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All interRAI assessment systems can be used to measure both the status and the outcomes of individuals or groups of people. Embedded within each instrument are various scales and indices that can be used to evaluate an individual's current clinical status. Changes in clinical status over time can also be evaluated and compared. These scales have been carefully researched to insure that the measures are comparable to industry "gold standard" scales. Following are descriptions of some of the most used outcome measures developed by interRAI members.
Activities of Daily Living Hierarchy
The ADL Hierarchy Scale groups activities of daily living according the stage of the disablement process in which they occur. Early loss ADL's (e.g., dressing) are assigned lower scores than late loss ADL's (e.g., eating). The ADL Hierarchy Scale ranges from 0 (no impairment) to 6 (total dependence). Diagram
RUG-III Activities of Daily Living Index
The RUG-III and RUG-III/HC algorithms include a summary measure of ADL that combines scores for bed mobility, toileting, transferring and eating. Scores range from 4 (independent or supervision in all 4 areas) to 18 (severe impairment in all 4 areas). Diagram
CHESS Scale
The Changes in Health, End-stage disease and Signs and Symptoms scale was designed to identify individuals at risk of serious decline. It can serve as an outcome where the objective is to minimize problems related to declines in function. CHESS, originally developed for use in the nursing home, has been adapted for use with the HC. It uses 6 items to create a five point scale from 0=not at all unstable to 5=highly unstable. In a nursing home population, there is clear differentiation of all 6 levels of CHESS scores, and higher levels are predictive of adverse outcomes like mortality, hospitalization, pain, caregiver stress, and poor self-rated health.
Cognitive Performance Scale
The Cognitive Performance Scale (CPS) combines information on memory impairment, level of consciousness, and executive function, with scores ranging from 0 (intact) to 6 (very severe impairment). The CPS has been shown to be highly correlated with the MMSE in a number of validation studies. Diagram
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Depression Rating Scale
The Depression Rating Scale (DRS) can be used as a clinical screen for depression. Seven items are used. Validation studies were based on a comparison of the DRS with the Hamilton Depression Rating Scale and the Cornell Scale for Depression. Compared to DSM-IV Major or minor depression diagnoses, the DRS was 91% sensitive and 69% specific at a cut-point score of 3 out of 7. Diagram
IADL Involvement Scale
The instrumental ADL scale is based upon a sum of 7 items: meal preparation, ordinary housework, managing finances, medications, phone use, shopping, and transportation. Individual items are summed to produce a scale that ranges from 0 to 21, with higher scores indicating greater difficulty in performing instrumental activities. Diagram
Index of Social Engagement
The Index of Social Engagement describes the individual's sense of initiative and involvement in social activities. The scale was validated in a nursing home population by comparing its scores with actual time spent in activity programs. Scores range from 0 (severe withdrawal) to 6 (high level of participation and initiative).
Pain Scale
The Pain Scale was originally developed for use in nursing homes and later translated for use with other interRAI instruments. The scale uses 2 items to create a score from 0 to 3. It has been shown to be highly predictive of pain on the Visual Analogue Scale in nursing home residents in the US. Diagram
References
Burrows A, Morris JN, Simon S, Hirdes JP, Phillips C. (2000) Development of a Minimum Data Set-based Depression Rating Scale for Use in Nursing Homes. Age and Ageing 29(2): 165-172.
Fries BE, Simon SE, Morris JN, Flodstrom C, Bookstein FL. (2001) Pain in US Nursing Homes: Validating a Pain Scale for the Minimum Data Set. Gerontologist 41(2): 173-179.
Hirdes JP, Frijters D, Teare G. (2003) The MDS CHESS Scale: A New Measure to Predict Mortality in the Institutionalized Elderly. Journal of the American Geriatrics Society 51(1): 96-100.>
Mor V, Branco K, Fleishman J, Hawes C, Phillips C, Morris JN, Fries BE. (1995) The Structure Of Social Engagement Among Nursing Home Residents. Journals of Gerontology: Psychological Sciences 50(1):P1-P8.
Morris JN, Carpenter I, Berg K, Jones RN. (2000) Outcome Measures for Use with Home Care Clients. Canadian Journal on Aging 19(2): 87-105.
Morris JN, Fries BE, Mehr DR, Hawes C, Philips C, Mor V, Lipsitz L. (1994) MDS Cognitive Performance Scale. Journal of Gerontology: Medical Sciences. 49 (4): M174-M182.
Morris JN, Fries BE, Morris SA. (1999) Scaling ADLs within the MDS. Journals of Gerontology: Medical Sciences 54(11):M546-M553.>
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