USE OF GOAL ATTAINMENT SCALING IN MEASURING CLINICALLY IMPORTANT CHANGE IN THE FRAIL ELDERLY

The selection of appropriate outcome measures is important in evaluati ng specialized geriatric programs, but how the various measures compar e, and which are most appropriate, are matters still largely unexplore d. We compared several outcome measures, including goal attainment sca ling, to assess their sensitivity to changes in the health status of f rail elderly patients admitted to two geriatric medicine wards. GAS is a measurement approach which accommodates multiple individual patient goals, and has a scoring system which allows for comparisons between patients. Forty-five patients (mean age 81 years, 30 females) received comprehensive assessments. GAS yielded a mean 5 goals per patient. Th e mean gain in the GAS score was 22 points (SD = 7) which was compared with the change in the Barthel Index (r = 0.59), the Functional Indep endence Measure (r = 0.45), the Physical Self-Maintenance Scale (r = 0 .54), the Katz Activities of Daily Living Index (r = 0.49) and the Spi tzer Quality of Life Index (r = 0.38). The inter-rater reliability of scoring the GAS follow-up guides was 0.91. Using a relative efficiency statistic, GAS proved more efficient than any other measure. The effe ct size statistic also demonstrated an increased responsiveness to cha nge of GAS compared with standard measures. GAS is an individualized m easurement approach which shows promise as a responsive measure in fra il elderly patients.