In assessing major depression in elderly home care patients, the study hoped to determine the treatment needs
of this large and growing patient population. Intensive diagnostic procedures were chosen to address the difficulties of accurately diagnosing depression in the elderly and
medically ill. On the one hand, depression can be underestimated because many older adults minimize psychological symptoms and attribute sleep disturbances,
fatigue, and other somatic symptoms of depression to
physical health causes (51, 52). On the other hand, the
prevalence of major depression can be inflated in medically ill populations by misattributing symptoms of medical illness, medication side effects, or treatment sequelae
to depression. Because we chose methods designed to
minimize both potential sources of diagnostic measurement error, we believe that the estimated prevalence of
major depression has clinical significance in this sample.