Diagnosis of depression in the elderly patient.

In the opening case study, Mrs. D.'s depressive symptoms should have been identified by the clinician, and the initiation of a complete workup should have been scheduled (see Figure 1 flow chart). Depression, although frequently difficult to diagnose in the elderly, is a common treatable illness. Screening for depression and asking the patient during routine visits about their mood will assist in identifying patients at risk. A systematic approach to the clinical evaluation, including a thorough history and physical examination, as well as laboratory tests necessary to identify comorbid medical conditions, is mandatory. Primary care providers need to be aware of confusing and confounding variables that may present in the patient's presentation. Once the diagnosis is made, a comprehensive treatment plan, including patient and family education, psychosocial intervention, and medication, when necessary, should be instituted. The primary care provider can positively affect the health and wellbeing of the elderly patient if they are diligent in the diagnosis and appropriate treatment of depression.