Geriatric Depression Scale

The Geriatric Depression Scale is a yes or no questionnaire designed to screen for depression in older adults. The original version has 30 items, and a short form has 15 items. It avoids somatic symptoms that overlap with normal ageing and medical illness.

It is used in primary care, hospital, community and care home settings. It is a screening tool, and a raised score requires clinical assessment for diagnosis.

Usage. It is used when low mood, withdrawal, weight loss or cognitive complaints are noticed in an older adult.

Indications. Screening for depression in adults aged 65 and over, and monitoring of response over time.

Preparation and technique. The patient answers each question yes or no about how they have felt over the past week. The questionnaire can be self-completed or read aloud. Answers keyed in the depressed direction are scored 1, giving a total of 0 to 30, or 0 to 15 for the short form.

Contraindications and precautions. Moderate to severe cognitive impairment limits reliability, and an informant rated scale is used in these cases.

Interpretation.

• On the 30-item scale, 0 to 9 is normal, 10 to 19 indicates mild depression, and 20 to 30 indicates severe depression.
• On the 15-item scale, a score of 5 or more suggests depression and warrants assessment, with a higher score indicating greater severity.
• Thresholds vary between services, and the local validated cut off is applied.

Causes of a raised score. Depressive disorder, early dementia, grief, chronic illness, social isolation, and medicines such as beta blockers and corticosteroids.

Critical values and findings needing immediate action.

• Thoughts of suicide or self-harm require a same day risk assessment.
• Refusal of food or fluids, or severe psychomotor retardation, requires urgent medical review.

Limitations and artefacts. Cognitive impairment reduces reliability, and depression in dementia may be missed. Denial and stigma reduce the accuracy of answers. The scale is not a diagnostic instrument.

Follow up tests. A clinical interview, cognitive screening, thyroid function tests, vitamin B12 and folate, full blood count, urea and electrolytes, and calcium.

Special groups. Patients with dementia are assessed with an informant rated tool. Very old adults and those in care homes may have different baseline scores.