Assessment of The Elderly in Gerontology Nursing

UNITS I & II: GERONTOLOGY NURSING
Assessment of the Elderly

BY
OLADELE, HELEN OLADUNNI
(RN, RM, RNE, RPHN, MSc)
PIONEER HEAD, PUBLIC HEALTH NURSING
PROGRAM,
OAUTHC, COLLEGE OF NURSING SCIENCES,
IFE CAMPUS,
Ile-Ife, Osun State, Nigeria.
7th October, 2024
Assessment of the Elderly – Two units
• Unit 1 Geriatric Depression Scale
• Unit 2 Sleep Index Tools
Outline
• Objectives
• Introduction
• Contents
• Understanding Depression & Sleep in Older Adults
• Overview of the Geriatric Depression Scale & Sleep Index Tools
• Administration and Scoring
• Interpretation of Results
• Clinical Applications, Advantages and Limitations
• Summary
• Conclusion
• References
Objectives
By the end of this interaction, participants will be able to:

• Understand the significance of assessing depression & sleep in older
adults.
• Describe the Geriatric Depression Scale, Sleep Index Tools and their
purposes.
• Administer the GDS, Sleep Index Tools and interpret the results.
• Recognize the clinical applications, advantages and limitations as
assessment tools for nursing practice and research.
Introduction
• Who is an elderly person?
• Why do we need the assessment of the elderly?
• Vulnerable?
The Elderly Person
• The World Health Organization (WHO) defines an elderly person as
someone aged 65 years or older.
• It varies across cultures and countries.
• In some contexts, and may be considered thus:
• - 60+ (United Nations)
• - 65+ (WHO, USA)
• - 70+ (some European countries)
• - 75+ (some African countries)
Peculiarities of the Elderly
• Retirement from work
• Decreased physical strength and mobility
• Reflection on life experiences
• Changing social roles (grandparenting, widowhood)
• Vulnerability due to ageing processes
• Increased health concerns (chronic diseases,
cognitive decline)
Understanding Depression in Older Adults
• Prevalence of depression in geriatric populations.

• Symptoms and challenges in recognizing depression in older adults.
• Risk factors contributing to depression, such as chronic illness, loss of
loved ones, and social isolation.
Overview of the Geriatric Depression Scale (GDS)
• First developed in the 1980s by Dr. Jean Yesavage and colleagues.

• A self-reported questionnaire designed for older adults.
• Three versions: 5- item, 15-item and 30-item scales.
• Focuses on mood and functional capacity, avoiding somatic symptoms
common in the elderly.
• Copies are provided for breaking into 3 groups
Administration and Scoring of GDS
• Administration:
• 1. Self-report or interviewer-administered & 2. Yes/No answer format.
• Scoring of the 15-item scale:
• 0-4: Normal range
• 5-9: Mild depression
• 10-15: Moderate to severe depression
• Scoring of the 30-item scale:
• 0-9: Normal
• 10-19: Mild depression
• 20-29: Moderate depression
• 30: Severe depression
Interpretation of GDS Results
• Guidelines for interpreting scores and determining next steps.

• Discussing results with the patient and involving family members.
• Referral for further evaluation or intervention when necessary.
Clinical Applications of GDS
1. Screening for depression in older adults.
2. Monitoring treatment response.
3. Research studies.
Application and Limitations of GDS
• Useful for: primary care, long-term care facilities, and psychiatric

settings.
• Limitations:
• 1. May not detect subtle or atypical depressive symptoms & has
potential for false positives/negatives.
• 2. Not suitable for severe cognitive impairment or dementia.
• 3. May require proxy reporting for severely impaired individuals,
follow-up assessments
Advantages of GDS
1. Simple and easy to administer.
2. Quick (5-10 minutes).
3. Sensitive to depressive symptoms in older adults.
4. Useful for monitoring treatment response.
Other Related Assessment Tools
• Patient Health Questionnaire-9 (PHQ-9)
• General Health Questionnaire (GHQ)
• Beck Depression Inventory (BDI)
• Hospital Anxiety and Depression Scale (HADS)
• Center for Epidemiological Studies Depression Scale (CES-D
UNIT 2: Sleep Index Tools (SIT)
• Sleep is essential for physical and mental health, and sleep disorders
can have significant consequences.
• It is a complex process characterized by altered consciousness,

reduced responsiveness, and decreased metabolic rate.
• SITs are used to assess sleep quality, duration, and disorders. Accurate
assessment and diagnosis are crucial for effective management
SITs
1. Pittsburgh Sleep Quality Index (PSQI)
2. Epworth Sleepiness Scale (ESS)
3. Insomnia Severity Index (ISI)
4. Sleep Apnea scale of the Sleep Disorders Questionnaire (SA-SDQ)
5. Berlin Questionnaire (BQ)
Measurement Approaches to SITs
1. Self-report measures (PSQI, ISI)
2. Observer-reported measures (ESS)
3. Combination measures (SA-SDQ)
Administration and Scoring of SITs
1. PSQI: 19-item scale, 0-21 points

2. ESS: 8-item scale, 0-24 points
3. ISI: 7-item scale, 0-28 points
4. SA-SDQ: 13-item scale, 0-39 points
5. BQ: 10-item scale, 0-10 points
Interpretation/Classification of the Scales
1. PSQI:
- 0-5: Good sleep quality
- 6-10: Poor sleep quality
- 11-21: Severe sleep disturbance
2. ESS:
- 0-9: Normal
- 10-14: Mild sleepiness
- 15-24: Severe sleepiness
3. ISI:
- 0-7: No insomnia
- 8-14: Mild insomnia
- 15-28: Severe insomnia
Clinical Applications of SITs
1. Screening for sleep disorders

2. Monitoring treatment response
3. Research studies
Advantages of SITs
1. Easy to administer
2. Quick
3. Sensitive to sleep disorders
4. Useful for monitoring treatment response
Limitations of SITs
• Subjective reporting
• May not detect subtle sleep disorders
• Cultural and language limitations
Summary
• The Geriatric Depression Scale is an essential tool for identifying

depression in older adults, enabling healthcare providers to initiate
appropriate interventions. Understanding its administration, scoring,
clinical implications & limitations can enhance the care provided to
this vulnerable population.
• Sleep index tools are essential for assessing sleep quality, duration,
and disorders. Accurate administration, scoring, and interpretation
are vital for effective diagnosis and management.
The Ultimate
• Appropriate use of the tools.
• Effective diagnosis and
management.
• Holistic care
• Graceful ageing of the elderly
• Job satisfaction for nurses
Conclusion
• Recognizing and addressing depression/sleep problems in older
adults is crucial for improving their quality of life.
• The GDS serves as a valuable screening instrument, but it should be
used as part of a comprehensive assessment.
• This training on the use of the GDS & SITs will empower nurses to
better support geriatric patients.
• Sleep index tools are valuable in clinical practice, enabling healthcare
professionals to identify and manage sleep disorders. Understanding
the strengths and limitations of these tools is crucial for effective
application.
• These assessment scales are also invaluable to Nurse Researchers.
DO YOU HAVE
Any Question?
Methodology: Ethical Consideration
• Letter of introduction from dept of Nursing Sc.

OAU
• OAUTHC, Research ethics Committee, Ile-Ife
• UTH, Ethics committee, Osogbo.
• Consent/assent forms
• Confidentiality of information
References
American Psychological Association. (2018). Geriatric Depression Scale. In Encyclopedia of
Psychology.
Bastien, C. H., et al. (2001). Validation of the Insomnia Severity Index as an outcome
measure for insomnia research. Sleep Medicine, 2(4), 297-307.
Buysse, D. J., et al. (1989). The Pittsburgh Sleep Quality Index: A new instrument for
psychiatric practice and research. Psychiatry Research, 28(2), 193-213.
Johns, M. W. (1991). A new method for measuring daytime sleepiness: The Epworth
Sleepiness Scale. Sleep, 14(6), 540-545.
Netzer, N. C., et al. (1999). Using the Berlin Questionnaire to identify patients at risk for the
sleep apnea syndrome. Annals of Internal Medicine, 131(7), 485-491.
Sheikh, J. I., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): Recent evidence and
development of a shorter violence. Clinical Gerontologist, 5(1-2), 165-173.
Yesavage, J. A., et al. (1982). Development and validation of a geriatric depression
screening scale: A preliminary report. Journal of Psychiatric Research, 17(1), 37-49.

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UNITS I & II: GERONTOLOGY NURSING

Assessment of the Elderly

By the end of this interaction, participants will be able to:

• Prevalence of depression in geriatric populations.

• First developed in the 1980s by Dr. Jean Yesavage and colleagues.

• Guidelines for interpreting scores and determining next steps.

• Useful for: primary care, long-term care facilities, and psychiatric

• It is a complex process characterized by altered consciousness,

1. PSQI: 19-item scale, 0-21 points

1. Screening for sleep disorders

• The Geriatric Depression Scale is an essential tool for identifying

• Letter of introduction from dept of Nursing Sc.

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