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Primary Care Physicians’ Detection of Psychological Distress Among Elderly Patients

Received June 8, 2004; revised September 8, October 17, 2004; accepted October 18, 2004. From Bar Ilan University (JR, DS, TH) and the Commission of Equal Rights for People with Disabilities (DF). Send correspondence and reprint requests to Jonathan Rabinowitz, Ph.D., Bar Ilan University, Ramat Gan, Israel. e-mail: jrabin{at}netvision.net.il
© American Association for Geriatric Psychiatry

Objectives: Elderly persons suffer from high rates of psychological distress that are sometimes unrecognized by healthcare providers. Authors compared rates of psychological distress and physician detection among elderly and non-elderly primary-care patients and examined, among elderly patients, variables associated with distress and physician detection. Methods: This was a national survey of a sample of 2,325 Israeli primary healthcare recipients and 67 physicians. Patients completed the General Health Questionnaire (GHQ) and background questionnaires. Physicians completed forms indicating their diagnosis and treatment and their attitudes toward elderly patients. Results: Of those age 60 and over, 58.7% had a GHQ score reflecting distress, as did 49% of those age 40–59 and 30.4% of those age 18–39. There was no age-group difference in physician concordance on GHQ. In elderly patients, variables associated with GHQ psychological distress were being female, having more self-reported chronic diseases, poorer self-reported health, and more frequent primary-care clinic visits. Physician agreement with GHQ distress for elderly patients was best for female patients and patients who visited a physician more often. Physicians treated 71% of the instances of distress they noted in older patients and 42% of the GHQ-detected cases. Conclusions: Physicians appear to detect distress no less accurately among older than younger patients. A majority of elderly primary-care patients are distressed, and many of them are neither diagnosed nor treated for distress. Increased attention by primary-care physicians to possible psychological distress among elderly patients who perceive their health status as poor and those patients who visit more frequently could improve detection of distress among these elderly patients.

Key Words: Depression • Medical Comorbidity • Primary Care • Anxiety

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