Read Geriatric Depression Scale text version

Tool and Resource Evaluation Template

Adapted by NARI from an evaluation template created by Melbourne Health. Some questions may not be applicable to every tool and resource.

Name and purpose Name of the resource: Geriatric Depression Scale (15 items and 5/15 items) Author(s) of the resource: JA Yesavage and TL Brink. Please state why the resource was developed and what gap it proposes to fill: The GDS is unique from other depression scales as it was specifically developed for use with older people, 60 years and above, and it contains fewer somatic items. The GDS is easily used by physically ill older people who have short attention spans and/or feel easily fatigued, more so than other scales. This is partly because of its simple yes/no format, making comprehension easier than instruments that present fourchoice answers. It has been extensively used in community, acute and long-term care settings. The 15-item GDS is the instrument of choice due to its psychometric properties. However, the GDS 5/15 may be utilised in faster paced settings, such as the emergency department or acute hospital ward. In the GDS 5/15, 5 screening questions are initially asked. If the GDS score is 2 or more then the remaining 10 questions are asked. This newer two-tiered instrument was developed due to concern regarding an increase in false positives (i.e. people identified who were not depressed) on the GDS 5 compared with the 15-item GDS. Hoyl et al. (1999) and Rinaldi et al. (2003) report comparable psychometric properties for the GDS 5 and 15. Please check all that apply: Health service users Medical staff Carers Nursing staff Any member of an interdisciplinary team

Target audience (the tool is to be used by)

Medical specialist, please specify: Specific allied health staff, please specify: Other, please specify: Target population/setting (to be used on/in) Is the resource targeted for a specific setting? Please check all that apply: Emergency Department Other, please specify: For which particular health service users would you use this resource (e.g. a person with suspected cognitive impairment)? An older person who is generally cognitively intact, with suspected depression. Structure of tool Website Pamphlet Methodology Education package Assessment tool Resource guide Video Screening tool Awareness raising resource (posters etc.) Inpatient acute Inpatient subacute Ambulatory

Other, please specify: Please state the size of the resource (e.g. number of pages, minutes to read): One page Availability and cost of tool Is the resource readily available? Is there a cost for the resource? Yes Yes No No Unknown Unknown Not applicable Not applicable

Please state how to get the resource: Tools are provided below: GDS Geriatric Depression Alternate They are also available on the internet at: http://www.bcbsga.com/provider/noapplication/plansbenefits/diseasemgmt/notertiary/pw_ad050083.pdf http://www.stanford.edu/%7Eyesavage/GDS.html Note that for GDS-15 the cut off of 6 is recommended, not 5 as indicated. GDS 5/15: http://nursinghomes.tmf.org/Portals/16/Documents/NH/Toolkits/Depression/GeriatricDepressionalternate.pdf Applicability to rural settings and culturally and linguistically diverse populations Is the resource suitable for use in rural health services (e.g. the necessary staff are usually available in rural settings)? Yes No Unknown Not applicable Is the resource available in different languages? Yes No Unknown Not applicable On the web: http://www.stanford.edu/~yesavage/GDS.html

Person-centred principles Training requirements

Is the content appropriate for different cultural groups? Yes No Unknown Not applicable Does the resource adhere to/promote person-centred health care? Yes No Unknown Not applicable

Is additional training necessary to use the resource? Yes No Unknown Not applicable

If applicable, please state how extensive any training is, and what resources are required: Training requirements are not extensive. It is a reasonably simple tool that takes a short amount of time to ensure familiarity with questions and scoring and with a little practice (e.g. on fellow clinicians) to develop ease with administration. To assist in this process a video demonstrating the use of the GDS can be found on the web: go to http://www.nursingcenter.com/TryThis/Survey.asp?Ep=2&Ch=0 The most difficult part of the administration, for clinicians who have not worked in mental health and are not used to discussing psychological conditions, is the level of discomfort experienced in discussing this topic. Developing a `standard' introduction and conclusion, as demonstrated in the video, may assist with this. Administration details How long does the resource take to use? 0-5 mins 5-15 mins 15-25mins 25mins +

Can the resource be used as a standalone, or must it be used in conjunction with other tools, resources, and procedures? Standalone Must be used with other resources, please specify: Cognitive screen required to ensure patient does not have a cognitive impairment that precludes them from understanding and responding to the questions in the scale (e.g. MMSE=15+) Can be used with other tools, please specify: Data collection and analysis Are additional resources required to collect and analyse data from the resource? Yes No Unknown Not applicable

If applicable, please state any special resources required (e.g. computer software): Sensitivity and specificity Sensitivity is the proportion of people that will be correctly identified by the tool. Specificity is the probability that an individual who does not have the condition being tested for will be correctly identified as negative. Has the sensitivity and specificity of the resource been reported? Yes No Unknown Not applicable If applicable, please state what has been reported: GDS 15: Sensitivity ranges from 79%-100% and specificity from 67%-80% (e.g. Kurlowicz & Greenberg, 2007; Friedman et al., 2005). There is debate as to which cut off score gives the best specificity and sensitivity (i.e. 5 or 6), but 6 is recommended, as it is associated with higher sensitivity. GDS 5: Sensitivity ranges from 89%-98% and specificity ranges from 73%-85% (e.g. Rinaldi et al. 2003, Weeks et al., 2003). Face Validity Does the resource appear to meet the intended purpose? Yes No Unknown Not applicable Reliability is the extent to which the tool's measurements remain consistent over repeated tests of the same subject under identical conditions. Inter-rater reliability measures whether independent assessors will give similar scores under similar conditions. Has the reliability of the resource been reported? Yes No Unknown Not applicable If applicable, please state what has been reported: GDS15: Reliability coefficient was 0.81 (Almeida & Almeida, 1999) and the inter-rater reliability was 0.85 (Nguyen et al., 2006). GDS 5 : Reliability coefficient was 0.84 and interrater reliability was 0.88 (Rinaldi et al. 2003). Strengths What are the strengths of the resource? Is the resource easy to understand and use? Are instructions provided on how to use the resource? Is the resource visually well presented (images, colour, font type/ size)? Does the resource use older friendly terminology (where relevant), avoiding jargon? Please state any other known strengths, using dot points: · A major strength of the GDS is its ease of administration and scoring.

Reliability

· · ·

The simple yes/no format assists in making the scale easy to understand, decreases confusion and perseveration (i.e. getting stuck repeating the same response). The GDS has also placed less emphasis on somatic complaints which are common in the elderly with complex medical presentations. The GDS maximises acceptability to older people who have been found to react negatively to items regarding sexual interest or suicidal ideation which are on general depression scales.

Limitations

What are the limitations of the tool/resource? Is the tool/resource difficult to understand and use? Are instructions provided on how to use the tool/resource? Is the tool/resource poorly presented (images, colour, font type/ size)? Does the tool/resource use difficult to understand jargon? Please state any other known limitations, using dot points: · Not a substitute for a diagnostic interview by mental health professionals. · Does not assess suicidality. · Questionable accuracy when used to detect minor depression (Lyness et al., 1997). · Original design was self-report, which can reduce the sensitivity and specificity. It should be implemented as an interviewer administered tool.

References and further reading

Supporting references and associated reading. Almeida, O.P. and Almeida, S.A. (1999). Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV International Journal of Geriatric Psychiatry. 14(10): 858 ­ 865. Brink TL, Yesavage JA, Lum O, Heersema P, Adey MB, Rose TL: Screening tests for geriatric depression. Clinical Gerontologist 1: 37-44, 1982. Chattat, R., Ellena, L., Cucinotta, D., Savorani, G., & Mucciarelli, G. (2001) A study on the validity of different short versions of the geriatric depression scale. Archives of Gerontology and Geriatrics, suppl.7, 81-86. Cwikel, J & Richie, K 1988, `The short GDS: evaluation in a heterogeneous, multilingual population', Clinical Gerontology, vol. 8, pp. 63-71. Friedman, B., Heisel, M.J. & Delavan, R.L. (2005) Psychometric properties of the 15-item geriatric depression scale in functionally impaired, cognitively intact, community-dwelling elderly primary care patients. Journal of the American Geriatric Society (JAGS), 53(9), pp1570-76. Goring, H, Baldwin, R, Marriott, A, Pratt, H, & Roberts, C. Validation of short screening tests for depression and cognitive impairment in older medically ill inpatients. International Journal of Geriatric Psychiatry 2004;19:465-71. Herrmann, N., Mittmann, N., Silver, L.L. Shulman, K.I., Busto, U.A., Shera, N.H. & Naranjo, C.A. (1998) A validation study of the Geriatric Depression Scale short form. International Journal of Geriatric Psychiatry, 11(5), pp457-460. Hoyl, M.T, Alessi, C.A., Harker, J.O., Josephson, K. R., Pietruszka, F.M., Koelfgen, M., Mervis, J.R., Fitten, L.J., and Rubenstein, L.Z. (1999) Development and testing of a five-item version of the Geriatric Depression Scale. Journal of the American Geriatrics Society, 47 (7): 873-878. Kurlowicz,L and Greenberg,S.A (2007) The Geriatric Depression Scale (GDS). Try This: Best Practices in Nursing Care to Older Adults. Issue 4. Lyness, J.M., Noel, T.K., Cox, C., King, D.a., Conwell, Y. and Caine. E.D. (1997) Screening for depression in elderly primary care patients. A comparison of the Center for Epidemiologic Studies-Depression Scale and the Geriatric Depression Scale. Archives of Internal Medicine. Volume 157, 4: 449-454. Nguyen, H. V. Inderjeeth, C. A. Tang, E. Barnabas, L. Merriam, M. (2006) Screening for depression in hospitalised and community-dwelling elderly: the use of the 4-item, 5-item and 15-item geriatric depression scales. Australasian Journal of the Ageing. 25 (4): 204-208 Rinaldi, P.;Mecocci, P.; Benedetti, C.;Ercolani, S.; Bregnocchi, M.;Menculini, G.;Catani, M.;Senin, U.;Cherubini, A. (2003). Validation of the Five-Item Geriatric Depression Scale in Elderly Subjects in Three Different Settings Journal of the American Geriatrics Society, Volume 51,Number 5, pp. 694-698(5). Sheikh, J.I., & Yesavage, J.A. (1986). Geriatric Depression Scale (GDS). Recent evidence and development of a shorter version. In T.L. Brink (Ed.), Clinical Gerontology: A Guide to Assessment and Intervention (pp. 165-173). NY: The Haworth Press, Inc. Sheikh JI, Yesavage JA, Brooks JO, III, Friedman LF, Gratzinger P, Hill RD, Zadeik A, Crook T (1991) Proposed factor structure of the Geriatric Depression Scale. International Psychogeriatrics 3: 23-28.

Weeks SK, McGann PE, Michaels TK, & Penninx, BW. Comparing various short-form geriatric depression scales leads to the GDS-5/15. Journal of Nursing Scholarship 2003;2:133-7. Yesavage JA, Brink TL, Rose TL, Lum O, Huang V, Adey MB, Leirer VO. (1983) Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research 17: 37-49.

Geriatric Depression Scale (GDS)

This scale was developed as a basic screening measure for depression in older adults. Created in the early 1980s by Yesage & Brink, the original scale is in the public domain.

MOOD SCALE Choose the best answer for how you have felt over the past week:

1. Are you basically satisfied with your life? 2. Have you dropped many of your activities and interests? 3. Do you feel that your life is empty? 4. Do you often get bored? 5. Are you in good spirits most of the time? 6. Are you afraid that something bad is going to happen to you? 7. Do you feel happy most of the time? 8. Do you often feel helpless? 9. Do you prefer to stay at home, rather than going out and doing new things? 10. Do you feel you have more problems with memory than most? 11. Do you think it is wonderful to be alive now? 12. Do you feel pretty worthless the way you are now? 13. Do you feel full of energy? 14. Do you feel that your situation is hopeless? 15. Do you think that most people are better off than you are?

Answers in bold score 1 point.

YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO YES / NO

The GDS is a screening tool and not a diagnosis. Although differing sensitivities and specificities have been obtained across studies, for clinical purposes a score of 6 points or more is suggestive of depression and should warrant a thorough assessment.

Screening Tool: Alternate Geriatric Depression Scale (GDS)

Resident's Name: ___________________________________________ Record #: _________________ Circle resident's response to questions. Each answer indicated by an asterisk (*) counts as 1 point. 1. 2. 3. 4. 5. Are you basically satisfied with your life? Do you often get bored? Do you often feel helpless? Do you prefer to stay home rather than going out and doing things? Do you feel pretty worthless the way you are now? Yes Yes * Yes * Yes * Yes * No * No No No No

GDS-5 Score _________ If the GDS-5 score is 1 or less, you may stop here. If the GDS-5 score is 2 or more, continue with the remaining 10 questions. A GDS-5 score of 2 or more indicates possible depression. 6. 7. 8. 9. Have you dropped many of your activities and interests? Do you feel that your life is empty? Are you in good spirits most of the time? Yes * Yes * Yes No No No * No No * No No * No * No No

Are you afraid that something bad is going to happen to you? Yes * 10. Do you feel happy most of the time? Yes 11. Do you feel you have more problems with memory than most? 12. Do you think it is wonderful to be alive now? 13. Do you feel full of energy? 14. Do you feel your situation is hopeless? 15. Do you think that most people are better off than you are? Yes * Yes Yes Yes * Yes *

GDS-15 Score _________ A GDS-15 score of 5-9 indicates possible depression; above 9 usually indicates depression ___________________________________________________________ Signature of person completing form ___________________ Date

References:

Weeks SK, McGann PE, Michaels TK, & Penninx, BW. Comparing various short-form geriatric depression scales leads to the GDS-5/15. Journal of Nursing Scholarship 2003;2:133-7. Goring, H, Baldwin, R, Marriott, A, Pratt, H, & Roberts, C. Validation of short screening tests for depression and cognitive impairment in older medically ill inpatients. International Journal of Geriatric Psychiatry 2004;19:465-71.

This material was prepared by TMF® Health Quality Institute, the Medicare Quality Improvement Organization for Texas, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. 8SOW-TX-NHQI-06-29

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