Skip to main content
SpringerLink
Log in

Depression im Alter

Herausforderung für eine Gesellschaft der Langlebigen

Depression in old age

Challenge for aging societies

  • Leitthema
  • Published:
Der Nervenarzt Aims and scope Submit manuscript

Zusammenfassung

Depressive Störungen im Alter sind häufig und folgenschwer. Der vorliegende Beitrag fasst aktuelle Ergebnisse zur Häufigkeit, zum Verlauf und zu den Risikofaktoren depressiver Störungen im Alter zusammen. Die Folgen depressiver Störungen für den Einzelnen und die Solidargemeinschaft werden aufgezeigt. Depressive alte Menschen gehören zu den Vielnutzern des Gesundheitssystems. Obgleich die allerwenigsten eine depressionsspezifische Behandlung erhalten, liegen die Kosten für depressive Senioren ein Drittel über den entsprechenden Kosten nichtdepressiver alter Menschen. Deutsche Studien zur aktuellen Versorgungssituation sind rar. Es kann von einer Unterversorgung ausgegangen werden. Internationale Erfahrungen zeigen, dass sich einfache Trainingsprogramme oder Wissensvermittlungen für Hausärzte als nicht effektiv erwiesen haben und komplexe Interventionen notwendig sind. Der Beitrag gibt einen Ausblick auf international erfolgreiche Wege zur Optimierung der Behandlung depressiver alter Menschen, deren Prüfung für den deutschen Versorgungskontext noch aussteht. Die demographische Entwicklung wird neue Wege in der Versorgung depressiver alter Menschen und eine intensivierte Versorgungsforschung erzwingen.

Summary

Depression in old age is common and has severe consequences. The paper reviews the most recent results of population-based and primary care-based studies reporting the prevalence, course and risk factors for depression in old age. Consequences of late life depression for the individual and for the society in terms of costs of illness are outlined. Studies of health service utilization and costs showed homogeneously that healthcare costs for depressive elderly individuals are one third higher compared to non-depressive individuals even though most do not receive depression-specific treatment. Late life depression is underrecognized and undertreated and data from Germany are rare. Improvement strategies, such as collaborative care models are discussed; however, adaptation and implementation to the German context are still pending. Future demographic changes will facilitate mental health service research into late life depression.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1

Literatur

  1. Baron S, Heider D, Gensichen J et al (2011) Cost structure of a telephone-based case management in primary care depression therapy. Psychiatr Prax 38:342–344

    Article  PubMed  Google Scholar 

  2. Beekman ATF, Deeg DJH, Braam AW et al (1997) Consequences of major and minor depression in later life: a study of disability, well-being and service utilization. Psychol Med 27:1397–1409

    Article  PubMed  CAS  Google Scholar 

  3. Blake H, Mo P, Malik S, Thomas S (2009) How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review. Clin Rehab 23:873–887

    Article  CAS  Google Scholar 

  4. Blazer DG (2003) Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci 58:249–265

    Article  PubMed  Google Scholar 

  5. Fiske A, Wetherell JL, Gatz M (2009) Depression in older adults. Annu Rev Clin Psychol 5:363–389

    Article  PubMed  Google Scholar 

  6. Gensichen J, Von Korff M, Peitz M et al (2009) Case management for depression by health care assistants in small primary care practices a cluster randomized trial. Ann Intern Med 151:369–378

    PubMed  Google Scholar 

  7. Gill D, Hatcher S (2000) Antidepressants for depression in medical illness. Cochrane Database Syst Rev 4:CD001312

    PubMed  Google Scholar 

  8. Glaesmer H, Kallert TW, Brähler E et al (2010) The prevalence of depressive symptomatology in the German elderly population and the impact of methodical aspects on the identified prevalence. Psychiatr Prax 37:71–77

    Article  PubMed  Google Scholar 

  9. Gum AM, Arean PA, Hunkeler E et al (2006) Depression treatment preferences in older primary care patients. Gerontologist 46:14–22

    Article  PubMed  Google Scholar 

  10. Hautzinger M, Bailer M, Hofmeister D, Keller F (2012) Allgemeine Depressions Skala: Manual. Hogrefe, Göttingen

  11. Jacobi F, Hofler M, Meister W, Wittchen HU (2002) Prevalence, recognition, and prescription behaviour in depressive syndromes. A German study. Nervenarzt 73:651–658

    Article  PubMed  CAS  Google Scholar 

  12. Jordan W, Bleich S, Cohrs S et al (2011) Definition of the core area of medical services in the psychiatric-psychotherapeutic field—the prerequisite for any delegation. Psychiatr Prax 38:S8–S15

    Article  PubMed  Google Scholar 

  13. Katon WJ, Lin E, Russo J, Unützer J (2003) Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry 60:897–903

    Article  PubMed  Google Scholar 

  14. König HH, Luppa M, Riedel-Heller S (2010) Die Kosten der Depression und die Wirtschaftlichkeit ihrer Behandlung. Psychiatr Prax 37:213–215

    Article  PubMed  Google Scholar 

  15. Lehnert T, Konnopka A, Riedel-Heller S, König HH (2011) Diabetes mellitus and comorbid depression: economic findings from a systematic literature review. Psychiatr Prax 38:369–375

    Article  PubMed  Google Scholar 

  16. Linden M, Gilberg R, Horgas AL, Steinhagen-Thiessen E (1996) Die Inanspruchnahme medizinischer und pflegerischer Hilfe im hohen Alter. In: Baltes PB, Mayer KU (Hrsg) Die Berliner Altersstudie. Akademie, Berlin, S 475–495

  17. Luber MP, Meyers BS, Williams-Russo PG et al (2001) Depression and service utilization in elderly primary care patients. Am J Geriatr Psychiatry 9:169–176

    PubMed  CAS  Google Scholar 

  18. Luppa M, Heinrich S, Angermeyer MC et al (2007) Cost-of-illness studies of depression: a systematic review. J Affect Disord 98:29–43

    Article  PubMed  Google Scholar 

  19. Luppa M, Heinrich S, Angermeyer MC et al (2008) Healthcare costs associated with recognized and unrecognized depression in old age. Int Psychogeriatr 20:1219–1229

    Article  PubMed  Google Scholar 

  20. Luppa M, Heinrich S, Matschinger H et al (2008) Direct costs associated with depression in old age in Germany. J Affect Disord 105:195–204

    Article  PubMed  Google Scholar 

  21. Luppa M, König HH, Heider D et al (2012) Direct costs associated with depressive symptoms in late life: a 4.5 year prospective study. Int Psychogeriatr (in press)

  22. Luppa M, Luck T, König HH et al (2011) Natural course of depressive symptoms in late life. An 8-year population-based prospective study. J Affect Disord (E-pub ahead of print). DOI 10.1016/j.jad.2012.05.009

  23. Luppa M, Sikorski C, Luck T et al (2012) Age- and gender-specific prevalence of depression in latest-life: systematic review and meta-analysis. J Affect Disord 136:212–221

    Article  PubMed  CAS  Google Scholar 

  24. Luppa M, Sikorski C, Motzek T et al (2012) Health service utilization and costs of depressive symptoms in late life: a systematic review. Curr Pharm Des (E-pub ahead of print)

  25. Meeks TW, Vahia IV, Lavretsky H et al (2011) A tune in „a minor“ can „b major“: a review of epidemiology, illness course, and public health implications of subthreshold depression in older adults. J Affect Disord 129:126–142

    Article  PubMed  Google Scholar 

  26. Mitchell AJ, Rao S, Vaze A (2010) Do primary care physicians have particular difficulty identifying late-life depression? a meta-analysis stratified by age. Psychother Psychosom 79:285–294

    Article  PubMed  Google Scholar 

  27. Murray J, Banerjee S, Byng R et al (2006) Primary care professionals‘ perceptions of depression in older people: a qualitative study. Soc Sci Med 63:1363–1373

    Article  PubMed  Google Scholar 

  28. Nelson T, Livingston G, Knapp M et al (2002) Slicing the health service cake: the Islington study. Age Ageing 31:445–450

    Article  PubMed  Google Scholar 

  29. Riedel-Heller SG, König HH (2011) Occurence and costs of cognitive disorders in Germany. Psychiatr Prax 38:317–319

    Article  PubMed  Google Scholar 

  30. Roelands M, Van Oyen H, Depoorter A et al (2003) Are cognitive impairment and depressive mood associated with increased service utilisation in community-dwelling elderly people? Health Soc Care Community 11:1–9

    Article  PubMed  Google Scholar 

  31. Schulz R, Drayer RA, Rollman BL (2002) Depression as a risk factor for non-suicide mortality in the elderly. Biol Psychiatry 52:205–225

    Article  PubMed  Google Scholar 

  32. Schwarzbach M, Luppa M, Sikorski C et al (2012) The relationship between social integration and depression in non-demented primary care patients aged 75 years and older. J Affect Disord (E-pub ahead of print)

  33. Sielk M, Altiner A, Janssen B et al (2009) Prevalence and diagnosis of depression in primary care a critical comparison between PHQ-9 and GPs‘ judgement. Psychiatr Prax 36:169–174

    Article  PubMed  Google Scholar 

  34. Sikorski C, Luppa M, König HH et al (2012) Does GP training in depression care affect patient outcome?: a systematic review and meta-analysis. BMC Health Serv Res 12:10

    Article  PubMed  Google Scholar 

  35. Skultety KM, Rodriguez RL (2008) Treating geriatric depression in primary care. Curr Psychiatry Rep 10:44–50

    Article  PubMed  Google Scholar 

  36. Skultety KM, Zeiss A (2006) The treatment of depression in older adults in the primary care setting: an evidence-based review. Health Psychol 25:665–674

    Article  PubMed  Google Scholar 

  37. Statistisches Bundesamt (2006) Koordinierte Bevölkerungsvorausberechnung – Annahmen und Ergebnisse. Entwicklung der Bevölkerung Deutschlands bis 2050. Statistisches Bundesamt, Wiesbaden

  38. Unützer J, Patrick DL, Diehr P et al (2000) Quality adjusted life years in older adults with depressive symptoms and chronic medical disorders. Int Psychogeriatr 12:15–33

    Article  PubMed  Google Scholar 

  39. Unützer J, Patrick DL, Simon G et al (1997) Depressive symptoms and the cost of health services in HMO patients aged 65 years and older: a 4-year prospective study. JAMA 277:1618–1623

    Article  PubMed  Google Scholar 

  40. Schaik DJF van, Klijn AFJ, Hout HPJ van et al (2004) Patients‘ preferences in the treatment of depressive disorder in primary care. Gen Hosp Psychiatry 26:184–189

    Article  PubMed  Google Scholar 

  41. Waern M, Runeson BS, Allebeck P et al (2002) Mental disorder in elderly suicides: a case-control study. Am J Psychiatry 159:450–455

    Article  PubMed  Google Scholar 

  42. Weyerer S, Eifflaender-Gorfer S, Kohler L et al (2008) Prevalence and risk factors for depression in non-demented primary care attenders aged 75 years and older. J Affect Disord 111:153–163

    Article  PubMed  Google Scholar 

  43. Weyerer S, Eifflaender-Gorfer S, Wiese B et al (2012) Incidence and predictors of depression in non-demented primary care attenders aged 75 years and older: results from a 3-year follow-up study. Age Ageing (In press)

  44. Wilson K, Mottram P, Sivanranthan A, Nightingale A (2001) Antidepressant versus placebo for depressed elderly. Cochrane Database Syst Rev 2:CD000561

    PubMed  Google Scholar 

  45. Wolf NJ, Hopko DR (2008) Psychosocial and pharmacological interventions for depressed adults in primary care: a critical review. Clin Psychol Rev 28:131–161

    Article  PubMed  Google Scholar 

Download references

Danksagung

This work is published in affiliation with the Study on Late-Life Depression in Primary Care (AgeMooDe study). The study is funded by the German Federal Ministry of Education and Research (grant: 01GY1155A).

Interessenkonflikt

Keine Angaben

Author information

Authors and Affiliations

  1. Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Medizinische Fakultät, Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland

    S.G. Riedel-Heller MPH & M. Luppa

  2. Arbeitsgruppe Psychiatrische Epidemiologie und Demographischer Wandel, Zentralinstitut für Seelische Gesundheit, Medizinische Fakultät Mannheim/Universität Heidelberg Mannheim, Mannheim, Deutschland

    S. Weyerer

  3. Institut für Medizinische Soziologie, Sozialmedizin und Gesundheitsökonomie (IMSG), Hamburg Center for Health Economics, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    H.-H. König

Authors
  1. S.G. Riedel-Heller MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Weyerer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H.-H. König
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. Luppa
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S.G. Riedel-Heller MPH.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Riedel-Heller, S., Weyerer, S., König, HH. et al. Depression im Alter. Nervenarzt 83, 1373–1378 (2012). https://doi.org/10.1007/s00115-012-3586-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00115-012-3586-6

Schlüsselwörter

Keywords

Search

Navigation