Synopsis
Recognise later-life depression and anxiety behind cognitive, physical and functional presentations, assess suicide and safeguarding directly, distinguish loneliness without medicalising it, and combine accessible psychological, social and medicine care with physical-comorbidity safeguards.
- Later-life depression may present as loss of interest, fatigue, pain, poor appetite, sleep change, memory complaint, irritability or functional withdrawal rather than stated sadness.
- First-line assessment combines direct interview, collateral and a validated tool such as PHQ-9 or GDS; a score neither diagnoses nor assesses suicide alone.
- Ask directly about suicide at initial and follow-up review. Do not assume older age, faith, family presence or bereavement makes risk low.
Key red flags
Ask directly about thoughts of death, self-harm, intent, plan, means, previous attempts, substance use, protective factors and current ability to remain safe.
Intent, plan, means, psychosis, severe hopelessness or inability to maintain safety requires immediate action.
Investigation priorities
Establish syndrome, chronology and function.
Management branches
Persistent low mood, anxiety, withdrawal, somatic or cognitive complaint occurs.
- Optimise communication and assess suicide, psychosis, mania, delirium and immediate medical danger.
- Use clinical interview, collateral and validated screening with functional, medicine, physical and social assessment.
Key medicines
SertralineFor a sensitive or frail older adult, start 25 mg orally once daily and increase to 50 mg after about one week if tolerated; later increases follow response, adverse effects and product-guided maximum dosing.
MirtazapineStart 15 mg orally at night and consider 30 mg after one to two weeks according to response and tolerance; the licensed maximum is 45 mg once daily.