Is ageism among prescribers an influential factor in the management of depression in the elderly? A vignette-based study.

Abstract

Background: The decision-making process, from diagnosing depression to treatment proposal, involves many interrelated factors. Patient age has been identified as a factor that influences care proposals. Our aim is to investigate the association between how prescribers perceive ageing and their decision-making when treating depression.

Methods: A cross-sectional survey of 57 physicians was conducted. The questionnaire collected socio-demographic data, and ageing semantic differential (ASD) scale to assess ageism. It also examined the reactions to treatment proposals in a clinical vignette about an 82-year-old woman with a single-episode depressive disorder of unspecified severity (mild or moderate). Physicians' reactions to two treatment options-antidepressant medication and psychotherapy-were assessed independently. For each option, participants could indicate whether they were in favor of initiation, against initiation, or had no opinion. Multiple linear regression was used to study the association between ASD and attitudes toward the initiation of antidepressant medication and psychotherapy.

Results: Prescribers' representations of ageing were significantly associated with their therapeutic decisions for late-life depression. When presented with the same clinical vignette, physicians showed substantial variability in treatment preferences. After adjustment, physicians in favor of initiating psychotherapy exhibited significantly more negative views of ageing compared with those opposed to this option. No significant association was observed between ageist attitudes and the decision to initiate antidepressant treatment.

Conclusions: The research underscores the complex role of ageism in medical decision-making and highlights the need for targeted training to mitigate its impact on late-life depression care.