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Keeping in Touch Helps Elderly Handle Depression

Symptoms fall dramatically with follow-up calls

TUESDAY, Dec. 10, 2002 (HealthDayNews) -- A carefully organized program of constant checking can help older people better cope with depression, a study finds.

For many of those people, the program can be lifesaving, since badly treated depression worsens their ability to manage other chronic conditions, such as diabetes or heart disease, says Dr. Jurgen Unutzer, an associate professor of psychiatry at the University of California at Los Angeles. He is lead author of a paper on the study, which appears in tomorrow's Journal of the American Medical Association.

It's a program that builds on the progress made over the past decade, a period during which doctors have become increasingly aware of the problem of depression among older people; 10 percent or more of the elderly are believed to suffer from some degree of clinically diagnosed depression.

"Ten years ago, the odds that these people would have gotten treatment was close to zero," Unutzer says. "It often was not recognized because patients and physicians were not comfortable with the idea of depression. The advent of antidepressant medications has made depression more treatable, and the majority of older adults will be prescribed an antidepressant by their primary physician."

"But even so, a large number of older adults don't get effective treatment. They get the prescription, but not the support they need. Some take too small a dose, others don't stay on the medication long enough because of side effects or other reasons. The primary-care physician doesn't have enough time to follow up on this."

So Unutzer and others organized a program that enrolled 1,801 depressed older people (60 or older) at 18 primary-care clinics. Half got the usual treatment, while people in the other group were assigned someone to keep in touch with them -- most often a nurse, sometimes a psychologist. There were periodical phone calls asking about the effectiveness of the medication and any side effects that might be causing problems -- "subtle things that the usual care was not able to keep track of," Unutzer says.

After a year, 45 percent of people who had that kind of follow-up reported a reduction in the symptoms of depression of 50 percent or more, compared to 19 percent of those who did not get the follow-up, the researchers report.

"I call it a systematic, proactive follow-up of patients after they have been diagnosed," says Dr. Elizabeth H. B. Lin, a scientific investigator and family physician at the Group Health Care Cooperative of Puget Sound in Seattle and a participant in the study. "It is a collaborative model for managing depression that helps primary-care patients get better care overall."

Improving depression treatment "does make it possible to do more in the way of health care for chronic conditions," Lin says, noting that 80 percent of the people enrolled in the program at her facility had one or more other long-term conditions.

"Our hope is that these results will encourage other clinics to follow our model," Unutzer says. "It is somewhat encouraging to see that many of the clinics in our program have gone on to build it into their usual care. If you take your existing staff and train them to do this in an organized way, you can nearly double the effectiveness of this kind of treatment."

What To Do

You can learn more about depression among the elderly, its symptoms and treatment, from the National Institute of Mental Health or the National Institute on Aging.

SOURCES: Jurgen Unutzer, M.D., associate professor, psychiatry, University of California, Los Angeles; Elizabeth H. B. Lin, scientific investigator, Group Health Care Cooperative of Puget Sound, Seattle; Dec. 11, 2002, Journal of the American Medical Association
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