ABC of mental health: Mental health in old ageBMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7105.413 (Published 16 August 1997) Cite this as: BMJ 1997;315:413
- A J D Macdonald
Psychiatric care of elderly people can be more interesting than that of younger patients. Successful treatment of elderly patients requires a demanding mélange of psychological, medical, social, political, and managerial skills—an epitome of modern medicine.
Important biological symptoms of depression in old age are change in sleep patterns (especially reduced sleep and early morning wakening); decline in appetite and weight loss; regular variation of mood over day (especially worse in early morning); constipation; physical and mental slowing not accountable by other disorders; and suicidal thoughts.
The prevalence of depression among people aged over 65 is 15% in the general community, 25% in general practice patients, and ≥30% in residential homes
Criteria for hospital admission of elderly patients with depression
Those who are likely to benefit from treatment and who
Express suicidal ideas of a definite sort, or who attempt suicide
Have problems with compliance or delivery, leading to unduly protracted treatment
Require electroconvulsive therapy for delusions and hallucinations
Neglect themselves substantially, particularly their fluid intake
Require removal from a hostile social environment
Are in such distress as to need tranquillisation or skilled nursing care
Have physical illness that would complicate treatment
Harm themselves, or threaten to, for the first time (especially men)
The central question for doctors is whether a depressive state will respond to treatment (including electroconvulsive therapy); all other questions are either peripheral or secondary to medical practice. Social engineering is not the doctor's role. Even deciding to admit a patient to hospital is secondary to treatability: there is little point in admission if the patient, however suicidal, is unlikely to improve; better to reserve your place in the coroner's court and concentrate on more treatable patients.
The categories of depression in elderly people that respond well to treatment are
Depression lasting more …
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