Making geriatric assessment work: selecting useful measures.

Often the goal of physical therapy is to reduce morbidity and prevent or delay loss of independence. The purpose of this article is to describe issues to consider when selecting measures of physical function for use with community-dwelling older adults over the age of 65 years. We chose 16 measures of physical function for review because they have been used in studies of community-dwelling older adults and some psychometric properties of reliability and validity have been described in the literature. Three major issues are discussed: (1) appropriateness of the measure for community-dwelling adults, (2) practical aspects of test administration, and (3) psychometric properties. These issues are illustrated using examples from the 16 measures. Two scenarios, applying the measures to the assessment of community-dwelling well older people and to the assessment of community-dwelling frail older people, are used to illustrate how this information can be used.

[1]  M. Tinetti,et al.  Development of the Common Data Base for the FICSIT Trials , 1993, Journal of the American Geriatrics Society.

[2]  M. Woollacott,et al.  Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. , 2000, Physical therapy.

[3]  E. Hing,et al.  Use of nursing homes by the elderly: preliminary data from the 1985 National Nursing Home Survey. , 1987, Advance data.

[4]  J. VanSwearingen,et al.  Assessing recurrent fall risk of community-dwelling, frail older veterans using specific tests of mobility and the physical performance test of function. , 1998, The journals of gerontology. Series A, Biological sciences and medical sciences.

[5]  R J Shephard,et al.  Exercise and aging: extending independence in older adults. , 1993, Geriatrics.

[6]  G H Guyatt,et al.  How should we measure function in patients with chronic heart and lung disease? , 1985, Journal of chronic diseases.

[7]  M. Bergner,et al.  The Sickness Impact Profile: Validation of a Health Status Measure , 1976, Medical care.

[8]  B Kirshner,et al.  A methodological framework for assessing health indices. , 1985, Journal of chronic diseases.

[9]  R. Helme,et al.  The classification of patients with chronic pain: age as a contributing factor. , 1997, The Clinical journal of pain.

[10]  R. Cumming,et al.  Interventions for preventing falls in the elderly. , 2000 .

[11]  L. Ferrucci,et al.  The effect of chronic diseases on physical function. Comparison between activities of daily living scales and the Physical Performance Test. , 1997, Age and ageing.

[12]  M. K. James,et al.  Validation of the PASE in older adults with knee pain and physical disability. , 1999, Medicine and science in sports and exercise.

[13]  G H Guyatt,et al.  Responsiveness and validity in health status measurement: a clarification. , 1989, Journal of clinical epidemiology.

[14]  Jacob Cohen A Coefficient of Agreement for Nominal Scales , 1960 .

[15]  A R Feinstein,et al.  Scientific and clinical problems in indexes of functional disability. , 1986, Annals of internal medicine.

[16]  C. Gilligan,et al.  Physical Activity Prescription for the Older Adult. , 1983, The Physician and sportsmedicine.

[17]  R. Hainsworth,et al.  Assessment of respiratory function in patients with chronic obstructive airways disease. , 1979, Thorax.

[18]  A. Jette,et al.  The Physical Activity Scale for the Elderly (PASE): development and evaluation. , 1993, Journal of clinical epidemiology.

[19]  M. Bergner,et al.  The Sickness Impact Profile: Reliability of a Health Status Measure , 1976, Medical care.

[20]  M. Bergner,et al.  The sickness impact profile. Development of an outcome measure of health care. , 1975, American journal of public health.

[21]  M. Tinetti Performance‐Oriented Assessment of Mobility Problems in Elderly Patients , 1986, Journal of the American Geriatrics Society.

[22]  S. Studenski,et al.  Functional Reach: A Marker of Physical Frailty , 1992, Journal of the American Geriatrics Society.

[23]  K. Rockwood,et al.  Testing the measurement properties of the Short Form-36 Health Survey in a frail elderly population. , 1998, Journal of clinical epidemiology.

[24]  J. E. Brazier,et al.  Validating the SF-36 health survey questionnaire: new outcome measure for primary care. , 1992, BMJ.

[25]  K Cerny A clinical method of quantitative gait analysis. Suggestion from the field. , 1983, Physical therapy.

[26]  W. Tierney,et al.  Changes in the SF-36 in 12 months in a clinical sample of disadvantaged older adults. , 1998, Medical care.

[27]  J. Cummings,et al.  Evaluating dementia screening tests , 1999, Neurology.

[28]  R. Burdett,et al.  A comparison of gait characteristics in young and old subjects. , 1994, Physical therapy.

[29]  A M Jette,et al.  Are performance-based measures sufficiently reliable for use in multicenter trials? Musculoskeletal Impairment (MSI) Study Group. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[30]  D. Cunningham,et al.  Age-related changes in speed of walking. , 1988 .

[31]  B. Ford International Classification of Impairments, Disabilities and Handicaps , 1984, Releve epidemiologique hebdomadaire.

[32]  E. Andresen,et al.  Test-retest performance of a mailed version of the Medical Outcomes Study 36-Item Short-Form Health Survey among older adults. , 1996, Medical care.

[33]  P J Holliday,et al.  Clinical and laboratory measures of postural balance in an elderly population. , 1992, Archives of physical medicine and rehabilitation.

[34]  W. Beam,et al.  A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. , 1999, Research quarterly for exercise and sport.

[35]  L G Branch,et al.  Physical performance measures in aging research. , 1989, Journal of gerontology.

[36]  D B Reuben,et al.  An Objective Measure of Physical Function of Elderly Outpatients , 1990, Journal of the American Geriatrics Society.

[37]  W. Satariano,et al.  Reliability of physical performance and self-reported functional measures in an older population. , 1998, The journals of gerontology. Series A, Biological sciences and medical sciences.

[38]  P. Vajro,et al.  Side effects of alpha-interferon therapy and impact on health-related quality of life in children with chronic viral hepatitis. , 1997, The Pediatric infectious disease journal.

[39]  Diane Podsiadlo,et al.  The Timed “Up & Go”: A Test of Basic Functional Mobility for Frail Elderly Persons , 1991, Journal of the American Geriatrics Society.

[40]  J. F. Yang,et al.  The modified Gait Abnormality Rating Scale for recognizing the risk of recurrent falls in community-dwelling elderly adults. , 1996, Physical therapy.

[41]  O. Edholm,et al.  Studies of gait and mobility in the elderly. , 1981, Age and ageing.

[42]  S. Studenski,et al.  Functional reach: predictive validity in a sample of elderly male veterans. , 1992, Journal of gerontology.

[43]  M. Bergner,et al.  The Sickness Impact Profile: Development and Final Revision of a Health Status Measure , 1981, Medical care.

[44]  Noel S. Weiss,et al.  Clinical Epidemiology: The Study of the Outcome of Illness , 1986 .

[45]  M. Fisher The Susceptibility of Staphylococci to Chloramphenicol A Survey of Experimental and Clinical Experiences , 1960 .

[46]  Suzanne G. Leveille,et al.  Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. , 2000, The journals of gerontology. Series A, Biological sciences and medical sciences.

[47]  R. Hays,et al.  Measuring Physical Function in Community‐Dwelling Older Persons: A Comparison of Self‐Administered, Interviewer‐Administered, and Performance‐Based Measures , 1995, Journal of the American Geriatrics Society.

[48]  D B Reuben,et al.  Value of functional status as a predictor of mortality: results of a prospective study. , 1992, The American journal of medicine.

[49]  S. Cummings,et al.  Risk factors for recurrent nonsyncopal falls. A prospective study. , 1989, JAMA.

[50]  L. Wolfson,et al.  Gait assessment in the elderly: a gait abnormality rating scale and its relation to falls. , 1990, Journal of gerontology.

[51]  L. Rubenstein Documenting Impacts of Geriatric Consultation , 1987, Journal of the American Geriatrics Society.

[52]  D M Buchner,et al.  A cross-sectional validation study of the FICSIT common data base static balance measures. Frailty and Injuries: Cooperative Studies of Intervention Techniques. , 1995, The journals of gerontology. Series A, Biological sciences and medical sciences.

[53]  D B Reuben,et al.  Screening for balance and mobility impairment in elderly individuals living in residential care facilities. , 1995, Physical therapy.

[54]  D. Patrick,et al.  Comparing the Performance of Health Status Measures for Healthy Older Adults , 1995, Journal of the American Geriatrics Society.

[55]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[56]  A. Jette Measuring subjective clinical outcomes. , 1989, Physical therapy.

[57]  C. Rubin,et al.  A Randomized, Controlled Trial of Outpatient Geriatric Evaluation and Management in a Large Public Hospital , 1993, Journal of the American Geriatrics Society.

[58]  D B Reuben,et al.  The predictive validity of self-report and performance-based measures of function and health. , 1992, Journal of gerontology.

[59]  S. Studenski,et al.  Functional reach: a new clinical measure of balance. , 1990, Journal of gerontology.

[60]  L. Rubenstein,et al.  Comprehensive geriatric assessment: a meta-analysis of controlled trials , 1993, The Lancet.

[61]  I. Rosow,et al.  A Guttman health scale for the aged. , 1966, Journal of gerontology.

[62]  R. Kaplan,et al.  Performance of a self-administered mailed version of the Quality of Well-Being (QWB-SA) questionnaire among older adults. , 1998, Medical care.

[63]  D. Mccarty,et al.  Simple method for measurement of lower extremity muscle strength. , 1985, The American journal of medicine.

[64]  M. Tinetti,et al.  Risk factors for falls among elderly persons living in the community. , 1988, The New England journal of medicine.

[65]  C. van der Schans,et al.  Quality of life in patients with cystic fibrosis , 1997, Pediatric pulmonology.

[66]  K. Berg Measuring balance in the elderly: preliminary development of an instrument , 1989 .

[67]  D G Lloyd,et al.  The effect of exercise on gait patterns in older women: a randomized controlled trial. , 1996, The journals of gerontology. Series A, Biological sciences and medical sciences.

[68]  C. Winograd Targeting Strategies: An Overview of Criteria and Outcomes , 1991, Journal of the American Geriatrics Society.

[69]  J. Morris,et al.  The SF-36 health survey questionnaire: is it suitable for use with older adults? , 1995, Age and ageing.

[70]  M. Tinetti,et al.  Identifying mobility dysfunctions in elderly patients. Standard neuromuscular examination or direct assessment? , 1988, JAMA.

[71]  L. Rubenstein,et al.  What do we know about patient targeting in geriatric evaluation and management (GEM) programs? , 1996, Aging.

[72]  N. Ikegami Functional assessment and its place in health care. , 1995, The New England journal of medicine.

[73]  Mahoney Fi,et al.  FUNCTIONAL EVALUATION: THE BARTHEL INDEX. , 1965 .

[74]  D L Riddle,et al.  Interpreting validity indexes for diagnostic tests: an illustration using the Berg balance test. , 1999, Physical therapy.

[75]  G H Guyatt,et al.  Effect of encouragement on walking test performance. , 1984, Thorax.

[76]  Yuan Wang,et al.  Regional Variation in Receptive Field Properties of Tectal Neurons in Pigeons , 2000, Brain, Behavior and Evolution.

[77]  A. Jette,et al.  Test‐Retest Reliability of Self‐Reported Disability Measures in Older Adults , 1997, Journal of the American Geriatrics Society.

[78]  D L Riddle,et al.  Health status measures: strategies and analytic methods for assessing change scores. , 1996, Physical therapy.

[79]  L. D. de Witte,et al.  Assessing the responsiveness of a functional status measure: the Sickness Impact Profile versus the SIP68. , 1997, Journal of clinical epidemiology.

[80]  D. Krebs,et al.  Functional reach: does it really measure dynamic balance? , 1999, Archives of physical medicine and rehabilitation.

[81]  A. Woodcock,et al.  Two-, six-, and 12-minute walking tests in respiratory disease. , 1982, British medical journal.

[82]  M. Williams Cardiovascular risk-factor reduction in elderly patients with cardiac disease. , 1996, Physical therapy.

[83]  U. Nayak,et al.  The effect of age on variability in gait. , 1984, Journal of gerontology.

[84]  D. Sackett,et al.  The Ends of Human Life: Medical Ethics in a Liberal Polity , 1992, Annals of Internal Medicine.

[85]  L G Branch,et al.  Short‐Term Variability of Measures of Physical Function in Older People , 1990, Journal of the American Geriatrics Society.

[86]  M. Tinetti,et al.  Fall risk index for elderly patients based on number of chronic disabilities. , 1986, The American journal of medicine.

[87]  Marco Trabucchi,et al.  Physical Performance Test and Activities of Daily Living Scales in the Assessment of Health Status in Elderly People , 1993, Journal of the American Geriatrics Society.

[88]  R. Schulz,et al.  The measurement of caregiver outcomes in Alzheimer disease research. , 1997, Alzheimer disease and associated disorders.

[89]  R B Wallace,et al.  Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. , 1995, The New England journal of medicine.

[90]  Alan M. Jette,et al.  Task Force on Standards for Measurement in Physical Therapy. Standards for tests and measurements in physical therapy practice. , 1991, Physical therapy.

[91]  L. Rubenstein,et al.  A randomized trial of comprehensive geriatric assessment in the care of hospitalized patients. , 1995, The New England journal of medicine.

[92]  Jm. Rothstein Guide to physical therapist practice 2nd, ed. , 2001 .

[93]  R. Shephard The cardiovascular benefits of exercise in the elderly , 1985 .

[94]  C. Herlitz,et al.  Causes of strain affecting relatives of Swedish oldest elderly. A population-based study. , 1999, Scandinavian journal of caring sciences.

[95]  Peter R. Cavanagh,et al.  Exercise and physical activity for older adults , 1998 .

[96]  Christianna S. Williams,et al.  Assessing Risk for the Onset of Functional Dependence Among Older Adults: The Role of Physical Performance , 1995, Journal of the American Geriatrics Society.

[97]  J R Beck,et al.  The use of relative operating characteristic (ROC) curves in test performance evaluation. , 1986, Archives of pathology & laboratory medicine.

[98]  Marjorie H. Woollacott,et al.  Motor Control: Theory and Practical Applications , 1995 .

[99]  L. Ferrucci,et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. , 1994, Journal of gerontology.

[100]  L. Rubenstein,et al.  Predictors of falls among elderly people. Results of two population-based studies. , 1989, Archives of internal medicine.

[101]  G. Guyatt,et al.  Measuring change over time: assessing the usefulness of evaluative instruments. , 1987, Journal of chronic diseases.

[102]  A. Stewart,et al.  Mobility-related function in older adults: assessment with a 6-minute walk test. , 1999, Archives of physical medicine and rehabilitation.

[103]  P. A. Hageman,et al.  Comparison of gait of young women and elderly women. , 1986, Physical therapy.

[104]  C. Sherbourne,et al.  The MOS 36-Item Short-Form Health Survey (SF-36) , 1992 .

[105]  L. Rubenstein,et al.  The Sepulveda GEU Study revisited: Long-term outcomes, use of services, and costs , 1995, Aging.

[106]  R. Strauss,et al.  The Physician and Sportsmedicine. , 1992, The Physician and sportsmedicine.

[107]  K. Westerterp,et al.  Validity of the Physical Activity Scale for the Elderly (PASE): according to energy expenditure assessed by the doubly labeled water method. , 1997, Journal of clinical epidemiology.