Being old, depressed, and disabled is to be in triple jeopardy

EDITOR—Llewellyn-Jones et al have provided strong evidence that a multifactorial intervention for late life depressive illness has a measurable beneficial effect.1 I have provided specialist medical services to the community that Llewellyn-Jones et al studied and as a researcher have tried to study similar participants in clinical trials of multifactorial interventions. Research into rehabilitation, falls, and geriatric evaluation and management share the same issues as depression.

Haynes (in his editorial accompanying the paper)2 and Deeks and Juszczak (in their commentary)1—and the rapid responses to the paper3—raise important issues. Although this area of clinical investigation remains in development, it is clinically relevant research. The researchers did well to follow up the percentage of participants that they did. The number eligible was 220, and they managed to have outcomes for 185 (85%). This included 15 participants who died: death is a legitimate end point for the frail older people studied.

The study showed an improvement of about 2 points on the 30 item geriatric depression scale. Is this worthwhile? As a clinician I vote yes. Remember that this is the real world of care of older people, with limited resources and hard pressed nursing staff, personal care staff, and general practitioners. If the intervention works in Llewellyn-Jones et al's large and architecturally outdated facility in Sydney it will be even more effective in well resourced retirement communities. In the United Kingdom the structure of general practice (which encourages closer medical supervision of frail older people) should also improve the effectiveness of the intervention.

The intervention has components that should be available to all older people as a right. Callahan argues for a basic humane health service as a minimum for all older people.4 The intervention falls into this league. Cost effectiveness analyses are unlikely to …