Risk of depression, anxiety in elderly can be cut

A new study finds that prevention is possible in the primary care setting.

By Victoria Stagg Elliott — Posted April 6, 2009

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

The chance that someone older than 75 will develop anxiety or depression can be halved if those with the early signs of these disorders are monitored and receive escalating levels of intervention, says a study in the March Archives of General Psychiatry.

"Depressive and anxiety disorders ... are associated with reduced quality of life, can be difficult to diagnose, can be difficult to treat and are costly," wrote Petronella J. van't Veer-Tazelaar, in an e-mail. She is the lead author and a scientist at VU University Medical Center's Institute for Research in Extramural Medicine in Amsterdam, the Netherlands. "Prevention is better than cure. We have proven to be successful in the prevention of depression and anxiety using a simple and relatively cheap program that can be applied [in] primary care."

Researchers randomized 170 elderly people presenting to primary care clinics with the first signs of anxiety or depression into two study groups -- one receiving usual services and a second for which intervention was stepped up as needed. This intervention group initially received watchful waiting. If symptoms did not resolve, they were visited at home by a nurse who provided coping skills training and written information about mental health.

If patients were still symptomatic, they received seven sessions of cognitive behavioral therapy. Finally, if still necessary, they were advised to discuss pharmaceutical options with their primary care physicians.

Experts praised this paper for increasing awareness that these mental health issues are not an inherent part of aging and suggesting a strategy to determine who needs additional help.

"It's not ... just part of getting older. In healthy, community living elderly, the rate is lower than in other population groups," said Jürgen Unützer, MD, MPH, professor of psychiatry at the University of Washington. He has extensively studied mental health issues in this age group.

Some physicians working in this area, however, wanted more assessment of the levels of anxiety tracked by this study, since the screening tools used to detect subclinical symptoms of mental health problems were focused on depression. A desire also was expressed to see data on the cost of this intervention and their effect on downstream health outcomes.

"I think it's great that the paper raises awareness, and I think it's interesting that it talks about prevention," said Bruce L. Rollman, MD, MPH, associate professor of medicine and psychiatry in the division of general internal medicine at the University of Pittsburgh School of Medicine. "But it would be helpful to see if the prevention of anxiety and depression affects emergency department utilization or other health care costs."

The study also gives rise to questions surrounding how to incorporate this kind of screening and intervention into geriatric care. Although validated screening tools exist to detect early signs of depression or anxiety, experts say mental health care can get lost in treatment for the other chronic conditions that so many elderly patients have. In addition, the symptoms for these other illnesses often mimic those for psychological ills.

"Early recognition and early intervention are essential," said Seren Cohen, PhD, a geriatric psychologist in Santa Fe, N.M. She also is a spokeswoman for the American Geriatrics Society. "But it's sometimes difficult with the geriatric population. We may not get an adequate mental health history because of stigma or a reluctance to disclose. Many in this generation don't perceive depression as necessarily being that important."

Meanwhile, reducing the risk of these mental illnesses as people age is increasingly the focus of research. "Path to prevention" is the theme of the 14th International Congress of the International Psychogeriatric Assn. in Montreal in September.

In addition, interest in the link between physical and mental health has grown significantly. Dr. Rollman is researching the impact of treating depression on outcomes for patients undergoing coronary artery bypass.

Preliminary data from this study were presented at the American Psychosomatic Society meeting in Chicago in March.

Back to top


Study at a glance

What can reduce the risk of anxiety and depression in elderly patients?

Objective: Determine the impact of a stepped-care prevention program focusing on anxiety and depression in those older than 75.

Methods: During the course of a year, 170 elderly men and women with subclinical anxiety or depression were recruited from 33 primary care practices in the Netherlands. Patients were randomized to either usual care or a stepped-care program. The latter involved watchful waiting, several forms of cognitive behavior therapy and referral for medication. Each segment lasted at least three months with patients moving on to more intensive interventions as needed.

Results: About 24% of those in the usual care group developed a depressive or anxiety disorder in 12 months, but only 12% of those in the stepped-care intervention group did.

Conclusion: This strategy is effective at preventing anxiety and depression among the elderly.

Source: Archives of General Psychiatry, March (link)

Back to top

External links

"Stepped-Care Prevention of Anxiety and Depression in Late Life," abstract, Archives of General Psychiatry, March (link)

American Medical Association on geriatric health (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn