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Erschienen in: Der Nervenarzt 11/2012

01.11.2012 | Leitthema

Depression im Alter

Herausforderung für eine Gesellschaft der Langlebigen

verfasst von: Prof. Dr. S.G. Riedel-Heller, MPH, S. Weyerer, H.-H. König, M. Luppa

Erschienen in: Der Nervenarzt | Ausgabe 11/2012

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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.
Literatur
1.
Zurück zum Zitat Baron S, Heider D, Gensichen J et al (2011) Cost structure of a telephone-based case management in primary care depression therapy. Psychiatr Prax 38:342–344PubMedCrossRef Baron S, Heider D, Gensichen J et al (2011) Cost structure of a telephone-based case management in primary care depression therapy. Psychiatr Prax 38:342–344PubMedCrossRef
2.
Zurück zum Zitat 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 27:1397–1409PubMedCrossRef 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 27:1397–1409PubMedCrossRef
3.
Zurück zum Zitat 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 23:873–887CrossRef 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 23:873–887CrossRef
4.
Zurück zum Zitat Blazer DG (2003) Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci 58:249–265PubMedCrossRef Blazer DG (2003) Depression in late life: review and commentary. J Gerontol A Biol Sci Med Sci 58:249–265PubMedCrossRef
5.
Zurück zum Zitat Fiske A, Wetherell JL, Gatz M (2009) Depression in older adults. Annu Rev Clin Psychol 5:363–389PubMedCrossRef Fiske A, Wetherell JL, Gatz M (2009) Depression in older adults. Annu Rev Clin Psychol 5:363–389PubMedCrossRef
6.
Zurück zum Zitat 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 151:369–378PubMed 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 151:369–378PubMed
7.
Zurück zum Zitat Gill D, Hatcher S (2000) Antidepressants for depression in medical illness. Cochrane Database Syst Rev 4:CD001312PubMed Gill D, Hatcher S (2000) Antidepressants for depression in medical illness. Cochrane Database Syst Rev 4:CD001312PubMed
8.
Zurück zum Zitat 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 37:71–77PubMedCrossRef 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 37:71–77PubMedCrossRef
9.
Zurück zum Zitat Gum AM, Arean PA, Hunkeler E et al (2006) Depression treatment preferences in older primary care patients. Gerontologist 46:14–22PubMedCrossRef Gum AM, Arean PA, Hunkeler E et al (2006) Depression treatment preferences in older primary care patients. Gerontologist 46:14–22PubMedCrossRef
10.
Zurück zum Zitat Hautzinger M, Bailer M, Hofmeister D, Keller F (2012) Allgemeine Depressions Skala: Manual. Hogrefe, Göttingen Hautzinger M, Bailer M, Hofmeister D, Keller F (2012) Allgemeine Depressions Skala: Manual. Hogrefe, Göttingen
11.
Zurück zum Zitat Jacobi F, Hofler M, Meister W, Wittchen HU (2002) Prevalence, recognition, and prescription behaviour in depressive syndromes. A German study. Nervenarzt 73:651–658PubMedCrossRef Jacobi F, Hofler M, Meister W, Wittchen HU (2002) Prevalence, recognition, and prescription behaviour in depressive syndromes. A German study. Nervenarzt 73:651–658PubMedCrossRef
12.
Zurück zum Zitat 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–S15PubMedCrossRef 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–S15PubMedCrossRef
13.
Zurück zum Zitat Katon WJ, Lin E, Russo J, Unützer J (2003) Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry 60:897–903PubMedCrossRef Katon WJ, Lin E, Russo J, Unützer J (2003) Increased medical costs of a population-based sample of depressed elderly patients. Arch Gen Psychiatry 60:897–903PubMedCrossRef
14.
Zurück zum Zitat König HH, Luppa M, Riedel-Heller S (2010) Die Kosten der Depression und die Wirtschaftlichkeit ihrer Behandlung. Psychiatr Prax 37:213–215PubMedCrossRef König HH, Luppa M, Riedel-Heller S (2010) Die Kosten der Depression und die Wirtschaftlichkeit ihrer Behandlung. Psychiatr Prax 37:213–215PubMedCrossRef
15.
Zurück zum Zitat Lehnert T, Konnopka A, Riedel-Heller S, König HH (2011) Diabetes mellitus and comorbid depression: economic findings from a systematic literature review. Psychiatr Prax 38:369–375PubMedCrossRef Lehnert T, Konnopka A, Riedel-Heller S, König HH (2011) Diabetes mellitus and comorbid depression: economic findings from a systematic literature review. Psychiatr Prax 38:369–375PubMedCrossRef
16.
Zurück zum Zitat 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 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.
Zurück zum Zitat Luber MP, Meyers BS, Williams-Russo PG et al (2001) Depression and service utilization in elderly primary care patients. Am J Geriatr Psychiatry 9:169–176PubMed Luber MP, Meyers BS, Williams-Russo PG et al (2001) Depression and service utilization in elderly primary care patients. Am J Geriatr Psychiatry 9:169–176PubMed
18.
Zurück zum Zitat Luppa M, Heinrich S, Angermeyer MC et al (2007) Cost-of-illness studies of depression: a systematic review. J Affect Disord 98:29–43PubMedCrossRef Luppa M, Heinrich S, Angermeyer MC et al (2007) Cost-of-illness studies of depression: a systematic review. J Affect Disord 98:29–43PubMedCrossRef
19.
Zurück zum Zitat Luppa M, Heinrich S, Angermeyer MC et al (2008) Healthcare costs associated with recognized and unrecognized depression in old age. Int Psychogeriatr 20:1219–1229PubMedCrossRef Luppa M, Heinrich S, Angermeyer MC et al (2008) Healthcare costs associated with recognized and unrecognized depression in old age. Int Psychogeriatr 20:1219–1229PubMedCrossRef
20.
Zurück zum Zitat Luppa M, Heinrich S, Matschinger H et al (2008) Direct costs associated with depression in old age in Germany. J Affect Disord 105:195–204PubMedCrossRef Luppa M, Heinrich S, Matschinger H et al (2008) Direct costs associated with depression in old age in Germany. J Affect Disord 105:195–204PubMedCrossRef
21.
Zurück zum Zitat 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) 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.
Zurück zum Zitat 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 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.
Zurück zum Zitat 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 136:212–221PubMedCrossRef 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 136:212–221PubMedCrossRef
24.
Zurück zum Zitat 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) 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.
Zurück zum Zitat 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 129:126–142PubMedCrossRef 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 129:126–142PubMedCrossRef
26.
Zurück zum Zitat 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 79:285–294PubMedCrossRef 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 79:285–294PubMedCrossRef
27.
Zurück zum Zitat Murray J, Banerjee S, Byng R et al (2006) Primary care professionals‘ perceptions of depression in older people: a qualitative study. Soc Sci Med 63:1363–1373PubMedCrossRef Murray J, Banerjee S, Byng R et al (2006) Primary care professionals‘ perceptions of depression in older people: a qualitative study. Soc Sci Med 63:1363–1373PubMedCrossRef
28.
Zurück zum Zitat Nelson T, Livingston G, Knapp M et al (2002) Slicing the health service cake: the Islington study. Age Ageing 31:445–450PubMedCrossRef Nelson T, Livingston G, Knapp M et al (2002) Slicing the health service cake: the Islington study. Age Ageing 31:445–450PubMedCrossRef
29.
Zurück zum Zitat Riedel-Heller SG, König HH (2011) Occurence and costs of cognitive disorders in Germany. Psychiatr Prax 38:317–319PubMedCrossRef Riedel-Heller SG, König HH (2011) Occurence and costs of cognitive disorders in Germany. Psychiatr Prax 38:317–319PubMedCrossRef
30.
Zurück zum Zitat 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 11:1–9PubMedCrossRef 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 11:1–9PubMedCrossRef
31.
Zurück zum Zitat Schulz R, Drayer RA, Rollman BL (2002) Depression as a risk factor for non-suicide mortality in the elderly. Biol Psychiatry 52:205–225PubMedCrossRef Schulz R, Drayer RA, Rollman BL (2002) Depression as a risk factor for non-suicide mortality in the elderly. Biol Psychiatry 52:205–225PubMedCrossRef
32.
Zurück zum Zitat 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) 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.
Zurück zum Zitat 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 36:169–174PubMedCrossRef 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 36:169–174PubMedCrossRef
34.
Zurück zum Zitat 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 12:10PubMedCrossRef 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 12:10PubMedCrossRef
35.
Zurück zum Zitat Skultety KM, Rodriguez RL (2008) Treating geriatric depression in primary care. Curr Psychiatry Rep 10:44–50PubMedCrossRef Skultety KM, Rodriguez RL (2008) Treating geriatric depression in primary care. Curr Psychiatry Rep 10:44–50PubMedCrossRef
36.
Zurück zum Zitat Skultety KM, Zeiss A (2006) The treatment of depression in older adults in the primary care setting: an evidence-based review. Health Psychol 25:665–674PubMedCrossRef Skultety KM, Zeiss A (2006) The treatment of depression in older adults in the primary care setting: an evidence-based review. Health Psychol 25:665–674PubMedCrossRef
37.
Zurück zum Zitat Statistisches Bundesamt (2006) Koordinierte Bevölkerungsvorausberechnung – Annahmen und Ergebnisse. Entwicklung der Bevölkerung Deutschlands bis 2050. Statistisches Bundesamt, Wiesbaden Statistisches Bundesamt (2006) Koordinierte Bevölkerungsvorausberechnung – Annahmen und Ergebnisse. Entwicklung der Bevölkerung Deutschlands bis 2050. Statistisches Bundesamt, Wiesbaden
38.
Zurück zum Zitat 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 12:15–33PubMedCrossRef 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 12:15–33PubMedCrossRef
39.
Zurück zum Zitat 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 277:1618–1623PubMedCrossRef 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 277:1618–1623PubMedCrossRef
40.
Zurück zum Zitat 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 26:184–189PubMedCrossRef 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 26:184–189PubMedCrossRef
41.
Zurück zum Zitat Waern M, Runeson BS, Allebeck P et al (2002) Mental disorder in elderly suicides: a case-control study. Am J Psychiatry 159:450–455PubMedCrossRef Waern M, Runeson BS, Allebeck P et al (2002) Mental disorder in elderly suicides: a case-control study. Am J Psychiatry 159:450–455PubMedCrossRef
42.
Zurück zum Zitat 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 111:153–163PubMedCrossRef 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 111:153–163PubMedCrossRef
43.
Zurück zum Zitat 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) 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.
Zurück zum Zitat Wilson K, Mottram P, Sivanranthan A, Nightingale A (2001) Antidepressant versus placebo for depressed elderly. Cochrane Database Syst Rev 2:CD000561PubMed Wilson K, Mottram P, Sivanranthan A, Nightingale A (2001) Antidepressant versus placebo for depressed elderly. Cochrane Database Syst Rev 2:CD000561PubMed
45.
Zurück zum Zitat Wolf NJ, Hopko DR (2008) Psychosocial and pharmacological interventions for depressed adults in primary care: a critical review. Clin Psychol Rev 28:131–161PubMedCrossRef Wolf NJ, Hopko DR (2008) Psychosocial and pharmacological interventions for depressed adults in primary care: a critical review. Clin Psychol Rev 28:131–161PubMedCrossRef
Metadaten
Titel
Depression im Alter
Herausforderung für eine Gesellschaft der Langlebigen
verfasst von
Prof. Dr. S.G. Riedel-Heller, MPH
S. Weyerer
H.-H. König
M. Luppa
Publikationsdatum
01.11.2012
Verlag
Springer-Verlag
Erschienen in
Der Nervenarzt / Ausgabe 11/2012
Print ISSN: 0028-2804
Elektronische ISSN: 1433-0407
DOI
https://doi.org/10.1007/s00115-012-3586-6

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