Watson LC, Lewis CL, Kistler CE, Amick HR, Boustani M. Can we trust depression screening instruments in healthy
'old-old' adults? Int J Geriatr Psychiatry. 2004;19(3):278-85.
OBJECTIVE: Despite a growing understanding of late-life depression, few studies focus on the old-old, those 75 years
and over. We wished to characterize depressive symptoms and determine the accuracy of two common screening instruments
for major and minor depression in a population of old-old retirees.
METHODS: Participants lived independently in one of two Continuing Care Retirement Communities and volunteered for an
in-home interview about cancer screening attitudes. As part of this baseline interview, they were screened with the
Geriatric Depression Scale (GDS) and the Center for Epidemiologic Studies-Depression (CES-D) scale. Those agreeing to
a second interview received an evaluation using the Structured Clinical Interview for DSM-IV (SCID-IV), performed by a
geriatric psychiatrist within two weeks of the initial interview.
RESULTS: In an educated and cognitively intact group of retirees averaging 80 years of age, the GDS and CES-D performed
poorly using standard cutpoints in detecting both major (sensitivity 60% for both) and minor (sensitivity 33% and 50%,
respectively) depression. One in five participants had significant depression as confirmed by SCID-IV evaluation. Twelve
percent had major depression and 7% had minor depression. Most participants had their first episode of either after age 60.
CONCLUSIONS: Contrary to most studies evaluating the GDS and CES-D for accuracy in detecting late-life depression, these
instruments at standard cutpoints performed poorly in this group of healthy older adults. The healthy old-old may require
novel screening interventions to detect clinically significant depression.
Copyright 2004 John Wiley & Sons, Ltd.
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