We often mistake an old person’s quiet withdrawal and lack of complaint as philosophic acceptance when, in fact, she is putting her best possible face on a bitterly disappointing, humiliating or frightening situation.

Either assumption, that it is normal to be unhappy or that old people are somehow happy about being unhappy, obstructs our view of the person’s true state of mind. Signs of distress deserve attention in old age as much as at any point in the lifespan.

Depression is one of the most common expressions of emotional distress in older men and women. The basic symptoms of depression are similar throughout adult life, but in old age it can be difficult to know where a physical difficulty leaves off and depression begins.

Reduced appetite and inability to get a good night’s sleep, for example, are among the clues that suggest depression. But old people may choose to eat less and have sleep difficulties for reasons other than depression. It is when an entire pattern begins to emerge that we should seriously consider the possibility of a depressive action.

The pattern is likely to include reduced and slowed-down speech, and the person may seem to be thinking slower as well. There is less attention to personal grooming. Energy is lacking even for routine activities. A general feeling of pessimism prevails and life appears increasingly grim and hopeless.

There may be talk of feeling empty inside, and of being useless, a worthless person. The future holds nothing; the past is no source of comfort; the present moment is intolerable. The depressed persons may turn their feelings against themselves, sometimes lashing out in anger at other people.

We can help such a person by encouraging him to use all the control he has, and by supporting him in all his remaining areas of vigor and competence. We can hear him out, listening carefully to his sorrows and alarms. This sharing is not only useful in itself, but it can also help the old person realize that problems of the past need not continue to weigh upon him today.

An impaired or emotionally upset old person should be helped without asking for anything in return and without unnecessary invasion of privacy. We should not assault a person’s integrity, condescend to him or deprive him of rights in the name of welfare.

There is general agreement that there is a higher percentage of people suffering emotional distress in old age than at any other time in adult life. Yet the provision of mental health services for the elderly is much below the average. The gap between need and suitable care is all too often filled by dubious measures, such as heavy-handed prescribing of drugs.

But there are also other ways in which the old, depressed person may endanger his own life. He may neglect a medical regime that is necessary to control an illness such as diabetes. He may limit himself to bed and chair, becoming increasingly inactive and thus more vulnerable to degenerative processes and infections. Depression may also be misinterpreted as proof of dementia, causing further social isolation and incorrect treatment.

However by giving support via friends and community, and appropriate treatment, the depressed individual can pass through these episodes and return to a meaningful adult level of functioning.