A fifth of the elderly are depressed, but few get treatment
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It is estimated that up to 17% of elderly people living in the community suffer from depression - twice the number who have dementia, yet it mostly goes undetected and untreated.
Part of the reason is ageism: people, including doctors and old people themselves, expect the elderly to feel down and do not consider this as a treatable illness.
Other likely reasons are that the elderly do not like to bother their doctors or that they fear the stigma of mental illness or that admitting a problem could lead to them losing their independence.
Assessment
Researchers in Sheffield believe a new way of assessing depression in elderly people could tackle the problem and improve mental health and its knock-on effects on physical well-being.
The Institute for Ageing Research and the Institute for General Practice in Sheffield have been evaluating the use of the Elderly Assessment System (EASY) by community health workers.
The system contains 25 questions on physical, mental and social well-being.
It is being piloted in 18 countries around Europe, including Wales, Scotland and Northern Ireland.
Professor Ian Philp, who leads the programme at the University of Sheffield, says that, after three years of pilots, the system has proved effective.
He is in discussions with social and health services to get it to be taken up as standard practice for community workers.
"The aim is to detect depression among people living in their homes before they have to see their GP," he said.
"EASY is a very brief screening questionnaire and we have found it works very well and helps health workers to understand older people better."
He said other scales for assessing depression tended to have been developed with young people in mind.
They concentrated more on physical indicators of depression, such as poor appetite.
In older people, these symptoms might indicate other problems since the elderly were likely to have multiple medical problems, said Professor Philp.
"EASY relies more on people's perceptions of their own well-being."
Follow-up
Other assessment systems which fulfill similar functions include the Geriatric Depression Scale which has four basic questions which require a yes/no answer.
They include:
Answers to the questions may prompt further more detailed questions or may require a trip to the GP.
The Sheffield pilot also looked at how health workers manage suspected depression among the elderly.
This involved primary care workers, social services and the voluntary sector.
Research shows screening can double GP recognition of depression, but this has little impact on treatment offered and follow-up.
Professor Philp says the people targeted are not severely mentally ill in which case they would need specialist services.
However, they may require a range of treatments, including social interventions, counselling or drugs.