Mann A H, Blanchard M, Waterreus A
I'Institute of Psychiatry, London.
Encephale. 1993 Aug;19 Spec No 3:445-50.
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.
社区中65岁以上人群中，有12% - 15%的人患有严重程度达到临床关注标准的抑郁症。只有一小部分人接受专业心理健康服务，这些抑郁的老年患者大多需要在初级保健中被识别并接受治疗。尽管抑郁症的症状一旦出现，与年轻患者相似，但老年人的初始症状可能具有误导性，而且这个年龄段抑郁症的发病和转归与当前身体健康状况和社会逆境密切相关。药物治疗对抑郁症有效，但家庭医生和老年患者可能都不愿考虑并坚持使用抗抑郁药物。本文描述了一项对照研究，其目的是通过评估护士作为个案管理员的作用，与家庭医生和社区机构合作实施抑郁症治疗计划，来改善初级保健中对老年患者的管理。初步结果表明，尽管通常无法按照建议使用抗抑郁药物，但护士通过与抑郁老年患者的个人工作取得了成效。
