Depression has become one of the most serious diseases threatening human health, its total disease burden is second only to cardiovascular disease, depression is a common mental illness in old age (Shanghai survey data show the prevalence rate of 6.8-12.9%), which seriously affects the physical and mental health of the elderly, making it impossible for them to live a normal life, and also reduces the quality of life of their families. The elderly depression patients are often neglected and misdiagnosed, because the elderly depression patients often do not highlight the depressed mood, bad mood, but more physical discomfort: such as loss of appetite, poor sleep, chest tightness, anxiety and irritability, fatigue, memory loss, slow behavior and other symptoms, the elderly often think they have a physical disease, will not think of mood disorders, so repeatedly to the hospital The elderly often think they are suffering from physical illnesses and do not think it is a mood disorder, so they repeatedly go to the hospital to see the doctor and prescribe medicine to eat, but they do not see any significant improvement in their condition. At the same time, it is easy to be ignored by family members and people around them as a normal manifestation of aging. Mrs. Wang, 72 years old, became inactive in the past six months, her movements were slow and stiff, and it took a long time to complete few household chores, and she did not like to speak actively. When I saw this patient, I found that when I mentioned her partner, the patient had tears in her eyes, and only after repeated questioning did she say that she couldn’t do many things by herself, couldn’t remember how to do them, her mind was blank, she couldn’t take care of her partner, and was sorry for her partner. It turned out that her partner had a cerebrovascular accident and was bedridden. This is a not uncommon form of depression in the elderly, and through antidepressant medication, Mrs. Wang recovered completely. Due to old age and frailty, family members and doctors pay more attention to the physical symptoms of patients, while emotional disorders are easily overlooked, especially in patients who present with delayed depression, such as Ms. Wang, whose depressive symptoms are masked by physical symptoms due to behavioral blockage, lack and slowing of random movements, and reduced somatic and physical activities, and are more likely to be misdiagnosed as Parkinson’s disease. Agitated depression is also common in the elderly and increases with age. There is no cause for restlessness, bewilderment, anxiety and fear, and a constant fear that misfortune will befall them and their families and that a great disaster will befall them, and in severe cases, they rub their hands and feet, and sit and sleep in fear. Chattering, often remembering some unpleasant past events. One old man was worried all day about his grandson being kidnapped, and he was not well, but he made four round trips to pick up his grandson every day, rain or shine, and often called his child’s school to find out what was going on. The son and daughter-in-law returned late from work, worried about a car accident. He is not interested in anything else in the environment, and people or things he used to like are now uninteresting, and he is reluctant to interact with other people. Patients often deny that they are depressed, but blame themselves for doing something wrong, fear causing misfortune to family members and others, and in severe cases, attempt suicide. About 1/3 of elderly patients with depression have hypochondriasis as their first symptom. The suspicion often involves multiple systems such as insomnia, headache, chest pain, back pain, abdominal pain and generalized pain, chest tightness, palpitations, anorexia, stomach and abdominal discomfort, bloating, constipation, dry mouth, hand tremors, sweating, and generalized weakness. Sleep disorder is the most common symptom and often becomes the main complaint of patients. Patients have difficulty falling asleep, wake up easily from light sleep, often wake up early, and have difficulty falling back to sleep after waking up, while a few patients show excessive sleep, sleep all day, and still feel tired and fatigue after waking up. Some patients also feel poor mood and can’t take interest in anything, but tend to attribute their low mood to somatic problems. Patients repeatedly undergo multiple examinations of various systems, and geriatric depression should be considered when multiple examinations do not reveal obvious organic lesions. After retiring at the age of 60, Ms. Li went abroad to help her son and daughter-in-law bring up her grandchildren. After staying abroad for only three months, she felt listless all day long, with chest tightness and palpitations, back pain, sleepiness and fatigue, wanting to sleep and not being able to sleep, poor appetite, feeling of fullness in the upper abdomen, uncomfortable top of the chest, dry mouth and constipation, suspecting that she had a serious illness, and returned home for a comprehensive physical examination, which did not reveal any major problems. She was afraid that the doctor and her family would hide it from her. This is a typical case of geriatric depression in which the first symptom is suspicion of illness due to physical discomfort. Old age is a special period of life, due to psychological and physiological changes, the ability of the elderly to adapt to life, tolerance is weakened, it is difficult to adapt to the new environment, life events that are not serious to young people, the elderly hit hard, easy to induce depression. There are also some elderly depression patients who are not identified and treated in the early stage, and when the disease develops to a serious stage, there is memory loss, intellectual impairment, thinking inhibition similar to the performance of Alzheimer’s disease, for such patients, special attention should be paid to identify the “fake dementia real depression” situation, so as not to delay the disease, delay the treatment, and affect the recovery. Zhang Lao, 92 years old, his family found that in the past six months, he has become less interested in reading books and newspapers, and does not watch TV, and he does not participate in the family talk about current affairs and news, which was not the case before. The son once told his family that it seemed that his father was really old and might have Alzheimer’s disease. Until one day the old man said to himself, “It would have been better to leave earlier, it’s so meaningless to live”. Only then did the family pay attention to him. After a detailed psychiatric examination, he was diagnosed with geriatric depression, and after two months of treatment with antidepressants, a dramatic change occurred, as he regained his pre-morbid attitude of laughing and talking freely, and his life returned to its former vibrant trajectory. In general, the clinical manifestations of geriatric depression and ordinary depression are not quite the same, atypical and very easy to be ignored. Children should pay attention to the psychological condition of their parents while caring for and paying attention to their physical body, and detect psychological problems of the elderly as early as possible for early treatment. The treatment of geriatric depression is mainly antidepressant medication and adjunctive psychotherapy. Surveys show that only 10-40% of elderly depressed patients receive regular medication. Current antidepressants are slow to take effect, generally taking 2 weeks before symptoms improve, and some take 8 weeks to achieve clinical efficacy, and maintenance treatment is still needed for at least 6-12 months after symptoms are completely relieved, with the aim of preventing relapse. Patients and family members often take a chance and do not adhere to the medication to consolidate the treatment, resulting in relapse of the disease. Psychological counseling should generally be carried out by specialized medical personnel or psychologists, while family members should actively cooperate, mainly by providing supportive psychotherapy, comforting, persuading, guiding and encouraging patients, helping them to relieve the burden of mental stress and improving their understanding and adaptability. Another point that needs to be paid great attention is that the risk of suicide in elderly depression is much greater than in other age groups, the suicide rate of depression is about 15% and that of geriatric depression is up to 25%, therefore, patients with geriatric depression should be more supervised and prevented from committing suicide. Prevention of geriatric depression should be carried out from three aspects: personal, family and social. Older people should enrich their daily life, learn more new knowledge and develop new hobbies. They should also learn to talk to their children or friends about any unpleasant things in their hearts. As children, we should try our best to maintain a harmonious atmosphere in the family, show more care and support among family members, listen patiently to our parents’ nagging, chat with them more often, and give them psychological support and comfort. The elderly are prone to feelings of loneliness and uselessness. The whole society should pay attention to and respect the elderly and give them more care and help.