Depression and Increased Health Services Utilization Among Elderly Primary Care Patients

Introduction The number of Israel's elderly (65 plus) has increased from just 85,200 (4.8% of the population) in 1955 to approximately 670,000 people (about 10%) in 2003 (Brodsky et al., 2005). According to the most conservative of three projections offered by the Israeli Central Bureau of Statistics (CBS), the number of seniors is expected to be approximately 676,500 (9.8% of the population) in 2005, to rise to 722,500 people (10.7% of the population) by 2010 and increase to 1,025,800 (almost 12% of the population) by the year 2020.

The increase in life expectancy in the 20th century has resulted in a major growth in the prevalence of age-related diseases and conditions. Depression has been found to be the most prevalent among various mental disorders in later life and is the third most common reason for consultation in primary care (Shah, 1992). Research shows that 10-15% of the persons over 65 years of age suffer from various levels of depressive symptoms (Jacob& Palmer, 1998).

Sadock & Sadock (2003) state that depression among elderly may reach up to 15 percent and among these suffering from dementia from 25- 50 percent. Israeli studies show similar rates of depressive symptomatology as performed in other Western countries. A prevalence of 21.5 percent of depressive symptomatology was found among a random sample of 937 Israeli adults. (Iancu et al., 2003).

Depression represents a heterogeneous set of disorders, usually characterized by sad mood and inability to experience pleasure. Among the elderly it often may present itself atypically, with somatic symptoms dominating the clinical picture (Jacob & Palmer, 1998). Common physical complaints, start with the most common features as loss of energy or fatigue, unexplained pain, gastrointestinal symptoms, headache, dizziness, palpitations, heartburn, numbness, loss of appetite, insomnia specifically early morning awakening. In general, the more unexplained somatic complaints and physical symptoms a patient have, the higher the likelihood of depression (Glass 2003). Elderly depression impairs significantly the quality of life by leading to disability, cognitive impairments, intensified symptoms from medical conditions and increases utilization of health care services and the direct and indirect medical costs (Luber et al., 2001).

Herrman et al.,( 2002) argue that health care utilization among depressed patients is higher then among those without depression. Elderly with depressive symptoms found to be at least as twice as likely to use emergency department and medical inpatient hospital services compared to patients without depressive symptomatology ( Himelhoch et al., 2002). Simon & Ormel(1995) as well as Katon et al. (2003) stated that patients with depressive symptoms account for 43-52% higher health care costs than patients without depressive symptoms.