A prospective evaluation of the Geriatric Depression Scale in an outpatient geriatric assessment center.

OBJECTIVE: To prospectively evaluate the Geriatric Depression Scale (GDS) in cognitively intact and impaired patients undergoing outpatient geriatric assessment. SUBJECTS: One hundred ninety-four geriatric patients evaluated in a 1-year period. SETTING: The outpatient Geriatric Assessment Center of the University of Nebraska Medical Center. MEASUREMENTS: The 30-item GDS was completed by all patients. The patients were then evaluated by one of three geriatric psychiatrists who were blind to the GDS results. The prospective clinical diagnosis of major depression was compared to the GDS results. Patients were categorized as cognitively impaired or intact on the basis of the Mini-Mental State Examination. Data were analyzed using ROC curves. An optimal cutoff was identified which was the total score on the GDS with the highest combined sensitivity and specificity. RESULTS: ROC curve analyses showed good agreement between the clinical diagnosis and the GDS in both cognitively intact and impaired subjects. Cognitively intact, euthymic patients reported a mean of 8.4 symptoms, while cognitively impaired, euthymic patients, reported a mean of 8.7. Cognitively intact, depressed patients reported a mean of 14.7 symptoms, while cognitively impaired, depressed patients reported a mean of 15.0. CONCLUSIONS: This study provides further evidence that the GDS is as accurate a screening test for depression in cognitively impaired as in intact patients.     

Validation of the five-item geriatric depression scale in elderly subjects in three different settings

OBJECTIVES: To test the effectiveness of a five-item version of the Geriatric Depression Scale (GDS) for the screening of depression in community-dwelling older subjects, hospitalized older patients, and nursing home residents. DESIGN: A cross-sectional study. SETTING: A geriatric acute care ward, a geriatric outpatient clinic, and a nursing home. PARTICIPANTS: One hundred eighty-one cognitively intact older subjects. MEASUREMENT: All the participants had a comprehensive geriatric assessment including a neuropsychological evaluation by a geriatrician experienced in the management of depression. The five-item GDS was compared with the 15-item version of the GDS using the clinical diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria as the criterion standard. The sensitivity, the specificity, the overall accuracy, positive and negative predictive values, and positive and negative likelihood ratios were calculated. The agreement between each of two different versions of the GDS and the clinical diagnosis and the test-retest and the interrater reliability of the five-item scale were also evaluated. RESULTS: In the whole sample, 48.1% of the subjects were depressed. The five-item GDS had a sensitivity of 0.94 (0.91-0.98), a specificity of 0.81 (0.75-0.87), a positive predictive value of 0.81 (0.75-0.87), a negative predictive value of 0.94 (0.90-0.97), a positive likelihood ratio of 4.92 (4.39-5.5), and a negative likelihood ratio of 0.07 (0.06-0.08). The five-item GDS and the 15-item GDS showed a significant agreement with the clinical diagnosis of depression (kappa = 0.74 for both scales). The five-item GDS had good interrater reliability (kappa = 0.88) and test-retest reliability (kappa = 0.84). Similar values were obtained in each setting and in both sexes. CONCLUSION: The five-item GDS is as effective as the 15-item GDS for the screening of depression in cognitively intact older subjects.     

Use of the 5-Item Geriatric Depression Scale in Demented Individuals and with Psychiatric Outpatients

Abstract

The effectiveness of the new 5-item version of the Geriatric Depression Scale (GDS) was assessed using archival data from 143 (71% women) discharged depressed psychiatric patients and 167 (51% women) demented individuals in the early stages of dementia of the Alzheimer type. Receiver-operating characteristic (ROC) curves analyses using a cut score of 2 indicated that the 5-item GDS is appropriate for use with both men and women after hospitalization for severe depression (area under the curve = .89 for the total sample). It is less useful with demented individuals (area under the curve = .68 for total sample).     

Validation of the Geriatric Depression Scale Among Nursing Home Residents

The Geriatric Depression Scale has been found to be a helpful screening instrument for depression among psychiatric and community elderly, but has never been validated among elderly nursing home residents. The reliability and validity of the Geriatric Depression Scale was examined among 51 nursing home residents. Reliability was assessed using several methods and was found to be acceptable. Validity was established using the Research Diagnostic Criteria for Major Depression as the classification criterion. The Geriatric Depression Scale significantly differentiated between residents with (a) no depression, (b) depressive features, and (c) Major Depression. Using recommended cutoff scores, the sensitivity rate for the Geriatric Depression Scale was 100 percent for residents with Major Depression. The results indicate that the Geriatric Depression Scale appears to be a helpful screening instrument for depression among nursing home residents.     

Factor Structure of the Geriatric Depression Scale in Cognitively Impaired Older Adults

This study explores the factor structure of the 30-item Geriatric Depression Scale (GDS) obtained from a sample of elderly adults who were diagnosed with some level of cognitive impairment. Principle components analysis obtained a four-factor solution utilizing all 30 GDS items. The derived factors were labeled Dysphoria, Meaninglessness, Apathy, and Cognitive Impairment. Although differences in factor structure were noted, some commonalities exist between this and former factor solutions conducted on healthy elderly populations. Further validation of this factor structure in the cognitively impaired elderly may provide another point of validation during clinical assessment and research when attempting to distinguish between geriatric depression, the onset of dementia, or a combination of these conditions.     

Cognitive impairment and depression predict mortality in medically ill older adults

BACKGROUND: Depression and cognitive impairment are common in medically ill older adults. Few studies, however, have investigated the roles of both in predicting mortality for medically ill older adults. METHODS: We used a cohort of consecutive patients aged 60 or older admitted to a rehabilitation hospital (N = 667) of whom 455 completed a standardized protocol measuring cognition (Dementia Rating Scale), depression (Geriatric Depression Scale), and disabilities (Functional Independence Measure). Burden of medical illnesses was measured with the Charlson Index. Vital status was assessed one year later. RESULTS: Those subjects who did not complete the screening were more likely to die (24% vs 17%; p = .02) during the one-year follow-up. Of those who completed the screening, male sex (odds ratio [OR] = 1.84), depression (mild OR = 1.64; moderate OR = 2.49), and more severe cognitive impairment (OR = 2.13) predicted mortality independent of age, medical illnesses, or disabilities. No interaction of cognitive impairment and depression was detected. In those subjects cognitively intact, moderate depression (OR = 4.95) and male sex (OR = 3.42) were independent risk factors for dying. In those subjects without depression, male sex (OR = 2.24) and elevated Charlson Index (OR = 1.42) predicted mortality. CONCLUSIONS: Depression and cognitive impairment are independent predictors of one-year mortality in this subgroup of medically ill older adults.     

Three-month follow up of patients discharged from a geriatric day hospital

OBJECTIVE: To determine if mobility and functional status of patients attending a geriatric day hospital are maintained three months after discharge. DESIGN: Prospective, before-after, quasi-experimental design. PARTICIPANTS: Community-dwelling elderly referred for comprehensive geriatric assessment and multidisciplinary management. METHODS: All patients who attended a geriatric day hospital for at least 5 visits and discharged between 1 August, 1999 and 1 March, 2000 were eligible (n = 41). Measurements were performed at admission, discharge and three months post-discharge. Data were analyzed using one way repeated measures ANOVA for parametric data and the Friedman-Chi square test for non-parametric data. OUTCOME MEASURES: Barthel Index, Timed Up and Go Test, Berg Balance Scale, Mini-Mental Status Examination, Geriatric Depression Scale. RESULTS: From admission to discharge, significant improvements were seen in Timed Up and Go Test, Berg Balance Scale, and Geriatric Depression Scale (all P相似文献   

The validation of the short form of the Geriatric Depression Scale (GDS) in Greece

The Geriatric Depression Scale-15 (GDS-15) is a short, 15-item instrument specifically designed to assess depression in geriatric populations. Its items require a yes/no response. The Geriatric Depression Scale was first introduced by Yesavage et al. in 1983, and the short form (GDS-15) was developed by Sheikh and Yesavage in 1986. The aim of the current study was the standardization of the GDS-15 for use in Greece. Subjects were divided into Group A: 168 control subjects, and Group B: 103 patients suffering from clinically diagnosed depression. All were over 65 years of age. A score of 6/7 on the GDS-15 was found to be the best cut-off point for diagnosing depression in an elderly Greek population, with Sensitivity = 92.23 and Specificity = 95.24. GDS-15 manifests high internal consistency with Cronbach's alpha = 0.94, and all items seem to be equivalent. Factor Analysis of the GDS-15 revealed 4 factors: a cognitive (thought content), an affective, a functional, and a factor that reflects helplessness and fear for the future. The two diagnostic groups differed on all 4 factors scores at p-value <0.001.     

Doctors' and nurses' observations on the Geriatric Depression Rating Scale

BACKGROUND: Screening older patients routinely for depression using the Geriatric Depression Scale is recommended, but there is little evidence that this practice is widespread. This study explored doctors' and nurses' attitudes towards the Geriatric Depression Scale in order to identify possibilities for improving practice. DESIGN: structured interviews. SETTING: Acute Care of the Elderly wards in the Royal Liverpool University Hospital. PARTICIPANTS: 20 junior doctors and 25 nurses. RESULTS: Only 10% of respondents would consider using the Geriatric Depression Scale for routine screening. Objections were to process as well as content. The Geriatric Depression Scale was felt to be 'too depressing' for routine use and a barrier to rapport with the patient. In addition to screening for possible depression, doctors and nurses expressed different requirements from a depression scale. Doctors wanted a formal method of rating and documenting symptoms. Nurses required a therapeutic structure within which they could help patients to explore feelings. Nurses also wanted the option of offering counselling for their patients but felt they needed training. CONCLUSIONS: Lack of enthusiasm for the Geriatric Depression Scale reduces its usefulness as a screening tool. A screening method that is more acceptable to nurses and doctors might improve depression screening practice.     

Validity and reliability of the screening questionnaire for geriatric depression used in the Mexican Health and Age Study

OBJECTIVE: To assess the validity and reliability of a geriatric depression questionnaire used in the Mexican Health and Age Study (MHAS). METHODS: The study was conducted at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ) clinic from May 2005 to March 2006. This depression screening nine-item questionnaire was validated using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (fourth revised version) and Yesavage's 15-item Geriatric Depression Scale (GDS-15) criteria. The instrument belongs to the MHAS, a prospective panel study of health and aging in Mexico. RESULTS: A total of 199 subjects 65 years of age and older participated in the validation process (median age= 79.5 years). MHAS questionnaire result was significantly correlated to the clinical depression diagnosis (p<0.001) and to the GDS-15 score (p<0.001). Internal consistency was adequate (alpha coefficient: 0.74). The cutoff point > or = 5/9 points yielded an 80.7% and 68.7% sensitivity and specificity respectively. The fidelity for the test retest was excellent (intra-class correlation coefficient= 0.933). Finally, the Bland and Altman agreement points indicated a difference 0.22 percent points between test retest. CONCLUSION: The MHAS questionnaire is valid and trustworthy, and allows screening in the research field for the presence of depression in the elderly.     

Psychometric properties of the 15-item geriatric depression scale in functionally impaired, cognitively intact, community-dwelling elderly primary care patients

OBJECTIVES: To examine the psychometric properties of the 15-item Geriatric Depression Scale (GDS-15), a brief depression screening measure. DESIGN: Cross-sectional. SETTING: Nineteen counties in western New York, West Virginia, and Ohio. PARTICIPANTS: Nine hundred sixty functionally impaired, cognitively intact, community-dwelling primary care patients aged 65 and older. MEASUREMENTS: The GDS-15, major depression as measured using the Mini-International Neuropsychiatric Interview, depressed mood, life satisfaction, suicidal ideation, and reported suicide attempts. RESULTS: Exploratory factor analyses suggested a two-factor structure for the GDS-15 in this category of patients, with component subscales assessing depression and positive affect. Cronbach alpha coefficients provide evidence for moderate, although acceptable, internal consistency reliability. Significant associations between the GDS-15 and measures of depressed mood, life satisfaction, and suicidal ideation demonstrated construct validity, whereas acceptable sensitivity and specificity to discriminate between depressed and nondepressed patients demonstrated criterion validity. Internal consistency reliability and construct validity did not differ significantly between patients with low and high functional impairment. A significant weakness of the scale is its low correlation with suicide attempt status. CONCLUSION: In general, this study provides evidence of impressive psychometric properties of the GDS-15 when administered to a sample of functionally impaired, cognitively intact, community-dwelling primary care patients.     

Behavioral Activation as a Treatment for Geriatric Depression

By encouraging older adults to become more active, behavioral activation (BA) may help reduce depressive symptoms brought on by activity restriction. The purpose of this study was to determine, through a multiple-baseline design, whether BA could be successfully applied to older adults with depression. Nine depressed older adults (M = 75 years of age) underwent a course of in-home BA therapy (mean number of sessions = 14.7). Overall, participants' Geriatric Depression Scale and Hamilton Rating Scale for Depression scores decreased from pre- to post-treatment, and 71% of participants no longer met criteria for a depressive disorder. Behavioral activation shows promise as a treatment for geriatric depression.     

Entwicklung eines neuen Depressionsscreenings für den Einsatz in der Geriatrie

Purpose

The purpose of the study was to develop and validate the depression in old age scale (DIA-S). The DIA-S is a new screening scale for depression, which is comparable to the GDS-15 in terms of practicality but which is more appropriate for the use in geriatric patients.

Methods

The DIA-S and the GDS-15 were validated among a sample of n=331 geriatric inpatients (n=151 depressed subjects and n=180 not depressed subjects), using the Montgomery and Asperg Depression Rating Scale as gold standard criterion for depression. For the comparison of the two scales, item analysis (missing values, difficulty, discriminatory power) was considered as well as test performance (internal consistency, correlation with the MADRS, ROC curves, sensitivity, specificity).

Results

All outcomes indicate a good psychometrical quality of the DIA-S. The new instrument showed a considerably higher discriminatory power for the items internal consistency and test specificity than the GDS-15.     

Does a nurse-led mental health liaison service for older people reduce psychiatric morbidity in acute general medical wards? A randomised controlled trial

OBJECTIVE: To determine the clinical effectiveness of a nurse-led mental health liaison service in managing mental health problems in older physically ill inpatients. DESIGN: Randomised controlled trial. SETTING: Four general medical wards in a district general hospital in a northern UK town. PARTICIPANTS: 153 medically ill older people (aged 65 or over) who scored above the threshold for depression and/or cognitive impairment on a brief screening instrument (4-item geriatric depression scale and 6-item orientation-memory-concentration test): 77 were randomised to a nurse-led intervention and 76 to usual care. Included in the analysis were 120 participants who completed 6-8 week follow-up assessments. INTERVENTION: Multi-faceted intervention led by a mental health liaison nurse. MAIN OUTCOME MEASURES: Scores on the Health of the Nation Outcome Scale 65+, the geriatric depression scale, and the Standardised Mini-Mental State Examination. RESULTS: No significant differences were found between groups on the total Health of the Nation Outcome Scale 65+ scores (11.5 versus 11.5, adjusted mean difference -0.04, 95% CI-1.4 to 1.3, P = 0.96) nor on the Standardised Mini-Mental State Examination (20.3 versus 21.8, adjusted mean difference -0.4, 95% CI-2.1 to 1.3, P = 0.63). Subjects randomised to the intervention arm had significantly lower Geriatric Depression Scale scores at 6-8 week follow-up than those receiving usual care (12.2 versus 14.0, adjusted mean difference -2.0, 95% CI-4.0 to -0.1, P = 0.043). CONCLUSIONS: Nurse-led mental health liaison services which accept all screened cases from acute medical wards are unlikely to be effective in reducing general psychiatric morbidity. Services which focus on the prevention of delirium and target particular patient groups or disorders such as depression are more likely to be effective.     

Development and testing of a five-item version of the Geriatric Depression Scale.

OBJECTIVE: To develop and test the effectiveness of a 5-item version of the Geriatric Depression Scale (GDS) in screening for depression in a frail community-dwelling older population. DESIGN: A cross-sectional study. SETTING: A geriatric outpatient clinic at the Sepulveda VA Medical Center, Sepulveda, California. PARTICIPANTS: A total of 74 frail outpatients (98.6% male, mean age 74.6) enrolled in an ongoing trial. MEASUREMENTS: Subjects had a comprehensive geriatric assessment that included a structured clinical evaluation for depression with geropsychiatric consultation. A 5-item version of the GDS was created from the 15-item GDS by selecting the items with the highest Pearson chi2 correlation with clinical diagnosis of depression. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values were calculated for the 15-item GDS and the new 5-item scale. RESULTS: Subjects had a mean GDS score of 6.2 (range 0-15). Clinical evaluation found that 46% of subjects were depressed. The depressed and not depressed groups were similar with regard to demographics, mental status, educational level, and number of chronic medical conditions. Using clinical evaluation as the gold standard for depression, the 5-item GDS (compared with the 15-item GDS results shown in parentheses) had a sensitivity of .97 (.94), specificity of .85 (.83), positive predictive value of .85 (.82), negative predictive value of .97 (.94), and accuracy of .90 (.88) for predicting depression. Significant agreement was found between depression diagnosis and the 5-item GDS (kappa = 0.81). Multiple other short forms were tested, and are discussed. The mean administration times for the 5- and 15-item GDS were .9 and 2.7 minutes, respectively. CONCLUSIONS: The 5-item GDS was as effective as the 15-item GDS for depression screening in this population, with a marked reduction in administration time. If validated elsewhere, it may prove to be a preferred screening test for depression.     

Development of an interview-based geriatric depression rating scale.

The geriatric depression rating scale (GDRS) is a new interview-based depression rating scale designed for use with adults 60 years of age or older. The scale was developed to fill a need for an instrument that would be sensitive to the problems encountered in assessing depression among older adults. The GDRS was designed by using items from the self-report Geriatric Depression Scale (GDS) as topic areas in a structured clinical interview similar to that of the Hamilton Rating Scale for Depression (HRSD). The 35-item rating scale was administered to 68 older individuals with a range of affective disturbance. The scale was found to have internal consistency and split-half reliability comparable to the HRSD and GDS. Concurrent validity, construct validity, external criterion validity, sensitivity, and specificity were all found to be acceptable.     

综合医院老年住院患者情感障碍的识别

目的探讨对综合医院老年病房住院老年患者进行老年综合评估与精神科医师会诊相结合的方式对情感障碍的识别作用。方法某三级甲等医院老年病房2011年8月至2013年3月收治的≥65岁老年住院患者,在人院时进行包括Zung抑郁自评量表（SDS）和老年抑郁量表（GDS）15项在内的老年综合评估,由老年科医师决定是否进行多学科团队查房及精神科医师会诊。精神科医师根据国际疾病分类第10版（ICD-10）标准诊断情感障碍。结果研究期间共收治≥65岁老年住院患者281例,年龄（75．2±6．8）岁,男：女为136：145,其中49例（17．4％）患者罹患情感障碍,年龄（73．5±6．0）岁,男：女为16：33,其中抑郁发作39例,恶劣心境障碍5例,双相情感障碍2例,复发性抑郁2例,未特定抑郁障碍（NOS）1例,情感障碍患病率17．4％。确诊的49例患者中,提请精神科会诊的第一位原因分别为：有相关病史7例,医师注意到患者有情绪问题23例,失眠2例,存在疾病不能解释的躯体症状5例,量表筛查阳性12例。结论情感障碍是老年住院患者常见的精神疾患,采用老年综合评估与精神科医师会诊相结合的方式有利于识别老年情感障碍,是一种值得推广的老年精神医学服务模式。     

Risk factors for geriatric depression: the importance of executive functioning within the vascular depression hypothesis

BACKGROUND: Results from recent studies addressing the vascular depression hypothesis have been mixed, with cerebrovascular risk factors (CVRFs) predicting depression in some geriatric patients but not in others. The current study seeks to examine executive dysfunction as a potential moderator of the relationship between CVRFs and depressive symptoms. METHODS: Data concerning CVRFs, executive functioning, and depressive symptoms from 77 geriatric rehabilitation patients were incorporated to test the hypothesis that patients with executive dysfunction and greater CVRFs would demonstrate the highest levels of depression over time. CVRFs (diabetes, hypertension, atrial fibrillation) were measured via diagnosis by treating physician. Depression was assessed using the 15-item Geriatric Depression Scale (GDS) at baseline and at 6-month and 18-month follow-ups. Executive functioning was measured at baseline using the Initiation/Perseveration (IP) Subtest of the Mattis Dementia Rating Scale. RESULTS: Multivariate analysis of variance demonstrated a significant statistical interaction between the number of CVRFs and scores on the IP Subtest on depressive symptoms. Patients with two or more CVRFs and lower IP scores demonstrated significantly greater depressive symptoms at baseline and at 18-month follow-up than patients with fewer CVRFs and higher IP scores. The univariate effect at 6 months was not significant. CONCLUSION: The current data suggest that scores on an index of executive functioning may moderate the relationship between CVRFs and depressive symptoms. Interpretation of these findings is provided in the context of the vascular depression hypothesis and related frontostriatal dysfunction. Patients with greater CVRF burden and poor executive functioning may be at particularly high risk for depression.     

Validity and reliability of the Minimum Data Set Depression Rating Scale (MDSDRS) for older adults in nursing homes

OBJECTIVE: this research examined the psychometric properties of the Minimum Data Set Depression Rating Scale for use among older adults living in nursing homes. METHODS: interviews with 145 older adults in three nursing homes were conducted to complete the Hamilton Depression Rating Scale and the Geriatric Depression Scale. Information relevant to completing the Minimum Data Set Depression Rating Scale was gathered from the Minimum Data Set. RESULTS:the Minimum Data Set Depression Rating Scale did not perform well when validated against the Hamilton Depression Rating Scale and the Geriatric Depression Scale. Minimum Data Set Depression Rating Scale cut-off levels of > or =2 and > or =3 were associated with relatively low total score correlations and sensitivity rates, but acceptable specificity. CONCLUSIONS:findings suggest that the Minimum Data Set Depression Rating Scale may be of limited clinical value to identify depression among older adults living in nursing homes.     

Instruments for screening for depression and dementia in a long-term care facility

The high prevalence of mental disorders such as depression and dementia in institutionalized elderly patients warrants screening for psychiatric diagnosis in patients newly admitted to long-term care facilities. The diagnostic accuracy of the Mini-Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS) was evaluated against a standardized psychiatric interview. The MMSE was found to be 81% sensitive and 83% specific in screening for dementia using a previously established cutpoint of less than 24/30 points. Adjusting MMSE scores for physical disabilities precluding completion of specific tasks on the MMSE did not significantly change the diagnostic accuracy of the test. The GDS was 47% sensitive and 75% specific in screening for depression using the suggested cutpoint of greater than 13/30 points. The MMSE was significantly correlated with functional status (r = 0.48, P = .0001), but not with the scores on the GDS or the clinical diagnosis of depression. The GDS did not correlate with functional status. In summary, the MMSE is a good screening test for dementia in institutionalized elderly, but the GDS is not sensitive for depression in this population.