Depression among older people in the community; the effect of intervention on a screened population

There has been debate concerning the prevalence of depression among older people, but recent community studies using specially designed questionnaires indicate that it is the commonest psychiatric illness among this group. Little is known about the precise nature of depression encountered in the community; there is a lack of knowledge concerning factors associated with this depression, its prognosis and response to treatment. 96 older people screened and identified as cases of probable pervasive depression, by household enumeration in the Gospel Oak area of North London, were interviewed in detail using a valid, semistructured psychiatric assessment. In liaison with their general practitioners, they were then randomly entered into a case-controlled study. Half received standard, local primary care. The other half received this with the addition of a study nurse who worked with general practitioners and attempted to deliver management plans which had been developed by the local old age psychiatry multidisciplinary team. At the end of three months the subjects were interviewed with the original screening instrument by a worker outside the study. Most of the depressed subjects were deemed by the local multidisciplinary team to require multifaceted interventions. Many of the pharmacological and social interventions could not be implemented and this was mainly due to the subjects' unwillingness to accept them. Most psychological interventions could be delivered. There appeared to be no additional therapeutic activity on the control side despite general practitioners being informed of depression caseness. There was a significant difference in outcome at three months between subjects allocated to study nurse intervention and those in the control group