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Depressive disorders are common among acutely medically ill elderly in-patients, but treatment and prognosis are poor. Due to the current demographic changes and alterations in the working practices of the geriatricians in the UK a study of prevalence, correlates and longitudinal stability of depression in medically ill elderly inpatients was undertaken. All consecutive acute admissions over a five-month period, without significant cognitive impairment, to a geriatric medicine unit were screened for depression with the Brief Assessment Schedule (BAS). Potential correlates of depression were measured by the Beck Scale for Suicidal Ideation scale (BSSI), the London Handicap Scale (LHS), the Barthel Index (BI) and the severity of physical illness (IPI). These patients were followed-up at a six-to-eight month interval and all instruments were administered again.The prevalence of depression in acutely medically ill elderly inpatients was 33%. Depression was associated with previous deliberate self-harm, severity of physical illness, higher BSSI scores, prescription of a psychotropic drugs, including antidepressants. Almost half of the depressed cases either had died or persisted as being depressed at follow-up.There is scope to improve treatment of depression in this setting. The efficacy of treating physical illness in improving depression requires evaluation.