Assessment and Treatment of Older People with Depression in a Secondary Mental Health Trust

Stephen      Curran; Rebecca      Spencer; Sonja      Kruger; Andrew      Byrne; Vijayalakshmi      Saravanan; Bo      Wynn

Abstract

The treatment of depression in older people needs an integrated approach with pharmacological and psychosocial approaches working together. Within secondary mental health services there are patients with severe depression who are often at a significant risk. There is evidence to suggest the older antidepressants are over prescribed to the elderly in primary care and there are gaps in the assessment information recorded. This study aimed to identify if the same issues were present in secondary care.

This study was a retrospective case note survey of 181 patients aged 65 and over referred to a secondary mental health service with depression. Eligible patient’s case notes were surveyed in pairs and data was recorded on data collection forms using electronic records and paper case notes to ensure the data was comprehensive.

Older people treated for their current episode of depression are seven times more likely to receive the newer classes of antidepressants (SSRI, SNRI and NASSA) than in their previous depressive episodes (odds ratio 7.27 95% CI: 3.78 - 13.98; p<0.001). NICE recommends SSRIs as they are less likely to be discontinued due to side effects. However, for all antidepressants prescribed there was no information recorded about side effects for 75%, or treatment response for 37%. Other significant missing information included severity and duration of depression, exercise, alcohol, smoking, nonpharmacological interventions and BMI. Comprehensive assessment and clear recording are needed. Further research could repeat this survey in other services to see how far the results can be generalised.

Keywords: Aged, Depression, Antidepressive Agents, Mental Health Services, Assessment, Patient-Centered Care.

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