• depression;
  • older patient–physician communication

OBJECTIVES: To determine the frequency of discussion about depression in follow-up medical visits of older patients, who initiates these discussions, the quality of responsiveness of physicians and patients in these discussions, and patient and physician characteristics that influence these discussions.

DESIGN: Convenience sample of 482 audiotaped follow-up visits.

SETTING: Three community-based practice sites.

PARTICIPANTS: Three hundred seventy-six community-dwelling older patients without dementia and 43 primary care physicians.

MEASUREMENTS: Audiotapes were analyzed using the Multi-Dimensional Interaction Analysis system to determine the content and process of medical conversations; patients completed Medical Outcomes Study 36-item Short Form Survey questionnaires immediately after the visit.

RESULTS: Depression was discussed in 7.3% of medical visits; physicians raised this topic in 41% of visits, patients raised it in 48% of visits, and accompanying persons raised it in 10% of visits. Visits were longer when the topic of depression was discussed. Depression was raised almost exclusively in the first 2.5 years of the patient–physician relationship. Physicians with some geriatric training were more likely to discuss depression, and these visits were shorter than visits to physicians without geriatric training.

CONCLUSION: Depression was raised infrequently in follow-up visits. The high prevalence of depression in older people and the associated mortality merit discussion of depression early and later in the patient–physician relationship. Although visits were longer when depression was discussed, physicians with some geriatric training were more likely to raise depression, and more time-efficient when they did so, than physicians without geriatric training.