Measurement Scales Used in Elderly Care

Abhaya Gupta, Almas Rehman

• Publisher: CRC Press
• Year: 2017
• ISBN:
  9781315343037
• Edition: 1
• Topic: Medicina
• Subtopic: Teoría, práctica y referencia médicas

This unique, concise ready reference for daily use collates for the first time the most useful, practical and simple assessment scales used in geriatric settings. It provides tools to identify clinical conditions and health outcomes objectively and reliably. It is essential as a clinical primer and everyday reference guide for all practising and training members of multidisciplinary teams, including consultants and doctors in specialist training, career grade doctors and general practitioners, and medical students; nurses, health visitors, dieticians, and social workers; allied health professionals such as physiotherapists, occupational therapists, speech and language therapists; and managers of elderly care services.'Assessment is central to the practice of Geriatric Medicine. All members of the multidisciplinary team require a sound knowledge of the basic principles of measurement scales. We need to be competent in using and selecting appropriate scales, understanding which scales are valid and fit for purpose. Unfortunately, up to now, this has been a difficult task often requiring reference to original papers. Dr Gupta's scholarship has come to the rescue. He has trawled through the many hundreds of scales available selecting those most useful for the specialty.This book will be valuable to all members of the multidisciplinary team. Dr Gupta has done an excellent job outlining the theory and practice of measurement scales. He has put together an extremely useful compendium of scales. I congratulate him and wish his publication every success. I can foresee this publication becoming an essential text for every unit library and valuable book for individual clinicians.' - Dr Jeremy Playfer in his Foreword. 'This book summarises the most commonly used validated assessment scales which can be used by medical students, postgraduate trainees, consultants and the multi-disciplinary team members. I hope a copy of this book will be kept on every ward, outpatient department and GP practice for daily use and reference' - Professor Bim Bhowmick OBE in his Foreword.

Section 1

DEFINITION OF SCALES

A scale is a series of question, ratings or items that is used to measure a concept. The response categories are then summed and statistical calculations can be performed on the summed scores. In other words, scales are numerical values that are used to represent attributes of quantities, qualities or categories The measurement scales are expected to be explicit and unambiguous, thereby implying an ability to standardise the concept. However, there are several practical considerations that must be taken into account when deciding which is the appropriate tool to use in a particular situation. Several measurement scales are available in the medical literature which are a means of identifying groups or individuals who have or will develop some target condition or outcome.

THE NEED FOR ASSESSMENT SCALES

Assessment of the older person

Assessment is defined as the process of objectively defining the needs of a person. This is to enable them to achieve, maintain or restore an acceptable level of social independence or quality of life. The scales help to achieve these needs, which may be simple or comprehensive.

The assessment of an older person is a complex process. Such assessments are needed in a variety of different settings - in primary care, in the hospital and in long-stay homes. Assessment scales for the elderly are necessary to enable an accurate diagnosis to be made, progress to be monitored and outcome to be evaluated. Such scales can measure different aspects of a person's health and well-being - physical, mental and/or social. In some cases the diagnosis may be missed unless scales are used. Assessment scales also provide a baseline for making treatment decisions. Standardised scales are a useful tool in comprehensive assessment of older people prior to entry to long-term care. In addition, scales are available to measure the needs of the carers, their home conditions and their social status. The instruments provide a baseline measurement and can be repeated when progress needs to be monitored. The measurements quantify the extent of a problem. They permit tabulation of clinical data and enable measurement of changes over time. They are the means by which problems and goals are defined and the achievement of goals is gauged. They are useful for evaluating outcomes by monitoring changes in health status of the individual. They can also be used to evaluate the effectiveness of an intervention. They establish a degree of uniformity in clinical assessment. Thus the scales enable comprehensive geriatric assessment to be more reliable, and they ensure consistency in the assessment process. In the hospital setting in particular, in acute care, but also in rehabilitation and long-term care of the elderly, these scales can be used to collect information that aids diagnosis, treatment and determination of the prognosis.

In general, there are three main ways to measure outcomes in the older patient:

1. a change in a particular scale or scales
2. measurement of the end points of a disease, admission to hospital, length of hospital stay or institutionalisation
3. death.

The NHS and Community Care Act proposals state that some form of assessment is necessary to ensure delivery of appropriate support and resources to disabled elderly people in the community.¹ The use of assessment scales is not simply a matter of 'ticking boxes', but provides a commitment to a holistic approach in which geriatric medicine has supremacy over any other branch of medicine. Since describing disabilities is one of the key aspects of management of elderly patients, use of standardised scales could enhance clinical care.

Communication between healthcare professionals and researchers

The scales aid communication of clinically relevant quantitative information among different healthcare professionals. They encourage the development of a common clinical knowledge, thereby aiding communication, especially in hospital practice, where so many professionals are involved both in multi-disciplinary teams and with external agencies. Thus they enhance clinical care in geriatric medical practice.

Audit

The scales are helpful in clinical audit of conditions that are prevalent in older people. Audit of service by the use of assessment scales could indicate whether or not the service is effective. These scales enable more meaningful comparisons to be made between clinicians, units or districts. This could enhance the quality of care, and is also useful in service evaluation and development.

Screening of disease and disability

Standardised scales are useful in screening of disability, impairment and handicap both in primary care (e.g. 'over-75' health checks) and in hospital settings. In this way various population norms have been produced (e.g. the prevalence of dementia in the population). The Office of Population Censuses and Surveys scales have been used to study the extent of disability in the population in the UK. The elderly screening initiative can identify a high prevalence of unreported physical, social and psychological needs of the elderly living in the community.

Health planning and management

Assessment scales can provide valuable information on the prevalence of disability, cognitive impairment and social well-being both during hospital contacts and in the community. Scales are helpful in planning services and determining allocation of appropriate resources by health and social services. They are the means by which resources needed for adequate healthcare for the elderly can be weighed against other competing demands. For example, the need for services for disabled people in the community can be determined. Assessment scales support clinical and service management in medical practice. With the rapidly changing organisational reforms in the NHS in the UK, the availability of standardised information on patient well-being can meet many of the management objectives.

Research

Assessment scales are very useful in clinical, epidemiological and health services research concerning elderly people. Interface with research occurs particularly when a clinician evaluates gerontological literature in which measurements are used to study the effects of clinical treatment or management interventions on the functioning and health of the patient. Indeed some geriatricians will be using these scales for their clinical research as well.

WHICH SCALE SHOULD BE USED?

In view of the wide variety of scales available, an important decision faced by the professional is which scale to apply. Several scales are available for measuring the various symptoms, conditions and diseases in older people. Some of them have been used more often than others, and have been tested repeatedly. Healthcare professionals must be confident both that they are choosing instruments which are appropriate for their clients, and that they are administering and interpreting those instruments correctly.

The elderly suffer a variety of chronic diseases (e.g. stroke, heart disease, arthritis) that accumulate over the lifespan, and certain disease-specific scales have been designed to assess a particular disease. Moreover, functional ability, mental health, social status and quality of life are also essential elements of the health of an older person, and these can be measured by generic scales. Thus measurements in older people require a multi-dimensional approach in which the following are assessed individually:

• physical health - disease-specific measures
• mental health:
  • cognitive functioning
  • mood (anxiety, depression)
• functional status - functional capability
• social status - includes broader aspects of health (life satisfaction, morale, social support).

The multi-dimensional tools usually assess a variety of medical, social, physical or emotional domains and provide a summary score of the overall result. They are most useful in survey research because of the need to collect a large amount of information at one time. However, in a clinical setting, healthcare professionals would choose instruments that focus on a specific area of interest.

There are many scales available from which to choose, and there is no consensus on which package should be used in different settings. Several issues need to be considered when selecting an assessment scale for a specific population. When choosing a measurement, the most important consideration is why it is being used. The commonest reason for undertaking a measurement is to ascertain the diagnosis, prognosis, severity and outcome of a condition. Discriminative tools are used to distinguish individuals who have a particular problem from those who do not (e.g. the Berg Scale is useful for identifying fall-prone elderly people in the community). Similarly, an evaluative tool is used to measure change over time or after treatment (e.g. the Modified Rankin Scale). Sc...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Foreword
• Preface
• About the author
• Acknowledgements
• Introduction
• SECTION 1
• SECTION 2
• Conclusion
• Appendix
• Further reading
• Index