MAJOR DEPRESSION AND REFUSAL OF LIFE-SUSTAINING MEDICAL-TREATMENT IN THE ELDERLY

Objective: To examine the effect of improvement or recovery from major depression in elderly patients on their desire for life-sustaining tr eatments. Design: Prospective case survey. Setting: Psychogeriatric Se rvice of Hornsby Ku-ring-gai Hospital & Community Health Services and Ryde Hospital & Community Health Services (a community-based service s erving an urban population with over 29 000 elderly people). Subjects: All patients referred with major depression (diagnosed by DSM-IV crit eria) and no significant cognitive impairment between October 1994 and January 1995. Outcome measures: Number of life-sustaining treatments desired before and after treatment of depression in two hypothetical a cute life-threatening illnesses (one with a good and the other with an uncertain prognosis), and intensity of depression on the Geriatric De pression Scale (GDS). Results: 22 subjects completed both stages of th e study. Initial depression was severe in five, moderate in 16 and mil d in one. GDS scores decreased in 18 subjects after treatment. Mean nu mber of life-sustaining treatments desired by these patients increased significantly from 4.0 to 6.1 (out of seven possible treatments) in t he ''good prognosis'' illness and from 6.4 to to 9.6 (out of 14) overa ll. The increase in the ''uncertain prognosis'' illness (2.3 to 3.4) w as not significant. Conclusions: Moderate or severe major depression i n the elderly is associated with a high degree of refusal of life-sust aining treatments. Treatment of the depression leads to increased acce ptance of these treatments, particularly if prognosis is good.