Kastenschmidt Erin K, Kennedy Gary J
Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, New York, NY, USA.
Mt Sinai J Med. 2011 Jul-Aug;78(4):527-45. doi: 10.1002/msj.20266.
Depression and anxiety represent a sizeable public-health problem for older Americans. Effective treatment of depression and anxiety in late-life patients can improve outcomes directly related to those diseases as well as to comorbid medical diseases. A variety of approaches has been shown to be effective in older adults and is easily accessible to the primary care, specialty, and inpatient practitioner. Because of the etiologic complexity associated with mood disturbance in late life, it is helpful to consider depression and anxiety in late life as a geriatric syndrome similar to frailty, falls, incontinence, and impaired cognition. These syndromes have multiple causes of associated disability, yielding a multitude of avenues for intervention. However, translating the science of care for depression and anxiety into improved mental-health services for older adults and their families remains a challenge to providers and policy-makers alike. In the Tables, the authors offer measures for screening and response evaluation as well as guidance for pharmacotherapy and psychotherapeutic interventions that may be incorporated into primary care.
抑郁症和焦虑症是美国老年人面临的一个相当严重的公共卫生问题。有效治疗老年患者的抑郁症和焦虑症，可改善与这些疾病以及合并存在的内科疾病直接相关的预后。已证明多种方法对老年人有效，且初级保健、专科和住院医师都容易采用。由于晚年情绪障碍的病因复杂，将晚年的抑郁症和焦虑症视为一种与衰弱、跌倒、尿失禁和认知障碍类似的老年综合征会有所帮助。这些综合征有多种导致残疾的原因，从而产生了众多干预途径。然而，将抑郁症和焦虑症的护理科学转化为针对老年人及其家庭的更好的心理健康服务，对提供者和政策制定者而言仍是一项挑战。在表格中，作者提供了筛查和反应评估措施，以及可纳入初级保健的药物治疗和心理治疗干预的指导。
