Assessment and Treatment of Geriatric Depression in Primary Care Settings
Michael Glasser, PhD;
Judith A. Gravdal, MD
Arch Fam Med. 1997;6(5):433-438.
Abstract
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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.
Author Affiliations
From the Department of Family and Community Medicine, University of Illinois College of Medicine at Rockford (Dr Glasser), and the Department of Family Practice, Lutheran General Hospital, Park Ridge, Ill (Dr Gravdal).
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