly associated with disagreement regarding unmet needs between perspectives. LIMITATIONS: The cross-sectional design of the study limits the results. Only a part of caring relatives was able to participate. CONCLUSIONS: Perceptions of unmet needs in the oldest old primary care patients suffering from depression strongly differ between raters. Severity of depression seems to exacerbate the discrepancy between involved perspectives. The negative impact that depression severity may have on the perception and assessment of unmet needs requires greater attention by GPs.

Excess health care costs of late-life depression - Results of the AgeMooDe study.

INTRODUCTION: The study aimed at determining excess costs of late-life depression from a societal perspective. Moreover, the impact of recognition of depression by GPs on costs was investigated. METHODS: Cross-sectional data were obtained from a large multicenter observational cohort study (AgeMooDe). Participants (n=1197) aged 75 years or older and were recruited via their GPs in Leipzig, Bonn, Hamburg, and Mannheim in Germany from May 2012 until December 2013. In the base case analysis, depression was assessed using the Geriatric Depression Scale (GDS; cutoff GDS≥6). Data on health care utilization and costs were based on participants' self-reports for inpatient treatment, outpatient treatment, pharmaceuticals, and formal and informal nursing care. RESULTS: Unadjusted mean costs in a six-month period for depressed individuals (€5031) exceeded those of non-depressed (€2700) by the factor 1.86 and were higher in all health care sectors considered. Statistically significant positive excess costs persisted in all formal health care sectors after adjusting for comorbidity and socio-demographics. Recognition of depression by the GP did not moderate the relationship of depression and health care costs. LIMITATIONS: Analyses were restricted to a cross-sectional design, not permitting any conclusions on causal interference of the variables considered. CONCLUSION: The findings stress the enormous burden of depression in old age for all sectors of the health care system. The fact that GPs' recognition of depression does not moderate the relationship between depression and costs adds further insights into the economics of this frequent psychiatric disorder.