Resources for the Comprehensive Geriatric Assessment based
Proactive and Personalised Primary Care of the Elderly

Depression

depression

Depression in older people has a prevalence of 5-10% over those aged over 65, but is frequently under-recognised. 

It is associated with higher morbidity and poorer outcomes from physical illness. 

Older people under-report symptoms of depression, and may attribute them to the effects of ageing. 

Somatic symptoms are more common than in younger people with depression.

GDS

Geriatric Depression Scale

Evaluation of depression in the elderly

GDS-4 : suitable as a screening test for depressive symptoms in the elderly (3 min)

GDS-15 : ideal for evaluating the clinical severity of depression, and for monitoring treatment. (10min.)

GDS-30 : the original full length GDS (20 min)

Hamilton Rating Scale

HDRS (HAM-D) Hamilton Depression Rating Scale

Evaluation for signs of depression

10-20 min.

HARS (HAM-A) Hamilton Anxiety Rating Scale

Rate the severity of a patient's anxiety

The scale predates the current definition of generalized anxiety disorder (GAD). However, it covers many of the features of GAD and can be helpful also in assessing its severity. The major value of HAM-A is to document the results of pharmacotherapy or psychotherapy, rather than as a diagnostic or screening tool.

15-20 min.

PHQ-9

Patient Health Questionnaire 9

Tool for reaching a tentative diagnosis of depression and assessment of its severity.

15-20 min.

GAD-7

Generalised Anxiety Disorder 7 Item Questionnaire

Brief screening questionnaire for generalized anxiety disorder.

5 min.

DSM-IV Criteria for Depression

 

  • Depressed mood or a loss of interest or pleasure in daily activities for more than two weeks that represents a change from the person's baseline.

 

  • Specific symptoms, present nearly every day (*must be present)

     1. Depressed mood or irritable most of the day, nearly every day, as indicated by either subjective report (e.g., feels

sad or empty) or observation made by others (e.g., appears tearful).*

     2. Decreased interest or pleasure in most activities, most of each day*

     3. Significant weight change (5%) or change in appetite

     4. Change in sleep: Insomnia or hypersomnia

     5. Change in activity: Psychomotor agitation or retardation

     6. Fatigue or loss of energy

     7. Guilt/worthlessness: Feelings of worthlessness or excessive or inappropriate guilt

     8. Concentration: diminished ability to think or concentrate, or more indecisiveness

     9. Suicidality: Thoughts of death or suicide, or has suicide plan

 

  • Subthreshold depressive symptoms: Fewer than 5 symptoms of depression.
 
  • Mild depression: Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.
 
  • Moderate depression: Symptoms or functional impairment are between 'mild' and 'severe'.

 

  • Severe depression: Most symptoms, and the symptoms markedly interfere with functioning. Can occur with or without psychotic symptoms.

 

  • Note that a comprehensive assessment of depression should not rely simply on a symptom count, but should take into account the degree of functional impairment and/or disability.

 

  • The use of a validated measure is recommended to evaluate the impact of treatment.

Assessment

 

The 4 questions Geriatric Depression Scale (GDS-4) provides a quick and reliable screen for depression.

  1. Are you basically satisfied with your life?

  2. Do you feel that your life is empty?

  3. Are you afraid that something bad is going to happen to you?

  4. Do you feel happy most of the time?

One point is allocated for a negative answer to question 1 and 4, and for a positive answer to question 2 and 3.

Where 2 to 4 fpoints are scored, depression is highly likely and should be investigated further. 

The 15 questions Geriatric Depression Scale (GDS-15) is ideal for evaluating the clinical severity of depression, and for monitoring treatment.

The 30 questions Geriatric Depression Scale (GDS-30) is the original full length GDS, requiring approximately 20 minutes to administer and score.

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Depression is one of 4 sub-domains of the

Psychological Assessment

Back To : Psychological Assessment

doctor and patient

The Psychological Assessment is one of 8 domains of the

Comprehensive Geriatric Assessment (CGA)

Back To : Comprehensive Geriatric Assessment