ABSTRACT
Depression is common and disabling in old age, particularly in people who
have co-morbid physical illness or are in institutional care. It is associated
with high costs for health care and social care. Despite this, it is often
missed, ignored or not managed adequately. Patients present when they
need help but often they do not complain of low mood. This is partly a
consequence of widely held ‘ageist’ assumptions that depression is intrinsic
to the ageing process, and that treatment is inappropriate, excessively risky
or unlikely to be effective. These assumptions are demonstrably untrue:
most older people are not clinically depressed (despite their increased risk
of loss and adversity); depression does not increase in prevalence with age
and those who are depressed respond as well to the range of pharmacologi-
cal and psychological treatment as do younger depressed patients.