Primary Care Doctors Overlook Mental Health in Older Adults

Even symptoms of severe depression have been ignored

Doctors spend little time discussing mental health issues with their older patients and rarely refer them to a mental health specialist even if they show symptoms of severe depression, according to a study funded by the National Institute of Mental Health and published December 2007 in the Journal of the American Geriatrics Society.

Suicide Rate Higher in People age 65 and Older While people age 65-plus represent 12 percent of the U.S. population, they accounted for a disproportionate 16 percent of suicide deaths in 2004. The study suggests that improved mental health screening in primary care may improve detection and treatment of mental disorders before drastic consequences, such as suicide, can occur.

How the Eldercare Mental Health Study Was Done
To determine how doctors deliver mental health care to older adults, researchers analyzed 385 videotaped visits of 35 doctors with 366 of their senior patients, identifying topics discussed and how much time was devoted to each topic.

Here's what the researchers found:

• Mental health-related topics occurred in 22 percent of visits, typically lasting about two minutes
• An average visit lasted about 16 minutes overall, and the majority of that time was spent discussing biomedical and other topics.
• Among doctors who address mental health issues during patient visits, their efforts to treat or provide care for a mental health issue varied widely. Most doctors fell into one of these three patterns of care:
  1. listening to the patient for an extended period of time and referring him or her to a mental health care specialist;
  2. gathering information but providing inadequate treatment; or
  3. being dismissive toward the patient and his or her emotional distress, and failing to follow up.

• More female patients (27 percent) discussed a mental health topic during a typical visit than male patients (12 percent).

In addition, researchers discovered that the gender pairing of doctor and patient affected the likelihood of discussing mental health issues. Women patients talking to female doctors were most likely to discuss mental health, while male patients with male doctors were least likely.

Primary Care Doctors Need Support to Increase Focus on Mental Health
The study researchers concluded that primary care doctors need more support in how to identify, treat and refer patients to mental health specialists. This can be especially important when treating older adults, who may be more isolated from family and friends who would notice behavior and mood changes.