Duke Long Term Care Resources Abstract
"Teaching Current Research in Functioning
Assessment and Screening in Gerontology"

by George L. Maddox, Ph.D.

July 2001 Addendum

From: State-of-the-Art Research Summaries:
Linking Gerontology Research Findings to Instructional Objectives
Published by: The Association for Gerontology in Higher Education (AGHE)
(Washington, DC: 1992)

This publication presents a brief overview and illustrations of the conceptualization and instruments developed over three decades to screen and assess the functional status of older adults. In the 1970's, the Duke OARS (Older Americans Resources & Services) Multidimensional Functional Assessment strategy was a prototype of effective screening instruments -- summarizable profiles on multiple domains of functioning based on reliable, valid information economically gathered by modestly trained interviewers. See G. Fillenbaum, Duke OAR's (1988). The distinction made between screening and assessment has continued to be important. A computerized version of the Duke OARS has subsequently made this instrument even more convenient and economical.

A major contribution of the 1980s was the review of alternatives measurement strategies provided by Kane and Kane's Assessing the Elderly (1981). This book correctly and effectively demonstrates that a variety of measures are useful, depending on the questions one wants to answer.

OBRA '87's mandate to create a Minimum Data Set (MDS) has been a major initiation in the 1990s. The MDS (see entry- Maddox, Encyclopedia of Aging, 2nd Edition, 1995) is designed as a comprehensive assessment instrument that emphasizes information, relevant medical, and nursing care. MDS is a relatively costly instrument to administer and is not a screening instrument. A more limited screening instrument derived for the MDS is the Resident Assessment Instrument (RAI).

For more information about screening, assessment instruments and applications see relevant articles in George L. Maddox, Editor-in-Chief, Encyclopedia of Aging, 2nd Edition (Springer Publishing, 1995).

July 2001 Addendum

A NEW RESOURCE

Two decades after Robert and Rosalie Kane published their seminal Assessing Older Persons (Oxford, 1982), these authors now offer a significantly revised handbook that brings assessment theory, measures, and applications up to date, Assessing Older Persons (Oxford, 2000). In the updated volume the Kanes provide helpful introductory and concluding observations for both novices as well as experienced gerontologists. This orientation is essential because the newer volume represents an academic exercise in which multiple domains of assessment and measurement were discussed by experts in seminars in which theory, measurement, and applications are critiqued and referenced broadly. The chapters not only deal with the usual dimensions of aging such as functioning, cognition and satisfaction but also dimensions such as quality of life,spirituality/values, caregiving, and physical environments.

The academic style of the newer volume, the metrics of constructing measures, and the broad range of applications described and references will be daunting to many readers. Recognizing that this is probable, Rosalie Kane in a concluding observation offers this practical advice to readers:

"With so many tools, does it matter which one is selected?
The answer, within limits, is 'not really.' The same basic
result can be achieved with any number of functional assessment
instruments." (p 520)

She goes on to repeat the good advice introduced in the initial volume:

"Before you choose an assessment instrument, be sure you know
the question you are trying to answer."

Individuals who are not experienced research investigators in gerontology may become better consumers of consultation regarding program design and evaluation through becoming acquainted with the variety of assessment strategies reviewed and with the various circumstances in which the use of one or another assessment instrument has proved to be useful.

All readers of the handbook will find useful the discussion of "mandated assessments" such as RAI/MDS and OASIS, the former required in the assessment of nursing home residents and the latter for use with the recipients of federally financed home care. The origins and uses of both these measures are described in detail and clearly reveal their emphasis on nursing and medical dimensions of assessment.

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