Older people in the US receive most of their health care from primary care providers (internists, family or general practitioners). Consequently it is incumbent on them to differentially diagnose physical vs. emotional health problems. Depression in older persons presents particular challenges in this regard. Depression in the elderly is frequently masked as a somatic episode and much of it appears as comorbidity. While depression among elders is known to be prevalent, there are estimates that up to 90 per cent of it is """"""""missed"""""""" during everyday clinical encounters. Physicians are often not well trained to recognize elder depression. Their practice settings may discourage its detection because it is time consuming and under-reimbursed. The overall goal of this SBIR is to develop an instructional videotape to sensitize internists, primary care physicians and family practitioners to the presence and subtleties of depression in their elderly patients in order to enhance their diagnostic skills. Tasks during Phase I will include: (a) developing (with a team of practicing psychiatrists and internists) the precise content areas of the video (e.g., somatized depression, comorbid depression, relationship to dementia, SDAT, etc.); (b) producing a script outline under the leadership of Ms. Carol Rainey (an award winning film producer at NERI); (c) review and written criticism of the script by an Advisory Committee; (d) revising the script on the basis of reviewers' recommendations; (e) developing a production schedule for early in Phase II. Phase II will involve the actual production and evaluation of the video in collaboration with the Division of General Internal Medicine, Boston University School of Medicine. The product at the end of Phase II will be an evaluated, state- of-the-science, educational videotape ready for mass production and distribution to internists, primarily providers, geriatricians, gerontologists, nurses and medical social workers during Phase III.
