Dr Briony Dow
Ms Betty Haralambous
Ms Xiaoling Lin, Ms Carolyne Jones
Dr Jean Tinney
Dr Christina Bryant
National Ageing Research Institute (NARI)
Beyond Blue Grant
Project completion year
For older people, depression is often associated with conditions such as physical disability and anxiety, that exacerbate the distress they and their carers experience. While recognition of depression in older people has improved in recent years, there are still gaps in knowledge about assessment and diagnosis for particular population groups. There is also insufficient knowledge about effective treatments for depression in older people.
This study aimed to identify the gaps in current knowledge about diagnosis and treatment of depression and anxiety among older adults (over 65 years of age) in Australia, in order to identify priority areas for research in this area.
The methods used were: a literature review; a survey of researchers; advisory group consultations; analysis of findings of a Beyond Blue consumer survey; and a review of Beyond Blue’s depression monitor.
The literature review identified groups of older people most at risk of depression and anxiety, including older people:
- in residential aged care
- with multiple physical conditions
- with dementia
- who are carers
- in hospital
- who are women
- who are Indigenous
- who come from culturally and linguistically diverse (CALD) backgrounds.
The review summarised common screening tools and treatment approaches in late-life depression and anxiety. It also identified barriers to treatment and management of late-life depression. The review found that older people with depression and anxiety have a much higher risk of suicide than the general population.
The review identified some gaps in research into late-life depression and anxiety. First, there is limited research into late-life anxiety compared to depression (although further research is required in both areas). Second, regarding diagnosis and screening tools, there are limited studies on:
- validation of common screening tools in specific population groups
- prevalence of depression and anxiety in older people from CALD backgrounds and older Aboriginal and Torres Strait Islander people
- diagnosis of depression and anxiety among people with dementia
- training and support of early identification of depressive and anxiety disorders for
- primary care.
- Finally, research in relation to treatment and management is limited regarding:
- the efficacy of psychological interventions in depression in later life
- multi-factorial intervention approaches in depression in later life
- the efficacy of other approaches in treatment of late-life depression
- cultural factors which can influence the coping strategies older people use and their
- willingness to seek help
- lack of access to specialist services, particularly in rural and remote communities.
The researcher survey, review of websites and advisory group consultations revealed some common areas of research in this field, including:
- risk factors and prevalence of late-life depression and anxiety
- efficacy of antidepressants in treatment of late-life depression
- depression and anxiety among particular subgroups of older people.
The consumer surveys revealed that general practitioners are generally seen as helpful and are an important avenue for diagnosis, advice, treatment and referrals. Counselling was always seen as helpful.
Themes emerging from the depression monitor indicate that there is a stigma surrounding depression among older people, and mental health literacy seems to be poor in this group.
GPs are often the first point of contact for older people seeking diagnosis, advice, and treatment on depression. Counselling was not regarded as helpful; neither were other treatment options, such as medication, psychotherapy and exercise.
Implications for policy, practice and further research
A recommendation of this project is that older age depression and anxiety should become a priority for funding. Groups who are most at risk include: older people from CALD backgrounds; older people living in residential aged care; socially isolated older people in the community; older Indigenous Australians; and older women.
Some of the issues the research should focus on are: validity and reliability of existing diagnostic criteria for depression and anxiety in older people; suitability and effectiveness of existing screening and assessment tools for older people from CALD and Indigenous backgrounds; and exploration of the potential application of e-mental health technologies, particularly in rural and remote areas.