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According to the National Mental Health Association (NMHA), only 42 percent of older adults seek help for depression. Of these, the NMHA reports, more than 55 percent are treated by primary care physicians. Less than 3 percent of patients with depression over the age of 65 years see a mental health professional, according to the NMHA.

This poses a problem because depression in older adults is poorly recognized even among physicians. According to the NMHA, primary care physicians accurately recognize less than 50 percent of depression patients. Many common symptoms of this condition in older adults (e.g., loss of energy, poor appetite, insomnia) are attributed to other medical problems. Other symptoms (e.g., confusion) may be mistaken for dementia.

Many individuals, including many physicians, view depression as normal or expected for older adults. This is particularly a problem in the face of the serious medical illnesses and social circumstances (e.g., death of a loved one) that affect many older adults. This belief is not true and often deters or delays proper diagnosis and treatment.

Another major obstacle to diagnosis is the attitude of the patients themselves. Some people believe there is a stigma attached to seeking help for any potential mental health condition. Older adults in particular may be reluctant to acknowledge any mental health problems. They are more likely than younger patients to try to deal with the condition themselves.

Before depression can be diagnosed, a physician will typically perform a physical examination to rule out other conditions that may be causing symptoms. Many people who are eventually diagnosed with depression visit their primary care physician first because they suspect there is a physical problem. However, a mental health professional is usually more capable of diagnosing depression.

Once the patient seeks the attention of a physician or non-physician mental health professional, diagnosis is possible. Diagnosis of depression typically begins with a complete medical history, including information about the onset, duration and severity of symptoms.

The diagnosis of depression in older patients may include the use of the geriatric depression scale. This is a screening tool designed specifically for older adults who may have depression. It is a short form made up of 15 simple yes or no questions. The physician or mental health professional will also ask whether the patient has experienced these symptoms before and, if so, whether and how they were treated. The patient will also be asked about alcohol and drug use, whether they have thought about death or suicide and whether other family members have had a depressive illness.

If there is a family history of depression, the practitioner will ask how it was treated and whether treatment was effective. A diagnostic evaluation should also be performed. This examination of the patient’s mental status determines if memory, speech or thought patterns have been affected.