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Kollaborative und aufsuchende Ansätze in der Behandlung depressiver alter Menschen

Ein Literaturüberblick

Collaborative and home based treatment for older adults with depression

A review of the literature

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Zusammenfassung

Hintergrund

Depressive Störungen im Alter werden mit der demographischen Entwicklung zu einer zentralen und drängenden Versorgungsherausforderung.

Fragestellung

Welche wirksamen Versorgungsansätze lassen sich international identifizieren?

Methode

Es wurde eine selektive Literaturübersicht zu komplexen Ansätzen zur Versorgung depressiver alter Menschen durchgeführt.

Ergebnisse

Gesicherte Evidenz existiert für Ansätze der kollaborativen Versorgung, in deren Zentrum Kooperation zwischen Behandlern (Hausärzten und Spezialisten), regelmäßiges Monitoring, Case-Management und der Einsatz evidenzbasierter Interventionen stehen. Sinnvoll erscheint ein gestuftes Vorgehen, bei dem zunächst Behandlungsstrategien von geringer Intensität genutzt werden. Für Patienten mit eingeschränkter Mobilität haben sich insbesondere aufsuchende Ansätze als praktikabel und effektiv erwiesen.

Diskussion

Ein multiprofessionelles und multimodales Vorgehen in der Behandlung älterer depressiver Menschen stellt eine effektive und effiziente Versorgungsmöglichkeit dar. Auch in Deutschland finden sich einige vergleichbare Initiativen, die sich konzeptuell an den erfolgreichen Modellen im Ausland orientieren.

Summary

Background

Due to the demographic development depressive disorders in old age are becoming a central and urgent healthcare challenge.

Objectives

The article reviews effective approaches towards treatment of depression in the elderly.

Methods

A literature review of complex interventions improving depression care was carried out.

Results

Robust evidence exists for the use of collaborative care models which incorporate collaboration between mental health and medical providers in the primary care setting (e.g. general practitioners and specialists), regular monitoring, case management, and evidence-based treatment. Staged treatment approaches seem to be appropriate by which initially use treatment strategies of low intensity. For patients with limited mobility, home-based approaches have proven to be particularly practical and effective.

Conclusion

Multidisciplinary and multimodal treatment approaches represent an effective and efficient way of healthcare provision for late life depression. In Germany, only few initiatives inspired by successful international models have so far been identified.

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Danksagung

Der Beitrag entstand im Rahmen der Projekte AgeMooDe (BMBF-Förderkennzeichen: 01GY1155A) und AgeMooDe+Synergie (BMG/BVA-Fördernummer: II A 5 – 2513 FSB 014)

Einhaltung ethischer Richtlinien

Interessenkonflikt. U. Gühne, M. Luppa, H.-H. König und S.G. Riedel-Heller geben an, dass kein Interessenkonflikt besteht. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Institut für Sozialmedizin, Arbeitsmedizin und Public Health (ISAP), Universität Leipzig, Philipp-Rosenthal-Str. 55, 04103, Leipzig, Deutschland

    U. Gühne, M. Luppa & S.G. Riedel-Heller

  2. Institut für Gesundheitsökonomie und Versorgungsforschung (IGV), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland

    H.-H. König

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  1. U. Gühne
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  2. M. Luppa
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  3. H.-H. König
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  4. S.G. Riedel-Heller
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Correspondence to U. Gühne.

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Gühne, U., Luppa, M., König, HH. et al. Kollaborative und aufsuchende Ansätze in der Behandlung depressiver alter Menschen. Nervenarzt 85, 1363–1371 (2014). https://doi.org/10.1007/s00115-014-4089-4

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