Psychotherapy, Pharmacotherapy Combo Best for Late-Life Depression and Pain

Treating these chronic conditions together may minimize the stigma of depression treatment.

LAS VEGAS — Late-life depression affects adults aged 60 years and older and is associated with increased healthcare utilization and costs, reduced quality of life, poorer prognosis for comorbid conditions, lower survival rates, and suicide.1,2

Approximately 5% of community-dwelling older adults are estimated to be affected by depression; the prevalence increases to 10% among those with medical comorbidities in primary care settings and as high as 35% after critical care hospitalizations.3,4

Chronic pain warrants attention in older adults due to its high prevalence.  An estimated  25% to 50% of community-dwelling older adults and 49% to 83% of nursing home residents report chronic pain, and the condition is independently associated with anxiety and depression.

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“Chronic low back pain (CLBP) is one of the most disabling and therapeutically challenging pain conditions afflicting older adults,” explained Jordan F. Karp, MD, an associate professor of psychiatry, anesthesiology, and clinical and translational science and medical director for psychiatry at the University of Pittsburgh Medical Center in Pennsylvania, at PAINWeek 2015.

In a study comparing patients with CLBP to those with knee arthritis, Dr. Karp and colleagues found that patients with CLBP had higher rates of mood disorders, slower gait (0.88 m/s vs 0.96 m/s; P = .002), and more comorbid conditions (mean 3.36 vs 1.97; P < .001).4 Furthermore, patients with CLBP performed significantly worse on psychological measures than those with knee arthritis.