Assessment of the Elderly The OARS Approach Gerda G. Fillenbaum, Ph.D. Center for the Study of Aging and Human Development Duke University Medical Center

Overview Aging is part of the lifespan Assessment of the Elderly, the OARS approach

Aging is part of the lifespan Prior experience affects condition in old age Prenatal circumstances Education Health status Employment Income

Assessment of the Elderly The OARS approach Ascertain current multidimensional status Determine recent and current service use Link current status and current service use to determine services needed

Assessment of the Elderly Ascertain current status Social Resources Economic Resources Mental Health Physical Health Activities of Daily Living

Assessment of the Elderly Ascertain current status Social Resources Extent of interaction with others Dependability and duration of social support Subjective adequacy of social support

Assessment of the Elderly Ascertain current status Economic Resources Income, sources of income, assets, work history Objective adequacy of income Subjective adequacy of income

Assessment of the Elderly Ascertain current status Mental Health Cognitive status Psychiatric status (presence/absence of problems) Subjective assessment of mental health

Assessment of the Elderly Ascertain current status Physical Health Chronic illnesses and conditions Medications Health habits Level of activity Subjective assessment of physical health

Assessment of the Elderly Ascertain current status Activities of Daily Living Basic activities, e.g., bathe, groom, dress, transfer, toilet, feed self Instrumental activities, e.g., travel, handle money, cook, housework, handle medicine

Assessment of the Elderly Ascertain current status Summarizing information Check individual measures in each area Summarize each area on 6-point scale 1 = Excellent 4 = Moderately impaired 2 = Good 5 = Severely impaired 3 = Mildly impaired 6 = Totally impaired Determine profile across the five areas Etc.

Assessment of the Elderly Service use and need Basic maintenance services e.g., transportation, food, housing, financial assistance Supportive services e.g., personal care, meal preparation, homemaker-household Remedial services e.g., medical, nursing care, supportive devices and prostheses

Assessment of the Elderly Service use and need Each service is defined in terms of: Purpose Activity involved Relevant personnel Unit of measure (e.g., time, number of meals)

Assessment of the Elderly Service use and need Each service is measured in terms of: Extent/amount of use Adequacy of current use Type of provider (family, friend, paid person)

Assessment of the Elderly Change in status over time Status across the 5 areas of personal functioning can be cross-tabulated against status at a later time.

Assessment of the Elderly Current and later status compared Impairment Initial One year later Number NoneSomeTotalDied None Some Total Number

Assessment of the Elderly Linking change in status to service use Status across the 5 areas of personal functioning can be cross-tabulated against status at a later time, bearing in mind the services received in the interim.

Assessment of the Elderly Linking change in status to service use Impairment Initial Receive basic services only Number (prop.) Status one year later NoneSomeTotalDied None Some Total Number (prop.)

Assessment of the Elderly Limitations of the OARS approach All relevant areas may not be covered: personal level – nutritional status, religiosity/spirituality, impact on care-givers environmental level – neighborhood characteristics (safety), service availability political – national stability, equity issues

Assessment of the Elderly Advantages of the OARS approach Multidimensional Valid and reliable Administration by paraprofessionals Facilitates accurate planning of services Facilitates communication across disciplines

Assessment of the Elderly Advantages of the OARS approach Useful at individual level (e.g., clinical evaluation) Useful at agency level (e.g., to determine whether agency is serving mandated clientele) Useful at population level (e.g., to determine status and needs of elderly in a particular area)