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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)

  • really?

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  • Cobblers

    Another special interest group urging a swamped GP service that they are not doing enough for their particular niche.

    What about depression and anxiety in GPs? Has to be a real problem IMHO.

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  • AlanAlmond

    Isolation, loneliness and chronic ill health
    ...most of these issues are about our wider society and how it's structured. If we want to make a serious difference the discussion needs to occur out there in the public domain and not conveniently boxed up 'for the attention of the healthcare system'.

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  • David Banner

    Why stop there? We need a new QOF tick box target asking everyone 75 whether they like.......
    - Bargain Hunt
    - Werther's Originals
    - Cats
    - Nostalgia
    - A NICE cup of tea
    - (any other insulting ageist stereotypes you care to add)

    After you have proudly trebled your 75 depression register, then discovered the waiting time for counselling is now greater than their life expectancy, you can reluctantly put them all on SSRIs, then be slagged off a year later for your reckless over-prescribing, polypharmacy, and causing recurrent falls

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  • David Banner

    Above should read OVER 75, the "greater than" symbol doesn't show!!

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  • so are we meant to put more people on antidepressants or not put them on antidepressants - i am getting mixed messages, or i maybe i should go out more and exercise and socialise like all the older people i know who are not depressed. just saying.

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  • GP should ask the elderly if they would like visits from (their) grandchildren, and if so GP should arrange them.
    If their grandchildren don't want to visit, it is GPs responsibility to source some other sustainably and responsibly produced grandchildren suitable for such visits.

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  • Stick a mop up my arse and I'll clean the floor on the way out..,

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  • Knowledge is Porridge

    There are lots of good reasons to ask people to come and see their GP. If we can charge for every consultation then the money follows the work.
    Seems to work in Australia.
    It will happen here as desperate practices go to the wall, realising that the GP forward view is just stringing them along.

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  • Maverick

    Has anyone ever admistered ECT? I have, when I was doing my 6 month VTS stint in psychiatry in 1985. The whole process was like a scene out of a Hammer Horror Frankenstein movie.... and it did nothing to help. We're moving back to the dark ages. How about a LES or DES for frontal lobotomies, leeches, lancing buboes and releasing vile humours.

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