Hostname: page-component-78c5997874-j824f Total loading time: 0 Render date: 2024-11-08T10:34:10.235Z Has data issue: false hasContentIssue false

Barriers to the diagnosis and treatment of depression in the community dwelling elderly

Published online by Cambridge University Press:  13 June 2014

Brian A Lawlor*
Affiliation:
Consultant in Old Age Psychiatry, St James's and St Patrick's Hospitals, James's Street, Dublin 8, Ireland

Abstract

There is broad agreement in the literature that depression in the community dwelling elderly is under-diagnosed and under-treated by general practitioners. Somatisation, overlap with medical illness, bereavement and atypical presentations of depression in this age-group may contribute to the difficulties in diagnosis in primary car settings. Furthermore, the apparent reluctance of primary care physicians to treat depression in the elderly may reflect the mistaken notion that depression in this population is a benign condition, an understandable reaction to physical illness and as such untreatable. Fundamental changes in the patterns of collaboration between psychiatry and general practice will be necessary to overcome these barriers to the detection and treatment of depression in the community dwelling elderly.

Type
Perspective
Copyright
Copyright © Cambridge University Press 1995

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Goldberg, D, Huxley, P. Mental illness in the community. The pathway to Psychiatric care. London: Tavistock, 1980.Google Scholar
2.Blanchard, MR, Waterreus, A, Mann, AH. The nature of depression among older people in inner London, and the contact with primary care. Br J Psychiatry 1994; 164:396402.CrossRefGoogle ScholarPubMed
3.Lawlor, BA, Radic, A, Bruce, I, Swanwick, GRJ, Walsh, JB, Coakley, D. The prevalence of mental illness in the community dwelling elderlyin Dublin using AGECAT. Ir J Psychol Med 1994; 11 (4): 157–60.CrossRefGoogle Scholar
4.Waxman, H, Camer, E, Blum, A. Depressive symptoms and health care utilization among the community elderly. J Am Geriatr Soc 1983;31:417–20.CrossRefGoogle ScholarPubMed
5.Livinston, G, Hawkins, A, Graham, N, Blizard, B, Mann, A. The Gospel oak study:prevalence rates of dementia, depression and activity limitation among elderly residents in Inner london. Psychol Med 1991; 20:137–46.CrossRefGoogle Scholar
6.MacDonald, A. Do general practitioners miss depression in elderly patients? BMJ 1986;292:1365–7.CrossRefGoogle ScholarPubMed
7.Bridges, K, Goldberg, D. Somatic presentation of DSM-I1I psychiatric disorders in primary care. J Psychosom Res 1985;29: 563–9.CrossRefGoogle ScholarPubMed
8.Good, MD, Good, BJ, Cleary, PD. Do patient attitudes influence physician recognition of psychosocial problems in primary care? J Fam Pract 1987; 25: 53-Google ScholarPubMed
9.Copeland, JRM, Davidson, IA, Dewey, ME, Gilmore, C, Larkin, BA, McWilliam, C, Saunders, PA, Scott, A, Sharma, V, Sullivan, C. Alzheimer's disease, other dementias, depression and pseudodementia: prevalence, incidence, and three year outcome in Liverpool. Br J Psychiatry 1992; 161:230–9.CrossRefGoogle ScholarPubMed
10.Kirby, M, Radic, A, Bruce, I, Walsh, JB, O'Neill, D, Coakley, D, Lawlor, BA. Outcome of depression in community dwelling elderly in Dublin. Eastern Health Board: 3rd Multidisciplinary Research Conference, Dublin 1994 (Abstract); 12.Google Scholar
11.Phelan, D. The psychiatrist in primary care: let's look before we leap. Ir J Psychol Med 1995; 12(1): 1721CrossRefGoogle Scholar