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. 1999 May;45:1219–1224.

Do family physicians treat older patients with mental disorders differently from younger patients?

C S Mackenzie 1, W L Gekoski 1, V J Knox 1
PMCID: PMC2328562  PMID: 10349066

Abstract

OBJECTIVE: To determine whether there are differences between family physicians' beliefs and treatment intentions regarding older patients with mental disorders and younger patients with similar disorders. Such differences might contribute to older adults' lower rates of mental health service use. DESIGN: Mailed survey. SETTING: Primary care practices in and around Kingston, Ont. PARTICIPANTS: Questionnaires were mailed to 294 general practitioners listed in the 42nd Annual Canadian Medical Directory. Of the 285 eligible physicians, 115 (40%) completed and returned questionnaires. MAIN OUTCOME MEASURES: Physicians' ratings of preparedness to identify and treat, likelihood of treating, likelihood of using each of five different treatment methods, likelihood of referral, preferences for six referral options, and treatment effectiveness with respect to hypothetical older and younger patients with panic disorder or dysthymia. RESULTS: Physicians reported being less prepared to identify and treat older patients than younger patients. In addition, physicians reported being significantly less likely to treat and to refer older patients than younger patients. Finally, physicians reported that both psychotherapy alone, and in combination with pharmacotherapy, were less effective for older patients than for younger patients. CONCLUSIONS: In addition to other possible reasons for older adults' low rates of mental health service use, this study suggests that family physicians' beliefs and treatment intentions could be contributing factors. Changes in medical education aimed at replacing inaccurate beliefs with accurate information regarding older patients might be one way to increase rates of use in this underserved age group, because family physicians play a key role in the mental health care of older adults.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Craven M. A., Cohen M., Campbell D., Williams J., Kates N. Mental health practices of Ontario family physicians: a study using qualitative methodology. Can J Psychiatry. 1997 Nov;42(9):943–949. doi: 10.1177/070674379704200905. [DOI] [PubMed] [Google Scholar]
  2. Flint A. J. Pharmacologic treatment of depression in late life. CMAJ. 1997 Oct 15;157(8):1061–1067. [PMC free article] [PubMed] [Google Scholar]
  3. Ford C. V., Sbordone R. J. Attitudes of psychiatrists toward elderly patients. Am J Psychiatry. 1980 May;137(5):571–575. doi: 10.1176/ajp.137.5.571. [DOI] [PubMed] [Google Scholar]
  4. Gaitz C. M. Barriers to the delivery of psychiatric services to the elderly. Gerontologist. 1974 Jun;14(3):210–214. doi: 10.1093/geront/14.3.210. [DOI] [PubMed] [Google Scholar]
  5. Gatz M., Pearson C. G. Ageism revised and the provision of psychological services. Am Psychol. 1988 Mar;43(3):184–188. doi: 10.1037//0003-066x.43.3.184. [DOI] [PubMed] [Google Scholar]
  6. Gatz M., Smyer M. A. The mental health system and older adults in the 1990s. Am Psychol. 1992 Jun;47(6):741–751. doi: 10.1037//0003-066x.47.6.741. [DOI] [PubMed] [Google Scholar]
  7. Goldstrom I. D., Burns B. J., Kessler L. G., Feuerberg M. A., Larson D. B., Miller N. E., Cromer W. J. Mental health services use by elderly adults in a primary care setting. J Gerontol. 1987 Mar;42(2):147–153. doi: 10.1093/geronj/42.2.147. [DOI] [PubMed] [Google Scholar]
  8. Iliffe S., Haines A., Gallivan S., Booroff A., Goldenberg E., Morgan P. Assessment of elderly people in general practice. 1. Social circumstances and mental state. Br J Gen Pract. 1991 Jan;41(342):9–12. [PMC free article] [PubMed] [Google Scholar]
  9. James J. W., Haley W. E. Age and health bias in practicing clinical psychologists. Psychol Aging. 1995 Dec;10(4):610–616. doi: 10.1037//0882-7974.10.4.610. [DOI] [PubMed] [Google Scholar]
  10. MacDonald A. J. Do general practitioners "miss" depression in elderly patients? Br Med J (Clin Res Ed) 1986 May 24;292(6532):1365–1367. doi: 10.1136/bmj.292.6532.1365. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Norquist G. S., Regier D. A. The epidemiology of psychiatric disorders and the de facto mental health care system. Annu Rev Med. 1996;47:473–479. doi: 10.1146/annurev.med.47.1.473. [DOI] [PubMed] [Google Scholar]
  12. Olfson M., Pincus H. A. Outpatient mental health care in nonhospital settings: distribution of patients across provider groups. Am J Psychiatry. 1996 Oct;153(10):1353–1356. doi: 10.1176/ajp.153.10.1353. [DOI] [PubMed] [Google Scholar]
  13. Parchman M. L. Physicians' recognition of depression. Fam Pract Res J. 1992 Dec;12(4):431–438. [PubMed] [Google Scholar]
  14. Pasnau R. O., Bystritsky A. Importance of treating anxiety in the elderly ill patient. Psychiatr Med. 1990;8(3):163–173. [PubMed] [Google Scholar]
  15. Rapp S. R., Parisi S. A., Walsh D. A., Wallace C. E. Detecting depression in elderly medical inpatients. J Consult Clin Psychol. 1988 Aug;56(4):509–513. doi: 10.1037//0022-006x.56.4.509. [DOI] [PubMed] [Google Scholar]
  16. Ray D. C., McKinney K. A., Ford C. V. Differences in psychologists' ratings of older and younger clients. Gerontologist. 1987 Feb;27(1):82–86. doi: 10.1093/geront/27.1.82. [DOI] [PubMed] [Google Scholar]
  17. Ray D. C., Raciti M. A., Ford C. V. Ageism in psychiatrists: associations with gender, certification, and theoretical orientation. Gerontologist. 1985 Oct;25(5):496–500. doi: 10.1093/geront/25.5.496. [DOI] [PubMed] [Google Scholar]
  18. Rockwell E., Lam R. W., Zisook S. Antidepressant drug studies in the elderly. Psychiatr Clin North Am. 1988 Mar;11(1):215–233. [PubMed] [Google Scholar]
  19. Schwartzberg J. G., Guttman R. Effect of training on physician attitudes and practices in home and community care of the elderly. Arch Fam Med. 1997 Sep-Oct;6(5):439–444. doi: 10.1001/archfami.6.5.439. [DOI] [PubMed] [Google Scholar]
  20. Waxman H. M., Carner E. A., Klein M. Underutilization of mental health professionals by community elderly. Gerontologist. 1984 Feb;24(1):23–30. doi: 10.1093/geront/24.1.23. [DOI] [PubMed] [Google Scholar]
  21. Waxman H. M., Carner E. A. Physicians' recognition, diagnosis, and treatment of mental disorders in elderly medical patients. Gerontologist. 1984 Dec;24(6):593–597. doi: 10.1093/geront/24.6.593. [DOI] [PubMed] [Google Scholar]

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