Can we trust depression screening instruments in healthy 'old-old' adults?
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.
Watson
Lea C
LC
Department of Psychiatry, Program of Geriatric Psychiatry, Duke University Medical Center, Durham, NC 27710, USA. watso069@mc.duke.edu
Lewis
Carmen L
CL
Kistler
Christine E
CE
Amick
Halle R
HR
Boustani
Malaz
M
D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000175:diagnosis*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D007406:Interview, Psychological / Q000379:methods; D008297:Male; D008403:Mass Screening / Q000379:methods; D012372:ROC Curve; D012680:Sensitivity and Specificity