Detecting Depression in Elderly Medical Inpatients

Prevalence rates for depression indicate that elderly medical patients are a population at high risk. Studies of middle-aged adults show that detection of depression in medical patients by primary health care providers is poor and that screening instruments can improve detection, although little is known about geriatric patients. The present study used Research Diagnostic Criteria to assess the base rate of detection by nonpsychiatric physicians in a random sample of 150 elderly medical inpatients. In addition, the psychometric properties of three slightly different self-report screening instruments were evaluated. Results indicated that detection by house staff was extremely low (8.7%). All three instruments were much more sensitive, were equally specific, and yielded greater predictive power than the procedures used by hospital staff. All three instruments were especially sensitive to major depression. Of the scales, the Beck Depression Inventory (BDI), the BDI Psychological subscale, and the Geriatic Depression Scale had the best reliability and validity and were the most efficient.