The elderly often become depressed and require skilled diagnosis and treatment.

They are frequently admitted to hospital in, apparently, a state of severe depression, but often it is found that they are suffering from concealed physical illness, especially infections, say, of the urinary tract, or chest disorders. Matters are complicated by malnutrition, the beginning of hypothermia (when they are unable to maintain their body temperature), self-neglect and general isolation. Improvement is often dramatic, but of course sometimes more serious conditions are uncovered; depression can occur with almost any disorder, including cerebral (brain) tumour, disease of the arteries and Parkinsonism (also called paralysis agitans or trembling palsy), in which the muscles become rigid and a tremor develops.

The severity of the illness appears to be linked with the family pattern and with the symptoms of reactive depression. Bereavements, loneliness, social isolation, poor diet, detachment from country and countrymen (i.e.; immigrants) are potent factors and quite often lead to suicide or suicide attempts. Indeed, the rate of hospital admissions due to servere depression, and especially for first admissions are highest between the ages of 60 and 65. Many of these are what has been described as 'out of kilter with society'.

The sufferers' loss of energy, responsiveness and initiative and a certain warping of their personalities are part of the same kind of depression that may occur in middle age. These factors, together with the loss of friends and relatives, and sometimes their rejection by their children, can produce anxiety and an unconscious transfer of feelings to other people or things (projection). Elderly people as part of their depression frequently develop paranoid thinking, commonly called a 'persecution complex'. This can often be relieved by understanding acceptance, and further reduced by taking the of a mild phenothiazine.

Sometimes the illness, especially in a previously stable personality, emerges as a psychosis. Patients may be less depressed but may show severe mental disturbance, such as hallucinations and delusion.

The cheerful, outgoing individual has the best chance of escaping this type of depression. As Cicero said' 'Old men retain their intellects well enough if they keep their minds active and fully employed.' The ideal is, of course, is to keep and treat the elderly in familiar surroundings, e.g., in their own homes, and, when the time comes, to allow them to die with dignity, surrounded by their loved ones.

Any physical disorder should be studied and where possible treated; this is often all that is required. Sometimes it is found that physical complaints are really caused by the depression and they will both respond to appropriate treatment. Many of the elderly are run down due to an inadequate or badly balanced diet, sometimes for long periods. Great care should be taken to ensure that they are fed properly and well, especially as the temptation to eat little or nothing grows stronger as ageing progresses.

The elderly are often isolated socially and much can be done to alleviate this. Community nursing supervision, 'meals on wheels', day hospital attendance, Darby and Joan and 'pop-in' clubs, financial supervision and assistance from social workers should all be promoted. In particular, there are many social services and local authority facilities which might be used to great effect, especially the Social Services Benefit which is often under-used. Social outings are a great pleasure and many groups organize these. Sometimes placing the elderly person in specially designed accommodation or in a special local authority 'ambulant unit' will transform the situation.