Depression, Alcohol Abuse in Elderly
UCSF is enrolling patients in a large,
multi-centered clinical trial that will study methods of treating the common but often
under-diagnosed problems of depression, anxiety and alcohol abuse among the elderly.
Generally, older Americans are treated for mental disorders in the primary care
setting, where a physician treats the problem by prescribing an antidepressant, says
Patricia Arean, PhD, UCSF assistant professor of psychiatry and study co-principal
investigator. Health care providers treat such problems in the primary care setting
because they believe it's hard to encourage older people to accept a referral to go
somewhere else for mental health care services, she adds. Even if the patients agree to
talk to someone outside the primary care setting, they often have to endure long waiting
lists that make getting an appointment difficult. As a result, they may give up, Arean
"You can't just give someone a prescription. They need to be followed for a period
of time, educated about their disorder and on how to manage it," she says.
"Providers don't have the time to do that. So the question is 'do we make mental
health services in primary care better or do a better job getting older people into
Carroll Estes, PhD, UCSF professor in the Institute for Health & Aging, is the
principal investigator of the five -year study that will examine two models of service
delivery for older patients. The first will integrate mental health services into the
medical practice, having a social worker and psychiatrist present in the clinic working
side by side with the primary care physician. If a physician recognizes signs of
depression in a patient, he or she would probably prescribe antidepressants and then have
the patient see the in-house psychiatrist, who would manage mental health services for
The second model will have a social worker present in the primary care practice to help
the patient find outside mental health services. "So rather than saying here is list
of names of people, the social worker would ask them what services they need and help them
find the services," Arean says.
The patients will be followed for a year, randomized to either arm. Outcomes
investigators will look at whether the patients receive the mental health services they
need and whether they improve.
"In terms of getting better, we will look at whether their mental illness goes
away, does the quality of their life improve, do they feel like their health has improved
and are they satisfied with the services," Arean says.
About 15 percent of elderly people experience depression at some point and the
condition is more chronic in the elderly than in younger people, according to the National
Institute of Mental Health. Abuse of alcohol and legal drugs - both prescribed and over
the counter -- affects up to 17 percent of adults over 60 years old in the United States,
according to the Center for Substance Abuse Treatment.
The American Medical Association called elderly alcoholics a "hidden group"
and the National Institute of Mental Health called depression in the elderly widespread
and a serious public health concern in recent reports. "Clinical depression is very
disabling to older people and suicide rates are higher for older men than in any other age
group," Arean says.
Older people who abuse alcohol often use it to cope with mental problems.
"There tends to be a downplaying of how much people drink, but we suspect rates of
heavy drinking to be fairly high in older patients who use alcohol as a means to cope with
depression and anxiety," Arean says. "When you drink to steady your nerves and
you do it consistently, you create another problem."
UCSF is one of 12 centers participating in the study and will enroll 300 patients. The
emphasis will be on elderly African-Americans, who may suffer from some of these disorders
even more so than other groups, according to Arean. "If you look at recent data on
younger people, it shows that rates of alcohol abuse and depression tend to be higher for
African-Americans," she said. "The same may hold true for older
Patients enrolled in the study will be seen at the Over 60 Health Center in Berkeley, a
public health medical clinic geared toward older people. Participants must be at least 65
For more information, call study coordinator Rowena Nery, MA, UCSF research associate
in the department of psychiatry at 415/476-7439.