Prevention

Depression in older people is frequently overlooked. It has been calculated that only 10 per cent of depressed older people in the community are adequately detected by primary care and many of these receive inadequate or no treatment. (44> Better detection would lead to improved outcome. Initiatives such as the Defeat Depression campaign in the United Kingdom and the Coping with Depression course in The Netherlands have attempted to heighten general knowledge and awareness of depression in older people. How successful they are is unclear.

Secondary prevention, aimed at preventing a recurrence of depression, should be applied to the continuation and maintenance phases. The main elements are systematic aftercare and a telephone number (and ideally a name) to contact in the event of relapse or recurrence. This will require liaison with primary care providers.

Efforts to improve the prognosis should involve a multidisciplinary approach, with facets including medication, social support, and psychological intervention. Secondary preventive programmes for depression can be managed by a trained nurse. For example, Waterreus et a/.(45> have shown the benefits of deploying a psychiatric nurse within the community to manage and follow up patients with depression. The interventions used were social support, counselling, education about medication and the illness (especially signs of recurrence), liaising in order to facilitate a health review, and help to attend a day-care centre. All were found to be helpful. Additionally, Ong et a/.(46) were able to demonstrate that a support group for discharged elderly depressive patients, run by a social worker and a community psychiatric nurse, resulted in a significant reduction in relapses and readmissions over a 1-year period. This is important as the skills deployed in this study were quite easy to learn, in essence being directed at support rather than requiring knowledge of specific psychological therapies.

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