A Randomised Controlled Experimental Study on the Influence of Patient Age on Medical Decisions in Respect to the Diagnosis and Treatment of Depression in the Elderly

Background . Elderly patients are often treated differently than younger patients, even when suffering from the same disorder. Objective . The study examines the influence of “patient age” on the perception of symptoms and conclusions of physicians in respect to diagnosis and treatment. Methods . In a randomised controlled experimental study on medical decision-making, 121 general practitioners were given two case vignettes which contained all the criteria for major depression according to ICD-10, but differed in respect to the age of the patient (39 or 81). Reaction time, diagnostic conclusions and therapeutic recommendations were assessed by computer. Results . Depression and anxiety were significantly seen as more probable in the young cases and dementia and physical illness in the old. In young age, psychotherapy, pharmacotherapy and referral to a specialist or inpatient treatment were significantly more recommended than in old age, for whom supportive counselling was significantly more recommended. The time needed for a decision was significantly longer in the older patients. Conclusion . Ageing stereotypes can also form medical illness concepts and have a significant influence on diagnostic and therapeutic decisions.