Question

Why is the rate of diagnosis worse for geriatric depression than for depression in younger people?

Answer

Often the diagnosis in an older person is not obvious, as the presentation of their conditions may vary considerably from those classically written down in the medical and psychiatric textbooks. However it should not be impossible for any physician to diagnose depression, even in an older person. Of course there is no blood test or other definitive laboratory test to confirm the diagnosis, which is entirely based on clinical suspicion. Rating scales may help in the diagnosis, but should not be used solely for this. Often in older people, a full mental state examination is necessary.

Although it is possible that even experienced practitioners may miss mild cases, it is extremely unlikely that the majority of patients with depression will be missed, providing they are seen by a practitioner in the first place. It may well be that older people are less forthright at coming forward, and their relatives and carers less aware of the need to present the older person to a qualified practitioner.

It must always be remembered that physical disease (ill health) can not only trigger severe depression but may make it resistant to treatment if it is not corrected in its own right.