Diagnostic tools and assessment scales

Clinical tools play a fundamental role in the diagnosis of depression in older adults, especially when symptoms are not expressed in a classic manner.

Unlike other age groups, older adults tend to present more somatic manifestations (pain, fatigue, sleep or appetite disturbances), which can make timely identification of depressive disorder difficult. Therefore, the use of specific scales and a comprehensive clinical evaluation are essential for an accurate diagnostic approach.

Specific screening scales (Yesavage Geriatric Depression Scale)

One of the most widely used tools for screening depression in the geriatric population is the Geriatric Depression Scale (GDS). This scale was designed specifically for older adults, taking into account their cognitive, emotional, and cultural characteristics.

There are 30-item and 15-item versions, the latter being very useful in rapid clinical settings. The GDS does not include physical symptoms, which is key, as many of these are common in old age and could overestimate depressive symptoms.

The questions focus on affective and cognitive aspects, such as interest in activities, feelings of worthlessness, or pleasure in everyday life. Scores above 5 on the short version suggest mild depression; above 10, severe depression.

Appropriate use of scales according to clinical context

While scales are useful tools, they do not replace clinical assessment. They should be interpreted considering the patient's biopsychosocial context.

For example, the GDS is most effective when applied to patients without severe cognitive impairment. In those with suspected dementia, adapted instruments may be more useful or may be supplemented with cognitive scales such as the MMSE (Mini Mental State Examination).

Similarly, in hospital settings, where depression may coexist with physical comorbidities, caution is required when interpreting results, as symptoms such as fatigue or insomnia can have multiple causes.

Scales should be used as a first approximation, and their results should always be checked against the clinical history, psychiatric interview, and reports from the family or primary caregiver.

Comprehensive clinical and social assessment of the depressed geriatric patient

The assessment of older adults with suspected depression cannot focus solely on mood. A broad view that considers medical, neurological, social, and emotional aspects is required.

It is essential to consider a history of chronic diseases, polypharmacy, recent stressful life events (bereavement, functional losses), and characteristics of the family or institutional environment. Loneliness, loss of social roles, isolation, or reduced recreational activities are factors that can contribute to or maintain a depressive state.

In addition, cognitive symptoms—such as changes in attention, memory, or thinking—should be investigated, as depression at this stage can be confused with neurocognitive disorders. It is also important to explore suicide risk, which is often underestimated in this population.

The medical history should include information on lifestyle habits, substance use, functional functioning, and perception of health. This ensures a comprehensive intervention tailored to the needs of the geriatric patient, ensuring not only an accurate diagnosis but also effective and humane treatment.