Geriatric Depression Scale (GDS-15)
Short Form — Validated Depression Screening for Older Adults
GDS-15 Depression Screening
Choose the best answer for how you have felt over the past week.
Understanding Late-Life Depression
How Common Is Depression in Older Adults?
Depression affects approximately 7% of the general elderly population, though rates are significantly higher among those in medical settings. Among older adults in primary care, prevalence rises to 10–15%, and among nursing home residents, rates can reach 25–30%. Despite these numbers, late-life depression remains one of the most underdiagnosed and undertreated conditions in geriatric medicine.
How Does Geriatric Depression Differ?
Depression in older adults often presents differently than in younger populations. Older adults are less likely to report sadness as a primary symptom and more likely to present with:
- Physical complaints such as fatigue, pain, or gastrointestinal problems
- Cognitive symptoms that may mimic or overlap with early dementia (“pseudodementia”)
- Social withdrawal and loss of interest in previously enjoyed activities
- Irritability, anxiety, or agitation rather than overt sadness
- Sleep disturbances, particularly early-morning awakening
Medical Comorbidities
Depression in older adults frequently co-occurs with chronic medical conditions including heart disease, diabetes, stroke, Parkinson disease, arthritis, and chronic pain. These conditions can both contribute to and mask depressive symptoms, making diagnosis more challenging. Additionally, many medications commonly prescribed to older adults can cause or worsen depressive symptoms.
Why Is It Underdiagnosed?
Several factors contribute to the underdiagnosis of geriatric depression:
- Symptoms are often attributed to “normal aging” by patients, families, and even healthcare providers
- Older adults may be reluctant to discuss emotional symptoms due to generational stigma around mental health
- Somatic complaints may dominate clinical visits, leaving emotional health unaddressed
- Cognitive impairment may make self-reporting difficult
- Limited time in primary care appointments may not allow for thorough mental health screening
GDS-15 Scoring Explained
Yes/No Format
The GDS-15 uses a simple Yes or No response format, which was specifically designed for older adults. Unlike many depression scales that use Likert-type scales (e.g., “not at all” to “nearly every day”), the binary format reduces cognitive burden and makes the instrument more accessible for elderly patients, including those with mild cognitive impairment.
Reverse-Scored Items
Not all “Yes” answers indicate depression. Five items (1, 5, 7, 11, and 13) are positively worded, meaning that a “No” response indicates a depressive symptom:
- Q1: “Are you basically satisfied with your life?” — No = 1 point
- Q5: “Are you in good spirits most of the time?” — No = 1 point
- Q7: “Do you feel happy most of the time?” — No = 1 point
- Q11: “Do you think it is wonderful to be alive now?” — No = 1 point
- Q13: “Do you feel full of energy?” — No = 1 point
The remaining 10 items are scored such that a “Yes” answer equals 1 point.
Score Interpretation
- 0–4: Normal — depression is not indicated
- 5–8: Mild depression — further evaluation recommended
- 9–11: Moderate depression — clinical follow-up warranted
- 12–15: Severe depression — comprehensive evaluation and treatment needed
Clinical Use in Geriatric Settings
The GDS-15 is widely used in primary care, geriatric clinics, nursing homes, and community health settings. It can be administered in approximately 5–7 minutes and can be completed by the patient independently or administered verbally by a clinician or caregiver. The instrument is available in the public domain and has been translated and validated in over 30 languages.
The GDS-15 is a screening tool, not a diagnostic instrument. A positive screen should always be followed by a comprehensive clinical evaluation, including assessment for medical causes of depression, medication side effects, and cognitive impairment.
Treatment for Older Adults
Depression in older adults is highly treatable. With appropriate intervention, the majority of elderly patients experience significant improvement. Treatment should be individualized and often involves a combination of approaches.
Antidepressant Medications
SSRIs (selective serotonin reuptake inhibitors) such as sertraline (Zoloft) and escitalopram (Lexapro) are generally considered first-line treatment for older adults due to their favorable side-effect profile. Key considerations include:
- Starting at lower doses and titrating slowly (“start low, go slow”)
- Monitoring for drug interactions with existing medications
- Avoiding tricyclic antidepressants due to anticholinergic effects
- Being aware of hyponatremia risk with SSRIs in the elderly
- Allowing 4–6 weeks for full therapeutic effect
Psychotherapy
Cognitive Behavioral Therapy (CBT) has strong evidence for treating depression in older adults. Other effective approaches include:
- Problem-solving therapy (PST)
- Interpersonal therapy (IPT)
- Behavioral activation
- Reminiscence or life review therapy
Psychotherapy can be adapted for cognitive or sensory impairments and delivered individually, in groups, or via telehealth.
Exercise & Physical Activity
Regular physical activity has been shown to have significant antidepressant effects in older adults. Even modest levels of exercise, such as daily walking, can improve mood, sleep, and cognitive function. Exercise programs should be tailored to the individual's physical abilities and medical conditions.
Social Engagement
Social isolation is both a risk factor for and a consequence of depression in older adults. Interventions that promote social connection can be an important component of treatment:
- Senior centers and community programs
- Volunteer activities
- Religious or spiritual communities
- Peer support groups
- Intergenerational programs
Electroconvulsive Therapy (ECT)
For severe or treatment-resistant depression in older adults, ECT remains one of the most effective treatments available. It is particularly appropriate when:
- Depression is severe with psychotic features
- The patient is at imminent risk of suicide
- Medications have been ineffective or cannot be tolerated
- Rapid response is medically necessary (e.g., the patient has stopped eating)
Modern ECT is safe and well-tolerated in older adults, with response rates often exceeding 80%.
Caregiver Resources
Signs to Watch For
As a caregiver or family member, you play a critical role in recognizing depression in an older adult. Watch for these warning signs:
- Persistent sadness, tearfulness, or expressions of hopelessness
- Withdrawal from social activities, hobbies, or family gatherings
- Significant changes in appetite or weight (loss or gain)
- Sleep disturbances, especially difficulty staying asleep or early-morning awakening
- Increased focus on physical complaints without clear medical cause
- Difficulty concentrating, making decisions, or remembering things
- Neglect of personal hygiene or household responsibilities
- Statements like “I’m a burden” or “Everyone would be better off without me”
- Giving away possessions or making unusual arrangements
How to Help
- Start the conversation gently. Express concern without judgment: “I’ve noticed you seem different lately. How have you been feeling?”
- Listen actively. Let them share at their own pace without minimizing their feelings
- Encourage professional help. Offer to help schedule an appointment and accompany them
- Help with practical barriers. Provide transportation, assist with medication management, or help navigate insurance
- Stay involved. Regular check-ins, visits, and phone calls can make a significant difference
- Be patient. Recovery from depression takes time, and setbacks are normal
Respite Care
Caregiving for a depressed older adult can be emotionally and physically demanding. It is important for caregivers to take care of their own mental health as well. Respite care services can provide temporary relief and include adult day programs, in-home respite providers, and short-term residential care. Contact your local Area Agency on Aging (AAA) or the Eldercare Locator (1-800-677-1116) for resources in your area.
Support Groups & Specialist Resources
- Eldercare Locator: 1-800-677-1116 — connects caregivers with local aging services
- National Alliance on Mental Illness (NAMI): nami.org — education, support groups, and helpline (1-800-950-6264)
- Caregiver Action Network: caregiveraction.org — peer support and education
- Geriatric Psychiatrists: Specialists trained in diagnosing and treating mental health conditions in older adults. Ask your primary care provider for a referral
- Geriatric Care Managers: Can coordinate care and connect families with appropriate resources
Frequently Asked Questions
The Geriatric Depression Scale — Short Form (GDS-15) is a 15-item self-report questionnaire specifically designed to screen for depression in older adults. Developed by Yesavage and colleagues in 1983, it uses a simple Yes/No format that is easy for elderly individuals to understand and complete. The original 30-item GDS was shortened to 15 items by Sheikh and Yesavage in 1986 without significant loss of diagnostic accuracy. It is in the public domain and has been translated into over 30 languages.
Depression screening is critical for older adults because late-life depression is commonly underdiagnosed and undertreated. Older adults often present with atypical symptoms — such as fatigue, pain, or cognitive complaints — rather than the classic sadness seen in younger populations. Untreated depression in the elderly is associated with increased medical morbidity, cognitive decline, functional impairment, higher healthcare costs, and elevated suicide risk. Adults aged 85 and older have the highest suicide rate of any age group. Routine screening allows for early detection and intervention, which significantly improves outcomes.
Geriatric depression often differs from depression in younger adults in several important ways. Older adults are less likely to endorse feelings of sadness and more likely to present with somatic complaints, cognitive difficulties (sometimes called “pseudodementia”), loss of interest and motivation, irritability, and anxiety. Late-life depression frequently co-occurs with chronic medical conditions and may be triggered by losses such as retirement, bereavement, declining health, or reduced independence. Additionally, the overlap between depressive symptoms and symptoms of medical illness or normal aging can make diagnosis more challenging.
Several evidence-based treatments are effective for depression in older adults. SSRIs such as sertraline and escitalopram are generally considered first-line pharmacotherapy due to their safety profile. Psychotherapy, particularly cognitive behavioral therapy (CBT), problem-solving therapy, and interpersonal therapy, has strong evidence of efficacy. For severe or treatment-resistant depression, electroconvulsive therapy (ECT) is highly effective and safe in older adults. Lifestyle interventions including regular exercise, social engagement, and structured activities are valuable adjuncts. Treatment should always consider potential drug interactions with existing medications and be tailored to the individual's medical, cognitive, and functional status.
There is no single standard for screening frequency, but general guidelines suggest that older adults should be screened for depression at least annually, and more frequently if risk factors are present. The U.S. Preventive Services Task Force recommends screening for depression in the general adult population, including older adults, when adequate systems are in place for follow-up. Consider more frequent screening after major life events (such as bereavement, hospitalization, or a new medical diagnosis), during transitions in care settings, and whenever a caregiver or family member notices behavioral changes.
No. The GDS-15 is a screening tool, not a diagnostic instrument. A score above the normal range suggests the possible presence of depression and indicates that a comprehensive clinical evaluation is warranted. Only a qualified healthcare provider — such as a physician, psychiatrist, or psychologist — can diagnose clinical depression after a thorough evaluation that includes a clinical interview, medical history review, physical examination, and possibly laboratory tests to rule out medical causes of depressive symptoms.
Medical Disclaimer
This GDS-15 screening tool is provided for educational and informational purposes only. It is not a medical diagnosis and is not intended to replace professional medical advice, diagnosis, or treatment.
- The GDS-15 is a screening tool, not a diagnostic instrument. Only a qualified healthcare provider can diagnose depression or other mood disorders.
- A high score does not necessarily confirm depression, and a low score does not guarantee its absence.
- If you or a loved one are experiencing symptoms of depression, please consult a primary care provider, geriatrician, or mental health professional.
- If you are having thoughts of self-harm, please contact 988 (Suicide & Crisis Lifeline) or go to your nearest emergency department.
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References
- Yesavage JA, Brink TL, Rose TL, et al. Development and validation of a geriatric depression screening scale: a preliminary report. Journal of Psychiatric Research. 1982-1983;17(1):37-49. PubMed
- Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist. 1986;5(1-2):165-173.
- Almeida OP, Almeida SA. Short versions of the geriatric depression scale: a study of their validity for the diagnosis of a major depressive episode according to ICD-10 and DSM-IV. International Journal of Geriatric Psychiatry. 1999;14(10):858-865. PubMed
- Marc LG, Raue PJ, Bruce ML. Screening performance of the 15-item Geriatric Depression Scale in a diverse elderly home care population. American Journal of Geriatric Psychiatry. 2008;16(11):914-921. PubMed
Geriatric Depression Scale — Short Form (GDS-15): J.A. Yesavage, T.L. Brink, T.L. Rose, et al. (1983). Public Domain.