It is welcome news that the National Institute for Health and Care Excellence has suggested that a “menu of treatment options” be offered to patients with mild depression before medication is considered (NHS to give therapy for depression before medication under new guidelines, 23 November). I hope that this is offered to older people, as it is not happening at the moment.
For the size of the older population, you would expect about 20% of referrals to the Improving Access to Psychological Therapies (IAPT) programme to be aged 65 and above, but before the pandemic it was around 7%, and this fell in many areas during the pandemic when IAPT moved towards digital delivery of its interventions, as this age group is more likely to suffer digital exclusion.
There is increasing evidence that older people do just as well as younger age groups when offered psychological-based approaches and that with support they can also use IT. The problem appears to be that depression is not recognised in the older population in the way that it is in younger people. This might be related to ageism and an assumption that it is normal to be depressed as you grow older. Health professionals may not be referring older people to services and older people themselves not seeking help because of this. We need to do more to understand and address the issues underlying this lack of help for older people.
Dr Chris Allen
Consultant clinical psychologist, Berkshire NHS foundation trust
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