Recognition and decision to treat depression in older adults presenting at GP surgeries
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Objectives: The population, globally and nationally, is ageing and the numbers of those over the age of 65 is increasing. Given this increase in numbers, it is important that the physical and mental health needs of older adults are addressed by service providers. Depression is the most common form of mental ill health in this age group and effective treatments are available. The main aim of the study was to investigate the extent to which general practitioners‘ (GPs) are able to identify depression and offer appropriate treatment strategies to patients over the age of 65 presenting to non-urgent community GP clinics. Method: GPs assessed each participant, attending a general clinic appointment, for depression. Participants (n=31, mean age=75.6 years) completed, with the author, the Abbreviated Mental Test Score (AMTS), and two screening tools: the Structured Clinical Interview for DSM-IV (SCID) and the Geriatric Depression Score – short form, 15 item (GDS-15). A structured interview was conducted and patient records examined to gain demographic information for each patient. Cohen‘s Kappa was used to assess the level of agreement between the GP assessment and the objective measurements for depression. Results: Depression was identified by both the GP and the SCID in three cases. The inter-rater reliability between the SCID and the GP assessment of depression was good (Kappa = 0.61, p <0.001). The inter-rater reliability between the SCID and the GP assessment of dysthymia was poor (Kappa = -0.08, p =ns). Participant numbers prevented further analysis of how the independent variables recorded affected the diagnosis and treatment of depression by GPs. Conclusion: The findings suggest that GPs are able to identify depression but not dysthymia in their older adult patients. The difficulties in engaging GPs in research are explored. The strengths and weaknesses of the study are considered. The clinical implications of the study are discussed.