Jeffrey Foster, MD

Lack of energy, recurrent thoughts of death and difficulty with concentration are viewed by more than half of medical decision-makers in families as natural components of aging rather than as symptoms of clinical depression, according to a Louis Harris and Associates survey.

When the 1,500-member American Association for Geriatric Psychiatry (AAGP) commissioned the Harris survey, it found that more than half of Americans 75 years of age and older believe depression is a natural part of the aging process. Additionally, 93% of all adults polled said they believe depression is a normal side effect for those suffering from a medical condition.

The AAGP began a national public education effort to address these misconceptions held by older Americans and their caregivers, to help them recognize depressive symptoms and to alert them to the availability and effectiveness of treatment. 

As part of that effort, the AAGP established a toll-free line whereby callers can request the brochure, 

Depression in Late Life-Not a Natural Part of Aging

, as well as a listing of geriatric psychiatrists in their area and other mental health and aging organizations which provide free consumer information. In the first year of operation, more than 20,000 brochures were distributed and more than 2,000 referrals were made to geriatric psychiatrists. 

With the National Council on Aging, AAGP is also participating in "Enlighten," a national consumer education program scheduled to be presented at more than 14,000 senior centers. The program features an educational video, brochure and leader's guide. At each site, presenters will include an AAGP member.

AAGP is also working with the National Mental Health Association to arrange late-life depression screening programs in more than 50 communities throughout the country. 

Concerned with educating health care professionals as well as consumers, AAGP has placed on its Web site (

) a summary of research conducted by AAGP member Jrgen Untzer, M.D., M.P.H., and colleagues which prospectively followed up 2,558 Medicare patients for depression symptoms, utilization and cost of medical services during four years. The researchers found that 14% of the patients had significant depressive symptoms at the beginning of the study, and that percentage climbed to 18% at the end of the four years. Additionally, patients with significant depressive symptoms at baseline had "higher median costs during the first year after the baseline survey ($2,147) than patients without depressive symptoms ($1,461)" and higher median costs for the total four-year period (Unutzer and colleagues).

"Our findings are important," the study authors said, "because by the year 2040 persons older than 65 years are projected to make up 21% of the population and consume almost half of the national's health care resources." 

Another element in AAGP's professional education effort will be seven regional symposia and 30 geriatric roundtables focused on treatment for late-life depression to which primary care physicians and psychiatrists will be invited.

Similar to the depression campaign, the AAGP, along with the Alzheimer's Association and the American Geriatrics Society, launched the "Initiative on Alzheimer's Disease and Related Disorders" in January of this year.  So far, that initiative has included a Consensus Conference on Alzheimer's Disease and Related Dementias, a consensus statement on the diagnosis and treatment of Alzheimer's Disease, which was published in  JAMA (Oct. 1997); and development of a consumer brochure, 

Understanding Alzheimer's Disease-The Most Common Dementing Disorder. 

Other activities for AAGP include planning for an anxiety and sleep disorders initiative; convening a consensus conference in 1998 to consider recommendations for improving the quality of mental health care in long-term care facilities; educating policy-makers and payers about the mental health treatment needs of nursing home residents; and guidelines for consumers in selection of health maintenance organizations. For example, for Medicare enrollees, AAGP joined with the American Psychiatric Association's Council on Aging to develop "Ten Questions to Ask Your HMO." Each question is followed by answers which indicate the HMO has carefully considered its benefit design for mental health services. For example, there is a question, "Do you have a directory of psychiatrists in your HMO? (Many HMOs have Directories of Medical Specialists, but do not list psychiatrists.) 

With all of its initiatives and advocacy efforts, AAGP seeks to maintain a balance of physician and consumer education programs to ensure improvement in patient care.

	UnÃ¼tzer J, Patrick DL, Simon G, et al. Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: A four-year prospective study. JAMA. 1997;277(20):1618-1623.

Articles

Lack of energy, recurrent thoughts of death and difficulty with concentration are viewed by more than half of medical decision-makers in families as natural components of aging rather than as symptoms of clinical depression, according to a Louis Harris and Associates survey. Additionally, 93% of all adults polled said they believe depression is a normal side effect for those suffering from a medical condition.

Jeffrey Foster, MD

Articles

Late-Life Depression, Dementias- Top Educational Priorities for AAGP