Dissertations / Theses on the topic 'Geriatric Depression Scale'

The recognition and diagnosis of elderly depression has been the focus of much research over the last 20 years (Brink, 1982; Goodstein, 1985; Klerman, 1983). One problem in diagnosing depression in the elderly has been adequate assessment devices that are sensitive, specific, and predictable with this population (Yesavage et al., 1983). One assessment device developed specifically for the elderly is the Geriatric Depression Scale (GDS) (Brink et al., 1982;Yesavage et al., 1983). This depression scale has yielded high reliability and validity with other self-rating depression scales. In recent research a Short Form Geriatric Depression Scale was produced containing 15 items, all from the original Long Form GDS. A problem with the Short Form involves the lack of research concerning its construct validity. The purpose of the present study was to demonstrate that the Short Form Geriatric Depression Scale does measure depression in the elderly, and therefore, does possess construct validity. To accomplish this task, it was believed that if significant correlations could be identified between various psychosocial variables highly associated with depression in the elderly and the Short Form GDS, validity could be established. The five psychosocial variables chosen: gender differences, physical/health problems, insufficient social support, marital status, and socioeconomic status (finances), have all been shown to be highly related-to depression in the elderly.The information used for this project was gathered from a survey questionnaire developed by the Institute of Gerontology at Ball State University in Muncie, Indiana. The survey questionnaire was sent to over 5,000 randomly selected elderly in the state of Indiana ranging in age from 60 to 85. Of the approximately 5,000 surveys, 2,979 were completed and returned. The survey incorporated questions concerning the five psychosocial variables reviewed and a modification of the Short Form GDS.In order to test the various hypotheses of the study, several analyses were conducted. Based upon the outcome of these analyses, it was concluded that the Short Form Geriatric Depression Scale does possess construct validity. It was also concluded that the Short Form Geriatric Depression scale does assess depression in the elderly and thus is a valid instrument to use in the assessment of depression with the elderly adult.Based upon the information obtained from the survey following hypotheses were supported:a. Elderly individuals with physical disabilities and/or health related problems had higher total GDS scores on the Short Form. b. A positive relationship was found between physiological problems in the elderly and total GDS score.c. Elderly individuals having no social support system had higher total GDS scores on the Short Form.d. A negative relationship existed between an elderly individual's social support system and total GDS score.e. Elderly widows and widowers produced higher total GDS scores than married elderly.f. Elderly individuals with low economic status had higher total GDS scores than elderly individuals with high economic status.
Department of Counseling Psychology and Guidance Services

The Geriatric Depression Scale (GDS) was originally designed as a measure for screening depression among elderly medical patients. Although this instrument is well validated among a general medical population, it has never been evaluated with specific regard to cardiac patients, the largest single group of medical patients over 40 years of age. A general cardiac sample of 655 patients completed the GDS within 10 weeks of the cardiac event. Exploratory factor analyses were conducted on the main sample, then on several subgroups of participants with regard to diagnostic category, gender, and age. The GDS generally produces factor structures with several symptom domains with a high rate of total variance. The myocardial infarction group endorsed general symptoms of depression whereas the coronary artery bypass graft group reported greater levels of despair regarding their condition. Overall, males primarily reported agitation and hopelessness while females reported symptoms of depressed mood.

Early detection of Alzheimer's disease (AD) and related dementias in the elderly is critical for improving treatment methods and is a necessary component for improving public health interventions. One of the earliest and most common behavioral syndromes of AD is apathy and is associated with executive dysfunction. Apathy in AD is often misdiagnosed as depression due to an overlap in symptoms. Studies that have found depression to be associated with executive dysfunction have not always controlled for the presence of apathy. The Geriatric Depression Scale (GDS) is a widely used instrument designed to assess depression in the elderly. This study utilized the GDS and a set of standard neuropsychological instruments to investigate the relationship between apathy, depression, and executive functions in individuals with AD and related dementias. The first objective of this study was to determine if apathy has a greater impact on executive functions compared to depression in AD and related dementias. The second objective was to determine the effectiveness of the GDS as a screen for apathy. The results of the analyses did not support the hypotheses. However, exploratory analyses suggested a possible non-linear relationship with apathy and various levels of dementia severity. Exploratory analysis also suggested mean levels of endorsement for apathy varied by diagnosis. Further research is warranted to investigate this relationship and the GDS endorsement patterns for caregivers regarding their impression of the demented individual.

Depression is poorly recognised, under-assessed and under-treated in patients receiving palliative care for a life-limiting illness. There are barriers to assessment and diagnosis, and limited access to specialist clinicians who might assist in these complex assessments and who could provide options for treatment. The three studies presented, using different research methodologies, and using both qualitative and quantitative analysis, seek to clarify these issues and to provide some solutions. A questionnaire was sent to all Palliative Care Services (PCS) in Australia. Questions included what part specialist psychological clinicians played in multi-disciplinary team meetings and in the treatment or coordination of patient care. Very few PCS used a valid screening instrument for psychological distress and very few had regular support from a psychiatrist or psychologist. Many did not have access to social work support. There are two competing issues with regard to recognising and assessing depression in palliative populations. A rapid reliable screen that points to a likely problem would be useful, but also there is a need to understand something of the patient experience of depression. In the second study, the one- and two-item screening instruments widely used in palliative care are examined and limitations that have been found in other settings are confirmed. A new novel screening tool is developed from this data and tested empirically. This algorithm is short, has good psychometric properties and is validated for an Australian palliative care population. Depending on the response pattern it is possible to identify that a particular patient has significant symptoms of depression by asking between one and four questions. Professional carer and patient acceptability of the questions is high. The understanding of the experience and symptom profile of depression in Australian palliative care patients is addressed in the third study. Patients and family carers were recruited prospectively from palliative care and oncology ambulatory clinics of two teaching hospitals in an Australian capital city. The Geriatric Depression Scale (GDS) was administered to the patient and the Collateral Source version of this instrument was asked of the carer. A subset of this sample completed the measures twice. The results using this 30-item scale were then compared with all the known previously published short versions of this scale. Two short forms met as many psychometric criteria as the longer forms. None of the versions of the GDS showed sufficiently high correlations between carer-completed and patient-completed forms. The frequency of symptoms was also assessed. Patients more frequently reported fatigue and anhedonia than depressed affect. Despite many screening instruments being available for depression, their use is limited in Palliative Care Services. Although these studies have validated several options for Australian palliative care patients, the issues behind the low uptake rates for screening have not been resolved. The final chapter of this thesis constructs known and potential barriers into a logical structure and then offers some solutions to improve access to mental health professionals by considering service models and applying this theory to the problem of depression and its assessment in palliative care populations.

The purpose of the current study was to explore the relationship between cognitive status and depression in a sample of geriatric patients. Participants included 282 geriatric patients ranging in age from 65 to 96 years who were classified according to diagnosis as: DAT, VaD, MCI, and Norm. All were referred for neurocognitive testing from the Geriatric Assessment Program (GAP) at the University of North Texas Health Science Center (UNTHSC) in Fort Worth, Texas. This study sought to identify factor structures for two versions of the GDS using a geriatric sample of cognitively impaired and intact patients. It then compared these factors to each other to determine whether the GDS-15 is truly a shorter version of the GDS-30. These were then compared to a previously determined factor structure. This study explored whether the four-factors of the GDS-30 are able to differentiate cognitive diagnostic groups. Further, this study sought to identify whether the severity of cognitive decline impacted GDS factor score for each of the cognitively impaired groups. Results revealed a two-factor model of the GDS - 15 and a four-factor model with the GDS - 30. The GDS-15 factors did not differ from the first two factors of the GDS-30. Comparison between the GDS-30 factor structure and that reported by Hall and Davis (in press) revealed no significant differences despite the inclusion of a normal, non-demented group in the current study. Comparisons of subscale scores revealed that DAT patients tended to score lower than the other groups on all but the cognitive impairment subscale. Severity level analyses indicated that as severity of deficits increases, awareness of deficits decreases. This study found that although the GDS-30 is a good screening tool for depression in geriatric patients, it is not particularly useful in differentiating cognitive status group. Also, the GDS-15 was not found to be a good substitute for the GDS-30.

Background The prevalence and incidence of stroke are known to increase with age, which, combined with demographic change, means that very old patients with stroke are a growing patient group. Risk factors for incident stroke among very old people have not been widely investigated. The impact of depression on mortality in very old people who have had a stroke also remains unclear.  The aim of this thesis was to investigate the risk factors for incident stroke, the epidemiology of stroke and depression, and the consequences of having had a stroke regarding the risk of depression and mortality among very old people. Methods A randomly selected half of 85-, all 90-, and all ≥95-year-olds in certain municipalities in Västerbotten County, Sweden, and Pohjanmaa County, Finland were targeted in a population-based cohort study from 2000-2012. The 65-, 70-, 75-, and 80-year-olds in all the rural and random samples from the urban municipalities in the same counties were furthermore targeted in a survey in 2010. In the cohort study patients were assessed in their homes, by means of the 15-item Geriatric Depression Scale (GDS-15) and other assessment scales, as well as blood pressure measurements, several physical tests, and a review of medical diagnoses appearing in the medical charts. Incident stroke data were collected from medical charts guided by hospital registry records, cause of death records, and reassessments after 5 years. Depression was defined as a GDS-15 score ≥5. A clinical definition of all depressive disorders, based on assessment scale scores and review of medical charts was also used. A specialist in geriatric medicine evaluated the diagnoses. The survey included yes/no questions about stroke and depression status, and the 4-item Geriatric Depression Scale. Associations with mortality and incident stroke were tested using Cox proportional-hazard models.  Results In the ≥85-year-olds examined in 2005-2007 (n=601), the stroke prevalence was 21.5%, the prevalence of all depressive disorders was 37.8% and stroke was independently associated with depressive disorders (odds ratio 1.644, p=0.038). The prevalence of depression according to GDS-15 scores was 43.2% in people with stroke compared with 25.0% in people without stroke (p=0.001). However, in ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, depression was not independently associated with incident stroke.  In ≥65-year-olds who responded to a survey in 2010 (n=6098), the stroke prevalence rose with age from 4.7% among the 65- to 11.6% among the 80-year-olds (p<0.001). The prevalence of depression rose from 11.0% among the 65- to 18.1% among the 80-year-olds (p<0.001). In the group with stroke, depression was independently associated with dependence in personal activities of daily living and having a life crisis the preceding year, while in the non-stroke group, depression was independently associated with several additional demographic, social and health factors. In ≥85-year-olds examined in 2005-2007 with valid GDS-15 tests (n=452), having had a stroke was associated with increased 5-year mortality [hazard ratio (HR) 1.53, 95% confidence interval (CI) 1.15-2.03]. Having had a stroke and depression was associated with increased 5-year mortality compared with having only stroke (HR 1.90, 95% CI 1.15-3.13), having only depression (HR 1.59, 95% CI 1.03-2.45), and compared with having neither stroke nor depression (HR 2.50, 95% CI 1.69-3.69). Having only stroke without a depression did not increase mortality compared with having neither stroke nor depression. In ≥85-year-olds examined in Sweden from 2000-2012 (n=955), from all past data collections in the study, the stroke incidence was 33.8/1000 person-years during a mean follow-up period of about three years. In a comprehensive multivariate model, atrial fibrillation (HR 1.85, 95% CI 1.07–3.19) and higher systolic blood pressure (SBP; HR 1.19, 95% CI 1.08–1.30 per 10-mmHg increase) were associated with incident stroke overall. In additional multivariate models, diastolic blood pressure (DBP) ≥90 mmHg (HR 2.45, 95% CI 1.47–4.08) and SBP ≥160 mmHg (v. <140 mmHg; HR 2.80, 95% CI 1.53–5.14) were associated with incident stroke. Conclusion The prevalence of both stroke and depression increased with age, and rates were especially high among very old people. Having had a stroke was independently associated with a higher prevalence of depression among very old people, however, depression was not independently associated with a higher incidence of stroke. Having had a stroke was associated with increased all-cause mortality among very old people, but only among those who were also depressed. High SBP (≥160 mmHg), DBP (≥90 mmHg) and atrial fibrillation were the only consistent independent risk factors for incident stroke among very old people.
I västvärlden inklusive Sverige så ökar gruppen av människor som uppnår åldern 80 år eller äldre. Människorna som uppnår denna mycket höga ålder har en hög förekomst av kardiovaskulära riskfaktorer, har ofta flera samtidiga sjukdomar och ofta funktionsnedsättningar. Medicinska behandlingsåtgärder är ofta mindre effektiva och förknippade med biverkningar i åldersgruppen. Stroke är en sjukdom som beror på skada av hjärnvävnad till följd av minskad blodtillhörsel till delar av hjärnan. Det är känt att såväl förekomsten av och insjuknandet i stroke ökar med stigande ålder. Den som drabbas av stroke löper risk att få en bestående funktionsnedsättning och att dö i förtid. En vanlig komplikation efter att ha drabbats av stroke är nedstämdhet eller depression. Vetenskapliga studier om stroke har tidigare negligerat mycket gamla människor, vilket i takt med den pågående demografiska utvecklingen framstått som allt mer orimligt. Det är ej helt klarlagt vilka riskfaktorer som leder till att insjukna med stroke i mycket hög ålder. Överdödligheten förknippad med att drabbas av depression efter stroke är också oklar i åldersgruppen. Det är också oklart vad som skiljer depression efter stroke från depression bland den övriga befolkningen av åldrade människor. Den populations-baserade kohortstudien GErontologisk Regional DAtabas (GERDA) inleddes år 2000 för att kartlägga faktorer förknippade med gott åldrande bland mycket gamla människor. Hälften av 85-åringarna, alla 90-åringar och alla ≥95-åringar i utvalda kommuner i Västerbotten erbjöds att delta i studien. Därefter har återbesök hos tidigare deltagare i sina nya åldersgrupper och rekrytering av nya deltagare genomförts vart femte år. Studien utvidgades med utvalda kommuner i Österbotten, Finland vid den första femårsuppföljningen. Datainsamlingen i studien bestod av demografiska frågor, skattningsskalor, blodtrycksmätning och kognitiva test genomförda vid ett hembesök i deltagarens hem, samt genomgång av journalhandlingar. År 2010 skickades även en enkät ut till 65-, 70-, 75- och 80-åringar i alla kommuner i Västerbotten och Österbotten. Enkäten innehöll frågor om demografi, hälsa, sjukdomar och intressen. Bland deltagarna i kohortstudien bestämdes förekomsten av tidigare stroke baserat på genomgång av journaluppgifter och uppgifter från hembesöken. Förekomsten av depression bestämdes baserat på poängsättning från en validerad skattningsskala för depression, samt baserat på en sammanvägning av journaluppgifter och skattningsskalor. En specialist i geriatrik fattade det slutliga beslutet om diagnoser. Insjuknande i stroke bestämdes baserat på journalgenomgång av individer med stroke-relaterade diagnoskoder i sjukhusregistret, i dödsorsaksregistret eller uppgift om stroke vid femårsuppföljningen i studien. Bland deltagarna i enkätstudien bestämdes förekomsten av tidigare stroke baserat på självrapportering, och förekomsten av depression bestämdes baserat på en sammanvägning av självrapportering och en skattningsskala för depression.  Förekomsten av stroke i enkätstudien steg med ålder, från 4.7% bland 65-åringar till 11.6% bland 80-åringar. Förekomsten av stroke var omkring 20% bland ≥85-åringar, med minimal variation mellan 85-, 90- och ≥95-åringar. Förekomsten av depression var högre bland dem med stroke jämfört med de övriga deltagarna, både gällande den sammavägda diagnosen och baserat endast på poängsättning. Stroke och sömnproblem var oberoende associerade med depression. Bland ≥65-åringar i enkätstudien var funktionsnedsättning och genomgången livskris associerade med depression hos dem med en tidigare stroke. Bland deltagare utan stroke var ett antal ytterligare externa faktorer, inklusive subjektiv upplevelse av dålig ekonomi och att inte ha någon att anförtro sig till, associerade med depression. Både stroke och depression var associerade med ökad dödlighet bland ≥85-åringar. De med stroke utan depression hade en dödlighet i linje med normalbefolkningen utan stroke eller depression. Förekomsten av samtidig stroke och depression var associerad med högre dödlighet än normalbefolkningen, jämfört med dem med enbart stroke eller enbart depression. Högt systoliskt blodtryck (≥160 mmHg), högt diastoliskt blodtryck (≥90 mmHg) och förmaksflimmer var oberoende riskfaktorer för att insjukna i stroke bland ≥85-åringarna. Sambandet mellan blodtryck och strokerisk försvagades ej hos människor med kognitiv eller funktionell nedsättning. Tidigare stroke, hjärtsvikt, kognitiv nedsättning, näringsbrist, depressiva symtom och låg gånghastighet var också associerade med att insjukna i stroke, men ej oberoende av varandra. Sammanfattningsvis så stiger förekomsten av stroke med åldern och är särskilt hög bland mycket gamla människor. Depression är betydligt vanligare hos mycket gamla människor med stroke, även justerat för störningsfaktorer. Depression är främst associerat med funktions-nedsättning hos människor med stroke, men med ett större antal externa faktorer hos människor utan stroke. Mycket gamla människor med stroke har särskilt hög dödlighet om de samtidigt är deprimerade, men en dödlighet i linje med normalbefolkningen om de inte är deprimerade. Högt systoliskt och diastoliskt blodtryck samt förmaksflimmer är viktiga och behandlingsbara orsaker till att drabbas av stroke i mycket hög ålder.

Thesis (Ph. D.)--Ohio State University, 2004.
Title from first page of PDF file. Document formatted into pages; contains xi, 163 p.; also includes graphics. Includes bibliographical references (p. 150-163).

O envelhecimento é um fenômeno novo e uma tendência mundial. Com ele, há um aumento de doenças e de queixas de dor. Este estudo permitiu que os profissionais de saúde tivessem uma melhor percepção na avaliação da dor no envelhecimento. O objetivo geral foi avaliar os diferentes tipos de dor crônica no envelhecimento. Os objetivos específicos foram mensurar a dor percebida, avaliar os descritores de dor crônica de maior atribuição, identificar diferentes temáticas de dor crônica percebida e avaliar sinais e sintomas de depressão. Foi realizada identificação sócio-demográfica, com perguntas relacionadas ao sexo, à idade, à escolaridade, à religião, ao estado civil, às atividades desenvolvidas na instituição, à situação econômica, ao tempo de institucionalização, ao recebimento de visitas e às doenças diagnosticadas e, posteriormente, foram feitos quatro Experimentos (amostras dependentes). Experimento 1 - Mensurar a dor percebida - a intensidade da dor crônica foi avaliada pelo método psicofísico de estimação de categorias e se percebiam dor no momento da entrevista, para identificar o local, o tempo e o horário. Experimento 2 - Avaliar os descritores de dor crônica de maior atribuição - a intensidade da dor foi avaliada por dois métodos psicofísicos independentes: estimação de categorias e estimação de postos. Experimento 3 - Identificar diferentes temáticas de dor crônica percebida - utilizou-se uma entrevista semiestruturada com sete perguntas relacionadas à dor crônica. Experimento 4 - Avaliar sinais e sintomas de depressão - utilizou-se a Escala de Depressão Geriátrica de 15 pontos. Participaram 46 idosos residentes em duas Instituições de Longa Permanência em Ribeirão Preto, São Paulo; dentre estes, 25 eram de instituição filantrópica e 21 de instituição particular. Os resultados foram a média de idade de 78,26±8,33 anos, 26 do sexo feminino, 23 viúvos, 28 católicos, 23 cursaram o ensino fundamental incompleto, 46 aposentados e 37 recebem até 1 salário mínimo, 16 tem hipertensão arterial, 37 residem nas instituições referidas no tempo de 0 a 5 anos, 34 declararam não realizar atividade nas instituições pesquisadas e 24 recebem visitas de familiares. No Experimento 1, 14 idosos atribuíram o valor 10 para a intensidade da dor percebida na última semana, sendo a média aritmética de 7,02±2,74 pontos; 28 relataram sentir dor no momento da entrevista e 32 não haver horário específico, sendo as regiões mais afetadas os membros inferiores e a região dorsal. No Experimento 2, no método de estimação de categorias, o descritor de dor de maior atribuição foi \"dolorosa\" e o de menor foi \"desastrosa\". No método de estimação de postos, o descritor de dor de maior atribuição foi \"desastrosa\" e o de menor atribuição foi \"dolorosa\". No Experimento 3, foram identificadas unidades temáticas como \"percepção quanto ao tempo\", \"dimensão da dor\", \"estratégias de enfrentamento\", \"causas relacionadas à dor\", \"percepção da situação atual\" e \"outras percepções\". No Experimento 4, observou-se que 33 idosos responderam à Escala de Depressão Geriátrica (EDG) - 15 pontos - e obtiveram um escore de 5 ou mais pontos podendo sugerir episódio de depressão, ao passo que 13 obtiveram um escore abaixo de 5 pontos, não sugerindo episódio de depressão.
Aging is a new phenomenon and a global trend. With it, there is an increase of diseases and complaints of pain. This study has allowed health professionals have a better assessment of pain perception in aging. The overall objective was to evaluate the different types of chronic pain in aging. The specific objectives were to measure the perceived pain, to evaluate the descriptors of chronic pain with higher scores, identify different issues of chronic pain perceived and assess for signs and symptoms of depression. Identification was carried out socio-demographic, with questions related to sex, age, education, religion, marital status, the activities of the institution, the economic situation at the time of institutionalization, to receive visits and disease diagnosed and later, four experiments were conducted (dependent samples). Experiment 1 - Measuring the perceived pain - chronic pain intensity was assessed by the psychophysical method of category estimation and perceived pain during the interview, to identify the location, time and time. Experiment 2 - Assess the descriptors of chronic pain with higher scores - the intensity of pain was evaluated by two independent psychophysical methods: estimation and estimation of categories of posts. Task 3 - Identify the different themes of chronic pain perceived - we used a semi-structured interviews with seven questions related to chronic pain. Experiment 4 - Assess signs and symptoms of depression - used the Geriatric Depression Scale of 15 points. Attended by 46 elderly residents of two long-term institutions in Ribeirao Preto, São Paulo, among these, 25 were from philanthropic institutions and 21 private. The results were the mean age of 78.26 ± 8.33 years, 26 females, 23 were widowed, 28 Catholics, 23 attended the elementary school, 46 retirees and 37 to receive a minimum wage, 16 have high blood pressure, 37 reside in the institutions mentioned in the time from 0 to 5 years, 34 said they did not carry out activities in the institutions surveyed and 24 receive family visits. In Experiment 1, 14 elderly people attributed the value 10 for the intensity of perceived pain last week, and the arithmetic mean of 7.02 ± 2.74 points, 28 reported pain at the time of interview and 32 there is no specific time, and regions most affected lower limbs and the dorsal region. In Experiment 2, the method of category estimation, the greatest pain descriptor assignment was \"painful\" and the least was \"disastrous.\" In the method of estimation of posts, the more pain descriptor assignment was \"disastrous\" and the assignment was less \"painful\". In Experiment 3, thematic units were identified as: \"the perception of time,\" \"dimension of pain,\" \"coping strategies\", \"pain-related causes,\" \"perception of the current situation\" and \"other perceptions.\" In Experiment 4, it was observed that 33 seniors responded to the Geriatric Depression Scale (GDS) -15 points - and obtained a score of 5 or more points may suggest a depressive episode, while 13 had a score below 5 points, not suggesting a depressive episode.

This study explores the relationship between living arrangement and psychological wellbeing in retired elderly individuals living in Yancheng, Jiangsu (PR China). Data on mode of residence, socio-economic background, daily activities, and intergenerational dynamics were collected from 200 subjects, and their potential correlations with depression (assessed via the Geriatric Depression Scale Short Version) were analyzed. Univariate as well as logistic regression confirmed mode of residence as a significant predictor of depression in this group. The following depression odds ratios associated with each mode of residence were derived via logistic regression: 1) nuclear household, i.e. living with a spouse only ¨C 1 [reference category], 2) multigenerational households in which a spouse is not present ¨C 4.341, 3) multigenerational households in which a spouse is present ¨C 0.781, and 4) living alone ¨C 3.018. Based on these ratios, we conclude that the traditional model of intergenerational coresidence is not, in itself, associated with less depression. Rather, it is the presence of a sharing spousal in a household (whether single or multigenerational) that protects against elderly depression. Other predictors of depression identified in backward logistic regression included presence of a chronic illness and self assessed wealth status. Additionally, a number of psychosocial variables were identified as independently correlated with depression, but were subsequently selected out by multivariate analysis. These included: educational background, religious affiliation, membership in an organization, attitude toward aging, and family status. Based on this study, we believe that efforts to promote mental wellbeing among today¡¯s Chinese elders should be directed toward psychosocial factors that are modifiable (education, building supportive social networks etc.) rather than insisting on the traditional ideal of multigenerational living and dependence on filial piety.

No validation studies have been conducted with the Beck Depression Inventory - Second Edition (BDI-II) or the Geriatric Depression Scale (GDS) in a cardiac population. Because depression is an independent risk factor for mortality in cardiac patients, it is essential to identify a depression screen that is appropriate for this group. A total of 119 patients (89 men and 30 women) were recruited from the coronary care units of three hospitals. Home interviews were conducted approximately 2 weeks post-myocardial infarction (MI) or post-unstable angina/acute coronary syndrome (UA/ACS) . Participants were screened for depressive symptoms using the BDI-II and GDS. Research diagnoses o f participants' depression were determined using, as a gold standard, the Structured Clinical Interview for DSM-IV-TR (SCID-I/NP) criteria for depression. Reliability estimates for both BDI-II and GDS scores were satisfactory. Criterion-related validity was examined by comparing the scores obtained on the BDI-II and GDS with the SCID-I/NP diagnoses of depression. Sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) were evaluated for different cut scores for the BDI-II and GDS, using receiver operating characteristic (ROC) curves. ROC curves revealed that both the BDI-II and GDS demonstrated excellent sensitivity for detecting major depressive disorder and double depression, however, the GDS demonstrated greater specificity and PPV than the BDI-II with this sample. For this population of medically-ill, older adults, it is recommended that researchers and clinicians use the GDS to screen for major depressive disorder or double depression. Neither the BDI-II nor the GDS was effective in screening for the broader or milder forms of depression (i.e., minor depressive disorder, partial remission of major depressive disorder, or dysthymia) in this post-MI and post-UA/ACS sample.
Education, Faculty of
Educational and Counselling Psychology, and Special Education (ECPS), Department of
Graduate

Trabalho de revisão do 6º ano médico com vista à atribuição do grau de mestre (área científica de geriatria) no âmbito do ciclo de estudos de Mestrado Integrado em Medicina.
Background: A depressão no idoso, como síndrome depressivo em indivíduos com mais de 65 anos de idade, assume, actualmente, um carácter de premência mundial. Uma vez que os Cuidados de Saúde Primários (CSP) são a porta de entrada para os cuidados de saúde e que a maioria dos indivíduos com queixas depressivas recorrem em primeira instância aos CSP, torna-se fundamental a criação de métodos auxiliares para correcto diagnóstico e de meios facilitadores de rastreio desta patologia pelos médicos de Medicina Geral e Familiar. Objectivos: Desenvolver um protocolo adequado à utilização nos Cuidados de Saúde Primários em Portugal para rastreio de depressão em utentes com mais de 65 anos e testar a aplicabilidade desse mesmo protocolo num projecto-piloto em utentes com mais de 65 anos da UCSP Mira determinando: a prevalência de depressão em idade geriátrica (independente da gravidade) na UCSP Mira, a proporção de utentes com diagnóstico prévio de depressão, determinar as características sociodemográficas, bem como a terapêutica neurofarmacológica e co-morbilidades dos utentes em estudo. Métodos: Foi desenvolvido um protocolo conciso, de fácil e rápida aplicação nos Cuidados de Saúde Primários para o rastreio precoce de Depressão em indivíduos de idade igual ou superior a 65 anos. O estudo-piloto realizado foi um estudo observacional e transversal. Após Consentimento informado, foram efectuados 116 inquéritos a utentes com idade igual ou superior a 65 anos da UCSP Mira. Os inquéritos consistiram numa caracterização sociodemográfica dos utentes inquiridos, seguida da aplicação da GDS 30 (Geriatric Depression Scale). Resultados: A aplicação da GDS-30 na amostra do projecto piloto foi demonstrada e indicou uma prevalência de 48% de perturbações depressivas em contraposição à registada com diagnóstico prévio (13,3%). Foi encontrada uma associação positiva entre a existência de co morbilidades e a prevalência de perturbação depressiva assim como uma elevada percentagem de indivíduos sob terapêutica neurofarmacológica na população inquirida. Conclusões: Os resultados obtidos encontram-se de acordo com as previsões iniciais de subdiagnóstico de depressão geriátrica e provou-se que o protocolo desenvolvido é aplicável. No entanto, as correlações entre as características demográficas e os resultados da GDS 30 não tinham significado estatístico, tornando-se imprescindível o alargamento da base de estudo. Pretende-se que a metodologia desenvolvida seja integrada num plano de medidas alargado de identificação precoce de patologia depressiva com vista à diminuição do subdiagnóstico de depressão em idade geriátrica.

Thesis (Ph. D.)--New School for Social Research, 2004.
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The submitted thesis deals with the issue of the meaning in life in the elderly. The meaningfulness of life, which was as a deep human need listed among the evaluated items in the WHOQOL assessments, is considered to be an important salutogenic factor. The thesis briefly introduces logotherapy, a method focused on the revelation and renewal of the meaning in life and the orientation towards values. It also mentions the possibilities of logotherapeutic approach in the communication with seniors being in a difficult life situation. The theoretical part specifies the fundamental terms regarding the ageing, the elderly, the demographic evolution of the contemporary society, health and psychosocial aspects of ageing and the seniors' needs. Further, this part summarizes the theoretical knowledge about the issue of quality of life and its meaning, the methods of their examination and the results of research. The last chapter of the theoretical part summarizes the existing knowledge regarding the depression in the elderly. The course of the research is described in the empirical part of the thesis. The aim of the research was to find out to what extent the seniors over 75 years of age in the Czech Republic live their lives as meaningful, to compare the measure of meaningfulness of life of older and younger...

The diploma thesis deals with problems of depression in older people. Mainly the work is focused on identifying and analyzing the role of nurses in screening for depression in older people in primary care, acute care, long-term care and home care. This thesis was focused on theoretical direction and was used the method of design and demonstration. In this thesis was set one main goals with five research questions. The main goal was to identify and analyze the role of nurses in screening for depression in the elderly. RQ 1: What is the role of the nurse in screening for depression in the elderly? RQ 2: What is the role of the nurse in the primary care in screening for depression in the elderly? RQ 3: What is the role of the nurse in screening for depression in hospitalized patients in acute care? RQ 4: What is the role of the nurse in screening for depression in seniors in long-term and home care? RQ 5: What rating scales and methods are used in screening for depression in the elderly? The thesis introduce the concept of depression. The following are specified the causes of and the important factors that affect depression in the elderly. It also deals the differences in the clinical symptomatology of depression in old age. It explains possibilities and various barriers in the diagnosis of depression. Another chapter introduces complete geriatric examination, diagnostic classification systems, possible screening methods and scales for detection of depression in the elderly population. It also deals methods of pharmacological and non-pharmacological treatment and its possible complications associated with older age. By reason of increased suicide rate caused by depressive disorder the issue of suicidal behavior in the elderly is introduced. The next chapter deals with the nursing process, which is used by nurses in practice. It consists of the evaluation of the patient's health condition, making nursing diagnosis, creating nursing plan and subsequent implementation and evaluation. The nursing process is also needy for providing quality care. The nursing process in the stage of nursing diagnosis, introduces possible nursing diagnosis for a patient suffering from depression, which are based on the latest classification. Finally is described the role of nurses in screening for depression in the elderly in different health facilities and their contribution to the timely evaluation of depression in the elderly. This chapter introduces the role of nurses, nursing screening and collaboration with a physician. The role of nurses in screening for depression in different medical facilities is based on the first phase of the nursing process of assessment. On the basis of objective and subjective information, the nurse will assess the overall health and mental condition of the patient. Primarily, it was investigated what is the role of the nurse in screening for depression. On the basis of content analysis and synthesis it was necessary to used and processed domestic and foreign literature. A number of relevant sources are the results of various studies and Meta-analyzes, mostly from abroad, but also from the Czech Republic. The thesis can serve as a basis for nurses. The result of this thesis is to create e-learning material available for students in the Faculty of Health and Social Sciences of South Bohemia in Ceske Budejovice in the tutorial called Moodle.