THE use of formal devices for assessing function is becoming standard in agencies serving the elderly. In the Gerontological Society's recent contract study on functional assessment (Howell, 1968), a large assortment of rating scales, checklists, and other techniques in use in applied settings was easily assembled. The present state of the trade seems to be one in which each investigator or practitioner feels an inner compusion to make his own scale and to cry that other existent scales cannot possibly fit his own setting. The authors join this company in presenting two scales first standardized on their own population (Lawton, 1969). They take some comfort, however, in the fact that one scale, the Physical Self-Maintenance Scale (PSMS), is largely a scale developed and used by other investigators (Lowenthal, 1964), which was adapted for use in our own institution. The second of the scales, the Instrumental Activities of Daily Living Scale (IADL), taps a level of functioning heretofore inadequately represented in attempts to assess everyday functional competence. Both of the scales have been tested further for their usefulness in a variety of types of institutions and other facilities serving community-resident older people. Before describing in detail the behavior measured by these two scales, we shall briefly describe the schema of competence into which these behaviors fit (Lawton, 1969). Human behavior is viewed as varying in the degree of complexity required for functioning in a variety of tasks. The lowest level is called life maintenance, followed by the successively more complex levels of func-

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Assessment of Older People: Self-Maintaining and Instrumental Activities of Daily Living

Accurate clinical staging of dementia in older subjects has not previously been achieved despite the use of such methods as psychometric testing, behavioural rating, and various combinations of simpler psychometric and behavioural evaluations The Clinical Dementia Rating (CRD), a global rating device, was developed for a prospective study of mild senile dementia--Alzheimer type (SDAT) Reliability, validity, and correlational data are discussed The CRD was found to distinguish unambiguously among older subjects with a wide range of cognitive function, from healthy to severely impaired

A new clinical scale for the staging of dementia.

THE use of formal devices for assessing function is becoming standard in agencies serving the elderly In the Gerontological Society's recent contract study on functional assessment (Howell, 1968), a large assortment of rating scales, checklists, and other techniques in use in applied settings was easily assembled The present state of the trade seems to be one in which each investigator or practitioner feels an inner compusion to make his own scale and to cry that other existent scales cannot possibly fit his own setting The authors join this company in presenting two scales first standardized on their own population (Lawton, 1969) They take some comfort, however, in the fact that one scale, the Physical Self-Maintenance Scale (PSMS), is largely a scale developed and used by other investigators (Lowenthal, 1964), which was adapted for use in our own institution The second of the scales, the Instrumental Activities of Daily Living Scale (IADL), taps a level of functioning heretofore inadequately represented in attempts to assess everyday functional competence Both of the scales have been tested further for their usefulness in a variety of types of institutions and other facilities serving community-resident older people Before describing in detail the behavior measured by these two scales, we shall briefly describe the schema of competence into which these behaviors fit (Lawton, 1969) Human behavior is viewed as varying in the degree of complexity required for functioning in a variety of tasks The lowest level is called life maintenance, followed by the successively more complex levels of func-

Assessment of older people: self-maintaining and instrumental activities of daily living

Clinicians whose practice includes elderly patients need a short, reliable instrument to detect the presence of intellectual impairment and to determine the degree. A 10-item Short Portable Mental Status Questionnaire (SPMSQ), easily administered by any clinician in the office or in a hospital, has been designed, tested, standardized and validated. The standardization and validation procedure included administering the test to 997 elderly persons residing in the community, to 141 elderly persons referred for psychiatric and other health and social problems to a multipurpose clinic, and to 102 elderly persons living in institutions such as nursing homes, homes for the aged, or state mental hospitals. It was found that educational level and race had to be taken into account in scoring individual performance. On the basis of the large community population, standards of performance were established for: 1) intact mental functioning, 2) borderline or mild organic impairment, 3) definite but moderate organic impairment, and 4) severe organic impairment. In the 141 clinic patients, the SPMSQ scores were correlated with the clinical diagnoses. There was a high level of agreement between the clinical diagnosis of organic brain syndrome and the SPMSQ scores that indicated moderate or severe organic impairment.

A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients

Background: Special care facilities for patients with dementia gain increasing attention. However, an overview of studies examining the differences between care f

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Special Care Units and Traditional Care in Dementia: Relationship with Behavior, Cognition, Functional Status and Quality of Life - A Review

1. Data are presented on a random sample of 1,077 persons residing in homes for the aged, nursing homes and state hospitals in New York City, who were 65 years of age or over at the time of first admission. Each person was examined by a psychiatrist using a standard interview technique, and by a psychologist who administered two brief tests: the face-hand test, and a 10-item questionnaire testing orientation and recall of personal and general information. 2. The results of both tests were highly related to psychiatrists' clinical evaluations of the presence and degree of chronic brain syndrome, the presence or absence of psychosis associated with chronic brain syndrome, opinion as to certifiability, and degree of management problem. 3. It is concluded that the face-hand test and the mental status questionnaire are valid measures for the determination of mental status in the aged, particularly for disorders associated with cerebral damage. 4. These tests are considered to have a considerable potential clin...

Brief objective measures for the determination of mental status in the aged.

Our results show that the mental and physical functional status of institutionalized aged persons are highly interrelated. The relationship is seen within each of the 3 types of institutions studied, and for all age groups. In the different types of institutions it was found that persons tended to have disabilities consistent with the type of services to be expected in the institution. Thus, patients in state hospitals had the largest number with poor mental functional status, while there was predominance of persons with poor physical functional status found in the nursing homes. Nevertheless, institutions of a given type differed widely from each other. Some homes for the aged and nursing homes had a larger proportion of persons with poor mental status than did some state hospitals, while some state hospitals and homes for the aged had more persons with poor physical functional status than did some nursing homes. Therefore, it is possible to make a more accurate prediction of a person's mental status on ...

The relationship of mental and physical status in institutionalized aged persons

This study is essentially an attempt to elaborate on a method of giving reassurance and emotional support to aged people. The method is based on clinical data organized in terms of observed adaptational efforts of aged persons. Our results are promising. While there is no doubt that a number of these patients would have done fully as well without treatment it also seems clear that treatment reveals a clue as to how they would have achieved their improvement or stabilization. This is the important aspect of Supportive treatment; it crystallizes a relationship in which the patient can heal some of his psychological wounds, and it watches and controls this process. Certainly if the patient can find a favorable relationship elsewhere the same healing will occur, but not for our enlightenment and without the assurance that everything possible to help keep it a healing process will be done. The results of treatment are in accordance with expectations based on well-known psychiatric facts. Past performance is th...

Psychotherapy of aged persons. II. Utilization and effectiveness of brief therapy.

The effect of one year of group psychotherapy upon two types of geriatric patients in a state mental hospital was tested in a controlled study of long-term patients who had aged in the hospital, among whom a diagnosis of schizophrenia was prevalent, and recently admitted aged patients, among whom a diagnosis of chronic brain syndrome was prevalent. Improvement appeared to be more pronounced among the long-term patients, although the results indicated that group psychotherapy was beneficial to both groups.

The response to group psychotherapy of aged recent admissions compared with long-term mental hospital patients.

The selection of aged patients for psychotherapy appears to follow the same sociopsychological trends as in younger persons. This manner of selection may tend to weed out the most helpless, anxious and most psychotherapeutically malleable candidates for psychiatric care.

Alvin I. Goldfarb

Papers

Brief objective measures for the determination of mental status in the aged.

The relationship of mental and physical status in institutionalized aged persons

Psychotherapy of aged persons. II. Utilization and effectiveness of brief therapy.

The response to group psychotherapy of aged recent admissions compared with long-term mental hospital patients.

Factors in selection of psychiatric treatment for institutionalized aged persons.