title: Negotiating depression treatment with older adults: primary care providers' perspectives.
abstract: BACKGROUND
  Primary care occupies a strategic position in the evaluation and treatment of depression in late life, yet many older patients do not initiate or adhere to treatments available in primary care.
  
  
  OBJECTIVE
  To explore how primary care providers describe the process of discussing depression care with older adults.
  
  
  METHODS
  Semi-structured interviews conducted with 15 providers involved with intervention studies of depression management for older adults. We used the constant comparative method to identify themes related to negotiating the treatment of depression with older adults.
  
  
  RESULTS
  Providers felt that older patients often attribute depression to non-medical causes. They talked about the challenges and described the need to 'convince' them of the medical model of depression.
  
  
  CONCLUSIONS
  How primary care physicians surmise patients' views of depression may influence the discussion of depression in practice. As medication is most often provided for depression treatment, some may feel compelled to convince their patients of biomedical explanations while others may avoid treating depression altogether.
authors.affiliation: Department of Family Medicine and Psychiatry, School of Medicine and Dentistry, University of Rochester, Rochester, New York 14642, USA. marsha_wittink@urmc.rochester.edu
authors.forename: Marsha N
authors.initials: MN
authors.lastname: Wittink
authors.forename: Jane L
authors.initials: JL
authors.lastname: Givens
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Knott
authors.forename: James C
authors.initials: JC
authors.lastname: Coyne
authors.forename: Frances K
authors.initials: FK
authors.lastname: Barg
mesh_terms: D000368:Aged; D000375:Aging / Q000523:psychology*; D001291:Attitude of Health Personnel; D003863:Depression / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017008:Negotiating; D011320:Primary Health Care / Q000379:methods; D011369:Professional-Patient Relations