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Randomized trial of case-finding for depression in elderly primary care patients
M A Whooley1, B Stone, K Soghikian
1Section of General Internal Medicine, Department of Veterans Affairs Medical Center, San Francisco, California 94121, USA. whooley@itsa.ucsf.edu
Journal of General Internal Medicine
|June 7, 2000
Summary
Case-finding for depression in elderly primary care patients did not improve depression diagnoses or treatment over two years. Further research is needed to explore more intensive interventions for older adults with depression.
Area of Science:
- Geriatric Medicine
- Primary Care
- Mental Health Research
Background:
- Depression is a prevalent condition in elderly primary care patients.
- Effective case-finding strategies are crucial for timely diagnosis and treatment in this population.
Purpose of the Study:
- To evaluate the impact of a systematic depression case-finding approach on depression diagnoses, antidepressant prescriptions, and healthcare utilization in elderly patients over a two-year period.
Main Methods:
- A randomized controlled trial was conducted across thirteen primary care clinics.
- 2,346 patients aged 65+ were screened using the Geriatric Depression Scale (GDS).
- Intervention clinics notified physicians of GDS scores and offered patient education; control clinics received usual care.
Main Results:
- No significant differences were observed in physician diagnoses of depression, antidepressant prescriptions, or depression prevalence (GDS scores) between intervention and control groups at two-year follow-up.
- Healthcare utilization, including clinic visits and hospitalizations, also showed no significant differences between the groups.
- While not statistically significant, a trend towards greater GDS score improvement was noted in intervention participants with severe initial symptoms (GDS > 11).
Conclusions:
- The implemented case-finding strategy did not demonstrate a significant benefit in improving depression outcomes or healthcare utilization in elderly primary care patients over two years.
- Further studies are recommended to investigate the efficacy of combining case-finding with more intensive patient education and follow-up protocols for this demographic.