Screening for Delirium, Dementia and Depression in Older Adults

Nursing Best Practice GuidelineAppendix I: Establishing a Diagnosisof Depression in the ElderlyRivard (1999) suggests that one of the best screening tools for depression in old age,reflecting DSM-IV criteria, is a mnemonic known as “Sig: E Caps” (“a prescription for energycapsules”) which stands for:S Sleep disturbance, usually early morning or frequent awakenings, and unrestfulsleep leaving the impression that one hasn’t slept.ILoss of interest in activities that were previously enjoyed.75G Feelings of guilt or excessive preoccupation with regrets about the past.E Low energy and excessive fatigue not due to coexisting medical problems.C Concentration and cognitive difficulties; older adults tend to experience more profoundcognitive dysfunction during depression than younger adults; this may lead to amisdiagnosis of dementia.A Appetite disturbance; usually loss of appetite, often accompanied by weight lossand complaints of poor digestion or constipation.P Psychomotor changes; either retardation (slowing) or agitation and complaints about“having bad nerves” which may be incorrectly attributed to an anxiety disorder.S Suicidal ideation is a common sign; suicide rates are especially high in older men.The daily presence of five or more of the above symptoms, lasting at least two weeks, indicatesthat the patient is suffering from a major depression, and likely requires pharmacotherapyas a part of treatment (Rivard, 1999).Reprinted from: Rivard M-F. Late-life depression: Diagnosis, Part I. Parkhurst Exchange, July 1999.With permission from Parkhurst Publishing.Reference: Jenike, M. A. (1989).Geriatric Psychiatry and Psychopharmacology: A Clinical Approach.Yearbook Medical Publishers.