gms | German Medical Science

Background: Elderly have higher risk for developing depression, relapse rates are higher and the prognosis is worse. Depressed elderly are often under-diagnosed as compared with younger adults. Health care professionals responsible for managing depressed elderly need easily accessible recommendations.

Objectives: To compare clinical guidelines for the management of depression in adults in primary health care, and their relevance for the elderly.

Methods: Systematic review of guidelines for managing depression in primary care, and their relevance for the elderly (2005 or later) in English or Scandinavian languages. We systematcally searched guideline resources, electronic databases, health authority and professional organisations' web-sites. We excluded guidelines for bipolar disorder, specialist health care and subgroups. Two authors independently extracted data and assessed editorial quality using AGREE II.

Results: We included 13 guidelines. All guidelines reported methods for grading the evidence, although methods varied. All performed well evaluated with AGREE II, except for 'applicability'; the guidelines described implementation strategies to a limited degree only. Four guidelines gave no recommendation on elderly, and only five gave five or more recommendations. The clinical recommendations were mostly comparable, except for recommendations regarding screening and initiation of pharmacotherapy. Presentations of recommendations varied, and they were to some extent difficult to identify.

Discussion: Recommendations from 13 guidelines were mostly comparable. The diverse presentation of recommendations is challenging.

Implication for guideline developers/users: Standards for presentation of recommendations should be considered. The quality of the underlying evidence should be graded, and the evidence should be linked to the recommendations to obtain sufficient clarity.