Background: Frailty is considered highly prevalent in old age and to confer high risk for falls, disability, hospitalization, and mortality. Frailty has been considered synonymous with disability, comorbidity, and other characteristics, but it is recognized that it may have a biologic basis and be a distinct clinical syndrome. A standardized definition has not yet been established. 

Methods: To develop and operationalize a phenotype of frailty in older adults and assess concurrent and predictive validity, the study used data from the Cardiovascular Health Study. Participants were 5,317 men and women 65 years and older (4,735 from an original cohort recruited in 1989-90 and 582 from an African American cohort recruited in 1992-93). Both cohorts received almost identical baseline evaluations and 7 and 4 years of follow-up, respectively, with annual examinations and surveillance for outcomes including incident disease, hospitalization, falls, disability, and mortality. 

Results: Frailty was defined as a clinical syndrome in which three or more of the following criteria were present: unintentional weight loss (10 lbs in past year), self-reported exhaustion, weakness (grip strength), slow walking speed, and low physical activity. The overall prevalence of frailty in this community-dwelling population was 6.9%; it increased with age and was greater in women than men. Four-year incidence was 7.2%. Frailty was associated with being African American, having lower education and income, poorer health, and having higher rates of comorbid chronic diseases and disability. There was overlap, but not concordance, in the cooccurrence of frailty, comorbidity, and disability. This frailty phenotype was independently predictive (over 3 years) of incident falls, worsening mobility or ADL disability, hospitalization, and death, with hazard ratios ranging from 1.82 to 4.46, unadjusted, and 1.29-2.24, adjusted for a number of health, disease, and social characteristics predictive of 5-year mortality. Intermediate frailty status, as indicated by the presence of one or two criteria, showed intermediate risk of these outcomes as well as increased risk of becoming frail over 3-4 years of follow-up (odds ratios for incident frailty = 4.51 unadjusted and 2.63 adjusted for covariates, compared to those with no frailty criteria at baseline). 

Conclusions: This study provides a potential standardized definition for frailty in community-dwelling older adults and offers concurrent and predictive validity for the definition. It also finds that there is an intermediate stage identifying those at high risk of frailty. Finally, it provides evidence that frailty is not synonymous with either comorbidity or disability, but comorbidity is an etiologic risk factor for, and disability is an outcome of, frailty. This provides a potential basis for clinical assessment for those who are frail or at risk, and for future research to develop interventions for frailty based on a standardized ascertainment of frailty.

https://www.sharp.com/services/hospice/upload/phenotype5-13.pdf

Frailty in Older Adults Evidence for a Phenotype

Cardiovascular Health Study Collaborative Research Group : Frailty in older adults : evidence for a phenotype

Pedagosko i psiholosko testiranje i procjenjivanje spadaju među najvažnije doprinose znanosti o ponasanju nasem drustvu i pružaju temeljna i znacajna poboljsanja u odnosu na ranije postupke. Iako se ne može ustvrditi da su svi testovi dovoljno usavrseni niti da su sva testiranja razborita i korisna, postoji velika kolicina informacija koje ukazuju na ucinkovitost kvalitetnih instrumenata u onim situacijama u kojima je njihovo koristenje potkrijepljeno validacijskim podacima. Pravilna upotreba testova može dovesti do boljih odluka o pojedincima i programima nego sto bi to bio slucaj bez njihovog koristenja, a također i ukazati na put za siri i pravedniji pristup obrazovanju i zaposljavanju. Međutim, losa upotreba testova može dovesti do zamjetne stete nanesene ispitanicima i drugim sudionicima u procesu donosenja odluka na temelju testovnih podataka. Cilj Standarda je promoviranje kvalitetne i eticne upotrebe testova te uspostavljanje osnovice za ocjenu kvalitete postupaka testiranja. Svrha objavljivanja Standarda je uspostavljanje kriterija za evaluaciju testova, provedbe testiranja i posljedica upotrebe testova. Iako bi evaluacija prikladnosti testa ili njegove primjene trebala ovisiti prvenstveno o strucnim misljenjima, Standardi pružaju okvir koji osigurava obuhvacanje svih relevantnih pitanja. Bilo bi poželjno da svi autori, sponzori, nakladnici i korisnici profesionalnih testova usvoje Standarde te da poticu druge da ih također prihvate.

Standards for educational and psychological testing

http://lib.ajaums.ac.ir/booklist/archives%20of%20neurology_24%20Jan-2_17.pdf

The cardiovascular health study: Design and rationale

Statistical Analysis with Missing Data

The factorial and discriminant validity of the Center for Epidemiological Studies Depression (CES-D) scale was examined for a sample of 116 parents who were participating in family support programs designed to prevent child abuse and neglect. Participants' self-reports of depressive symptoms as measured by the CES-D were analyzed in relation to their self-esteem (measured with the Rosenberg Self-Esteem scale) and state and trait anxiety (measured with Spielberger's State-Trait Anxiety Inventory). Factorial validity was adequate, and results indicated a moderate correlation between the CES-D and self-esteem and state anxiety. However, a high correlation was obtained between the CES-D and trait anxiety, which suggests that the CES-D measures in large part the related conceptual psychological domain of predisposition for anxiousness.

Factorial and Discriminant Validity of the Center for Epidemiological Studies Depression (CES-D) Scale.

Preface Prologue Part I What Are You Getting Into? 1 Integrating Evaluation and Practice Introduction to Single-System Designs What Are Single-System Designs? Evidence-Based Practice Single-System Designs and Classical Research: The Knowledge-Building Context Single-System Evaluation, Qualitative Research, and Quantitative Research Advantages of Using Single-System Designs in Practice A Walk through the Evaluation Process Summary Part II Conceptualizing and Measuring Targets and Objectives/Goals 2 Basic Principles of Conceptualization and Measurement Introduction What Is Conceptualization? What Is Measurement? Definition as a First Step in Measurement Can Everything Be Measured? Key Characteristics of All Measures Summary 3 Specifying Problems and Goals Introduction: From General Problems to Specific Targets of Intervention Specifying Client Concerns: Identifying and Clarifying Problems and Potentials Specifying Goals and Objectives Using Goal Attainment Scaling (GAS) to Establish Goals Setting Goals in Groups Problems and Issues in Setting Goals Summary 4 Developing a Measurement and Recording Plan Introduction Steps in Developing a Recording Plan Charting: Putting Your Information on Graphs Problem-Oriented Records (POR) Use of Computers in Evaluation and Practice Summary Computer Assisted Social Services (CASS): A User's Guide Appendix: Installing CASS 5 Behavioral Observation Introduction General Guidelines for Behavioral Observation Sampling Behaviors Instruments for Recording Behaviors Ensuring Accurate Observations Methods of Recording Behavior Analog Situations Recording Behavior in Groups Summary 6 Individualized Rating Scales Introduction Uses of Individualized Rating Scales Constructing and Using Individualized Rating Scales Summary 7 Standardized Scales Introduction What Are Standardized Scales? Selecting a Standardized Scale Administering a Standardized Scale Some Available Standardized Self-Report Scales Some Available Standardized Scales for Practitioners Some Available Standardized Scales for Relevant Others Some Available Standardized Scales for Independent Observers Do-It-Yourself Scales Using Standardized Scales in Groups Computer Management of Standardized Scales Summary Appendix Computer Assisted Assessment Package (CAAP): A User's Guide 8 Logs Introduction Types of Client Logs Putting Qualitative and Quantitative Information Together Introducing Clients to Logs Practitioner Logs Maximizing and Verifying the Reliability and Validity of Logs Summary 9 Reactivity and Nonreactive Measures Introduction Reactivity of Measures Unobtrusive (Nonreactive) Measures Summary 10 Selecting a Measure Introduction Considerations in Deciding on a Measure Use of Multiple Measures Selecting a Measure Summary Part III Evaluation Designs 11 Basic Principles of Single-System Designs Introduction An Example Connecting Practice and Evaluation Designs Purposes of Single-System Designs Unique Characteristics of Single-System Designs Causality in Single-System Designs External Validity and Generalizability Overview of Single-System Designs Summary 12 Baselining Introduction Purposes of the Baseline Types of Baselines How Long Should Baselining Continue? When Are Baselines Not Necessary? Issues Regarding Baselining Summary 13 From the Case Study to the Basic Single-System Design: A-B Introduction Case Studies or Predesigns Design A-B: The Basic Single-System Design Summary 14 The Experimental Single-System Designs: A-B-A, A-B-A-B, B-A-B Introduction Basic Experimental Designs Summary 15 Multiple Designs for Single Systems Introduction Multiple-Baseline Designs: Across Problems, Clients, or Settings Multiple-Target Designs Variations on Multiple Designs Summary 16 Changing Intensity Designs and Successive Intervention Designs Introduction Changing Intensity Designs: A-B1-B2-B3 Successive Intervention Designs: A-B-C, A-B-A-C, A-B-A-C-A Summary 17 Designs for Comparing Interventions Introduction Alternating Intervention Design: A-B/C-(B orC) Interaction Design: A-B-A-B-BC-B-BC Summary 18 Selecting a Design Introduction Framework for Selecting a Design Needed: A Design for All Seasons Creativity in Single-System Designs: Making Your Own Designs Evaluation in Minimal-Contact Situations Single-System Designs in Managed Care: The Stretch Design Trouble-Shooting: "Okay, I Understand Everything That You Said, but My Case Is Different." Summary Part IV Analyzing Your Results 19 Basic Principles of Analysis Introduction Distinguishing Effort, Effectiveness, and Efficiency Significance-Practical, Statistical, and Theoretical Evaluating Goal Achievement Issues in Analysis of Data Computer Analysis of Data for Single-System Designs The Issue of Autocorrelation Tools in Analysis of Data Summary 20 Visual Analysis of Single-System Design Data Introduction Definition of Terms Basic Patterns and Implications Visual Inspection of Raw Data Interpreting Ambiguous Patterns Problems of Visual Inspection Creating a Chart with SINGWIN Summary 21 Descriptive Statistics Introduction Measures of Central Tendency Measures of Variation Using Measures of Central Tendency and Variability to Graph Group Data Computing and Graphing Measures of Central Tendency and Variation with SINGWIN Measures of Trend Measures of Effect Size Optimal Uses and Cautions for Specific Descriptive Statistics Summary 22 Tests of Statistical Significance for Single-System Designs Introduction Proportion/Frequency Approach Three-Standard-Deviation-Band Approach (X-Moving-Range-Chart) Chi-Square Conservative Dual-Criteria (CDC) Approach t-Test General Considerations in Using Tests of Statistical Significance Optimal Uses and Cautions for Specific Analytic Procedures Summary 23 Computer Analysis of Single-System Design Data Chapter Overview Starting SINGWIN Exiting SINGWIN Getting the Big Picture Using Specific Procedures Appendix: Installing Singwin Summary 24 Selecting a Procedure for Analyzing Data Introduction Framework for Selecting a Procedure for Analyzing Data Other Statistical Considerations Nonstatistical Considerations Limitations Summary Part V The Challenge of Single-System Designs 25 Not for Practitioners Alone Introduction Special Applications of Single-System Designs Recent Criticisms of Single-System Evaluation For the Client For the Administrator For Educators and Students Summary References Name Index Subject Index

Evaluating Practice: Guidelines for the Accountable Professional

We examine why some foster families continue to foster whereas others do not. Reasons for quitting include lack of agency support, poor communication with caseworkers, lack of say in foster children's future, and difficulties with foster children's behavior. As compared with continuing foster parents, former foster parents and foster parents planning to quit say that they receive less postlicensure training and are less likely to have a foster-parent mentor. As compared with continuing and former foster parents, current foster parents planning to quit are more likely to say they need day care, transportation, and help with health-care costs.

A Comparison of Family Foster Parents Who Quit, Consider Quitting, and Plan to Continue Fostering

Foster Family Characteristics and Behavioral and Emotional Problems of Foster Children: A Narrative Review* The purpose of this article is to review the literature on the foster family characteristics that are thought to contribute to the behavioral and emotional problems of foster children. The review is shaped by an understanding of the personal and familial factors associated with children's problem behaviors in the general population. These factors include parenting, the family home environment, family functioning, marital functioning, family demography, child temperament, parents' mental health, and social support. Limitations within the existing research on these foster family characteristics are noted, and suggestions for future research are provided. Despite trends away from out-of-home placement (Department of Health and Human Services, Children's Bureau, 1997; Pecora, Whittaker, Maluccio, Barth, & Plotnick, 1992), the number of children removed from their homes and placed in foster care is large and increasing. In 1982 there were 262,000 children in care. In 1996 507,000 children were in foster care, and 725,000 children were served by the foster care system at some time during that year (Tatara, 1998). Many children in foster care have significant behavioral and emotional problems (e.g., Heflinger, Simpkins, & Combs-Orme, 2000; Pilowsky, 1995), and many of them are at risk for developing additional problems because of a history of child abuse and neglect, family poverty, or parental mental health problems (e.g., Blumberg, Landsverk, Ellis-MacLeod, Ganger, & Culver, 1996; Courtney, Piliavin, & Wright, 1997; Department of Health and Human Services, Children's Bureau, 1997; Horwitz, Simms, Farrington, 1994; Rosenfeld et al., 1997; Schmidt-Tieszen & McDonald, 1998; Stein, Rae-Grant, Ackland, & Avison, 1994; Takayama, Wolfe, & Coulter, 1998). In addition to familial risk factors for behavioral and emotional problems, foster placement itself may be a risk factor for such problems (e.g., adjustment to a new family, placement disruptions). However, the link between foster care placement and child problem behaviors is not well established, and the causal direction of this relationship is unclear (Fanshel, Finch, & Grundy, 1990; Fanshel & Shinn, 1978; Pardeck, 1984; J. Rowe, Cain, Hundleby, & Keane, 1984). Foster Families In 1996, approximately three fourths of the children in foster care were placed with foster families (Adoption and Foster Care Analysis and Reporting System, 1997, Table 08-C), the remainder being in other types of care, such as residential or group homes. On a day-to-day basis, foster families are the front-line service providers for these children and form the foundation of substitute care services in the United States. As Fanshel and Shinn (1978) observed, "We can think of no greater influence on the well-being of foster children while they are in care than those who directly minister to their needs" (p. 496). Foster family services are increasingly crucial because federal and state resources for child welfare services have not kept pace with the critical needs of foster children. Hiring freezes, low pay, and difficult working conditions have led to caseworker shortages, less experienced and educated caseworkers, high caseloads, and high burnout and turnover rates among caseworkers (Department of Health and Human Services, Children's Bureau, 1997; Department of Health and Human Services, National Center on Child Abuse and Neglect, 1995; General Accounting Office, 1995). Also, a large proportion of foster children with behavioral and emotional problems who are referred for mental health services to treat urgent needs do not receive such services (Blumberg et al., 1996; Risley-Curtiss, Combs-Orme, Chernoff, & Heisler, 1996). This proportion of children with behavioral and emotional problems might increase in the near future because of recent efforts to move children quickly through the foster care system. …

John G. Orme

Papers

Factorial and Discriminant Validity of the Center for Epidemiological Studies Depression (CES-D) Scale.

Evaluating Practice: Guidelines for the Accountable Professional

A Comparison of Family Foster Parents Who Quit, Consider Quitting, and Plan to Continue Fostering

Foster Family Characteristics and Behavioral and Emotional Problems of Foster Children: A Narrative Review*

The long-term correlates of family foster care