updated 3:50 p.m. ET July 13, 2008

Amy Caldwell first sensed that her mother was depressed during a phone call last September. "My life is miserable," said the 77-year-old widow, who lives in Tempe, Ariz., and suffers from asthma. "I don't want to live any longer."

Caldwell's heart sank. Was this a genuine suicide threat? Caldwell, 43, who lives in Boston, decided not to take a chance and flew out to see her mom. She set up appointments with a family physician and pulmonologist, who put her mother on a new regimen that eased her breathing problems for a couple of months. But then her mother suffered another attack and, during a dispiriting phone conversation with Caldwell's brother, dropped another bomb: "I should just get a razor, slit my wrists, and get this over with already."

This time, Caldwell's brother hopped on a plane, while Caldwell contemplated the inescapable truth: In addition to the physical ailments her mother suffered from, she was very likely depressed.

That put her mom in the company of 2 million other Americans over age 65 who suffer from depression , as well as another 5 million who struggle with some but not all symptoms of the crippling disease. Their plight is one of the great hushed-up scandals of American health care:

As many as 90 percent of people suffering from depression in late life are not getting the care they need. The suicide rate in adults age 75 and older is a shocking 1 1/2 times the average — higher than that of any other group, including teenagers.

Elderly people receiving home care are twice as likely to suffer major depression as those in nursing homes. A whopping 78 percent of them receive no treatment at all. Patients diagnosed with major depression spend almost twice as much money on their health care as patients who don't have the disease.

The emotional devastation of depressed seniors is particularly heartbreaking, for their suffering stands in stark contrast to the contentment and satisfaction enjoyed by the rest of their peers: Recent research shows that the happiest Americans are the oldest — their days typically filled with the joys of travel and recreation, grandchildren, introspection, and other well-earned pleasures. An elderly parent's mental illness wreaks havoc on other family members as well: Caldwell joined the millions of adult children , most of them women, who must grapple with their parent's torment and help them find relief from a condition that's as difficult to treat as it is to identify. But relief can be found: Caldwell managed to locate a psychiatrist who specialized in depression among the elderly; within weeks, her mother felt her spirits lift, thanks to the salubrious effects of an antidepressant.

If you suspect that your parent needs help, you'll need to learn how to spot early but subtle cues, educate yourself about treatment options, and create a social support system for your parent — often from afar — to turn her life around. It's not a simple task, but it's eminently doable. Here's how.

• Know the warning signs
• Get her the help she needs
• Develop a support system

Know the warning signs
In the absence of a glaring harbinger like a suicide threat, depression among the elderly often slips under doctors' — and adult children 's — radar for several reasons: It's usually entangled with physical ailments (such as asthma, arthritis or chronic obstructive pulmonary disease) and cognitive problems (such as dementia). The multiple medications many older people take can often cause side effects that mask underlying depression. Few psychiatrists are well versed in mood disorders that affect the elderly, and geriatricians (doctors who specialize in treating this age group) are scarce. Many seniors are also stigmatized by mental illness and try to cover up their symptoms. Finally, late-life depression doesn't always resemble the disorder in younger people. "We associate depression with crying and chronic sadness," says clinical psychologist Donna Rasin-Waters, Ph.D., who co-chairs a public policy committee for the American Psychological Association's Society of Clinical Geropsychology. "But a lot of depressed older adults will tell you that they don't feel blue."

Depression triggers, too, can be different from those that afflict younger people. Be on the lookout for mood changes if your parent relocates, suffers a loss of status (by forced retirement, for instance) or independence (she can no longer drive), or experiences a decline in physical ability. Although the death of a spouse understandably results in much sadness, grief that lasts longer than a year may indicate the need for intervention.

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