Conclusions

Depression in older people is very often under-diagnosed and under-treated. There are ageist beliefs among professionals and among older people themselves that may prevent older people from receiving adequate access to effective psychological treatment for depression. This is very unfortunate, as there is a growing evidence base demonstrating the effectiveness of psychological treatments for older people. As many older adults are unable to tolerate antidepressants or there may be contraindications to their use with older people with cardiac problems (Orrell et al., 1995), psychological treatments are a much-needed, effective treatment alternative (Gerson et al., 1999). In many cases, psychological treatments can be considered an effective treatment of first choice for depression in older people (Thompson et al., 2001). It is argued that there is no empirical evidence or therapeutic necessity to adapt psychological therapies such as CBT in order to make them suitable and accessible for older adults without cognitive impairment or in the absence of frailty. Older people themselves appear to want the opportunity to participate in psychotherapy. Given the increase in the numbers of older people with the increase in life expectancy, the psychological needs of this important section of society are likely to increase rather than decrease.

Future research into the effectiveness of psychological treatment for depression in older people needs to examine their effectiveness in physical conditions with high levels of psychological distress, such as dementia, post-stroke depression and Parkinson's disease. Many of these conditions are currently at early stages of evaluation of efficacy in terms of psychological and physical treatments for depression. At present, there is a large unmet need. Likewise in other populations with high levels of emotional distress, such as in nursing homes, it is important to assess the potential impact of psychological treatments to alleviate suffering. Finally, suicide among older people is on the increase, and the future research extension of psychological treatments for older people cannot afford to ignore the potential for alleviating distress and reducing tragedy at the end of life. Suicide in older people left untargeted is a terrible, damning judgement on the priorities of the society we live in.

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