This study takes advantage of the primary care setting to consider whether we can identify presentations of depression in older adults that are characterized more by motivation disturbance (e.g., anhedonia, executive function disturbance and cognitive content related to physical illness (e.g., hopelessness, anxiety) rather than by mood disturbance (e.g. sadness).
The specific aims of this proposal to be carried out in the primary care setting are: o to systematically describe and validate a depressive syndrome, apathetic depression, that does not meet standard criteria for Major Depression in older primary care patients; o to assess how physical illness, cognitive impairment, anxiety, and hopelessness among older primary care patients alters the course of depression and associated functional impairment over time; and, o to evaluate the clinical presentation of depression and associated symptoms in late life in relation to the assessment and treatment decisions of primary care physicians. An age-stratified sample of 3000 adults aged 65 years and older who have visited one of 30 participating primary care physicians will be interviewed with a revised version of the CES-D in the physician's office. Patients above a threshold will be asked to participate in a home assessment and follow-up study. Approximately 300 patients will have significant depressive symptoms and will be asked to participate in a longitudinal, observational study with a 10% random sample of persons without depression. The main study will include a baseline in-home assessment, a 3-monthly telephone follow-up, and a 12-month in-home follow-up evaluation of depression, function, and other factors. Information on assessment and treatment of depression will be obtained from participating physicians. We seek to identify, in primary care, an anhedonic depression syndrome which appears to be associated with physical illness and significant functional limitation and for which misidentification of depression could be avoided if the syndrome were better understood.
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