A complete physical examination as soon as symptoms are noticed is absolutely essential. There are numerous medical disorders that are easily treated that can cause depression in the elderly. To assist the physician or treatment team in making an accurate diagnosis, give the physician a complete record of all symptoms, all medications and health care preparations being used for any purpose, a personal medical history and a medical history of the family. Include information on any recent changes or losses.

People with depression need to be included in the decision making process at all times. Their wishes need to be respected and if possible, honored.

Doctors and health care professionals should talk directly to them as much as possible while keeping supporters informed. They should never be talked down to or patronized. They should be treated with courtesy, dignity and respect in all circumstances. Nothing should be done for people that they can't do for themselves.

Family members, care givers and health care professionals need to be sure that the person is not been abused or neglected.

What will help

Education--Family members and supporters need to learn all they can about depression. This facilitates good decision making about treatment, care, support, lifestyle, living space, and activities. It gives the information needed to ask health care professionals the right questions.

Addressing Lifestyle Issues--Are there issues in the person's life that need to be addressed and changes that need to be made?

Diet--Poor diet can cause or worsen depression. Is the person able to purchase and prepare healthy food? Do they do this? If they can't or don't, what can be done to remedy this situation.

If they usually prepare food for themselves, others may need to prepare food for them until they are feeling better. People need to have three healthy meals a day that contain complex carbohydrates and protein. The health care team may recommend specific food supplements. Caffeine and sugar intake should be limited. Issues of excessive use of alcohol need to be addressed.

Exercise--While physical disabilities may hamper movement, older people need to get as much exercise and keep as active as possible. Movement increases feelings of well-being and is a cheap and effective anti-depressant.

Light--The strong connection between depression and light through the eyes has been discovered in recent years. Fluorescent lighting fixtures should be fitted with full spectrum light bulbs. There should be daily time outdoors. Indoor space should be light and sunny. Spending time near windows helps. If the depression has a seasonal component, a light box might alleviate the problem.

Electromagnetic Radiation--Avoid excessive exposure to electromagnetic fields. Warm comforters should be used instead of electric blankets. Electric blankets can be used to warm the bed before getting in. Hot water bottles should be used instead of heating pads.

Meaningful Activity--Is the person engaged in some meaningful and enjoyable activity as much as possible- at least some time every day? Helping a person find creative activities that make use of their abilities and talents and making it possible for them to engage in these activities can make a big difference. Perhaps volunteer work would be possible.

Support--Lack of social support has a negative effect on other stressing events and can worsen depression. Everyone needs someone else to listen to them. The greatest gift one person can give another is listening time.

Supporters should avoid criticism and judgments and only give advise and feedback when it is requested.

Does the person have daily contact with others they like and who are supportive- people who will listen to them? If they don't, how could this situation be improved? Could the person get out to church and other activities? How could a system of social support be arranged?

Living Space--Does the person have a comfortable, secure place to live that they enjoy-a place that feels like home to them? If not, how could this situation be improved?

When relocating, those who freely choose where they will live have less adjustment problems, as do those in centers that have specific preventive plans to help them accept and adjust to a new environment.

Relaxation--There are a variety of relaxation and stress reduction activities that elders may find helpful. They include:

• meditation or prayer

• listening to music

• looking at pleasant scenes or art

• body scan exercises

• guided imagery

These exercises need to be practised daily to be effective.