Review highlights need for improved treatment of depression in elderly stroke patients

A review of the management of post-stroke depression in the elderly conducted by The George Institute for International Health calls for significant improvements to be made in the organisation of stroke services to address a major unmet need.

Depression is an often neglected area of recovery from stroke as most healthcare professionals and researchers focus on the more obvious, physical outcomes of stroke, while individuals have difficulty expressing or seeking help for depression. Healthcare systems have not been properly configured to deal with this common consequence of stroke.

The review, by The George Institute's Senior Research Fellow Maree Hackett and Professor Craig Anderson, focused on the frequency, consequences and management of depression following stroke, specifically in older people.

Research is drawing attention to depression as an important complication of stroke, affecting around one in three stroke survivors. However, as most strokes occur in people over the age of 65 years and diagnosis of depression is currently missed in approximately half of all older people with such a mood disorder, this is a major concern as Australia's population continues to age. The frequency of stroke also remains high at around 50,000 people affected annually.

Ms Hackett said that "We found that there is currently a very limited use of interventions for depression. It appears that many stroke patients do not receive treatment for depression, particularly older patients."

"Most health professionals would not have a problem diagnosing young, otherwise healthy people with a depressive disorder. However, in stroke patients the confounding influence of cognitive, sensory and language impairment add to complexities of assessing a patient following a stroke. In addition, other factors such as existing illnesses make treatment far more difficult in the elderly. However depression should not be considered a natural consequence of aging." She added.

Currently there is little agreement among clinicians and researchers regarding the best way to diagnose depression in older stroke victims. Researchers believe that current tools such as psychiatric interview and questionnaires limit any advances in the better identification of depression. Other studies have shown that antidepressants along with psychotherapy are beneficial treatment to depression, yet it is uncertain how effective these strategies are at improving outcomes among elderly patients.

Professor Anderson, who co-authored the paper, noted that elderly stroke patients require special attention to overcome the main barriers to obtaining and adhering to treatment for depression. "All treatments should be tailored to individual needs, taking in to consideration the severity and duration of the disorder, along with patient preferences such as cost, accessibility and availability," Prof Anderson said.

Prof. Anderson added that by simply providing support and information for stroke patients is not good enough. Comprehensive programs that offer education, training and goal setting for patients and caregivers are more appropriate, but the challenge now lies in how to provide such service models in a cost-effective manner to the broader stroke population.

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The George Institute for International Health is currently planning a detailed research program to further investigate effective management strategies for patients with stroke, and to encourage the further education about depression in the context of physical illness.

To obtain a copy of the study papers, or arrange interviews, contact:
Emma Eyles, Public Affairs Officer,
The George Institute for International Health
p) 61-29-993-4592, mobile: 41-041-1983,
email: eeyles@thegeorgeinstitute.org or visit www.thegeorgeinstitute.org

Notes for Editors:
Professor Craig Anderson is Director of the Neurological and Mental Health Division at The George Institute. He is also Professor of Stroke Medicine and Clinical Neuroscience in the Faculty of Medicine at the University of Sydney and the Institute of Neurosciences of Royal Prince Alfred Hospital. He is currently President of the Stroke Society of Australasia and a member of several specialist societies, is an Editor for the Cochrane Stroke Group, and. Professor Anderson has published widely on the clinical and epidemiological aspects of stroke, cardiovascular disease and aged care, and is on the Steering Committee for several large-scale research projects. Maree Hackett is a Senior Research Fellow in the Neurological and Mental Health Division at The George Institute. Maree holds a Master of Arts with Honours (Psychology) degree from the University of Auckland and has recently submitted her thesis for examination for the degree of Doctor of Philosophy in Medicine.

Maree has previously worked as a Research Coordinator at the Department of Gastroenterology and Hepatology at Auckland Healthcare from 1995 to 1999, and as a Research Fellow at the Clinical Trials Research Unit of The University of Auckland's Faculty of Medical and Health Sciences from 1999 to 2005.

Maree's interests are in health outcomes research, particularly psychological problems associated with physical illness and she has been awarded an NHMRC Public Health (Australia) Fellowship to develop research in this area. She has publications in, and conducts reviews for, several key medical journals, is a reviewer for the National Health and Medical Research Council of Australia, the Health Research Council of New Zealand, and the Canadian Institutes of Health Research, is a member of the Stroke Society of Australasia and the Australasian Epidemiological Society, and is on the editorial board of Stroke.

The George Institute for International Health seeks to gather evidence to address the growing problems of heart and vascular disease, injury, mental illness and neurological diseases through high-quality research, evidence-based policy development and a range of capacity development programs. Recognising the significant health burdens associated with the ever increasing numbers of older people around the world, The George Institute established the Neurological and Mental Health Division with the aims of developing new strategies for the prevention, treatment and rehabilitation of neurological diseases and related disorders that predominantly affect older people, namely stroke, dementia, depression and frailty. In addition to complimentary activities with the other Divisions of The George Institute, the Neurological and Mental Health Division is collaborating with neuroscience and health research institutes in Australia and oversea


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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