The Geriatric Depression Scale by Lenore Kurlowicz,
Depressionis commonin late life, effectingnearly5 million of the 3 1 million Americansaged65 and older, Both major and minor depressionare reportedin 13%of community dwellingolder adults,24% of older medicaloutpatients,and 43% of both acutecareand nursinghome-dwelling older adults.Contraryto popularbelief, depressionis not a natural part of aging.Depressionoften is reversible with prompt and appropriatetreatment.However,if left untreated, depressionmay resultin the onsetof physical,cognitive,and socialimpairment and delayedrecoveryfrom medical illnessand surgery,increased healthcareutilization,and suicide. WHY
BEST TOOL: While there are many instrumentsavailableto measure depression,the GeriatricDepression Scale(GDS),first createdby Yesavage et al., hasbeentestedand usedextensivelywith the older population.It is a brief questionnairein which participants are askedto respondto the 30 questionsby answeringyesor no in referenceto how they felt on the day of
76 n Home Care Provider
administration.Scoresof 0 to 10 are considerednormal, 11 to 20 indicate mild depression,and 21 to 30 indicate severedepression. TARGET POPULATION: The GDSmay be usedwith healthy,medicallyill, and mild to moderatelycognitivelyimpairedolder adults.It hasbeenused extensivelyin community,acute,and long-term caresettings.
The GDSwas found to havea 92% sensitivity and a 89% specificitywhen evaluatedagainst diagnosticcriteria. The validity and reliability of the tool havebeensupported through both clinical practice and research. VALIDITY/RELIABILIT
STRENGTHS
AND LIMITATIONS:
The GDSis not a substitutefor a diagnostic interview by mental health professionals.It is a usefulscreeningtool in the clinical settingto facilitate assessmentof depressionin older adults,especiallywhen baselinemeasurementsare comparedwith subsequent scores.
PhD, RN, CS
MORE ON THE TOPIC:
KoenigHG, MeadorKG,CohenJJ, BlazerDG. Self-rateddepressionscales and screeningfor major depressionin the older hospitalizedpatient with medicalillness.J Am Geriatr Sot 1988:699-706.
KurlowiczLH, NICHE Faculty. Nursingstandor practiceprotocol: depressionin elderlypatients.Geriatr Nurs 1997;18:192-9. NIH ConsensusDevelopment Panel.Diagnosisand treatmentof depressionin late life. JAMA 1992;268:1018-24. SheikhRL,Yesavage JA.Geriatric DepressionScale(GDS):recentevidenceand developmentof a shorter version.Clinical Gerontologist 1986;5:165-73. Yesavage JA,Brink TL, RoseTL, Lum 01,HuangV,Adey M, et al. Developmentand validationof a geriatric depressionscreeningscale:a preliminary report.J PsychiatrRes 1983;17:37-49.
Directions to Patient: Pleasechoosethe best answerfor how you havefelt over the past week. Directions to Examiner: PresentquestionsVERBALLY.Circle answergivenby patient. Do not show to patient. 1.Are you basicallysatisfiedwith your life? .......................................
.yes
no (1)
2. Haveyou dropped many of your activities and interests? ..........................
.yes(1)
no
3.Doyoufeelthatyourlifeisempty?
yes(I)
no
4.Doyouoftengetbored? ......................................................
yes(l)
no
5. Are you hopeful about the future? .............................................
.yes
6. Are you botheredby thoughtsyou can’tget out of your head?.......................
.yes(I)
no (1) no
.............................................
7.Areyouingoodspiritsmostofthetime?
........................................
8. Are you afraid that somethingbad is going to happen to you? ...................... 9.Doyoufeelhappymostofthetime?
............................................
yes .yes(I) yes
no (1) no
.yes(1)
no (1) no
yes(l)
no
12.Do you prefer to stay at home rather than go out and do things? ....................
.yes(1)
no
13.Do you frequentlyworry about the future? ......................................
.yes(1)
no
14.Do you feel you havemore problemswith memory than most? .....................
.yes(1)
no
15.Do you think it is wonderful to be alive now? ....................................
.yes
16.Do you feel downheartedand blue? ............................................
.yes(1)
no (1) no
17.Do you feel pretty worthless the way you are now? ................................
.yes(1)
no
yes(l)
no
.yes yes(l)
no (1) no
21. Do you feel full of energy? ...................................................
.yes
no (1)
22. Do you feel that your situation is hopeless?......................................
.yes(1)
no
23. Do you think that most peopleare better off than you are? .........................
.yes(1)
no
24. Do you frequently get upset over little things? ...................................
.yes(1)
no
25. Do you frequently feel like crying? .............................................
.yes(1)
no
26. Do you havetrouble concentrating?............................................
.yes(1)
no
27. Do you enjoy getting up in the morning? .......................................
.yes
28. Do you prefer to avoid social occasions?........................................
.yes(1)
no (1) no
29. Is it easyfor you to make decisions? ...........................................
.yes
no (1)
yes
no (1)
lO.Do you often feel helpless?................................................... ll.Doyouoftengetfidgetyandrestless?
...........................................
.............................................
lS.Doyouworryalotaboutthepast?
19.Do you find life very exciting? ................................................ 20.Isithardforyoutogetstartedonnewprojects?
30.Isyourmindasclearasitusedtobe?.
..................................
..........................................
TOTAL: Pleasesum all answersworth one point for a total score. Scores:0 to 10: normal
11 to 20: moderate depression
21 to 30: severedepression
Format modifiedslightlyfiorn Yesavage JA,Brink TL, RoseTL, Lum 0, Huang KAdey M, et al. Developmentand validation of a geriatric depressionscreeningscale: a preliminary report.J PsychiatrRes1983;17:37-49. Reprintedwith permissionfrom ElsevierScience.