Recognising depression in elderly patients in general practice

Background: Older patients with depression may not complain of sadness or feeling depressed on presentation. Delay in diagnosis can cause significant suffering to the patient and their families with increased health expenditure resulting from complications. Objective: This article outlines an approach to help with diagnosis and assessment, of elderly patients with depression in the primary healthcare setting. Discussion: Recognising depression in old people is not always easy as its presentation may differ from that of younger people. Older people tend to under report depressive symptoms and may not concede that they are depressed. This could be due to age, lack of cognisance of the disorder, shame or a belief in not talking about depression or admitting to not coping - it may also be embedded in their culture. Some common depressive symptoms such as poor sleep, chronic unexplained pain, poor concentration or impaired memory are wrongly ascribed to old age, dementia or poor health. As a result, depression in old age may go undetected and untreated for a long time. An assessment process which is less time consuming but has high sensitivity leading to the direct diagnosis of depression can help general practitioners in their busy general practice to facilitate management tailored to individual needs.