Introduction

It is unacceptable that treatable illnesses should mar any enjoyment that retirement may bring to an older person, or increase any burden from isolation and loss that occurs at that age. The primary care team is in an ideal position to identify and alleviate depression, a widespread and treatable disorder. This chapter addresses that task, demonstrating both the extent of the problem and possible solutions. Throughout, reference will be made to a series of studies carried out in the North London area of Gospel Oak. These studies were set up to describe mental illnesses amongst older people identified by household enumeration in an electoral ward, the use by these people of the local Health and Social Services and the outcome of interventions for treatment of mental illnesses (Livingston et al., 1990a,b).

The prevalence and nature of depression in primary care

Prevalence surveys of depression in older people have measured morbidity at three levels: Community, Primary Care and Hospital Clinic. The results are not comparable because of the large hidden morbidity in the older population that will be discovered in a community sample, the large number of cases that never reach specialist mental health resources from primary care, and the severe and resistant cases which tend to accumulate in clinics (Shepherd et al., 1966; Goldberg & Huxley, 1992). In addition, all published prevalence studies have their own idiosyncracies of case definition, sample frame and means of assessment that make differences between results hard to interpret.