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Ninety-six people of pensionable age from an inner-London electoral ward who had been identified by short-CARE screening as having 'probable pervasive depression' were interviewed further to ascertain their GMS-AGECAT and self-CARE status, comorbid features, and current primary-care psychiatric management. Estimated incidence rates of 30.8 per 1000 per year for 'probable pervasive depression' and 15.4 per 1000 per year for GMS diagnostic depression were calculated using results from a short-CARE screen in 1988. Among GMS diagnostic depression cases, anxiety was the major psychiatric comorbid feature (95%) and organic features were uncommon (8.4%). Of 66 self-CARE cases, 48 (73%) were also GMS-AGECAT cases; of 24 self-CARE non-cases, 15 (62.5%) were not GMS-AGECAT cases. Among subjects who had 'probable pervasive depression', 38% said that they had declared their symptoms to their general practitioner. Only 14% of subjects were prescribed antidepressants; 24% were prescribed hypnotics. Half the GMS-AGECAT-case subjects who stated that they had declared to their general practitioner were on specific therapy. Screening for depression and health education aimed at increasing psychological declaration are seen as ways forward in the management of this depression.

Depression at a level requiring clinical attention affects 12-15% of those over 65 in the community. Only a small minority are in contact with specialist mental health services, the majority of these depressed older patients will require detection and treatment in primary care. Although the symptoms of depression, once elicited, are similar to those of younger patients, initial presentation in older people can be misleading, and the onset and outcome of depression in this age group is closely linked with the state of current physical health and social adversity. Pharmacotherapy is effective for treatment, but both the family doctor and older patient may be reluctant to consider and persist with antidepressant medication. A controlled study is described which aims to improve the management of older patients in primary care by evaluating the role of a nurse acting as case manager to work in conjunction with family doctors and community agencies to implement a plan of treatment for depression. Preliminary results indicate that the nurse was effective through her personal work with depressed older patients, despite the fact that the recommended introduction of antidepressant medication was often not possible.