Late-life depression: how to make a difficult diagnosis.

Approximately 15% of persons age 65 and older have major depression. Risk factors include a recent loss (eg, widowhood or mastectomy), living alone, co-morbidities (eg, hypertension, stroke, cognitive deficits), and drug interactions. Warning signs of depression may include weight loss, sleep problems, feelings of guilt or worthlessness, loss of interest in sexual relations, or changes in activities of daily living. The diagnosis of depression is easy to miss if the physician doesn't look for it, because older persons often don't mention feeling depressed. Yet undetected depression can be deadly for older patients, who have the highest rate of suicide among all Americans. Plans for suicide may be direct or covert, as in not eating or not taking heart medication.