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Screening

Geriatric Depression Scale (GDS) Form

2 pages•15 fields•HIPAA-ready
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Geriatric Depression Scale (GDS) Form

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Patient Name
Jane Martinez
Date of Birth
03/15/1985
Date of Screening
03/15/1985
Satisfied with Life
Option A
Option B
Option C
Dropped Activities and Interests
Option A
Option B
Option C
Feel Life is Empty
Option A
Option B
Option C
Often Get Bored
Option A
Option B
Option C
In Good Spirits Most of the Time
Option A
Option B
Option C
Afraid Something Bad Will Happen
Option A
Option B
Option C
Feel Helpless
Option A
Option B
Option C
Prefer Staying Home
Option A
Option B
Option C
Memory Problems
Option A
Option B
Option C
Current Medications
GDS Total Score
0
Provider Notes
Enter details here...
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The Geriatric Depression Scale (GDS) Form is a specialized depression screening tool developed specifically for the elderly population. Unlike general depression inventories, the GDS avoids somatic symptom questions that may overlap with normal aging or medical comorbidities, focusing instead on cognitive and affective symptoms of depression. The simple yes/no response format reduces cognitive burden and makes this instrument accessible for older adults, including those with mild cognitive impairment.

This form includes the full set of GDS screening items covering life satisfaction, mood, energy levels, social withdrawal, hopelessness, and feelings of worthlessness. It incorporates a scoring section with established cutoff thresholds that differentiate between normal, mild depression, and moderate-to-severe depression. Additional fields capture relevant medication history, recent life events, and current social support systems that inform clinical decision-making.

Widely used in geriatric medicine, primary care, nursing homes, assisted living facilities, and home health settings, the GDS is recommended by geriatric care guidelines for routine depression screening in adults aged 65 and older. This form facilitates consistent documentation and supports timely intervention, helping providers address a condition that is both common and often underdiagnosed in the elderly population.

What's included

  • Complete GDS yes/no screening question set
  • Age-appropriate items avoiding somatic symptom overlap
  • Scoring with normal, mild, and moderate-severe cutoffs
  • Recent life events and social support documentation
  • Current medication and treatment history fields
  • Provider assessment and referral recommendation section
  • Structured medication list with dosage and frequency tracking

Who uses this template

  • Routine depression screening at geriatric wellness visits
  • Nursing home and assisted living facility intake assessments
  • Home health visit mental health evaluations
  • Post-hospitalization mood screening for elderly patients

All form fields

15 fields across 2 pages. Customize any field after signing up.

Patient NameText
Date of BirthDate
Date of ScreeningDate
Satisfied with LifeMultiple Choice
Dropped Activities and InterestsMultiple Choice
Feel Life is EmptyMultiple Choice
Often Get BoredMultiple Choice
In Good Spirits Most of the TimeMultiple Choice
Afraid Something Bad Will HappenMultiple Choice
Feel HelplessMultiple Choice
Prefer Staying HomeMultiple Choice
Memory ProblemsMultiple Choice
Current MedicationsMedications
GDS Total ScoreNumber
Provider NotesLong Text
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