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
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•
•
•
•
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
One year later
Impairment
None
Initial
None
.85
Number
Some
Total
Died
.12
.00
.03
210
.70
Some
.05
.75
.15
.05
60
.20
Total
.00
.10
.50
.40
30
.10
Number
181
.60
73
.24
24
.08
22
.07
300
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
Receive basic services only
Impairment
Initial
Status one year later
None
None
Some
Total
Number
(prop.)
Some
Total
Died
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)
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Assessment of the Elderly