RANDOMIZED CONTROLLED TRIAL OF EFFECT OF INTERVENTION BY PSYCHOGERIATRIC TEAM ON DEPRESSION IN FRAIL ELDERLY PEOPLE AT HOME

Objective-To investigate the efficacy of intervention by a psychogeria tric team in the treatment of depression in elderly disabled people re ceiving home care from their local authority. Design-Randomised contro lled trial with blind follow up six months after recruitment. Setting- Community of south east London. Subjects-69 people aged 65 or over who received home care and were depressed according to criteria of the st andardised automatic geriatric examination for computer assisted taxon omy (AGECAT). 33 were randomly allocated to an intervention group and 36 to a control group. Intervention-Members of the intervention group received an individual package of care that was formulated by the comm unity psychogeriatric team in their catchment area and implemented by a researcher working as a member of that team. The control group recei ved normal general practitioner care. Main outcome measures-Recovery f rom depression (AGECAT case at recruitment but non-case at follow up). Results-Data were analysed on an intention to treat basis. 19 (58%) o f the intervention group recovered compared with only nine (25%) of th e control group, a difference of 33% (95% confidence interval 10% to 5 5%). This powerful treatment effect persisted after controlling for po ssible confounders in logistic regression analysis, with members of th e intervention group more likely than members of the control group to have recovered at follow up (odds ratio 9.0 (2.0 to 41.5)). This did n ot seem to be a simple effect of antidepressant prescription: use of a ntidepressants at follow up did not have a significant effect (multipl y adjusted odds ratio 0.3 (0.0 to 1.9)). Conclusions-Depression is tre atable in elderly people receiving home care. Therapeutic nihilism bas ed on an assumed poor response to treatment in these socially isolated , disabled elderly people in the community is not supported.