Does the use of the geriatric depression scale make redundant the need for separate measures of well-being on geriatrics wards?

Introduction

There is increasing interest in using standardized assessment scales in hearth care for elderly people [1]. A working party of the Royal College of Physicians of London and the British Geriatrics Society [2] recommended the use of the Geriatric Depression Scale [3] (GDS) for assessment of depression, and the Philadelphia Geriatric Center Morale Scale UK version [4] (PGCMS) for assessment of well-being. The purposes of assessment are envisaged very differently for the two scales. The GDS is intended as a screening tool to identify cases of depression, because such cases are frequently missed by practitioners [5, 6]. The PGCMS, on the other hand, is intended to improve practitioners' understanding of their patients and for use as an audit tool to measure change in well-being, an essential component of quality of life [7].

A recent study evaluated the feasibility of introducing a basket of standardized assessment scales including the GDS and PGCMS, into acute hospital care of elderly people. It was found that nurse practitioners were able to administer both scales once during the course of inpatient care. They felt that use of the scales improved their understanding of their patients and helped with decision-making [8]. However, nursing staff expressed concern that there were overlaps between the two scales, and they would prefer to have to administer only one.

In this study we report an analysis of the similarities and differences in patient profiles obtained by the use of the GDS and PGCMS, including evidence on intercorrelation. We also report data on two other different types of well-being scales included in the same study, the Southampton Self-esteem and Sources of Self esteem Scale [9] (SSESS) and the Bradburn Affect Balance Scale [10] (BABS). These two scales were on the short-list of scales considered by the Royal College of Physicians and British Geriatrics Society Working Party for standardized assessment of well-being in routine practice [2].

Methods

Choice of scales: There have been many reports on the properties of the Geriatric Depression Scale (GDS) in different elderly populations, both in the UK and the US [3, 11-13]. It was designed to provide an improved index of old age depression by relying more on items with psychological content and less on somatic items, with which older people often indicate difficulties or complaints in the absence of depressed mood. It exists in 30- and 15-item versions. Results both for the longer version and the extracted 15 items are reported in this paper.

The Philadelphia Geriatric Center Morale Scale (PGCMS) in its British form has been frequently used in the last ten years as a measure of well-being in social gerontological studies in the UK [14, 15]. It has been shown to be sensitive to intervention, most notably in the evaluations of enhanced forms of community care carried out by the Personal Social Services Research Unit at the University of Kent [16-18]. Like most well-being scales it consists of a series of statements, 17 in the case of the PGCMS, to which the …