Characterization of the Quality of Electroconvulsive Therapy Among Older Medicare Beneficiaries.

Abstract

BACKGROUND:

Electroconvulsive therapy (ECT) is an important therapy for treatment-resistant depression and is especially effective for elderly individuals with depression. This is the first US nationally representative description of ECT in the elderly.

METHODS:

Using 2014-2015 Medicare claims data, we compared elderly individuals with major depressive disorder (using ICD-9 and ICD-10 codes) who received ECT with those who did not on demographic and clinical measures. We characterized treatment patterns by setting and the proportion of individuals receiving index and continuation/maintenance courses, subtherapeutic courses of ECT, and post-ECT follow-up care.

RESULTS:

Of all Medicare beneficiaries aged 65 years and older diagnosed with depression in 2014-2015, 7,817 (0.41%) received 1 or more ECT sessions. Compared to the general population of elderly Medicare beneficiaries with depression, recipients of ECT were slightly younger and more likely to be male, non-Hispanic, and white and live in a zip code with a higher median income. Among those who received any ECT, 33.7% received < 5 total treatments. Of those who received an index ECT treatment, 33.7% received a continuation/maintenance course of ECT, while 60.9% received some form of post-ECT follow-up treatment (additional ECT or new psychotropic medication). Receipt of psychotherapy was the strongest predictor of those who received ≥ 5 ECT treatments (adjusted odds ratio = 1.43; 95% CI, 1.22 to 1.67).

CONCLUSIONS:

Despite substantial evidence of efficacy, ECT use remains rare among elderly patients with depression. Findings suggest a potential need for efforts to increase the proportion of patients receiving adequate courses of ECT and evidence-based post-ECT follow-up care.

• Authors: Taeho Greg Rhee, Mark Olfson, Kyaw Sint, Samuel T Wilkinson
• Journal: The Journal of clinical psychiatry (J Clin Psychiatry) Vol. 81 Issue 4 (07 07 2020) ISSN: 1555-2101 [Electronic] United States
• PMID: 32659875 (Publication Type: Comparative Study, Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)
• Copyright: © Copyright 2020 Physicians Postgraduate Press, Inc.

Chemical References

• Psychotropic Drugs

Topics

• Age Factors
• Aged
• Aged, 80 and over
• Combined Modality Therapy
• Databases, Factual
• Depressive Disorder, Major (therapy)
• Electroconvulsive Therapy (standards)
• Female
• Humans
• Male
• Medicare (statistics & numerical data)
• Psychotropic Drugs (therapeutic use)
• Sex Factors
• Treatment Outcome
• United States