Depressive illness is commonly missed in older patients. This is partly because the clinical picture can mimic a dementing illness, so that a history from a reliable informant, as has already been stressed, is mandatory. Another reason is so-called masked depression in which the patient denies depressed mood but presents with other symptoms, such as those of apparent physical illness. In this sort of case a reliable account of sleep and appetite disturbance, weight loss, and anhedonia give clues as to the presence of an affective disorder. It should also be remembered that dementia and depressive illness are common disorders and not infrequently occur together, so that the diagnosis of one does not rule out the other.

Older men are still the group most at risk of suicide in most countries of the world where statistics are recorded (see Chapter.B.S.Z.). The psychiatrist does not shrink from specific enquiry about suicidal thinking in patients of any age, but it can sometimes be difficult to differentiate between a rational desire to die when the time comes and active suicidal ideation. In-depth probing is therefore mandatory and the examiner should not be put off by the patient's attempts to leave the topic, if he or she thinks that there is likely to be risk of self-harm.

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