SUMMARYDepression is an illness that kills. The links between depression and medical illness are well established and bi-directional, but evidence is mounting that depression increases mortality as well as morbidity in adults, particularly older adults. We examine the evidence that the increase in mortality in depression applies to all-cause mortality as well as cardiac mortality, and describe plausible physiological theories for the association. We conclude that excess mortality arising from depression is a major public health problem that is largely unrecognised and needs to be addressed by a range of clinicians.

Patients tend to get referred to psychogeriatricians late in the course of a dementing illness, often when a crisis has occurred and carers can no longer cope. Earlier referral is disirable, but generates extra work for the psychogeriatrician. Nurse screening may overcome this. In this study a nurse, trained in the administration of the CAMDEX structured interview and supervised by a psychogeriatrician, performed a diagnostic assessment on patients with early cognitive impairment referred from primary care. This initial phase of the study sought to validate the nurse's assessment, and found that in 33 patients with possible early cognitive impairment, there was good broad agreement between the nurse's diagnosis and a psychogeriatrician's diagnosis supported by standardized rating scales. Nurse screening may be a cost‐effective means for a secondary care psychogeriatric service to provide support to general practitioners, form a case register of patients with early dementia, and follow these patients through as their dementia progresses.

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Aims and MethodThe aim of this study was to explore older users' and carers' views of attending out-patient clinics for older adults. A questionnaire was designed to be distributed to all patients attending out-patient clinics for a period of 1 month in January 2007.ResultsThe response rate for returning the completed questionnaire was 71%, and 95% of these respondents were satisfied with their overall experience of attending out-patient clinics. Although satisfaction levels were high with every aspect of out-patient clinics, 49% preferred the hypothetical option of being seen at home.Clinical ImplicationsThe role of psychiatric out-patient departments for older adults merits further research, comparing cost and user/carer acceptability with home or general practitioner surgery-based treatment.

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