[Psychotherapeutic work with older patients]

[Multiprofessional outpatient psychosocial treatment for elderly patients with mental disorders]

Mental disorders contribute substantially to the loss of quality of life and life expectancy in old age. Life expectancy is reduced especially by the bidirectional interaction with heart diseases, diabetes mellitus as well as the depression-specific risk of suicide. Depression in old age is a strong risk factor for nursing home placement, which is usually an undesired outcome for older people. Utilization of mental health services is hindered by self-stigmatization and prejudice; however, according to recent surveys older people increasingly value psychotherapeutic services. Shortcomings in the diagnostics and therapy in the primary treatment of old age depression have stimulated research in low-threshold options in primary care and collaborative multiprofessional outpatient interventions in many countries. The core features of collaborative care approaches are improved diagnostics, stepped-care protocols, continuous disease monitoring, and access to psychiatric and psychotherapeutic supervision or services. Collaborative multiprofessional outpatient approaches have been shown to be superior for the treatment of old age depression compared to treatment as usual.

Approval of psychotherapy and medication for the treatment of mental disorders over the lifespan. An age period cohort analysis

AIMS

Previous cross-sectional studies revealed inconsistent results regarding mental health treatment preferences among the general population. In particular, it is unclear to what extent specific age groups approve psychotherapy or psychotropic medication for the treatment of mental disorders. We explore whether treatment recommendations of either psychotherapy or psychiatric medication change over the lifespan which includes age-related effects due to increasing age of a person, cohort effects that reflect specific opinions during the time a person was born and period effects that reflect societal changes.

METHODS

Using data from three identical population surveys in Germany from 1990, 2001 and 2011 (combined n = 9046), we performed age-period-cohort analyses to determine the pure age, birth cohort and time period effects associated with the specific treatment recommendations for a person with either depression or schizophrenia, using logistic Partial Least-Squares regression models.

RESULTS

For both disorders, approval of both psychotherapy and medication for a person with mental illness increases with age. At the same time, younger cohorts showed stronger recommendations particularly for psychotherapy (OR around 1.07 per decade). The strongest effects could be observed for time period with an increase in recommendation between 1990 and 2001 with odds ratio of 2.36 in depression and 2.97 in schizophrenia, respectively. In general, the treatment option that showed the strongest increase in recommendation was medication for schizophrenia and psychotherapy for depression.

CONCLUSION

Underutilisation of psychotherapy in old age seems not to reflect treatment preferences of older persons. Thus, special treatment approaches need to be offered for this group that seems to be willing for psychotherapy but do not yet use it. Cohort patterns suggest that approval of psychotherapy among older persons will likely further increase in the coming years as these people get older. Finally, strong period effects underpin the importance of changing attitudes in the society. These could reflect reporting changes about psychiatric topics in the media or a general increase in the perception of treatment options. Nevertheless, more treatment offers especially for older people are needed.

[Treatment preferences of elderly patients with mental disorders]

BACKGROUND

Successful treatment in psychosomatic medicine requires intrinsic motivation of the patient and the belief that the chosen therapeutic option can help. Depression, somatization disorder and generalized anxiety disorder (GAD) are frequent mental disorders in the elderly population. Finding a suitable and successful treatment for elderly people with mental disorders is often difficult. Undertreatment and the utilization of inappropriate healthcare services are frequent.

OBJECTIVE

Treatment preferences of elderly patients with mental disorders were ascertained in order to evaluate the motivation for psychotherapy or other therapeutic measures.

MATERIAL AND METHODS

The data were derived from the 8-year follow-up of the epidemiological study on chances of prevention, early recognition and optimized therapy of chronic diseases in the elderly population (ESTHER), a population-based cohort study in Saarland, Germany. A total of 3124 patients aged 55-84 years were included in this analysis. The treatment preferences were documented using a questionnaire with 12 different answer categories. The occurrence of depression, somatization disorder and GAD was collated using the patient health questionnaire (PHQ-D).

RESULTS

Physiotherapy and inpatient rehabilitation were the most frequently named treatment preferences in all three subgroups of patients with mental disorders. Psychotherapy was the preferred treatment for 18.3 % of depressive patients, for 15.0 % of somatization patients and for 15.7 % of GAD patients.

CONCLUSION

Mentally ill elderly patients in Germany preferred physical treatment techniques, such as physiotherapy and inpatient rehabilitation over psychotherapy. Discussion is needed over the reasons for these findings and the clinical implications.