Team approach helps older patients suffer less depression

A new team approach helps older patients suffer less depression, function better physically, enjoy better overall health and a better quality of life. The study appears in this week's British Medical Journal (BMJ).

"Depressed older adults rarely get effective treatment. This study shows we can engage these patients in treatment in their usual primary care setting, and help them lead happy, productive lives," said Enid Hunkeler, lead author of the study and an investigator with the Kaiser Permanente Division of Research in Oakland, California.

The study followed 1,801 depressed patients, 60 and older, for two years. Patients were given either standard treatment or IMPACT care (Improving Mood Promoting Access to Collaborative Care Treatment). IMPACT is a program designed specifically to meet the needs of the depressed elderly.

The IMPACT team included primary care and mental health specialists, who worked together using a computer program to track each patient's individual needs, and provide treatment accordingly. Treatment included both the use of antidepressants and problem-solving talk therapy.

IMPACT patients did significantly better than patients in standard care and the benefits persisted even one year after the program ended.

A 70-year-old patient who participated in the study, James Robinson of Newark, California, said, "I was very depressed, physically and mentally. I had someone to talk to who listened to me. I felt like a new person. I still think about our meetings and it makes me feel better."

According to the National Institute of Mental Health of the 35 million Americans who are 65 years and older, an estimated 7 million may suffer depression, 2 million severely, putting them at greatly increased risk for committing suicide. Studies show treatment can be effective in controlling depression in up to 80 percent of cases. However, only a small percentage of elderly depressed patients get adequate treatment in primary care or see a mental health specialist. The IMPACT program provides a model for how effective depression care can be offered to depressed older adults seen in primary care clinics around the country. The program is currently being disseminated in the U.S. and Canada with funding from the John A. Hartford Foundation (www.impact.ucla.edu).

IMPACT was funded by the John A. Hartford Foundation, the California HealthCare Foundation, the Hogg Foundation, and the Robert Wood Johnson Foundation.

The Kaiser Permanente Division of Research conducts, publishes, and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and the society at large. It seeks to understand the determinants of illness and well being and to improve the quality and cost-effectiveness of health care. Currently, DOR's 400-plus staff is working on more than 250 epidemiological and health services research projects.