Senior Living: Geriatric Depression Scale Questionnaire for Seniors

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Geriatric Depression Scale Questionnaire for Seniors

Before seeing your physician, you might want to print out and then complete the following Geriatric Depression Scale questionnaire. It will help your doctor and you better manage your medical needs. Answer as many questions as you can.

Are you basically satisfied with your life?
Yes
No

Have you dropped many of your activities and interests?
Yes
No

Do you feel that your life is empty?
Yes
No

Do you often get bored?
Yes
No

Are you in good spirits most of the time?
Yes
No

Are you afraid that something bad is going to happen to you?
Yes
No

Do you feel happy most of the time?
Yes
No

Do you often feel helpless?
Yes
No

Do you prefer to stay at home, rather than going out and doing new things?
Yes
No

Do you feel you have more problems with memory than most?
Yes
No

Do you think it is wonderful to be alive?
Yes
No

Do you feel pretty worthless the way you are now?
Yes
No

Do you feel full of energy?
Yes
No

Do you feel that your situation is hopeless?
Yes
No

Do you think that most people are better off than you are?
Yes
No

Sheikh JI, Yesavage JA. Geriatric Depression Scale (GDS): Recent evidence and development of a shorter version. Clinical Gerontologist 1986;5:265.

Medical Questionnaire	ADAM (men only)
CAGE	Epworth Sleepiness Questionnaire

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