To tell or not to tell - comparison of older patients' reaction to their diagnosis of dementia and depression

Objective Investigation of the reaction of elderly patients to the disclosure of their diagnosis of dementia compared with depression. Design Elderly patients suffering from dementia and depression were asked to complete a questionnaire about the diagnosis and other aspects of their clinical summary sent to them by post. Demographic data included age, gender, marital status and occupation; degree of dementia or depression was established by administering the mini-mental state examination and the geriatric depression scale, respectively. Setting Patients were consecutive attendees of outpatient clinics (old age psychiatry) located in two suburban areas near London. Measures Demographic data included age, gender, marital status and occupation; degree of dementia or depression was established by administering the mini-mental state examination and the geriatric depression scale, respectively. Results One hundred cases were recruited, 53 with dementia and 47 with depression. Most depressed and dementia patients ( > 75%) liked the idea of reading their diagnosis but 25% of dementia cases felt upset. Within the dementia group, the majority of patients with mild or severe dementia welcomed the idea of knowing their diagnosis; and 13 (100%) of the patients with vascular dementia wished to know (compared with 68% cases with Alzheimer's disease). None felt upset, and only 39% of them felt pessimistic after reading their own clinical summary. However, among dementia patients who also happened to be depressed, a higher proportion (60%) expressed an unfavourable view towards knowing their diagnosis, but only a minority (40%) of them were actually upset. Most older married females, especially those with depression and Alzheimer's disease, felt pessimistic afterwards. Conclusions There was no significant difference between patients with dementia or depression in their wish to know their diagnosis. Patients with severe dementia, even if they felt upset, preferred to be told their diagnosis. Patients with vascular dementia tended to express a more favourable view.