Measuring Depression in the Elderly: Which Scale is Best?

Holroyd, MD, Anita H. Clayton, MD

Disclosures

Medscape General Medicine. 2000;2(4) 

In This Article

Abstract & Introduction

Abstract

Assessing depression in the elderly is acknowledged to be difficult because depression may have atypical presentations in elderly individuals. Numerous rating scales for depression are available, but few have been validated in geriatric populations. Rating scales that are used to assess depressive symptoms in the elderly population are reviewed and critiqued in this article. Although advantages and limitations are noted for the scales reviewed, no scale is felt to be useful in all clinical situations or in sample populations. The Geriatric Depression Scale has been the best validated among the elderly; however, it may not useful in the moderately to severely cognitively impaired elderly, and there has been little research in its ability to detect symptom changes over time in the context of clinical trials.

Introduction

Despite the increased interest and research in geriatric depression, depression in the elderly is often undiagnosed or untreated. It has been estimated that only 10% of depressed elderly persons receive treatment.[1] Reasons for the lack of treatment in this population include: the widespread belief that depression is normal or expected with aging,[2,3] conscious underreporting or denial of symptoms by patients due to shame or stigma,[3] and symptoms of depression in late life may be atypical, sometimes called "masked depression."[2,4,5] Thus, accurate assessment of depression in the elderly poses a challenge because they may deny that they are depressed despite having classic symptoms of depression.

In response to these concerns, there has been a growing body of research addressing the use of instruments for assessing depression in the elderly. In this article, we will review the current literature on the use of depression scales in the geriatric population. The purpose is to help the reader understand the advantages and limitations of different scales in the geriatric population. There are numerous depression-rating scales currently available. However, most of these scales were not originally designed for the elderly and lack proper validation in the elderly population. Scales that have been used in the elderly population include the Hamilton Rating Scale for Depression (HAM-D), the Zung Self-Rating Depression Scale (SDS), the Geriatric Depression Scale (GDS), the Montgomery-Asberg Depression Rating Scale (MADRS), the Cornell Scale for Depression in Dementia (CSDD).

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