Team care helps depressed elderly

Even 12 months after the year-long program had ended, Dr. Jurgen Unutzer of the University of Washington School of Medicine in Seattle and colleagues found, men and women who had participated in the program were less likely to report thoughts of suicide than those who received standard care.

Finding effective ways to treat depression in elderly people is particularly important, the researchers note in their article in the Journal of the American Geriatric Society. Mood disorders are common in older people, and the suicide rate among the elderly -- particularly white men -- is much higher than average.

Unutzer and his team evaluated at a one-year program called the Improving Mood: Promoting Access to Collaborative Treatment (IMPACT) trial. In the intervention, a trained nurse or psychologist worked with the patient's primary care doctor to manage depression care, discussing treatment options including antidepressant medications and therapy with the patient.

Patients were also offered the opportunity to participate in a four- to eight-session series of behavioral treatments designed to improve problem-solving abilities.

The trial involved 1801 men and women 60 and older who were randomly assigned to the IMPACT program or to usual care, which involved psychotherapy with the primary care physician and the option of taking antidepressant medication. More than half of patients in the usual-care group were prescribed an antidepressant by their primary care doctor.

At the beginning of the study, 15.3 percent of people in the collaborative-care arm of the study reported thoughts of suicide, as did 13.3 percent of the comparison group. By six months, the percentage of IMPACT patients having suicidal thoughts had fallen to 7.5 percent, compared to 12.1 percent for controls; at 12 months it was 9.8 percent vs. 15.5 percent.

Even six to 12 months after treatment had ended, patients in the IMPACT group were significantly less likely to report suicidal thoughts.

Primary care physician-based care may be particularly effective for older people, who tend to be reluctant to seek help from a mental health professional, the researchers note, and programs like IMPACT can be very helpful given how busy such doctors generally are.

"The benefits of improved care for late-life depression go well beyond reducing thoughts of suicide and include less emotional and physical pain and better physical functioning," the researchers add.

SOURCE: Journal of the American Geriatric Society, October, 2006.