Old age is often a time of loss: of physical health, sensory capacity, cognitive function, independence, work, income and social support. The diagnosis of anxiety and depression in older patients is difficult. There is a complex relationship between depression and physical illness, there is uncertainty regarding diagnostic criteria and the PHQ-9 should probably not be used. We are more likely to recognise late life anxiety and depression if we are aware of the risk factors and the less obvious ways in which patients can present.