Depression in the elderly in family practice

Depression among the elderly is an important problem in general practice. There is insufficient knowledge of the prevalence of this condition, of possible ways to improve diagnosis and of its course. The questions in this project were: a) how prevalent is depression in the active population of the GP, and which patients are identified as such by the GP, b) how can the depressed elderly patient be diagnosed in daily practice and which signals can be used by the GP to include or exclude the diagnosis, and c) what is the recovery of this condition among the elderly and is recovery related to recognition by the GP? a) The prevalence has been estimated in two studies (n = 384, n = 580) in 1990 en 1992 with self-report questionnaires and interviews. The samples consisted of consecutive elderly attenders of general practices. We used the Zung scale, the Geriatric Depression Scale (GDS) and the Diagnostic Interview Schedule (DIS). b) To improve diagnosis the relationship of various characteristics to depression status at interview in 1992 was analyzed, and we also evaluated whether the 30-item version of the GDS could be shortened for use in daily practice. c) Patients with depression at baseline interview in 1992 were reassessed with the DIS at 6 and 12 months to evaluate the course. a) Many elderly patients indicated depressive complaints on the self-report questionnaires for depression, respectively 11{\%} and 13{\%} for Zung and GDS. One in twelve elderly patients had depression according to the interview in 1992 (46/580). Not all patients who have depressive complaints or depression were recognised by the GPs. b) Vague or gastrointestinal (GI) reasons for visiting the GP or presenting symptoms and female gender were related to depression. To make suspected depression more likely or to exclude depression, 4 questions may suffice. c) At 12 months 72{\%} of the 25 patients with depression at baseline interview were not depressed. Whether patients were depressed at follow-up interviews was not related to recognition by the GP. The conclusion is that vague complaints and GI problems may be a signal for depression in the elderly and a few short questions may make this diagnosis more likely or exclude it. The course of this condition in general practice needs further study.