66

Original Article
Pharm Sci Res, Vol 7 No 1, 2020

Pharmaceutical Sciences and Research (PSR), 7(1), 2020, 66 - 74

Assessment of Depression Among Older Adults Staying in Old Home

Care in Klang, Malaysia
Muhammad Qamar*, Nurul Zahirah, Sohail Ahmad
Department of Clinical Pharmacy, Faculty of Pharmacy, MAHSA University, Bandar Saujana Putra, 42610 Jenjarom,
Kuala Langat, Selangor, Malaysia

ABSTRACT

Mental disorders such as depression are widespread, often underdiagnosed, and usually
inappropriately treated. The early recognition of factors that may promote depression with the help
of depression screening aid can help to plan better care for the patient. Therefore, this study aimed to
determine the depression prevalence among the older adults staying in old home care, to explore any
association and differences of depression across various socio-demographic variables, and to study
the predictors of depression among study subjects. A cross-sectional study was conducted with a
ARTICLE HISTORY convenience sample of 141 elderly by using the validated tool. The study instrument was divided into
two sections: Section I (Socio-demographic data); Section II (M-Geriatric Depression Scale-14). The
Received: May 2019 results showed 44.7% were in the age group of 65-75 years, the majority were Chinese (42.6%), and
Revised: October 2019 male (57.4%). Among the subjects, 43.3% had hypertension, followed by 39% of diabetes, and 8.5%
Accepted: April 2020 were with heart disease, while more than 90% reported not known history of depression. The study
revealed that more than 50% of the respondents had depression. Statistically, a significant difference
was observed between the depression prevalence with marital status (p=0.021) and a history of heart
disease (p= 0.002). On multivariate analysis, heart disease was found to be statistically significant.
Depression was prevailing among the older community those who were staying in old home care.
Daily evaluation should be done for the older population staying in old home care to attenuate the
prevalence of depression. Family and social support were vital to highlight the issue of depression
among older adults.

Keywords: depression, older adults, old home care, Klang, Malaysia

*corresponding author
Email: mqamar18@gmail.com

INTRODUCTION geriatric who are in need of psychiatric treatment ever

receive this service (Friedhoff, 1991).
Worldwide countries around the world are experiencing
an increase in the older population. Globally, it is Depression is a mood disorder and also a state of feeling
estimated that the populace of the elderly would increase unhappy, miserable, and loss of self-confidence, which
by 21% in the next 5 decades and it is expected that the eventually will cause a loss of interest. Depression is
population of geriatric will increase to fourfold by the usually related to morbidity and mortality, thus making it
year 2050. Most probably, it would be almost 2 billion more significant and common in the geriatric population
in the developing nations (Venne, 2005). The total (Prashanth et al., 2015). Psychiatric disorders such as
population of Malaysia is 25 million and is consists of depression are especially prevalent among geriatric
various ethnic groups, among which major are Malays with a prevalence of approximately 10-15% worldwide
followed by Chinese, Indian, and foreigner immigrants (Choulagai et al., 2013). Consequences of depression
laborers (Mat, 2003). From the past 20 years, there has include poor quality of life, social deprivation,
been a positive change in statistics of the Malaysian loneliness, reduction of quality in activities of daily
population. It is expected that in the year 2020, more living, cognitive diminish, suicide as well as increased
than 10% of Malaysians will be at the age of 60 years mortality (Steffens et al., 2000). Every year, there was
and more. This is due to better health care, longer life over 800.000 individuals die due to suicide according to
expectancy, and low death rate as well as a decline in a report of the World Health Organization (WHO, 2008).
fertility (Department of Statistic, 1998).
As people are aging, depression is not a natural part of
However, mental health is important to the elderly it (Yesavage et al., 1982). Depression is usually can be
population, among which those who need it only a small reversed with quick recognition and proper treatment
fraction of them receive mental health service (Andrews (Brown et al., 2003). Very frequently, the geriatric has
et al., 1999). By one estimation, only about 10% of difficulty in recognizing depression and/or reporting it to
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their care providers. This is the reason why only a few of crucial for improving the functioning of the elderly and
the depression cases are detected or treated (Cole et al., hence the quality of life. It has been described previously,
1999). Further adding to this problem, if depression was somewhere else, about the validation, factor structure,
left untreated, it might lead to the onset of functional, and also the overall development of GDS-15. GDS-15
cognitive, physical and social disabilities as well as has been evaluated in a variety of populations including
a reduction in quality of life, lengthen the recovery inpatients, outpatients, primary care, and nursing homes.
from medical disease and surgery, higher health care On the other hand, the short form is more suitable as well
utilization and suicide (Yesavage et al., 1982). as practical to be used among the elderly, whereas its
administration to home care patients who was burdened
Depression is accounting for large morbidity and with lack of medical and functional status has not been
mortality within the elderly section of the society reported.
(Blazer, 2003). Based on the report of the World Health
Organization (WHO), the size of the elderly section The objective of the present study was to determine the
of the society has shown a fast and significant growth. prevalence of depression among older subjects living in
Therefore, it is important to make the health and fitness geriatric home care in the region of Klang, Malaysia,
issue of this population in our health care system (WHO, to identify the differences and association between the
2008). depression and sociodemographic characteristic of
respondents and predictors of depression among elderly
In order to determine the nature and magnitude of people living in geriatric home care.
depression, the screening and assessment of depression
among the geriatric staying in nursing home care are METHOD
necessary (Lyness et al., 1997). Structured Clinical
Interview for DSM-IV (SCID) is one of the diagnostic Research Design and Subjects
instruments, but this instrument is not regularly used A cross-sectional descriptive study was conducted in
in the home care setting (Spitzer et al., 1992). There the city of Klang by using a validated questionnaire.
is no specific information regarding the validity of The recommended sample size with 5% margin of error,
the standardized screening process that was related 95% confidence interval with 50% response distribution,
to diagnostic criteria in those populations, although was 141 respondents as calculated by the online Raosoft
screening for depression is the key element of a complete calculator. Before enrolling, a consent form was signed
assessment in an old care center (Marc et al., 2008). from respondents. This study recruited the elderly people
age > 65 years old who were living in geriatric home
The Geriatric Depression Scale (GDS) is one of the most care.
widely used tool for assessing the depression among
the geriatric in a primary care setting. This tool is freely Data Collection
available with no copywrite issue. It is available in two Elderly individuals living in old folks home were
version (GDS-30 and GDS15) using a different cut-off approached after taking approval from person In-charges
values and across different setting (Mitchell et al., 2010; of folk’s homes and written consent from respondents.
Pocklington et al., 2016; Watson & Pignone, 2003). All of them gave consent to participate in the study. The
It is available in many languages including English, study questionnaire was distributed at 5 different old age
Spanish, Malay, Dutch, Korean, Farsi and Tai. However, homes in Klang. Respondents were requested to respond
the original GDS has 30-items (GDS-30), the shorter to the questionnaire on the spot, and it was collected after
version of GDS with 15-items (GDS-15) scale was completion. The subjects were enrolled by convenience
validated against the longer GDS-30 scale, and the GDS- sampling.
15 is recommended to be used in primary care settings
(Mitchell et al., 2010; Yesavage & Sheikh, 1986). In Inclusion and Exclusion Criteria
2016, meta analytic review was conducted to examine Elderly subjects were enrolled with inclusion criteria
the diagnostic accuracy of the shorter version (15 items of age ≥65 years and respondents staying in the old
or less) of the geriatric depression scale against the gold folk home for ≥6 months (permanent or temporary
standard tools (DSM-IV and ICD-10) to diagnose the resident).  Participants with serious morbidities such
major depressive disorders (Pocklington et al., 2016). as psychiatric illness despite depression, critically ill
elderly, advanced heart disease or chronic renal disease,
The Geriatric Depression Scale-15 (GDS-15) was a cancer, and elderly with severe hearing or speech
suitable tool for assessing and screening of depression impairment, making the elderly unable to comprehend
in the general population across different age, gender, the questions were excluded from this study.
ethnicity, and chronic illness status (De Craen et al.,
2003). Early detection and effective interventions are

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Malay Geriatric Depression Scale-14 (M-GDS-14) scale consisted of “Yes” and “No” category and the
GDS-15 was translated to Malay language and validated. depression score ranged from 0-15 and the cut-off
The Malay version of GDS is a reliable and valid tool as level was determined as <5 points which indicated
like with original 30 or 15 items version (Ewe & Che no depression category, 5-9 points which fell under
Ismail, 2004). Item-9 of the GDS-15 was omitted due suggestive of depression or mild depression and ≥10
to its non-discriminatory value in clinical diagnosis of points which fell under indicative of depression.
depression and poorly correlated with total item score, Independent t-test and ANOVA test were used to find
thus making it a 14-items scale with Cronbach’s alpha the differences in depression scores across various socio-
score of 0.84, with test-retest validity of 0.84 (Ewe & demographic categories and medical illnesses. Pearson’s
Che Ismail, 2004). Malay version of geriatric depression Chi-Squared test was used to find the association
scale (M-GDS-14) is based on the Geriatric Depression between socio-demographic data and medical illnesses
Scale (GDS-15) as recommended by Royal College of with the depression score category. Logistic regression
Physicians, British Geriatric Society and The Royal was used to find the predictors of depression. The level
College of General Practitioners that GDS-15 is a of statistical significance was set at p<0.05.
suitable tool to screen for depression in the older adults.
In the current study, M-GDS-14 scale was used to assess RESULTS
and determine the prevalence of the depression among
elderly respondents. Socio-Demographic Data of the Respondents
Out of 150, 141 respondents aged > 65 years old gave
The M-GDS-14 consisted of 14 “Yes” and “No” their consent to participate and return the questionnaire to
questions. The score was obtained by summing up the the principal research. Therefore, the response rate of the
responses of positive and negative answers. The first part study was 94% (141/150) that surpassed the good index
of the questionnaire consisted of information regarding of response rate. It can be observed that most respondents
the socio-demographic variables and the second part of who participated in this study were male (57.4%) with
the questionnaire includes Malay Geriatric Depression inclusive of major ethnicity Chinese (42.6%), followed
Scale (M-GDS-14) for depression level measurement. by Malay (32.6%), and Indian (24.8%). The majority of
The study subjects were asked to respond to 14 items respondents who enrolled in this study were within the
by responding ‘yes’ or ‘no’ in reference to how they felt age range of 65-70 (44.7%). In this study, the marital
on the day the questionnaire was administered. A score status of widow/widower was found to be the highest,
of more than 5 points in GDS-14 indicated depression with 41.1% (Table 1).
and was categorized with the cut of the value of 0-4 are
considered normal; 5-8 indicate mild depression; 9-11 Table 1: Socio-demographic data of the respondents
indicate moderate depression, and 12-15 indicate severe (n=141)
depression. Moreover, the score between 5 to 9 indicated
as suggestive depression, while score ≥10 indicated Sociodemographic Category N (%)
as depression. However, respondents with a score >5
points were advisable to get a follow-up comprehensive Male 81 (57.4)
Gender Female 60 (42.6)
assessment. On the basis of formal interview diagnostic
criteria evaluation, the GDS was found to have sensitivity 65-70 63 (44.7)
and specificity of 92% and 89%, respectively (Yesavage Age 71-75 22 (15.6)
> 76 56 (39.7)
& Sheikh, 1986).
Chinese 60 (42.6)
Ethical Consideration Ethnicity Malay 46 (32.6)
The study was approved by the ethics board of the Indian 35 (24.8)
Research Management Centre (RMC) of MAHSA
Married 17 (12.1)
University. Individual participation in this study was Single 43 (30.5)
voluntary. Oral, as well as written consent, was taken Marital Status Widow/widowed 58 (41.1)
from each subject. Confidentiality and anonymity of Divorced 23 (16.3)
all participants were maintained as no names were
mentioned in the questionnaires. Medical Illnesses of the Respondents
Regarding medical illness, 43.3% of the respondents
Statistical Analysis were diagnosed with hypertension, followed by diabetes
The extracted data from completed questionnaires mellitus (39%) and hypercholesterolemia (22.7%), while
were analyzed using Statistical Package for the Social 99.3% of subjects reported with no history of depression
Sciences®. Descriptive and inferential statistics were (Table 2).
used to express the data. The geriatric depression

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Table 2: Medical illness of the geriatric respondents According to the World Health Organization (WHO)
in geriatric home care in Klang (n=141) predicted that depression would be one of the major
burdens of illness in most of the developing countries
Medical Illness Status N (%)* (Murray, 1996). Among geriatrics, one in six patients
Diabetes Mellitus Yes 55 (39) affected with depression and had been treated in general
medical practice and indeed higher percent in hospitals
Hypertension Yes 61 (43.3) and nursing homes (Reynolds & Kupfer, 1999)
Hypercholesterolemia Yes 32 (22.7)
The present study reported that the overall prevalence of
Heart Disease Yes 12 (8.5) depression in the enrolled respondents from the nursing
Osteoarthritis Yes 14 (9.9) home was 52.5%. It was one of the most common
psychiatric disorders in the elderly population, especially
Asthma Yes 10 (7.1) among those who are living in nursing home care (Li et
COPD Yes 7 (5) al., 2015). The percentage of those residents who were
Cataracts Yes 2 (1.4) affected by the condition in the forms of depressive
symptoms of depression, major and minor depression
Depression Yes 1 (0.7)
was approximately 15% to 52% (Ames, 1993).
*% > 100 (Multi response)

Scores of Geriatric Depression Scale Prevalence of depression among the geriatric people
Out of 141 geriatric respondents, 34 subjects had a living in community was 15.6% while those staying
score >10 (24.1% [34/141]), which was an indication in old age home was 27.7% (Abhishek et al., 2015)
of depression, whereas 40 respondents attained the whereas in another study by Mann et al. (2000) in the
score range between 5-9 (28.4% [40/141]) which was United Kingdom reported that elderly residing in old
suggestive of depression (Table 3). Those who score age home found to have 40% prevalence (Mann et al.,
more than 5 points were advised to have a follow-up 2000). It had been found that the depression prevalence
comprehensive assessment with psychiatrists for proper varied from one study to another. These differences were
diagnosis. most probably due to diagnostic criteria used to assessed
and measure depression, differ in culture, and diversity
Table 3: Scores of Geriatric Depression Scale (GDS) in the population (Evans & Mottram, 2000). There was
evidence indicating higher rates of depression in old
GDS (Score) N (%)
age home/nursing home compared to the community
No depression <5 67 (47.5) (Rovner et al., 1986; Grayson et al., 1995).
Suggestive of depression 5-9 40 (28.4)
Marital status had shown a significant difference
Indicative of depression > 10 34 (24.1)
(p=0.021) with a mean depression score. The finding
from the current study revealed that geriatric who are
Differences, Association, and Regression between divorced had a higher depression score as compared to
Socio-Demographic Data and Depression single and married. It had shown that marriage was one
Based on the findings of inferential statistics (Table 4), of the protective factors against depression in the elderly
significant differences were observed between geriatric population (Chen, 2008). The finding was consistent
depression scores across marital status (p=0.021) and a with the previously reported studies conducted in private
history of heart disease (p=0.002). But no statistically clinics in Malaysia (Sidik et al., 2003; Imran et al.,
significant association was observed between the 2009). It was assumed that people who were married
depression categories across the socio-demographics were prone to have less stressful experiences in their
of the respondents (Table 5). On multivariate analysis, whole married life and thus have less chance of being
history of heart disease was found to be primary depressed. On the other hand, another reason for being
predictors for depression (Table 6). depressed, single elderly might feel isolated because of
the lack of togetherness. Being alone was one of the risk
DISCUSSION factors for depression. The elderly community who were
living alone either in a community or in nursing care
Mental disorder such as depression was frequently were vulnerable to loneliness (Chen, 2008; Savikko et
reversible with immediately and desirable treatment. If it al., 2005).
was left without medical care, it might also result in the
onset of cognitive, physical, and social impairment and Moreover, depression was also prevalent in a patient
delay the recovery from medical disease and surgery. with heart failure (HF). Approximately one in five HF
Consequently, increased health care services and suicide patients present with depression, with about 48% of
(Rashid et al., 2011).
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Table 4: Differences between sociodemographic data with depression score

df (t-stat)1 /
Variables n Mean (+SD) p-value
df (f-stat)2

Gender
Male 81 5.72 (4.16) 139 (-1.109)1 0.269
Female 60 6.48 (3.93)
Age
65-70 63 5.63 (3.89) 2 (1.35)2 0.260
71-75 22 5.45 (3.82)
> 76 56 6.73 (4.31)
Ethnicity
Malay 46 5.76 (3.61) 2 (0.591)2 0.555
Chinese 60 5.88 (4.10)
Indian 35 6.69 (4.58)
Marital Status
Married 17 6.06 (4.05) 3 (3.357)2 0.021*
Single 43 5.19 (3.88)
Window 58 5.76 (3.70)
Divorced 23 8.35 (4.65)
Medical Illness
Diabetes Mellitus
Yes 55 5.71 (4.08) 139 (-0.778)1 0.438
No 86 6.26 (4.06)
Hypertension
Yes 61 5.38 (3.62) 139 (-1.709)1 0.090
No 80 6.55 (4.32)
Heart Disease
Yes 12 9.42 (4.99) 139 (3.097)1 0.002*
No 129 5.73 (3.84)
Osteoarthritis
Yes 14 6.43 (4.83) 139 (0.373)1 0.710
No 127 6.00 (3.99)
Asthma
Yes 10 8.10 (4.22) 139 (1.671)1 0.097
No 131 5.89 (4.02)
COPD
Yes 7 7.71 (4.46) 139 (1.117)1 0.266
No 134 5.96 (4.04)
1
Independent t‑test, 2 ANOVA

these individuals were having significant depression Besides, studies conducted by Norsiah and Sherina
(Mbakwen, 2016). The finding from the current study on depression among geriatric in primary health care
also showed that elderly with heart failure had a higher centers indicated a higher prevalence of depression of
depression score than with non-heart failure patient and 14% and 18%, respectively (Norsiah, 1999; Sherina,
was significantly associated (p = 0.002) with depression. 2002). The higher depression prevalent in these studies
was certainly due to the higher underlying morbidity of
Based on community studies, a statistic from systematic elderly attending primary health care centers, while a
review and meta-analysis found that on an average high percentage of prevalence of depression in our study
prevalence of clinically acceptable depressive syndrome was most likely due to the loneliness (divorced) staying
of 13.5% among the elderly aged 55 or older. Among in geriatric home care.
which 9.8% was grouped as minor depression and 1.8%
as major depression (Cole & Dendukuri, 2003).

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Table 5: Association between depression score category across the socio-demographic (n=141)

Score n (%) p-value *

Normal Suggestive Indicative
Variables <5 5-9 > 10

Gender
Male 42 (62.7) 18 (45) 21 (61.8) 0.170
Female 25 (37.3) 22 (55) 13 (38.2)
Age
65-70 33 (49.3) 17 (42.5) 13 (38.2) 0.299
71-75 10 (14.9) 9 (22.5) 3 (8.8)
> 76 24 (35.8) 14 (35) 18 (52.9)
Ethnicity
Malay 24 (35.8) 13 (32.5) 9 (26.5) 0.290
Chinese 26 (38.8) 21 (52.5) 13 (38.2)
Indian 17 (25.4) 6 (15) 12 (35.3)
Marital Status
Married 8 (11.9) 5 (12.5) 4 (11.8) 0.178
Single 25 (37.3) 9 (22.5) 9 (26.5)
Widow/Widower 28 41.8) 19 (47.5) 11 32.4)
Divorced 6 (9) 7 (17.5) 10 (29.4)
* Chi-square test

Table 6: Multivariate analysis of selected characteristic of having depression among geriatrics

Variables Adjusted odd ratio (95% CI) p-value

Gender
Female Reference 0.087
Male 1.876 (0.91-3.86)
Age
>75 Reference 0.411
65-75 0.730 (0.34-1.54)
Marital Status
Married Reference 0.913
Unmarried* 0.941 (0.31-2.84)
Diabetes Mellitus
No Reference 0.554
Yes 1.267 (0.57-2.77)
Hypertension
No Reference 0.722
Yes 1.156 (0.52-2.56)
Hypercholesterolemia
No Reference 0.367
Yes 0.652 (0.25-1.65)
Heart Disease
No Reference 0.038
Yes 5.553 (1.09-28.11)
Osteoporosis
No Reference 0.736
Yes 1.227 (0.37-4.02)
Asthma
No Reference 0.261
Yes 2.33 (0.53-10.2)
COPD
No Reference 2.97
Yes 2.97 (0.50-17.46)
* Single/Widow/widower/Divorced/Separated
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CONCLUSION Andrews, G., Hall, W., & Teesson, M. (1999). Henderson

Sl.  The mental health of Australians. Canberra, ACT:
The depression prevailing among geriatric staying Commonwealth of Australia Department of Health and
in geriatric home care was high in Malaysia. Heart Aged Care.
failure and divorced were significantly associated with
depression. These factors were modifiable. Blazer, D. G. (2003). Depression in late life: review
and commentary. The Journals of Gerontology Series
Nursing home care providers should come up with a A: Biological Sciences and Medical Sciences,  58(3),
proper assessment program on screening of depression M249-M265.
among the elderly in their center. It was advisable to
identify and assessed the risk factors of depression and Brown, E. L., McAvay, G., Raue, P. J., Moses, S., &
then treated accordingly to facilitate depression among Bruce, M. L. (2003). Recognition of depression among
the elderly. elderly recipients of home care services. Psychiatric
Services, 54(2), 208-213.
In general, the prevalence of depression among elderly
living in the old folk home needed to be alleviated and Chen, R., Hu, Z., Wei, L., Qin, X., McCracken, C., &
should be addressed in order to increase the awareness Copeland, J. R. (2008). Severity of depression and risk
of mental health and to make ensure that they have a for subsequent dementia: cohort studies in China and the
happier and healthier life at a home care center. UK. The British Journal of Psychiatry, 193(5), 373-377.

The obvious limitation of the current study was a cross- Choulagai, P. S., Sharma, C. K., & Choulagai, B.
sectional study design so that results could not be P. (2013). Prevalence and associated factors of
generalized for all geriatric people staying in nursing depression among elderly population living in geriatric
home care in Malaysia. homes in Kathmandu Valley. Journal of Institute of
Medicine, 35(1), 39-44.
Further research was also required to recognize the risk
factors of elevation of depression among the elderly. This Cole, M. G., Bellavance, F., & Mansour, A. (1999).
might help in improving their quality of life in the future Prognosis of depression in elderly community and
as well as contribute to the emancipation of the elderly. primary care populations: a systematic review and meta-
The majority of depressed participants expressed their analysis. American Journal of Psychiatry, 156(8), 1182-
satisfaction in living in geriatric home care. However, 1189.
there was a need for a bigger study to be conducted
to confirm these outcomes as this study may not have Cole, M. G., & Dendukuri, N. (2003). Risk factors
sufficient strength to identify the depression caused by for depression among elderly community subjects: a
these demographic variables in geriatric home care in systematic review and meta-analysis. American journal
Malaysia. of psychiatry, 160(6), 1147-1156.

ACKNOWLEDGMENTS de Craen, A. J., Heeren, T. J., & Gussekloo, J. (2003).

Accuracy of the 15‐item geriatric depression scale
The authors wish to thank the elderly for their full (GDS‐15) in a community sample of the oldest
cooperation during data collection and authors also old. International journal of geriatric psychiatry, 18(1),
grateful to all the centers permitting us to conduct the 63-66.
study in their center.
Department of Statistics. Malaysia. (1998) Senior
REFERENCES citizens and population. Ageing in Malaysia. Population
Census Monograph Series no. 4. Kuala Lumpur. National
Abhishek, G., Uday, M., Singh Shivendra, K., Manish, Printing Department.
M. K., Chandra, T. S., & Kumar, S. V. (2015). Screen
depression among elderly in a city Asia. Journal of Evans, M., & Mottram, P. (2000). Diagnosis of
Clinical and Diagnostic Research, 9(9), 3-7. depression in elderly patients. Advances in psychiatric
treatment, 6(1), 49-56.
Ames, D. (1993). Depressive disorders among elderly
people in long-term institutional care.  Australian and Ewe, E. T., & Che Ismail, H. (2004). Validation of Malay
New Zealand Journal of Psychiatry, 27(3), 379-391. version of Geriatric Depression Scale among elderly
inpatients. Age, 17, 65-4. URL:www.priory.com/psych/
MalayGDS.htm

E-ISSN 2477-0612
Assessment of Depression Among Older Adults Pharm Sci Res, Vol 7 No 1, 2020 73

Friedhoff, A. J. (1991). Consensus development Sidik, M.S., Zulkefli, N. A. M, & Shah, S. A. (2003).
statement: Diagnosis and treatment of depression in Factors associated with depression among elderly
late life. In Diagnosis and treatment of depression in patients in a primary health care clinic in Malaysia. Asia
late life: Results of the NIH consensus development Pacific Family Medicine, 2(3), 148-152.
conference (pp. 493-511).
Murray, C. J., Lopez, A. D., & World Health Organization.
Grayson, P., Lubin, B., & Van Whitlock, R. (1995). (1996). The global burden of disease: a comprehensive
Comparison of depression in the community‐dwelling assessment of mortality and disability from diseases,
and assisted‐living elderly.  Journal of Clinical injuries, and risk factors in 1990 and projected to 2020:
Psychology,  51(1), 18-21. http://www.Mentalhealth. summary. World Health Organization.
Com/Book/Pus-Dpo1htm [access June 2008]
Norsiah, M. N. (1999). Prevalence of depression among
Imran, A., Azidah, A. K., Asrenee, A. R., & Rosediani, the elderly attending Klinik Kesihatan Pokok Sena
M. (2009). Prevalence of depression and its associated and who do they go for help. MMed Thesis. Universiti
factors among elderly patients in outpatient clinic of Kebangsaan Malaysia.
Universiti Sains Malaysia Hospital. The Medical Journal
of Malaysia, 64(2), 134-139. Pocklington, C., Gilbody, S., Manea, L., & McMillan,
D. (2016). The diagnostic accuracy of brief versions
Li, Z., Jeon, Y. H., Low, L. F., Chenoweth, L., O’Connor, of the Geriatric Depression Scale: a systematic review
D. W., Beattie, E., & Brodaty, H. (2015). Validity of and meta‐analysis. International Journal of Geriatric
the geriatric depression scale and the collateral source Psychiatry, 31(8), 837-857.
version of the geriatric depression scale in nursing
homes.  International psychogeriatrics,  27(9), 1495- Prashanth, A. K., Rakesh, M. P. K., Praveena, V., Preethi,
1504. A., Prithvi, S., Priyadharshini, R., & Suvetha, K. (2015).
A cross-sectional study analysing the level of depression
Lyness, J. M., Noel, T. K., Cox, C., King, D. A., Conwell, and its causative factors among patients visiting a
Y., & Caine, E. D. (1997). Screening for depression multispecialty hospital. Advanced medical sciences: An
in elderly primary care patients: A comparison of the international journal, 4(2), 1-6.
Center for Epidemiologic Studies—Depression Scale
and the Geriatric Depression Scale. Archives of internal Rashid, A., Manan, A., & Rohana, S. (2011). Depression
medicine, 157(4), 449-454. among the elderly Malays living in rural Malaysia. The
Internet Journal of Public Health, 1(2), 128-136.
Mann, A. H., Schneider, J., Mozley, C. G., Levin,
E., Blizard, R., Netten, A., ... & Todd, C. (2000). Reynolds III, C. F., & Kupfer, D. J. (1999). Depression and
Depression and the response of residential homes to aging: a look to the future. Psychiatric Services, 50(9),
physical health needs. International Journal of Geriatric 1167-1172.
Psychiatry, 15(12), 1105-1112.
Rovner, B. W., Kafonek, S., Filipp, L., Lucas, M. J., &
Marc, L. G., Raue, P. J., & Bruce, M. L. (2008). Screening Folstein, M. F. (1986). Prevalence of mental illness in
performance of the 15-item geriatric depression scale in a community nursing home. The American journal of
a diverse elderly home care population. The American psychiatry, 143(11), 1446-1449.
Journal of Geriatric Psychiatry, 16(11), 914-921.
Savikko, N., Routasalo, P., Tilvis, R. S., Strandberg, T.
Mat, R. (2003). 2003. Socio-economic characteristics E., & Pitkälä, K. H. (2005). Predictors and subjective
of elderly in Malaysia. In 21st Population Census causes of loneliness in an aged population. Archives of
Conference, Kyoto, 2003 (pp. 19-21). gerontology and geriatrics, 41(3), 223-233.

Mbakwem, A., Aina, F., & Amadi, C. (2016). Expert Sherina, M. S., & Mustaqim, A. (2002). A Study on the
opinion-depression in patients with heart failure: is Association of Depression andFunctional Disability
enough being done?. Cardiac failure review, 2(2), 110. Among the Elderly in MukimSepang, Sepang, Selangor,
Malaysia.  Malaysian Journal of Psychiatry,  10(2), 28-
Mitchell, A. J., Bird, V., Rizzo, M., & Meader, N. (2010). 32.
Diagnostic validity and added value of the Geriatric
Depression Scale for depression in primary care: a meta- Spitzer, R. L., Williams, J. B., Gibbon, M., & First, M. B.
analysis of GDS30 and GDS15.  Journal of affective (1992). The structured clinical interview for DSM-III-R
disorders, 125(1-3), 10-17. (SCID): I: history, rationale, and description. Archives of
general psychiatry, 49(8), 624-629.
E-ISSN 2477-0612
74 Pharm Sci Res, Vol 7 No 1, 2020 Qamar, et al.

Steffens, D. C., Skoog, I., Norton, M. C., Hart, A. D., World Health Organization. (2008).  The world health
Tschanz, J. T., Plassman, B. L., & Breitner, J. C. (2000). report 2008: primary health care now more than ever.
Prevalence of depression and its treatment in an elderly World Health Organization.
population: the Cache County study. Archives of General
Psychiatry, 57(6), 601-607. Yesavage, J. A., & Sheikh, J. I. (1986). 9/Geriatric
depression scale (GDS) recent evidence and development
Venne, R. (2005). Mainstreaming the concerns of older of a shorter version. Clinical gerontologist, 5(1-2), 165-
persons into the social development agenda. United 173.
Nations Secretariat. Division for Social Policy and
Development, 2(5). Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang,
V., Adey, M., & Leirer, V. O. (1982). Development and
Watson, L. C., & Pignone, M. P. (2003). Screening validation of a geriatric depression screening scale: a
accuracy for late-life depression in primary care: a preliminary report. Journal of psychiatric research,
systematic review. Journal of Family Practice, 52(12), 17(1), 37-49.
956-956.

E-ISSN 2477-0612