Depression in older people. Some criteria for effective treatment.

Depression at a level requiring clinical attention affects 12-15% of those over 65 in the community. Only a small minority are in contact with specialist mental health services, the majority of these depressed older patients will require detection and treatment in primary care. Although the symptoms of depression, once elicited, are similar to those of younger patients, initial presentation in older people can be misleading, and the onset and outcome of depression in this age group is closely linked with the state of current physical health and social adversity. Pharmacotherapy is effective for treatment, but both the family doctor and older patient may be reluctant to consider and persist with antidepressant medication. A controlled study is described which aims to improve the management of older patients in primary care by evaluating the role of a nurse acting as case manager to work in conjunction with family doctors and community agencies to implement a plan of treatment for depression. Preliminary results indicate that the nurse was effective through her personal work with depressed older patients, despite the fact that the recommended introduction of antidepressant medication was often not possible.