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

January 09, 2006

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.

Research Australia