depression should be considered in any older patient who is agitated but has no cognitive impairment. The major exception to this guideline is a diagnosis of adjustment disorder based on documentation of some life disturbance occurring within the past six months. "This would seem to be a safe approach to diagnosis, given epidemiologic data showing the prevalence of agitated depression in the elderly and the predilection for most anxiety disorders to present much earlier in life" (Reynolds, 1995, p. S14).
Diagnosis problems also may occur in relation to the issue of sleep disturbances as a depressive symptom (Reynolds, 1995, pp. S6-S15). Although early morning awakening is prevalent among elderly patients who are depressed, this behavior may not reflect a change in the normal sleep pattern for the individual patient. The clinician must ascertain whether an apparent sleep disorder actually represents a change in functioning for the individual elderly patient before a diagnosis of depression is m
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