SCREENING FOR COMMON PROBLEMS IN AMBULATORY ELDERLY - CLINICAL CONFIRMATION OF A SCREENING INSTRUMENT

PURPOSE: To develop a test that will be administered by nonphysician o ffice staff to screen elderly persons seen in ambulatory settings for problems commonly contributing to functional disability. METHODS: We r eviewed the literature to identify problems that reduce function and s creening measures appropriate for use in office settings. Using this i nformation, we developed an instrument including screening items for m alnutrition/weight loss, visual impairment, hearing loss, cognitive im pairment, urinary incontinence, depression, physical disability, and r educed leg mobility. The instrument was tested on 109 new patients at a university-based ambulatory geriatrics medicine clinic and validated using two standards: blinded and unblinded geriatricians' assessments . For each of the individual items on the screening instrument, we cal culated sensitivity and specificity using both the blinded and unblind ed geriatricians' evaluations as the reference standards, prevalence o f the disorders, positive and negative predictive values, interrater r eliability, and the direct annual costs of administering the test for an individual physician's office. RESULTS: The screen was administered in 8 to 12 minutes. Inter-rater agreement varied by item from 77% to 100%. The sensitivities of the items varied between 0.65 to 0.93 (blin ded) and 0.70 to 0.95 (unblinded). Specificities ranged between 0.50 t o 0.95 (blinded) and 0.64 to 0.95 (unblinded). Problem prevalences var ied from 21% to 72%. Positive and negative predictive values were 0.60 to 0.91 and 0.77 to 0.96, respectively. Direct annual costs for a cli nical practice include a one-time $530 fee for equipment and, dependin g on the screening administrator's salary, between $1 to $7 per patien t screened. CONCLUSIONS: The screening instrument is relatively inexpe nsive and brief and easy to use in the ambulatory setting. it has good validity and reliability when compared to the assessment of a geriatr ician. We are currently conducting a randomized trial to assess the ef fectiveness of the screen among older persons seen in community physic ians' offices.