Plakiotis Chris, George Kuruvilla, OʼConnor Daniel W
From the *School of Psychology and Psychiatry, Monash University; †Monash Health, and ‡Eastern Health, Melbourne, Victoria, Australia.
J ECT. 2014 Sep;30(3):232-41. doi: 10.1097/YCT.0000000000000092.
Existing research on electroconvulsive therapy (ECT) in older adults has largely examined its efficacy and safety in treating depression, but there are few population-level studies of its use in this patient group. Our objective was to provide a comprehensive 10-year picture of ECT use among adults aged 65 years and older in the State of Victoria, Australia. We focused especially on comparing patterns of ECT use between young-old and old-old individuals, to better inform practicing physicians, policy makers, and researchers about ECT practices in this diverse range of patients.
We analyzed statewide ECT service provision data from 1998 to 2007 provided by the Office of the Chief Psychiatrist of Victoria.
Age-adjustment of crude data revealed that old-old adults had the highest rate of ECT use overall (especially women) as well as the highest utilization rates for depression and public sector treatment. Although the highest rate of exclusively involuntary treatment under the Mental Health Act was also observed among old-old adults, most of the old-old patients were treated on an exclusively voluntary basis. The number of ECT treatments administered to young-old and old-old patients did not differ.
The higher ECT utilization rates we previously reported in older adults as a whole were further accentuated in old-old individuals. Old-old adults may have medical comorbidities and personal care needs that have implications for ECT technique and service delivery. Our findings underscore the need for greater inclusion of old-old patients in future ECT research to increase its clinical applicability.
现有关于老年人电休克治疗（ECT）的研究主要考察了其治疗抑郁症的疗效和安全性，但针对该患者群体使用ECT的人群水平研究较少。我们的目的是提供澳大利亚维多利亚州65岁及以上成年人使用ECT的全面十年情况。我们特别关注比较年轻老年人和高龄老年人之间ECT的使用模式，以便更好地让执业医师、政策制定者和研究人员了解这类多样化患者的ECT治疗情况。
我们分析了维多利亚州首席精神病医生办公室提供的1998年至2007年全州ECT服务提供数据。
对原始数据进行年龄调整后发现，高龄老年人总体上ECT使用率最高（尤其是女性），抑郁症和公共部门治疗的利用率也最高。尽管在高龄老年人中也观察到根据《精神卫生法》进行的纯非自愿治疗比例最高，但大多数高龄患者是完全在自愿基础上接受治疗的。年轻老年人和高龄老年人接受ECT治疗的次数没有差异。
我们之前报告的老年人整体ECT利用率较高的情况在高龄老年人中进一步凸显。高龄老年人可能存在合并症和个人护理需求，这对ECT技术和服务提供有影响。我们的研究结果强调，未来的ECT研究需要更多地纳入高龄患者，以提高其临床适用性。
