Study Suggests Older Elderly Patients Experience Poorer Outcomes Following Collaborative Depression Care
Affecting between 5% and 10% of older adults seen within a primary care setting, major depression and dysthymia are associated with increased morbidity and mortality. Since collaborative care models have been shown to improve depression care for older adults in primary care settings, this study examines the differences between young-old (age 60 to 74) and old-old (age 75 and older) patients who received collaborative depression care as part of the IMPACT (Improving Mood: Promoting Access to Collaborative Treatment) study. Collaborative care for depression combines provider/patient education, treatment monitoring, and/or the use of depression care managers to coordinate care. Investigators analyzed data for 906 patients (606 young-old and 300 old-old) who were randomized to receive collaborative care for major depression and/or dysthymia at 18 primary care clinics from eight healthcare organizations, including VA. Measures included process of care and depression outcomes.
Findings show that young-old and old-old patients who receive collaborative depression care have a similar initial clinical response, but old-old patients may have a lower rate of long-term treatment response and complete remission. For example, young-old and old-old patients randomized to the IMPACT intervention responded similarly to initial treatment at 3 months, but the old-old were less likely to respond to treatment at later follow-up intervals. Treatment response and remission rates peaked for both age groups at 6 months, although treatment response rates for the young-old were significantly higher than those for the old-old group (51% vs. 44%). Study findings also show that the process of care did not differ between young-old and old-old patients who received the IMPACT intervention. If additional studies confirm these findings, the authors suggest that future research focus on improving long-term outcomes for patients age 75 and older with depression and/or dysthymia.
Van Leeuwen Williams E, Unützer J, Lee S, and Noël P. Collaborative Depression Care for the Old-Old: Findings from the IMPACT Trial. American Journal of Geriatric Psychiatry December 2009;17(12):1040-1049.
Dr. Noël and Ms. Lee are part of HSR&D's Veterans Evidence Based Research Dissemination and Implementation Center in San Antonio, TX.