Treatment of elderly and other adult patients for depression in primary care
Treatment of elderly and other adult patients for depression in primary care
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DOI：
10.1046/j.1532-5415.2003.51506.x
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发表时间：
2003-11-01
影响因子：
6.3
通讯作者：
Heinrich, RL
中科院分区：
文献类型：
--
作者：
Fischer, LR;Wei, FF;Heinrich, RL
目的：为了确定是否抑郁症是不同的治疗在老年人和年轻人在初级保健clinics.DESIGN：管理数据被用来确定患者的抑郁症诊断代码。数据来源为基线和3个月随访调查、健康计划电子数据库和图表审计。设置：中西部一家健康维护组织拥有的9家初级保健诊所。研究样本（N= 1，023）由19至93岁的成年患者组成，并分为6个年龄组，从年轻人，35岁以下，到老年人，测量：自变量是一系列虚拟变量：年龄组，基线抑郁症严重程度，性别和事件抑郁症。结果被定义为护理过程（评估，资源）和抑郁症状的改善（流行病学中心抑郁量表简表）。单变量和多变量逻辑回归分析被用来分析病人的特征，抑郁症状，和护理过程变量。统计学处理采用卡方概率检验，P <0.05。结果：基线调查和随访调查的调整应答率分别为69%和82%。老年抑郁症患者比年轻抑郁症患者更容易丧偶，教育水平低，健康状况一般或较差，并且有三个或更多的共病健康问题。年龄、抑郁症状数量、抗抑郁治疗或随访建议方面无差异。年轻患者比老年患者更有可能有新的抑郁症诊断，并在过去一年的大部分时间里报告抑郁症。提供者询问老年抑郁症患者自杀风险的可能性只有6%，约四分之一的可能性将他们转介给心理健康治疗师，约五分之一的可能性询问他们是否感到抑郁，以及二十分之一的可能性询问酒精问题。老年人约有三分之一的可能报告3个月后的抑郁症状的改善，作为老年人的patients.CONCLUSION：这项研究表明，一个可能的模式，注意力不足的最古老的抑郁症患者。由于老年抑郁症患者的自杀率很高，没有询问自杀风险尤其令人担忧。医生们不太可能关注老年患者的抑郁症，这一发现可能部分是因为普通人的不可见性。
OBJECTIVES: To determine whether depression is treated differently in older and younger patients in primary care clinics.DESIGN: Administrative data were used to identify patients with a depression diagnosis code. The sources of data were baseline and 3-month follow-up surveys, the health plan electronic database, and chart audits.SETTING: Nine primary care clinics owned by a health maintenance organization in the Midwest.PARTICIPANTS: The study sample (N=1,023) consisted of adult patients, aged 19 to 93, and was divided into six age groups, from young adult, under age 35, to old old, 75 or older.MEASUREMENTS: Independent variables were a series of dummy variables: age groups, baseline depression severity, sex, and incident depression. Outcomes were defined as care processes (assessment, resources) and improvement in depression symptoms (Center for Epidemiologic Studies-Depression scale short form). Univariate and multivariate logistic regression analyses were used to analyze patient characteristics, depression symptoms, and care process variables. Significance level was reported based on the chi-square test of probability, Pless than or equal to.05.RESULTS: The adjusted response rates to the baseline and follow-up surveys were 69% and 82%. Elderly depressed patients were more likely than younger depressed patients to be widowed, have low levels of education, have fair or poor health, and have three or more comorbid health problems. There were no differences, by age, in number of depressive symptoms, antidepressant treatment, or recommendation for a follow-up appointment. Younger patients were more likely than older patients to have a new diagnosis of depression and to report being depressed most of the past year. Providers were only 6% as likely to ask old-old depressed patients about suicide risk, about one-fourth as likely to referral them to a mental health therapist, about one-fifth as likely to ask if they felt depressed, and one-twentieth as likely to ask about a problem with alcohol as they were with young-adult depressed patients. The old-old were about one-third as likely to report improvement in depression symptoms after 3 months as the young-adult patients.CONCLUSION: This study suggests a possible pattern of underattention to the oldest depressed patients. Failure to ask about suicide risk is especially of concern because of the high suicide rate of depressed geriatric patients. The finding that physicians are less likely to focus on depression with old-old patients may be explained, in part, by the concept of invisibility of the ordinary.