Late-life depression is highly prevalent worldwide. In addition to being a adebilitating illness, it is a risk factor excess morbidity and mortality. Older adults with late-life depression often have significant medical comorbidity and , poor treatment adherence . Furthermore , psychosocial considerations such as gender , ethnicity , stigma and bereavement are necessary to understand the full context of late-life depression.
The face that most older adults seek treatment for depression in primary care settings led to the development of collaborative care interventions for depression. These interventions have consistently demonstrated clinically meaningful effectiveness in the treatment of life-life depression. We describe three pivotal studies detailing the management of depression in primary care settings in both high and iow-income countries , Beyond effectively treating depression , collaborative care models address addi-tional challenges associated with late-life depression . Although depression treatment interventions are effective compared to usual care , they exhibit relatively low remission rates and small to medium effect sizes.
Several studies have demonstrated that depression prevention is possible and most effective in at-risk older adults. Given the relatively modest effects of treatment in averting years lived with disability, preventing late-life depression at the primary care level should be highly prioritized as a matter of health policy.
1.Clinical presentation and challenges in the primary care setting: introduction
Depression is among the leading causes of illness-related dis-ability and is projected to be the greatest contributor to disease burden in 2030 in high-income countries {1}.Estimated depression prevalence I ates among aging populations range between 1 and 3 % in the community and 6 and 9% in primary care (PC) setting {2}.Given the prevalence of late-life depression (LLD), and the pref-erence of older adults to seek out treatment in PC settings {3}, it is important to tecognize the challenges surrounding the diagno-sis and treatment of LLD faced by primary care physicians (PCP’s), Additionally, one should understand the evidence-based strategies designed to mitigate these challenges.
This review aims to : (1) characterize the clinical presentation of LLD and the challenges often encountered by the primary care physician (PCP) : (2) provide the rationale for the development of collaborative care models and present three pivotal studies high-lighting their effectiveness in treating depression : and (3) describe relevant literature in LLD prevention.