Measuring Depression in the Elderly: Which Scale is Best?

Holroyd, MD, Anita H. Clayton, MD

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Summary

Based on the research that used depression rating scales in the elderly population, it is clear the GDS is the best validated instrument in various geriatric populations. For example, in cognitively intact elders, the GDS appears to be a well-validated instrument in various treatment settings. In severely demented individuals, the GDS is not felt to be reliable; however, in this population, no other depression scale has been well validated. The CSDD may be better given its inclusion of information from caregivers, but further research in the severely demented elderly is needed.

When considering a sample, one should consider (1) whether to use an observer- or self-rated scale, (2) whether to use a short or long version, (3) the purpose of the scale, and (4) whether the scale will be diagnostic or study change over time.

Recommendations for further research include further validation of the HAM-D in the geriatric population (especially among various clinical settings) as well as further study of the GDS in eliciting changes over time in various elderly populations.

It is important to remember that results obtained from the use of any rating scale, specifically for use in diagnosis, are imperfect in the geriatric population.[53] Given the atypical presentations of depression in this population that can challenge even the most experienced clinician, the use of any rating scale in the elderly should be used with these limitations in mind. In a large drug-study setting, of course, it may be appropriate to include only those with typical symptoms. Thus, use of a rating scale for inclusion criteria is reasonable. However, to use a rating scale to either decide to treat or not treat an individual patient will invariably result in false-negatives and, thus, use of rating scales is not recommended as a way to decide to treat or not treat individual patients. Finally, among moderately to severely demented patients, the diagnosis of depression is an acknowledged challenge for which clinical judgment and empiric treatment may be the only answer.

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