Collaborative Care Management of Late-Life Depression in the Primary Care Setting

Abstract

Major depression and dysthymic disorder affect between 5% and 10% of older adults seen in the primary care setting.^1-3 Late-life depression is often chronic or recurrent^4-8 and is associated with substantial suffering, functional impairment, and diminished health-related quality of life.⁹ Depressed, older primary care patients are frequent users of general medical services^5,10-12 and may have poor adherence to medical treatments.¹³ They are also at increased risk of death from suicide¹⁴ and medical illnesses.^15-17 Although late-life depression can be successfully treated with antidepressant medications or psychotherapy,^18-21 few depressed older adults receive adequate trials of such treatments in primary care^22-28 or see a mental health specialist.^25,29-35 Efforts to improve late-life depression treatment using screening and health care practitioner feedback and education have not resulted in consistent improvements in depression.^22,23 A more comprehensive intervention strategy may be needed to improve outcomes for this population.