Screening and Referral for Depressed Older Adults

#096- Do you regularly screen for depression in the older adults you work with? Do you know which screening tools are best to use with older adults? With adults with mild cognitive impairment? With adults with moderate to severe dementia? 

No worries! I got you covered. 

 In this week's video, you'll learn: 
⭐️ 5 must have (and free) depression screening tools to use with older adults

⭐️ the screening tools to assess for depression and anxiety when older adults are medically hospitalized

⭐️ Which depression screening tools are best for use with older adults who have mild cognitive impairment or early stages of dementia

⭐️ A screening tool to identify depression in the moderate to severe stages of dementia. 

Click here to get access to each of these screening tools

PROFESSIONALS: Grab your free guide to working with older adults here


Attention Social Workers, Therapists, Counselors, Psychologists, Aging Life Care Experts... Click here to get Continuing Education Credits

Transcript

Depression is a medical condition that impacts more than 7 million adults, ages 65 and older. It impacts psychological, physical, emotional, and spiritual processes and benefits from treatment. In fact, treatment is just as effective for older adults as it is for other age groups. All right. So here is why screening is so important. Screening for depression, either in a medical health system or a mental health system is critical to identifying which older adults need mental health care, and then connecting them to the mental health care that they do need. So what are screening tools?

Screening tools tend to be brief questionnaires that help professionals, medical professionals, mental health professionals, senior care professionals identify if a certain condition may be happening, or identify if an older adult may be vulnerable to a certain. mental health or medical condition. So today I'm talking about depression screening tools and so depression screening tools are brief questionnaires that we use with older adults to identify if they may be experiencing symptoms of depression.

Screening tools are not diagnostic tools, so they don't diagnose a depression. They just highlight if an older adult might be vulnerable to a depression and clue us in as to whether or not that older adult should be referred for further evaluation with a mental health provider.

I wanna share three depression screening tools that are commonly used with older adults. The first one I wanna talk about is the Geriatric Depression Scale, also known as the "GDS". This is a 30 or 15 item measure. It's a questionnaire where simply the older adult will answer yes or no to questions about how they have been feeling in the past week.

The GDS 15 takes about five to seven minutes to administer and asks questions like, "are you basically satisfied with your life?", or "are you afraid something bad is going to happen to you?" do you prefer to stay at home rather than going out and doing new things? . The great thing about the geriatric depression scale is that it can be easily used with people who have a cognitive disorder, so especially in mild cognitive impairment.

Or early stages of dementia. I really like using the GDS because even if a person is cognitively impaired, they can still generally answer yes or no questions. Listen to the whole video to hear about a screening tool to use with people with moderate to severe dementia, because yes, people with moderate to severe dementia also can experience depression and benefit from treatment. So stay with me to the end and I'll share a screening tool that you can use in that context.

The GDS 15 is my go-to resource when it comes to working with older adults in outpatient primary care or outpatient mental health care. I will say also the PHQ-9, which is very common in medical settings and mental health settings, is normed for older adults and is great to use. However, because it's a likert scale, that gets a little bit more complicated for people with dementia or cognitive impairment. And so if you find that the PHQ-9 is not working, the GDS 15 is a great alternative. It's also important to know that the GDS 15 is actually open for public domain. It's out of Stanford and Is available in lots of different languages from Arabic to Yiddish. And so head on over at the link where you're watching this video and you can learn more about where to download the GDS 15 and start using it in your practice. So another scale that I wanna talk with you about is the Depression in Older Adults Scale. This is a scale that's commonly used for adults in the hospital, or older adults who are medically hospitalized. Has similar questions to the GDS 15, but it has fewer questions and they've removed questions that would make it complicated for somebody who's medically hospitalized to answer. Similar to the GDS 15, it asks yes or no questions, so it's great if people are not feeling well or have a cognitive impairment and it asks questions like: I can enjoy my life even when things are sometimes difficult." , " I tend to worry a lot." If you'd like to learn more about the D I A S scale and how to score it, head on over to the link wherever you're watching this video and you can learn more. There's another scale that can be helpful, which is called the Hospital Anxiety and Depression Scale, or the HADS, that's pretty commonly used in medical settings as well, so you can take a look at that.

All right. Now the third screening tool that I wanna share with you is a screening tool for identifying a person's vulnerability to depression in the context of dementia. And yes, even people with dementia can have a depression, and that depression can indeed be treated. But we first have to identify if a person might be experiencing depression in the context of dementia.

And this screening tool that I'm gonna share with you might just help you out. So this screening tool is called the Cornell Scale for Depression in Dementia, or the C S D D.

This is a screening tool that's helpful to use for people who may have moderate to severe dementia. So even if the person is non not able to communicate very well, you can still use this screening tool. This assessment tool takes about 30 minutes to administer and is commonly given directly to the caregiver. The person who knows the person living with dementia the best and is providing the most direct care and can answer questions about the person's mood or behavior or belief system. And so, it starts by talking directly to the caregiver and getting the caregiver's sense of how the person with dementia is doing.

This screening tool has 19 questions and is broken into categories. Categories like, is the caregiver noticing mood related signs like sadness or irritability or anxiety? Is the caregiver noticing any behavioral disturbances like restlessness and fidgetiness, or a lot of stillness and not much movement at all?

Are they noticing physical signs, like changes to appetite or changes to level of energy?

Is the caregiver noticing changes to cyclical functions, like changes to going to sleep times or wake up times? And finally, ideational disturbances. This is a fancy word for, is the person describing suicidal thoughts, more thoughts about death and dying? Are they experiencing more hallucinations or delusions? Are they expressing low self-esteem and low self-worth? These are all important in identifying a person's vulnerability to depression. You can learn more about the CSDD or the Cornell Scale for depression and dementia, at the link wherever you're watching this video. So now that you've administered a screening for depression, say that you're concerned that an older adult may in fact be depressed. So how do you refer a person for a more comprehensive evaluation for depression? Well, the first thing you need to do is talk with the older adult about your concerns.

If it's the GDS 15 and they score more than five, I say, you know, I'm concerned that you may be experiencing depression.

Let's get you connected to care so that we can see what's really going on. Recommend that they see their primary care provider first to rule out any medical or medication reason that they might be experiencing depression symptoms. So at the same time, or once that's done, you can recommend that they see a mental health provider that specializes with older adults who can give a more comprehensive evaluation. To find a mental health provider who specializes with older adults. There's more information where you're watching this video in the link below. 

All right. So, how do you start the conversation with older adults when you're concerned? So say you're a concerned family member or a concerned clinician. So you wanna talk with the older adult in a compassionate, calm, and straightforward way. You don't wanna beat around the bush. You can say, Hey, you know, I've been noticing that you're not yourself lately, and then you can describe what you observe. 

You've been staying in bed a lot more lately, or your appetites seem to change. I'm concerned about you. I've been worried about you. Can we talk about what's been going on? If you're not comfortable talking with me, is there somebody you are comfortable talking with? Can I help connect you to or something like, it seems like you're going through a hard time. How can I help you get connected to care. 

Even if the person declines your offers at first, don't ignore them or what's going on. Respect where they're at, and then keep connected to that person and then over time, try again gently, compassionately, and in a straightforward way..

If you see something, say something. So often we assume that depression is a normal part of aging. It is not. It is highly treatable. So it's really important that we're screening for depression if we're professionals, and that we're getting older adults connected to care. You have a really important role in ensuring that older adults get access to mental healthcare.

So thank you for being here and doing your part. so as I mentioned earlier, if you're looking for a mental health provider who specializes with older adults, click the link below and get connected. 

So this screening tool is called the Cornell Cornell . The screening tool for depression in the context of dementia I wanna share with you is called the Cornell , is called the Cornell Scale for Depression in Dementia, or the C S D D.