A randomised controlled experimental study on the influence of patient age on medical decisions in respect to the diagnosis and treatment of depression in the elderly.

Background. Elderly patients are often treated differently than younger patients, even when suffering from the same disorder. Objective. The study examines the influence of "patient age" on the perception of symptoms and conclusions of physicians in respect to diagnosis and treatment. Methods. In a randomised controlled experimental study on medical decision-making, 121 general practitioners were given two case vignettes which contained all the criteria for major depression according to ICD-10, but differed in respect to the age of the patient (39 or 81). Reaction time, diagnostic conclusions and therapeutic recommendations were assessed by computer. Results. Depression and anxiety were significantly seen as more probable in the young cases and dementia and physical illness in the old. In young age, psychotherapy, pharmacotherapy and referral to a specialist or inpatient treatment were significantly more recommended than in old age, for whom supportive counselling was significantly more recommended. The time needed for a decision was significantly longer in the older patients. Conclusion. Ageing stereotypes can also form medical illness concepts and have a significant influence on diagnostic and therapeutic decisions.