Is electroconvulsive therapy use among young-old and old-old adults comparable? a 10-year population-level analysis of service provision

OBJECTIVES: Existing research on electroconvulsive therapy (ECT) in older adults has largely examined its efficacy and safety in treating depression, but there are few population-level studies of its use in this patient group. Our objective was to provide a comprehensive 10-year picture of ECT use among adults aged 65 years and older in the State of Victoria, Australia. We focused especially on comparing patterns of ECT use between young-old and old-old individuals, to better inform practicing physicians, policy makers, and researchers about ECT practices in this diverse range of patients. METHODS: We analyzed statewide ECT service provision data from 1998 to 2007 provided by the Office of the Chief Psychiatrist of Victoria. RESULTS: Age-adjustment of crude data revealed that old-old adults had the highest rate of ECT use overall (especially women) as well as the highest utilization rates for depression and public sector treatment. Although the highest rate of exclusively involuntary treatment under the Mental Health Act was also observed among old-old adults, most of the old-old patients were treated on an exclusively voluntary basis. The number of ECT treatments administered to young-old and old-old patients did not differ. CONCLUSIONS: The higher ECT utilization rates we previously reported in older adults as a whole were further accentuated in old-old individuals. Old-old adults may have medical comorbidities and personal care needs that have implications for ECT technique and service delivery. Our findings underscore the need for greater inclusion of old-old patients in future ECT research to increase its clinical applicability.