The document discusses depression in older adults and the Geriatric Depression Scale (GDS). It provides details on the GDS, including the different versions, how it is administered and scored, interpretation of scores, its validity and reliability. It emphasizes the importance of screening older adults for depression given its prevalence and impacts. The GDS is described as a useful screening tool to accurately assess severity of depressive symptoms in older adults when used appropriately based on a patient's health status and cognitive level.

1. Social and Older Adult Depression in Hargo Dedali
Social and Older Adult Depression in Hargo DedaliSocial and Older Adult Depression in
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sourceORDER NOW FOR CUSTOMIZED, PLAGIARISM-FREE PAPERSNURSING PRACTICE &
SKILL Depression Assessment in Older Adults: Using the Geriatric Depression Scale What is
Depression Assessment in Older Adults Using the Geriatric Depression Scale? › Depression
is a mood disorder that is characterized by affective, cognitive, and/or physical signs and
symptoms. The American Psychiatric Association Diagnostic and Statistical Manual Fifth
Edition (DSM-V) defines depressive disorders as, “characterized by discrete episodes of at
least 2 weeks’ duration involving clear-cut changes in affect, cognition, and neurovegetative
functions and inter-episode remissions” (p.155) (For more information on depression, see
the series of relatedQuick Lessons and Evidence-Based Care Sheets) • What: The Geriatric
Depression Scale (GDS) is a tool that is designed to assess for signs and symptoms of
depression in older adults ? 65 years of age. The GDS is a patient self-reporting screening
tool used to identify depressive symptoms. Several versions of the GDS are available to
screen for depression in older adults, including GDS-5, GDS-short (which is a 15-itemtool),
and GDS-30 • How: The GDS is a self-administered questionnaire that requires “yes” or “no”
answers. Scoring for each question is calculated as 0 or 1, depending on the patient’s
answer • Where: The GDS can be administered and interpreted in any healthcare setting,
including primary care outpatient clinics, acute care in hospitals, long-term care (e.g., in
skilled nursing facilities [SNFs]), and/or community settings (e.g., during the provision of
in-home care or educational programs) • Social and Older Adult Depression in Hargo
DedaliWho: Nurses, primary care providers, acute care providers, and mental health
professionals can administer and interpret the GDS to older patients who are suspected or
known to experience signs and symptoms of depression ICD-9 311 ICD-10 F32.9 Author
Hillary Mennella, DNP, ANCC-BC Cinahl Information Systems, Glendale, CA Reviewers
Darlene Strayer, RN, MBA Cinahl Information Systems, Glendale, CA Nursing Practice
Council Glendale Adventist Medical Center, Glendale, CA Editor Diane Pravikoff, RN, PhD,
FAAN Cinahl Information Systems, Glendale, CA September 22, 2017 What is the Desired
Outcome of Administering the Geriatric Depression Scale for Assessment of Depression in

2. Older Adults? › The healthcare provider gains an accurate, subjective assessment of the
severity of a patient’s depressive signs and symptoms in order to appropriately develop or
revise a psychotherapeutic plan of care to maintain patient safety and assist in resolving
depression Why is Depression Assessment in Older Adults Using the Geriatric Depression
Scale Important? › Depression is a psychiatric illness that has many causes (e.g., genetic and
environmental factors) and is underdiagnosed in older adults. Depression results in
emotional and/ or physical pain, impaired functioning, reduced quality of life, and
difficulties in relationships and/or employment, as well as high financial costs to society
and healthcare systems • Depression is the leading cause of disability worldwide •
Depression is linked with an increased risk for suicide › Older adults with depression have a
good prognosis for recovery when treated with a combination of psychotherapy and
psychotropic medications › Depression can impede the recovery process in older adults
with a medical illness Published by Cinahl Information Systems, a division of EBSCO
Information Services. Copyright©2017, Cinahl Information Systems. All rights reserved. No
part of this may be reproduced or utilized in any form or by any means, electronic or
mechanical, including photocopying, recording, or by any information storage and retrieval
system, without permission in writing from the publisher. Cinahl Information Systems
accepts no liability for advice or information given herein or errors/omissions in the text. It
is merely intended as a general informational overview of the subject for the healthcare
professional. Cinahl Information Systems, 1509 Wilson Terrace, Glendale, CA 91206 ›
Depending on the severity of the GDS score, patients who test positive for depressive signs
and symptoms may be offered the following psychotherapeutic interventions, as
appropriate: • Counseling • Group therapy • Initiation and/or dose adjustment of
psychotropic medications • Psychiatric inpatient admission Facts and Figures ›
Approximately 2 million older adults ? 65 years of age are clinically depressed, with a
financial impact in the United States of more than $43 billion/year in direct and indirect
costs (Means, 2013a) › Depression occurs in 16–30% of older adults living in SNFs. The risk
for suicide related to depression is highest in older men who are White or Asian American
(Keech, 2010) › Risk factors for depression in older adults include (Means, 2013a) •
previous history of depression • undiagnosed medical conditions • physical disability •
cognitive impairment • loneliness, lack of social , and/or isolation • fear of death and/or
memory loss • vascular changes in the brain • Social and Older Adult Depression in Hargo
Dedalirecent death of a loved one • chronic illness and/or pain (e.g., Alzheimer’s disease
[AD], cancer) • alcohol and/or substance abuse • use of certain medication (e.g.,
chemotherapy, clonidine, digitalis) and/or nonadherence to the prescribed medication
regimen › Ageism may contribute to clinicians’ acceptance for depression in older adults as
normal (Keech, 2014) › The GDS-30 was developed for older adults who are cognitively
intact. The original version of the GDS-30 assesses mood and incorporates fewer somatic
symptoms of depression than other screening tools (e.g., Beck’s Depression Inventory)
(Means, 2013b) › The GDS-short was modified from the GDS-30 to focus only on mood,
excluding questions about somatic symptoms. The GDS-short version is beneficial for use in
patients with mild to moderate cognitive impairment, who are medically ill, who have a
short attention span, and/or who are easily fatigued (Greenberg, 2007) › The validity and

3. reliability of the GDS is ed through research results and clinical practice; it has a 92%
sensitivity rate (Kurlowicz, 2002) › Investigators of a cross-sectional study of 96
community-dwelling older adults ? 55 years of age found that the Spanish versions of the
GDS-5 and GDS-short are reliable screening tools for depression in persons with mild to
moderate dementia (Lucas-Carrasco, 2012) › Results of a study comparing the use of the
GDS-30 in 156 patients with dementia and mild cognitive impairment (MCI) with 247
patients with Alzheimer’s disease (AD) demonstrated that the GDS-30 was reliable for
screening of depression in patients with MCI but not in patients with AD (Debruyne et al.,
2009) › The GDS-30 and GDS-short are available in Spanish; the GDS-5 is only available in
English (Means, 2013b) › Investigators of a meta-analysis evaluating which version of the
GDS is most useful in nursing homes and medical settings (e.g., primary care physicians’
offices; hospital inpatient settings) found that although the GDS-5,GDS-short, and GDS-30
are all valuable tools to assist in screening for depression, the GDS-5 is the most efficient
with fewer false negative results in medical settings. More research is required to validate
use of the GDS-5 in nursing homes (Mitchell et al., 2010) › Authors of a 2013 study found
that the GDS-short was sensitive for detecting major depression but not for detecting minor
depression among older adults admitted to nursing homes (Allgaier et al., 2013) ›
Researchers in Sweden report that the GDS-short is appropriate to evaluate depressive
symptoms in adults ? 85 years with Mini-Mental Status Examination (MMSE) scores >
10(Conradsson et al., 2013) What You Need to Know Before Administering the Geriatric
Depression Scale to Assess Depression in Older Adults › Social and Older Adult Depression
in Hargo DedaliThe GDS assesses for depressive signs and symptoms exhibited within the
past week › A patient with poor reading or language comprehension will require verbal
assistance in the patient’s native language to complete the GDS › GDS-30 is preferred for
cognitively intact older adults › GDS-short is preferable for use in older adults with cognitive
dysfunction/decline (e.g., dementia) › The GDS-5 is a 5-question format that can be used
when an extremely short administration time is necessary based on patient characteristics
or environmental constraints › Timeframes for administering the GDS are as follows: • GDS-
30 is completed in 10–15 minutes • GDS-short is completed in 5–10 minutes • GDS-5 is
completed in < 5 minutes › Scoring and interpretation depend on the version of GDS used •
In all three versions of the GDS, the yes/no answers that are in bold and italicized font are
used to emphasize increased significance of the depressive symptoms (for details, see How
to Use the Geriatric Depression Scale for Assessing Depression Older Adults, below) –For
example, when scoring “Have you stopped being involved in many of your activities and
interests?” the yes/no answers that are in – normal font and are not italicized are assigned a
score of 0 points – bold font and italicized are assigned a score of 1 point › Total GDS-30
scoring is 0–30; a score of • 0–9 is considered normal • 10–19 suggests mild depression •
20–30 suggests severe depression › Total GDS-short score is 0–15 as indicated by the
following: • A score of 0–4 suggests no depression is present • A score of 5–8 suggests that
mild depression is present • A score of 9–11 suggests that moderate depression is present •
A score of 12–15 suggests that severe depression is present › The GDS-5 is not scored on a
numeric scale, and scoring is based on adding the total of responses in sections where
answer choices are in bold and italicized fonts; two or more responses in sections with

4. response choices that are in bold and italicized fonts in the GDS-5 suggests the presence of
depression as indicated in the following examples: • Responding to “Are you satisfied with
your life overall?” with the bold and italicized answer “ No ” is a positive screen for
depression • Responding to “Are you often bored?” with the bold and italicized answer “ Yes
” is a positive screen for depression › Preliminary steps that should be performed before
administering the GDS include the following: • Social and Older Adult Depression in Hargo
DedaliReview the treating clinician’s order for administering the GDS, if appropriate,
although administering the GDS does not require a physician’s written or verbal order •
Review the instructions for administering, scoring, and interpreting the GDS • Review the
patient’s medical record and/or ask the patient and family members, if available, about –the
patient’s mental health history –the patient’s cognitive status –family history of mental
illness –the patient’s medical history –the patient’s social and developmental history (e.g.,
alcohol use, recent losses, living situation) › Gather supplies that are necessary for the
depression assessment, which typically include • the GDS, in English or Spanish, as
appropriate • a pen for data collection How to Use the Geriatric Depression Scale for
Assessing Depression Older Adults › Perform hand hygiene › Identify the patient according
to facility protocol › Establish privacy by closing the door to the patient’s room and/or
drawing the curtain surrounding the patient’s bed › Verify that the patient is alert and
oriented. Introduce yourself to the patient and family member(s), if present, and explain
your clinical role in administering the GDS. Assess the coping ability of the patient/family
and for knowledge deficits and anxiety regarding the GDS • Determine if the patient/family
requires special considerations regarding communication (e.g., due to illiteracy, language
barriers, or deafness); make arrangements to meet these needs if they are present –Follow
facility protocols for using professional certified medical interpreters, either in person or
via phone, when language barriers exist • Explain details of administering the GDS,
including its purpose; answer any questions and provide emotional as needed • Obtain
verbal consent to administer the GDS as appropriate to facility protocols • Assess the
patient’s cognitive and general health status, if appropriate. (For more information on
cognitive assessment, see Nursing Practice & Skill … Neurological Assessment:
Administering the Mini-Mental State Examination (MMSE) ) • Verify that the selected
version of the GDS is appropriate for the patient based on assessment of his/her cognitive
and general health status –Patients with mild to moderate cognitive impairment, a history
of chronic pain, a short attention span, and/or fatigability may benefit from assessment
using the GDS-shortor GDS-5 tool • As appropriate, ask family members and other visitors
to leave the room during administration of the GDS to promote privacy and create an
environment that allows the patient to concentrate without self-consciousness. Ask a family
member to stay in the room if the patient requires assistance (e.g., due to reading
limitations or poor eyesight) • Administer the GDS to the patient –Offer to personally assist
the patient with completing the questionnaire if he/she requests privacy and/or is
uncomfortable completing the GDS in the presence of family members – Social and Older
Adult Depression in Hargo DedaliAllow sufficient time for the patient to answer all
questions › Verify that all items of the GDS are completed, calculate the score, and interpret
the results • Bold and italicized font emphasizes greater significance of depressive

5. symptoms. A higher number of bolded and italicized yes or no responses correlate directly
with a greater need for further patient assessment for depression –For example, scoring “Do
you consider your life to be empty?” is as follows: – Yes/no answers that are in normal type
and are not italicized are assigned a score of 0 points – Yes/no answers that are in bold type
and italicized are assigned a score of 1 point • Refer to the following scale for interpretation
of the GDS-30version: –0–9 is considered normal –10–19 suggests mild depression –20–30
suggests severe depression • Refer to the following scale for interpretation of the GDS-
shortversion: –A score of 0–4 suggests no depression is present –A score of 5–8 suggests
that mild depression is present –A score of 9–11 suggests that moderate depression is
present –A score of 12–15 suggests that severe depression is present • Two or more
answers in sections with response choices that are in bold and italicized fonts suggest
depression when using the GDS-5version › As appropriate, discuss the results and
interpretation of the GDS with the patient and/or family members › Add the completed GDS
to the patient’s medical record › Update the patient’s plan of care, as appropriate, and
document the administration of the GDS in the patient’s medical record, including the
following information: • Date and time the GDS was administered • Social and Older Adult
Depression in Hargo DedaliVersion of the GDS administered • Total score, interpretation of
the GDS results, and whether or not the treating clinician was notified • Referrals and/or
consultations requested, if appropriate (for details, see Red Flags below) • Results of patient
assessment, including –patient’s mood and mental status (e.g., alert, oriented) –patient’s
response to the administration of the GDS (e.g., cooperative, inability to understand and/or
answer questions) –details of physical assessment and vital signs, if appropriate • Any
unexpected patient events or outcomes (e.g., refusal to complete the GDS, anger),
interventions performed, and whether or not the treating clinician was notified • All
patient/family education provided, including the purpose of administering the GDS,
response to education provided, plan for follow-up education and/or psychotherapeutic
interventions, barriers to communication, and techniques that promoted successful
communication Other Tests, Treatments, or Procedures That May be Necessary Before or
After Administering the Geriatric Depression Scale to Assess for Depression in Older Adults
› Patients may require additional evaluation by a specialist (e.g., psychiatrist and/or
psychologist) if the GDS suggests mild to severe depression › Patients with comorbidities
(e.g., anxiety, bipolar disorder) may require additional assessment by a psychiatrist and/or
psychologist › Basic laboratory tests (e.g., thyroid stimulating hormone, urine drug screen)
may be performed to assess for an organic cause of depressive signs and symptoms What to
Expect After Administering the Geriatric Depression Scale to Assess for Depression in Older
Adults › Patients will be evaluated and promptly referred for appropriate psychotherapeutic
intervention to improve mood and promote safety, as appropriate › Collaborate with a
psychiatrist and/or psychologist and other members of the treatment team regarding
initiating the revised plan of care, as appropriate Red Flags › Concurrent medical disorders,
medications, and/or cognitive, communication, and physical impairment can mask signs
and symptoms of depression in older adults › The GDS is not a substitute for clinical
judgment › Depression in older adults can be mistaken for dementia › Depression can result
in cognitive impairment › Older adults are less likely to report experiencing symptoms of

6. depression compared with younger adults › Persons with moderate to severe depression
are at increased risk for suicide and require immediate referral to a mental health
professional for prompt assessment What Do I Need to Tell the Patient/Patient’s Family? ›
Social and Older Adult Depression in Hargo DedaliExplain that the purpose of the GDS is to
assess for depressive signs and symptoms that have occurred within the last week › Educate
the patient regarding the average length of time it takes to complete the GDS and that it is
important to ask for assistance if he/she has difficulty understanding a question › Explain
the scoring system and correlating indications, and emphasize that the GDS is a
measurement tool for depression, not a diagnostic tool › Educate regarding risk factors for
depression in older adults and encourage seeking care for depressive symptoms, if present ›
Educate the patient and family members that referral to a mental health clinician and/or
revision of the currently prescribed regimen of psychotherapeutic interventions may be
necessary Note › Recent review of the literature has found no updated research evidence on
this topic since previous publication on December 18, 2015 References 1. Allgaier, A. K.,
Kramer, D., Saravo, B., Mergl, R., Fejkova, S., & Hegerl, U. (2013). Beside the Geriatric
Depression Scale: The WHO-Five Well-being Index as a valid screening tool for depression
in nursing homes. International Journal of Geriatric Psychiatry, 28(11), 1197-1204.
doi:10.1002/gps.3944 (R) 2. American Psychiatric Association. (2013). Diagnostic and
statistical manual of mental disorders: DSM-5 TM (5th ed.). Arlington, VA: American
Psychiatric Publishing. (GI) 3. Conradsson, M., Rosendahl, E., Littbrand, H., Gustafson, Y.,
Olofsson, B., & Loveheim, H. (2013). Usefulness of the Geriatric Depression Scale 15-item
version among very old people with differing levels of cognitive function. Aging and Mental
Health, 17(5). doi:0.1080/13607863.2012.758231 (R) 4. Debruyne, H., Van Buggenhout, M.,
Le Bastard, N., Aries, M, Aduenaert, K., De Deyn, P. P., & Engleborghs, S. (2009). Is the
Geriatric Depression Scale a reliable screening tool for depressive symptoms in elderly
patients with cognitive impairment?. International Journal of Geriatric Psychiatry, 24(6),
556-562. doi:10.1002/gps.2154 (R) 5. Social and Older Adult Depression in Hargo Dedali