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GPs should ask elderly 'if they like visits from grandchildren' to spot depression

NHS England has published new guidance to help GPs spot the signs of anxiety and depression in older people, including asking them whether they enjoy visits from their grandchildren.

The new guidance, titled Mental Health in Older People, said that depression is both the most common and the most treatable condition in old age, affecting one in five members of the community, and suggested that electroconvulsive therapy could be used to treat them. 

The guidance was released last month, but NHS England national clinical director for dementia Professor Alistair Burns issued a statement about the guidance today alongside a survey from Age UK that found that more than a third of over 55s said they did not know where to go for help and support.

Professor Burns said that diagnosis of older people had often been hampered by a ’stiff upper lip’ mentality.

The guidance gave examples of a number of indicators GPs could use to determine whether they were suffering from depression and anxiety.

Depression symptoms highlighted to GPs in the guidance include:

  • Reporting physical rather than emotional symptoms (somatisation). Typical symptoms are: faintness or dizziness, pain, weakness all over, heavy limbs, lump in throat, constipation;
  • Health anxieties (hypochondriasis), especially if unusual for the person;
  • Prominent anxiety;
  • Unusual behaviour;
  • Slowing-down of emotional reactions or agitation;
  • Psychotic features (delusions of guilt, poverty or physical illness, or having no clothes which fit;
  • Auditory hallucination.

It added: ‘A sensitive indicator for the diagnosis of depression includes lacking interest in something previously enjoyed. A measure of the severity of that depression is to ask if people enjoy visits from their grandchildren. People who don’t, tend to be very depressed.’

The guidance also suggested different clinical and non-clinical treatments for older people suffering from depression including, in some cases, electroconvulsive therapy.

It comes as Age UK has called for GPs to spot the warning signs of depression in older people. following a survey it commissioned from YouGov. 

The survey found that nearly half of all over 55s have experienced depression or anxiety, with ill health, (47%) the death of loved ones, (36%) and financial worries (27%) the most common triggers for depression and anxiety among older people.

It also found that more than a third of over 55s said they did not know where to go for help and support and that they were less likely than younger generations to want to ‘bother their GP’ about such issues.

Professor Burns said: ‘GPs are the first port of call for many older people, so we are equipping doctors and their teams to better spot and tackle mental ill health in older adults. This is further evidence to show why the NHS is putting mental health front and centre of patient care. As part of what has been independently described as the world’s most ambitious effort to treat depression, anxiety and other common mental illnesses, we are helping doctors to recognise and respond to mental ill-health in later life

’Depression and anxiety affect nearly eight million people over 55, but can often go unnoticed and untreated. Older people mustn’t miss out on help and treatment because of a ”stiff upper lip” approach to dealing with problems, or because they aren’t offered or don’t know where to go for help.’

The research found that feelings of loneliness and isolation could play a major role in the problems older people are facing and that more than a third felt that talking therapies such as counselling would help combat anxiety and depression.

Readers' comments (20)

  • Can Pulse editors please compile a list of all the additional questions we have been asked by various special interests groups, Royal colleges, Government s etc to squeeze into the 10 min consultation in addition to presenting problem!? A look back over 5 years of issues to do it,

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  • Professor Burns is quite a regular and reliable producer of "GPs should". One sense however with this one a slight note of desperation, maybe a scraping of the bottom of the barrel perhaps?

    Buck up Professor Burns.

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  • Vinci Ho

    Ok , again , very politically correct to ask overstretched GPs for solutions.
    The punch line at the bottom of this article was telling:

    ''The research found that feelings of loneliness and isolation could play a major role in the problems older people are facing and that more than a third felt that talking therapies such as counselling would help combat anxiety and depression.''

    As a modern society in 21st century, it is sad to see many of our elderlies feeling the way they feel, lonely and helpless. Should we not all be more introspective about how much more attention we should give them? Remember, one day we will be all in the same boat as time goes on . With all due respect, Professor , I presume you see your parents (presumably they are still around) on regular basis keeping them quite happy.
    This is NOT a problem (which politicians , academics and policy makers fail to solve) to be easily dumped onto an overstretched profession named GP and ask GPs to be the guardian of morality by proxy...........
    Politicians can say so much about no economy, no health and social care but there is a 'bare minimum' at least to fulfil for looking after people with needs ,as well as , helping other people to look after these people.
    If Carl Von Ossietzky was right about the world in 1935 when he received the Nobel Prize of Peace , mind me to change his quote slightly;
    We cannot look to the conscience of a society if our own conscience is fast asleep.......

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  • Please Maverick keep your uninformed and stigmatising comments to yoursel. ECT is lifesaving. Most psychiatrists would say they want it if they get depression. It has a very low number needed to treat and works almost immediately in psychotic/ catatonic depression.

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  • Council of Despair

    wonder how many GPs are currently stressed / anxious / depressed ?

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  • Not all grandchildren are agreeable.

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  • some grandchildren will be super-spreading the flu when they come to visit

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  • Forgot has hit the nail on the head,the pertinent question here is whether one wishes to see the scrounging little bastards in the first place,a point one would not expect a high end academic to have considered
    This is a lovely example of the evils of the NHS
    It slowly sucks the sanity from society
    The population appear unable to plan for retirement,one minute you are on a club 18-30,the next drooling into your porridge,no time to think,plan.
    Elderly people should construct their will to reflect the level of visiting,positive or negative correlation depending on whether you can stand your relatives.
    Essentially a fee per visit,paid in arrears on demise
    Let them know the deal,and you won't be able to keep them away.

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  • What if the grandchild is 25, unemployed, and everytime the come round they eat everything and steal the persons money and kicks the cat/dog/goldfish....?

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  • "world's most ambitious effort to treat depression etc" seems to consist of berating GPs.

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