According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 4^th edition (DSM-IV), the diagnosis of major/minor depression is based on the presence and number of predetermined criteria:

1.    Depressed mood

2.    Loss of interest or pleasure in most activities

3.    Significant weight loss/gain or decreased/increased appetite

4.    Insomnia or hypersomnia

5.    Psychomotor agitation or retardation

6.    Loss of energy or fatigue

7.    Feelings of worthlessness or excessive/inappropriate guilt

8.    Diminished ability to think/concentrate or indecisiveness

9.    Recurrent thoughts of suicide or death

10. Symptoms causing clinically significant impairment of social, occupational or other important areas of functioning.

 

           Major depression is diagnosed if the first two criteria as well as any three others are present every day for at least a two week period.  Minor depression involves less than five of the above criteria, including either number one or two, for at least two weeks.  Experts consider depression a widely prevalent and under-diagnosed mental health condition.  Beyond the considerable personal suffering caused by depression, depression exacts a heavy economic toll in the form of missed work days, frequent physician visits, etc. 

            While data suggests that, overall, major depression is less prevalent among geriatric patients than among younger populations, older adults are at an increased risk for undetected depression.  Risk factors such as losses of partners and social ties, and impaired functional status are more frequently present for the aging patient.  Research shows that geriatric depression may be overlooked due to the fact that this condition affects memory and can, in some cases, resemble dementia. 

Symptom-based assessments are especially useful in identifying those geriatric patients at risk for depression but who do not meet DSM-based diagnoses.  In her October 2007 American Journal of Nursing article, “How to Try This:  The Geriatric Depression Scale: Short Form” Sherry A. Greenberg, APRN discusses a well-established depression screening tool which assists nurses in identifying older adults who need further clinical care.  The benefits of this screening tool, known as the GDS: SF, are that it takes only seven minutes to conduct, requires little training to perform, can be used in cases of mild cognitive impairment, is in the public domain and therefore easily accessible and reproducible, and can be administered in any patient care setting. 
These questions constitute the GDS: SF:

1. Are you basically satisfied with your life? YES / NO

2. Have you dropped many of your activities and interests? YES / NO

3. Do you feel that your life is empty? YES / NO

4. Do you often get bored? YES / NO

5. Are you in good spirits most of the time? YES / NO

6. Are you afraid that something bad is going to happen to you? YES / NO

7. Do you feel happy most of the time? YES / NO

8. Do you often feel helpless? YES / NO

9. Do you prefer to stay at home, rather than going out and doing new things? YES / NO

10. Do you feel you have more problems with memory than most? YES / NO

11. Do you think it is wonderful to be alive now? YES / NO

12. Do you feel pretty worthless the way you are now? YES / NO 

13. Do you feel full of energy? YES / NO

14. Do you feel that your situation is hopeless? YES / NO

15. Do you think that most people are better off than you are? YES / NO

 

Answers given by the patient that match the bold answers listed above result in a depression point.  A total score of 5-8 represents mild depression, 9-11 moderate depression, and 12-15 severe depression.  When depression is suspected, it is essential to screen for suicidal ideations and behaviors and to act accordingly (The toll-free National Suicide Prevention Lifeline is available 24 hours a day at (800) 273-8255).

While the GDS: SF is a screening tool and not a diagnostic tool, Greenberg reports that it is highly effective in calling attention to those older adults whose depression is sub-clinical or undetected.  Following the administration of this simple tool, nurses are in an ideal position to connect their older patients with providers who can give their mental healthcare the additional attention it merits.     

 

References:

 
Greenberg, Sherry A. (2007).  How To Try This:  The Geriatric Depression Scale: Short

From.  American Journal of Nursing, 32(12), 60-69.

 

Uphold, C. & Graham, M. (2003).  Clinical Guidelines in Family Practice. 

Gainesville, FL:  Barmarrae Books, Inc.

 

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