Australian Doctor 2nd June 2023 02JUNE2023 issue | Seite 32

2 JUNE 2023 ausdoc . com . au

Geriatric Depression Scale ( Short Form )

Patient ’ s Name : Date :

Instructions : Choose the best answer for how you felt over the past week . Note : when asking the patient to complete the form , provide the self-rated form ( included on the following page ).

Scoring :

Answers indicating depression are in bold and italicized ; score one point for each one selected . A score of 0 to 5 is normal . A score greater than 5 suggests depression .

Sheikh and Yesavage , 1986 / bit . ly / 3FgMotK

Geriatric Depression Scale ( Short Form ) Self-Rated Version

Patient ’ s Name : Date : Instructions : Choose the best answer for how you felt over the past week .

No . Question Answer Score 1 . Are you basically satisfied with your life ? YES / NO 2 . Have you dropped many of your activities and interests ? YES / NO 3 . Do you feel that your life is empty ? YES / NO 4 . Do you often get bored ? YES / NO 5 . Are you in good spirits most of the time ? YES / NO 6 . Are you afraid that something bad is going to happen to you ? YES / NO 7 . Do you feel happy most of the time ? YES / NO 8 . Do you often feel helpless ? YES / NO 9 . Do you prefer to stay at home , rather than going out and doing new things ? YES / NO 10 . Do you feel you have more problems with memory than most people ? YES / NO 11 . Do you think it is wonderful to be alive ? YES / NO 12 . Do you feel pretty worthless the way you are now ? YES / NO 13 . Do you feel full of energy ? YES / NO 14 . Do you feel that your situation is hopeless ? YES / NO 15 . Do you think that most people are better off than you are ? YES / NO

( Sheikh & Yesavage , 1986 )

Box 6 . Risk factors for dementia

TOTAL

Sources :

• Sheikh JI , Yesavage JA . Geriatric Depression Scale ( GDS ): recent evidence and development of a shorter version . Clin Gerontol . 1986 June ; 5 ( 1 / 2 ): 165-173 .

• Yesavage JA . Geriatric Depression Scale . Psychopharmacol Bull . 1988 ; 24 ( 4 ): 709-711 .

• Yesavage JA , Brink TL , Rose TL , et al . Development and validation of a geriatric depression screening scale : a preliminary report . J Psychiatr Res . 1982-83 ; 17 ( 1 ): 37-49 .

an increased focus on dementia , with research and policy initiatives aimed at raising awareness , improving diagnosis , ensuring quality care and support for people with dementia and their carers , and finding effective treatments .

Dementia is viewed with great negativity ; ongoing stigma can lead to feelings of shame and frustration for those affected , resulting in a reluctance to

61 , 62 seek medical advice .

Symptoms of dementia are commonly distinguished as cognitive and non-cognitive . Cognitive symptoms include memory loss , aphasia , visual-spatial deficits , difficulties with problem-solving , loss of co-ordination and motor function , and confusion and disorientation . Non-cognitive symptoms , also known as changed behaviours , expressions of unmet need in non-clinical settings or behavioural and psychological symptoms of dementia ( BPSD ) in clinical settings , include anxiety , agitation , aggression , depression , apathy , disinhibition , motor disturbances , night-time behaviours and appetite issues . 63

While cognitive decline is more predictable in dementia and worsens over time , BPSD are not as predictable . 64 , 65 BPSD may worsen and be more frequent over time , and are not

64 , 65 consistent across all dementias . The BPSD are more likely to result in adverse events including accelerated cognitive decline , increased risk of secondary complications including morbidity , hospitalisation and falls , accelerate the rate of institutionalisation and increase carer burden and distress . 66 Although the aetiology of BPSD is complex and likely multifactorial , symptoms may manifest as a result of social and environmental stimuli or unmet needs . 66 , 67 Understanding and addressing these precipitants may help reduce and effectively manage the symptoms of BPSD .

RISK FACTORS FOR DEMENTIA Aside from the non-modifiable familial risk , there are several modifiable risk factors , which when managed early , may reduce the risk of dementia . A 2020 Lancet review reported that addressing 12 modifiable risk

Table 3 . Summary of key focus areas

factors ( lower levels of education across the lifespan , hypertension , hearing impairment , smoking , obesity , depression , physical inactivity , diabetes , low social contact , excessive alcohol consumption , traumatic brain injury and air pollution ) may

Focus area Key points Screening Assessment / management Dementia

Falls

Mental illness

Elder abuse

Memory loss is not a normal part of ageing

Dementia is an umbrella term describing a broad range of degenerative neurological conditions

There is a great deal of stigma associated with dementia and its diagnosis

Falls are common in older people with the likelihood of a fall increasing with age

Falls can be prevented ; exercise ( strength and balance training ) reduces falls

Fear of falling is also common in older adults , including those who have and have not fallen ; fear of falling can lead to activity restriction and associated decline in functional capacity

Mental illness is under-recognised and undertreated in older people

About 10 % of people aged over 65 experience mental illness , and the prevalence is increased in residential aged care

Elder abuse causes harm to older people and is under-recognised and underreported

Elder abuse includes financial , physical , sexual , psychological and emotional abuse and neglect

The main perpetrators of elder abuse are adult children , friends , partners / spouses

Figure 3 . Geriatric depression scale .

• Aim to maintain systolic BP of 130mmHg or less from age 40 .

• Protect ears from excessive noise and encourage use of hearing aids for hearing loss .

• Reduce exposure to air pollution and second-hand smoke .

• Prevent head injury .

• Limit alcohol use to less than 21 units weekly .

• Avoid the uptake of smoking and promote smoking cessation .

• Provide primary and secondary education to all children .

• Reduce obesity and the linked condition of diabetes .

• Sustain physical activity .

• Address other risk factors with lifestyle interventions . Source : Livingston G et al 2020 68

Ask the person if they have problems with memory or orientation

Use a validated screening tool if yes

Ask about history of falls in previous year

Ask about fear of falling and concerns about balance

Observe walking and consider conducting sitto-stand test ( also known as chair rise test )

Use a screening tool such as the GDS that can be completed by an older person or administered by interview

Consider using a validated screening tool

The Australian Elder Abuse Screening Instrument has face validity and is recommended

Assess with validated cognition tool

Dementia requires specialist diagnosis and support , eg , specialist clinics or referral to a neurologist / geriatrician

Prevention of cognitive decline or for cognitive impairment : cognitive stimulation to address hearing loss , ensure social connection and implement physical activity

Undertake comprehensive falls risk assessment to determine falls risk factors

Address individual falls risk factors , including prescribing exercise

Review medication to determine level of polypharmacy and use of falls risk increasing drugs

First-line treatment is non-pharmacological

Physical activity reduces the risk of depression and improves mental wellbeing

Psychological or psychosocial interventions , eg , CBT can reduce depression and anxiety

There is limited evidence on effectiveness of primary prevention interventions

Reporting of elder abuse is mandatory for people working in residential aged care

Consider referring your patient to a helpline or reputable website