Objective: Electro Convulsive Therapy (ECT) is primarily used to treat severe depression that has failed to respond to other therapies. Although the world wide use of ECT is declining, there is a trend for it to be used more often in older rather than younger people. The objective of this research was to examine factors associated with the use of ECT in older individuals.
Design: A retrospective case note study was employed. The medical notes of an identified target population were analysed in order to collect data on patient demographics, diagnosis, symptom profile and number of ECT treatments received. The age of the people when they began treatment was also recorded and this was used to allocate them to groups so that a quasi-experimental design could be used, comparing younger with older people.
Materials and Methods: The medical records of all patients who have been treated with ECT over a three year period (1999-2001) at the Maudsley and Bethlem Royal Hospitals in London, England, were identified for inclusion in this study. Fifty one patients were treated in 1999 with a total of 55 courses, 53 patients in 2000 totalling 63 courses and 41 patients totalling 45 courses in 2001. The OPCRIT computerised diagnostic system was used to generate DSM4 diagnoses and symptom profiles. Statistical analysis comparing younger with older people treated with ECT involved using t-tests and Chi2, and when this was not appropriate, Fisher’s exact test.
Results: Of the total 163 courses in the target population, records have been located and analysed on 79 courses (48%). For 75 of the courses, the diagnosis of the patient was major depression; the remaining 4 were diagnosed with schizophrenia or schizoaffective disorder. Further analysis was limited to the 75 of the patients with major depression. The age range of these people was 26-94. Based on the distribution, these were split into a relatively older group of aged 75 or over (n=30) and a relatively younger group of people aged below 65 (n=18). It was found that the older patients received significantly longer courses of ECT than the younger patients (mean = 11.8 compared with 7.6 treatments). There was no significant difference between the groups for the presence of suicidality, agitation, treatment resistance, nihilistic delusions, dirunal mood variation or failure to eat or drink. However, it was found that people in the older group were significantly more likely to display a lack of insight into their illness than people in the younger group.
Conclusion: Older people who receive ECT generally resemble, in terms of clinical profile, younger people who receive ECT treatment for major depression. However, they are more likely to have a lack of insight into their condition. They are also likely to receive longer courses of treatment. This may reflect a slower recovery in people who fail to comprehend the nature of their illness.
Back to PB Tuesday Poster Sessions
Back to The Eleventh International Congress