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Effective Health Care Approaches in Elderly Patients



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Am Fam Physician. 2000 Feb 15;61(4):1161-1162.

Two recent Australian studies document the effectiveness of interventions by family physicians and community-based health professionals on aspects of health in elderly patients. Llewellyn-Jones and colleagues used a multifaceted, population-based intervention to detect and manage depression in elderly patients. They screened 1,466 elderly residents living in a large Australian residential facility (self-care units and hostels) using a standardized rating scale for depression in geriatric patients.

The 220 residents aged 65 years and older who scored above threshold levels on a geriatric depression scale and who had no other serious medical or psychologic condition that met exclusion criteria were randomly assigned to receive routine care (in the control group) or multidisciplinary care (in the intervention group). The intervention techniques included activities for patients and health professionals. Educational and supportive services for patients stressed positive attitudes and promoted the belief that depression could be overcome. Other patient services included emotional support, exercise classes, activities and educational sessions on the management and prevention of common health problems. The physicians and staff who cared for patients in the intervention group also received education and advisory services on the management of depression in elderly patients.

After a mean follow-up period of 9.5 months, scores on the depression scale improved in both groups but were significantly greater in the intervention group. The intervention group also showed significant gains in social support compared with the routine-care group. The authors conclude that depression in elderly persons who reside in residential facilities can be improved by simple multidisciplinary approaches that are directed at improving the skills of caretakers, professional staff and the patients themselves.

In a second study, Kerse and colleagues studied the effect of an educational program for general physicians on the health outcomes of their elderly patients (65 years of age and older). The 42 participating physicians were randomly assigned to an intervention or a control group. Ten elderly patients were selected from the practice of each participating physician. Before intervention took place, interviewers assessed patient outcomes that included self-assessment of health, level of activities (especially walking), frequency of social contacts, use of medications and use of influenza immunization.

During a two- to three-month period, the physicians in the intervention group undertook a five-part educational program incorporating health promotion for the elderly into their practice. The patients were reassessed one year after the intervention by interview and review of medical records. Although the physicians and patients in the intervention and control groups were similar, patients in the intervention group reported higher health status, greater frequency of pleasurable activities and more walking than the control group one year after intervention. No significant differences were found in other measures, including functional status, psychological well-being or overall use of medication.

The authors calculate that a 22 percent net reduction in mortality could be achieved over a five-year period if these results are generalizable to the population.

Llewellyn-Jones RH, et al. Multifaceted shared care intervention for late life depression in residential care: randomised controlled trial. BMJ. September 11, 1999;319: 676–82, and Kerse NM, et al. Improving the health behaviours of elderly people: randomised controlled trial of a general practice education programme. BMJ. September 11, 1999;319:683–7.

editor's note: Both of these studies have been criticized for methodologic weaknesses, yet they provide encouragement for those of us caring for elderly patients. Until recently, we have had little evidence of the effectiveness of health promotion or screening and treating depression in the elderly. It is particularly interesting that, although both studies showed only modest gains in traditional “hard” measures of health, patients in each study reported significant increases in self-perceived health and participation in social activities. A recent British study reported that social and day-to-day activities (such as gardening, shopping and housework) could be just as powerful in promoting health as formal exercise. These reports validate the health-promoting power of encouragement and support that has always been part of good family practice.—a.d.w.

 

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