WHY: Depression and depressive symptoms are common in older adulthood and not a natural part of aging. The prevalence of depressive symptoms that do not meet the criteria for major depressive disorder defined by The Diagnostic and Statistical Manual of Mental Health Disorders, 5^th Edition (DSM-5) is significant in older adults with rates reported around 15% (Kennedy, 2022). Major depression has been identified in 6%-10% of older adults in primary care clinics, 12%-20% of nursing home residents, and 11%-45% of hospitalized older adults (Kennedy, 2022). Minor depression in outpatient medical settings varies with reported rates of 8% to over 40% (GNRS). In mental health settings, major depressive disorder is the most common diagnosis seen among older adults and accounts for over 40% of outpatient caseloads and inpatient psychiatric admissions (Kennedy, 2022). Depression is more common in those with multiple chronic conditions.

Risk factors for depression and access to mental health services may vary in older people from ethnic minority populations compared to Whites. Depression is often reversible with prompt recognition and appropriate treatment. However, if left untreated, depression may result in the onset of physical, cognitive, functional, and social impairment, as well as decreased quality of life, delayed recovery from medical illness and surgery, increased health care utilization, and suicide.

BEST TOOL: While there are many instruments available to measure depression, the Geriatric Depression Scale (GDS), first created by Yesavage, et al., has been tested and used extensively with the older population. The GDS Long Form is a brief, 30-item questionnaire in which participants are asked to respond by answering yes or no in reference to how they felt over the past week. A Short Form GDS consisting of 15 questions was developed in 1986. Questions from the GDS Long Form which had the highest correlation with depressive symptoms in validation studies were selected for the short version. Of the 15 items, 10 indicated the presence of depression when answered positively, while the rest (question numbers 1, 5, 7, 11, 13) indicated depression when answered negatively. Scores of 0-4 are considered normal, depending on age, education, and complaints; 5-8 indicate mild depression; 9-11 indicate moderate depression; and 12-15 indicate severe depression. The GDS Short Form is more easily used by physically ill and mildly to moderately persons with dementia who may have short attention spans and/or feel easily fatigued. It takes about 5 to 7 minutes to complete.

TARGET POPULATION: The GDS may be used with healthy, medically ill and mild to moderately cognitively impaired older adults. It has been extensively used in community, acute care, and long-term care settings.

VALIDITY AND RELIABILITY: The GDS was found to have a 92% sensitivity and an 89% specificity when evaluated against diagnostic criteria. The validity and reliability of the tool have been supported through both clinical practice and research. In a validation study comparing the Long and Short Forms of the GDS for self-rating of symptoms of depression, both were successful in differentiating depressed from non-depressed adults with a high correlation (r = 0.84, p < .001) (Sheikh & Yesavage, 1986).

STRENGTHS AND LIMITATIONS: The GDS is not a substitute for a diagnostic interview by mental health professionals. It is a useful screening tool in the clinical setting to facilitate assessment of depression in older adults especially when baseline measurements are compared to subsequent scores. It does not assess for suicidality.

FOLLOW-UP: The presence of depression warrants prompt intervention and treatment. The GDS may be used to monitor depression over time in all clinical settings. Any positive score above 5 on the GDS Short Form should prompt an in-depth psychological assessment and evaluation for suicidality.

MORE ON THE TOPIC:

Best practice information on care of older adults: HIGN

The Stanford/VA/NIA Aging Clinical Resource Center (ACRC) website. Retrieved September 10, 2022, from https://web.stanford.edu/~yesavage/ACRC.html. Information on the GDS. Retrieved September 10, 2022, from https://web.stanford.edu/~yesavage/GDS.html.

Koenig, H.G., Meador, K.G., Cohen, J.J., & Blazer, D.G. (1988). Self-rated depression scales and screening for major depression in the older hospitalized patient with medical illness. JAGS, 36, 699-706. https://doi.org/10.1111/j.1532-5415.1988.tb07171.x

Kennedy, G. J. (2022). Depression and other mood disorders. In B. Resnick (Ed.), Geriatric Nursing Review Syllabus (GNRS) (7th ed.). American Geriatrics Society.

Sheikh, J.I., & Yesavage, J.A. (1986). Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. In T.L. Brink (Ed.),

Clinical Gerontology: A Guide to Assessment and Intervention (pp. 165-173). The Haworth Press, Inc.

Yesavage, J.A., Brink, T.L., Rose, T.L., Lum, O., Huang, V., Adey, M.B., & Leirer, V.O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 37-49. https://doi.org/10.1016/0022-3956(82)90033-4