A number of misconceptions lead to the underdiagnosis, misdiagnosis, and underreporting of depression in older adults. Hopelessness, “ageism,” and the lack of linkage among health care, mental health, and service professionals have created a system of care for elderly depressed patients that is fragmented, inadequate, and passive. Concurrent medical problems and lower functional expectations of patients by physicians often obscure the degree of impairment that exists. Typically, patients might not complain of depressed mood; instead, they might complain of less specific symptoms such as insomnia, anorexia, and fatigue.
Patients may stoically view their feelings of sadness as a weakness or as something to be expected. Although there is generally agreement that treatment is required for a major depressive episode in both young and old patients, less severe depressive illness, which may be viewed as an acceptable response to life stress or a normal part of aging, is often dismissed.
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With the social, physical, emotional, and financial challenges of later life, it is surprising that elderly people do not become depressed more frequently. Besides the obvious decline in quality of life, there are increased risks of suicide, social and cognitive impairment, poor compliance in treating their own physical illness, and worsening of associated physical condi-tions. The role of the primary care physician is paramount in the care of the depressed elderly.