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|Title:||Identification and management of late life depression : working across primary care and community service boundaries|
|Authors:||Arthur, Antony John.|
|Abstract:||In 1990, annual health checks for people aged 75 years and over were introduced into general practice. This was seen as a potential vehicle for systematic screening, with subsequent referral to specialist community services, for older people with depression. Previous research had identified a number of obstacles to the recognition and treatment of late life depression.;This thesis consists of two studies to evaluate the effectiveness of a structured approach by primary care and community services to the identification and management of depression among older people. Phase One was a validation study of the short Geriatric Depression Scale (GDS15) as part of an annual over-75 health check by the practice nurse. A stratified random sample of patients who completed the GDS15 was followed up with a diagnostic interview. At a cut-point of <3/3+ the GDS15 was 100% sensitive and 72% specific in detecting cases of depression.;Phase Two was a randomised controlled trial of follow-up assessment by the local Community Mental Health Team (CMHT) for older people identified as depressed at the practice nurse health check. A total of 93 older people with GDS15 scores of 5 or more were randomised to either CMHT assessment (N=47) or routine GHP care (N=46). Uptake of the intervention was 72% (N=34). At the follow-up health check, 18 months after the initial health check, a greater proportion of the control group had improved GDS15 scores (p=0.08). Requests by the CMHT to continue to be involved with some of the patients in the intervention group were often rejected by patients' general practitioners.;Although the GDS15 appears to be a useful instrument in the context of an over-75 health check, further mental health assessment should only be considered where there is a commitment by all service provides to implement recommendations.|
|Rights:||Copyright © the author. All rights reserved.|
|Appears in Collections:||Theses, College of Medicine, Biological Sciences and Psychology|
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