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PubMed1985

OARS methodology. A decade of experience in geriatric assessment.

The Older Americans Resources and Services (OARS) methodology was designed to assess functional capacity in five dimensions (social resources, economic resources, mental health, physical health, and activities of daily living) and to measure use of and need for 24 types of generic services. The OARS questionnaire now has been used in more than 150 research and practice settings. Recent refinements in the OARS methodology include new information about validity and reliability, computerized summary ratings for the five dimensions of functional status, and eleven scales that measure specific aspects of functioning within the five dimensions. This paper describes the conceptual foundation, appropriate uses, psychometric properties, and recent refinements in the OARS methodology. Empirical data from a geriatric clinic population are used for purposes of illustration. The paper presents an assessment of the strengths and limitations of the OARS methodology based on more than a decade of experience. Particular attention is paid to the degree to which the measures of functional status can be related to health service use measures to inform geriatric research and practice.

Activities of Daily Living↗
PubMed1983

Site of urinary tract infection in elderly women admitted to an acute geriatric assessment unit.

There have so far been no reported studies of localization of urinary tract infection (UTI) in elderly women. The site of infection, renal or bladder, in significant urinary tract infection in 50 elderly women (mean age 80) admitted acutely to a geriatric unit was determined by the Fairley bladder washout method. Of the 31 patients with an unequivocal result, 17 (55%) had renal infection and in only 14 (45%) was the infection confined to the bladder. This study has shown that, contrary to widely-held belief and standard teaching, in over 50% of cases of UTI in elderly hospitalized female patients the infection is renal.

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PubMed1988

Religious activities and attitudes of older adults in a geriatric assessment clinic.

Few studies have examined the prevalence, salience, and impact of religious beliefs, activities, and commitment among medical patients in later life. Surveys of the U.S. population aged 65 years and over reveal a high frequency of such beliefs and activities, which are reported to play a significant role in their lives. In this study, the religious beliefs, activities, and motivations of 106 consecutive patients (mean age 74.4 years) attending a geriatric outpatient clinic were examined. A high prevalence of orthodox Christian beliefs, religious community activity, private devotional activity, and intrinsic religious orientation was found. Levels of religious activity and intrinsic orientation were lower among patients with cancer, chronic anxiety, depressive symptoms, and those who smoked cigarettes or consumed moderate to large amounts of alcohol. Intrinsic religiosity was lower among men with hypertension. Patients with mild to moderate dementia tended to have higher levels of intrinsic religious orientation. The results of this study suggest that religion is a powerful cultural force in the lives of older medical patients and is integrally related to both mental and physical health.

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PubMed1999

[Comprehensive geriatric assessment--its clinical, social and economic importance and prospects].

It is well known that many elderly patients are referred to nursing homes because of "functional decline" without being thoroughly investigated. We studied 9 elderly patients, all referred to hospital due to functional decline and diagnosed as follows: spinal stenosis--2 cases, depression--3, thyrotoxicosis--1, Parkinson--1, polypharmacy and congestive heart failure--1 patient each. Proper diagnosis and appropriate treatment prevent unnecessary hospitalization in nursing homes. Our study is meant to draw attention to this crucial aspect of geriatric medicine.

Activities of Daily Living↗
PubMed1989

Geriatric assessment in the office setting.

Attention to functional limitations must be incorporated into the routine care of the elderly. Several brief, validated functional assessment instruments are now available for office use. Routine screening of the elderly population typically uncovers unknown concerns in one third to one half of patients, even if those patients are well known to their physician. Functional assessment instruments have been developed with specific site and populations in mind. Therefore, physicians should evaluate which instrument best matches the population to be tested. Functional measures should be viewed as an adjunct to improving care, not as a stand-alone diagnostic test.

Activities of Daily Living↗
PubMed1984

Replicated evidence on the construct validity of the SCAG (Sandoz Clinical Assessment-Geriatric) scale.

Factor analysis procedures, applied to a data bank of 1165 senile patients from 21 double-blind studies, yielded 5 factors: cognitive dysfunction (4 items), interpersonal relationships (4 items), apathy (4 items), affect (3 items) and somatic function (3 items). A retrospective review of the 1165 case histories revealed that patients fell into three distinct diagnostic classes: (a) patients whose symptoms of dementia were likely associated with multiple infarcts; (b) patients with other medical disorders such as metabolic imbalances, pulmonary diseases, etc. which may have induced dementia-like symptoms; and (c) primary degenerative dementia for patients with no evidence of other intervening causes. Factor analysis applied independently to the SCAG data of each of the three groups produced similar factor constructs, thereby suggesting that results reported with this instrument are valid across different geriatric diagnostic categories.

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PubMed2006

Brief report: Brief instrument to assess geriatrics knowledge of surgical and medical subspecialty house officers.

PROBLEM: Initiatives are underway to increase geriatrics training in nonprimary care disciplines. However, no validated instrument exists to measure geriatrics knowledge of house officers in surgical specialties and medical subspecialties. METHODS: A 23-item multiple-choice test emphasizing inpatient care and common geriatric syndromes was developed through expert panels and pilot testing, and administered to 305 residents and fellows at 4 institutions in surgical disciplines (25% of respondents), emergency medicine (29%), medicine subspecialties (19%), internal medicine (12%), and other disciplines (15%). RESULTS: Three items decreased internal reliability. The remaining 20 items covered 17 topic areas. Residents averaged 62% correct on the test. Internal consistency was appropriate (Cronbach's alpha coefficient=0.60). Validity was supported by the use of expert panels to develop content, and by overall differences in scores by level of training (P<.0001) and graded improvement in test performance, with 58%, 63%, 62%, and 69% correct responses among HO1, HO2, HO3, and HO4s, respectively. CONCLUSIONS: This reliable, valid measure of clinical geriatrics knowledge can be used by a wide variety of surgical and medical graduate medical education programs to guide curriculum reform or evaluate program performance to meet certification requirements. The instrument is now available on the web.

Clinical Competence↗