Some people think that depression is a natural consequence of getting older. They assume that depression in older people must result from the loss of youthful vitality, a decline in physical functioning, feelings of not contributing to society or being a burden to others, mounting medical problems, pain and discomfort, the deaths of friends and family members, and a heightened sense of one's own approaching death.

Although the elderly are at higher risk for depression, we know from research and clinical experience that most older people who are facing these issues are in fact not depressed. They may feel sad from time to time, but they don't experience the persistent low mood, discouragement, worthlessness, sleep and appetite disturbances, or thoughts of suicide characteristic of major depression.

Treating depression in an older person is important for several reasons. First, it can offer relief from suffering. Also, persistent depression may increase the risk of other conditions, including heart disease and possibly diabetes.

And in the elderly, depression can become a type of dementia that fortunately can be reversed with treatment. Most important, depressed older persons, especially white males, are at the highest risk for suicide.

Depression in the elderly can be treated with psychotherapy or antidepressant medication. A combination of the two usually works best.

But recognizing major depression in the elderly can be challenging unless they say they have felt depressed for weeks and don't want to live any more. Often, as with children who are depressed, elderly people may signal their depression mostly through behavior changes and physical complaints.

Here's a Geriatric Depression Scale you can use to gauge whether you or an older person you know may be depressed:

1. Are you basically satisfied with your life?
2. Have you dropped many of your activities and interests?
3. Do you feel that your life is empty?
4. Do you often get bored?
5. Are you in good spirits most of the time?
6. Are you afraid that something bad is going to happen to you?
7. Do you feel happy most of the time?
8. Do you often feel helpless?
9. Do you prefer to stay at home, rather than going out and doing things?
10. Do you feel that you have more problems with memory than most?
11. Do you think it is wonderful to be alive now?
12. Do you feel worthless the way you are now?
13. Do you feel full of energy?
14. Do you feel that your situation is hopeless?
15. Do you think that most people are better off than you are?

Score one point each if you answered NO to Questions 1, 5, 7, 11, and 13. Score one point each if you answered YES to Questions 2, 3, 4, 6, 8, 9, 10, 12, 14, and 15. Total the points.

A score of 5 or more points raises the possibility that you have major depression and that you should certainly consider consulting with a health care provider. You can find out more about the scale and other related information from the Geriatric Mental Health Foundation.

Depression in the elderly is not inevitable. More than that, it's abnormal. Only when we take depression in elderly people seriously can we start to see it as a problem and make sure that it is effectively treated.