Pathway to psychiatric care of the elderly with depression

Goldberg and Huxley describe a pathway to psychiatric care which has five levels and four filters. To explore the application of this pathway to the elderly with depression we searched the relevant literature to estimate median annual rates of moderate-severe depression at each level of the pathway. Among 27 elderly per thousand each year who had depression, 22 consulted a family physician who detected the disorder in 5.3. Of these, 2.8 were referred to psychiatric services and 1.3 were ultimately admitted to psychiatric units. Thus, only 10% of the elderly with moderate-severe depression were assessed or treated by a psychiatrist. If confirmed, these findings have implications for geriatric psychiatry services and research.