While depression is more common in young people, in older people it is associated with more functional and cognitive impairment and carries significant costs for the family and health system.1 People over 70 years of age experience greater symptom severity than younger people and are more likely to have a diagnosis of depression after 2 years.
Persistent severe depression is associated with the onset of dementia.
There is a paucity of trials on medication or talk therapy in those over 75 years. Medication has increased risk of falls and seizures.
Carers are important therapeutically and in terms of progress and relapse but risk getting stressed.
The authors recommend focussing on physical functioning, sustained support, psychosocial functioning and greater community support. Suicide is an issue in the infirm elderly and removing lethal means such as medication, gardening poisons and guns is worth considering.