title: Improving access to psychological therapies and older people: findings from the Eastern Region.
abstract: BACKGROUND
  Evaluations of the Improving Access to Psychological Therapies (IAPT) scheme have not yet focused on minority subgroups. This paper aims to evaluate accessibility, waiting times and clinical outcomes of IAPT for older adults.
  
  
  METHODS
  All referrals from six Primary Care Trusts (PCT) in the East of England were used in this analysis. During each session, the therapist recorded information on anxiety symptoms using the Generalised Anxiety Disorder Questionnaire (GAD-7) and depressive symptoms with the Patient Health Questionnaire (PHQ-9). Waiting times, type of referrals and reliable recovery rates were investigated.
  
  
  RESULTS
  Older adults accounted for only 4% of all the IAPT referrals made between September 2008 and July 2010 in the Eastern Region. Waiting times for both IAPT assessment and treatment were slightly lower for older adult. In all centres, reliable recovery rates were higher in older adults compared to younger adults post-treatment, however these differences were not significant, with the exception of a difference in anxiety scores (χ(2)(1) = 18.6, p < 0.001). In multivariate analyses, being an older adult was associated with recovery for depression (OR = 1.30, 95% CI 1.10-1.53), anxiety (OR = 1.42, 95% CI 1.21-1.66), and overall recovery (OR = 1.31, 95% CI 1.10-1.54) after adjustment for gender, PCT region, baseline score, maximum treatment step during treatment, dropping out, and number of sessions.
  
  
  CONCLUSIONS
  The IAPT services were shown to be beneficial to older patients, however, access to these services in later life has been lower than expected. The service pathway for older populations needs to be better researched in order to eliminate possible obstacles in accessing services.
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Robinson Way, University Forvie Site, Cambridge CB2 0SR, UK; NIHR Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough (CLAHRC-CP), UK; King's College London, Institute of Psychiatry, Health Service and Population Research Department, Centre for Global Mental Health, London SE5 8AF, UK. Electronic address: matthew.prina@kcl.ac.uk.
authors.forename: A Matthew
authors.initials: AM
authors.lastname: Prina
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Robinson Way, University Forvie Site, Cambridge CB2 0SR, UK.
authors.forename: Riccardo E
authors.initials: RE
authors.lastname: Marioni
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough (CLAHRC-CP), UK; Department of Psychiatry, University of Cambridge, UK.
authors.forename: Geoffrey C
authors.initials: GC
authors.lastname: Hammond
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough (CLAHRC-CP), UK; Department of Psychiatry, University of Cambridge, UK.
authors.forename: Peter B
authors.initials: PB
authors.lastname: Jones
authors.affiliation: Department of Public Health and Primary Care, Institute of Public Health, University of Cambridge, Robinson Way, University Forvie Site, Cambridge CB2 0SR, UK; NIHR Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough (CLAHRC-CP), UK.
authors.forename: Carol
authors.initials: C
authors.lastname: Brayne
authors.affiliation: NIHR Collaboration for Leadership in Applied Health Research and Care for Cambridgeshire and Peterborough (CLAHRC-CP), UK; Division of Psychiatry, Institute of Mental Health, University of Nottingham, UK.
authors.forename: Tom
authors.initials: T
authors.lastname: Dening
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000523:psychology*; D001007:Anxiety / Q000628:therapy; D003863:Depression / Q000628:therapy; D004739:England / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D011613:Psychotherapy; D012017:Referral and Consultation; D013997:Time Factors; D055815:Young Adult
keywords: Accessibility; Anxiety; CBT; Depression old age psychiatry; General practice; Psychological therapies; Waiting times
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