Depression in older people in the general hospital: a systematic review of screening instruments

Background: depression is common in later life, particularly in people with poor physical health. In the acute hospital setting this is associated with poor outcomes, increased length of stay and compromised care. The recognition and diagnosis of depression is therefore a key first step in managing depression in the general hospital, and this may be facilitated by the use of an appropriate screening instrument. Objective: the aim of this study is to review all relevant literature on rating scales used to detect depression in older people in general hospitals so as to identify the most appropriate tool and cut-off score with optimal performance. Method: an electronic search was conducted applying key search terms. Selection of articles was conducted in a staged manner and by utilising predetermined quality criteria. When appropriate pooled analysis was undertaken. Findings: only 14 studies satisfied the inclusion criteria and only one instrument-the Geriatric Depression Scale (GDS)-has been studied to an adequate extent in older people in the acute general hospital setting. Best performance for the GDS was for a cut-off of 5/6 for the GDS-15 and 10/11 for the GDS-30. Conclusion: further research is required before recommending the use of brief depression screening instruments (single or two items) in the acute hospital setting. The GDS would appear the most validated instrument currently (in either 15 or 30 item versions), though other tools such as the BASDEC show promise.