The General Medical Health Rating: A bedside global rating of medical comorbidity in patients with dementia

OBJECTIVE: Dementia is a serious public health problem. General medical com orbidity is common in dementia patients and critical to their care. However , little is known about medical comorbidity in these patients, and there ar e no straightforward bedside global rating scales for the seriousness of co morbid medical illness. This paper describes the development and measuremen t properties of the General Medical Health Rating (GHMR), a rapid global ra ting scale of medical comorbidity in dementia patients. DESIGN: Interrater reliability, concurrent validity, and predictive validit y of the GMHR are reported. SETTING: An outpatient dementia clinic, assisted living, and nursing home. PARTICIPANTS: A total of 819 consecutive dementia clinic outpatients and 18 0 consecutive admissions to Copper Ridge, a long-term care residence for pe ople with dementia, were included in the study. RESULTS: GMHR was found to be highly reliable (weighted kappa = .91). Acros s all stages and types of dementia, GMHR ratings were correlated with numbe r of comorbid medical conditions, number of medications being taken for com orbid conditions, and with activity of daily living impairment, even after adjustment for severity of dementia. GMHR ratings were also a strong predic tor of falls and of mortality in long-term care residents after adjustment for age and severity of dementia. CONCLUSION: GMHR is a reliable, valid, global bedside measure of severity o f general medical comorbidity for patients with dementia that can be used f or clinical and research purposes.