MDS 3.0: Recommended Form - Ucla - GeroNet

Section DMoodD1. Should Resident Mood Interview be Conducted?—Attempt to conduct interview with all residentsEnterCode0. No (resident is rarely/never understood) Instead complete (D5-D6) Staff Assessment of Mood1. Yes Continue to D2, Resident Mood InterviewD2. Resident Mood Interview (PHQ-9 © )Say to resident: “Over the last 2 weeks, haveyou been bothered by any of the followingproblems?”I. Symptom Presence II. Symptom FrequencyIf symptom is present, enteryes (1), then obtain symptomfrequency in Column II.If yes in column I, Symptom Presence, then ask theresident: “about how often have you been bothered by this?”Read and show the resident a card with the symptomfrequency choices. Indicate response below.1 Day 2–6 Days 7–11 Days 12–14Days“Rarely”“Severaldays”“More thanhalf the days”Entera. Little interest or pleasure in doing things 0. No1. Yes 0 1 2 3Code9. No responseEnterb. Feeling down, depressed, or hopeless 0. No1. Yes 0 1 2 3Code9. No responseEnterc. Trouble falling or staying asleep, or 0. Nosleeping too much 1. Yes 0 1 2 3Code9. No responseEnterd. Feeling tired or having little energy 0. No1. Yes 0 1 2 3Code9. No responseEntere. Poor appetite or overeating 0. No1. Yes 0 1 2 3Code9. No responseEnterf. Feeling bad about yourself—or that you 0. Noare a failure or have let yourself or your 1. Yes 0 1 2 3Codefamily down9. No responseEnterg. Trouble concentrating on things, such as 0. Noreading the newspaper or watching 1. Yes 0 1 2 3Codetelevision9. No responseEnterh. Moving or speaking so slowly that other 0. Nopeople could have noticed. Or the 1. Yes 0 1 2 3Codeopposite—being so fidgety or restless9. No responsethat you have been moving around a lotmore than usualEnteri. Thoughts that you would be better off 0. Nodead, or of hurting yourself in some way 1. Yes 0 1 2 3Code9. No responseii) If “Yes”, check here to indicate that responsiblestaff or provider has been informed:“Nearlyevery day”D3. Total Severity ScoreAdd scores for all selected frequency responses in Column II, Symptom Frequency. Score may be between00 and 27. Enter 99 if unable to complete interview (i.e., “No response” to 3 or more items).Enter NumbersCopyright© Pfizer Inc. All rights reserved. Reproduced with permission.Recommended MDS 3.0 8