Margaret W. Linn

CUMULATIVE ILLNESS RATING SCALE

Abstract: A Cumulative Illness Rating Scale, designed to meet the need for a brief, comprehensive and reliable instrument for assessing physical impairment, has been developed and tested. The scale format provides for 13 relatively independent areas grouped under body systems. Ratings are made on a 5‐point “degree of severity” scale, ranging from “none” to “extremely severe.” Findings, in terms of reliability and validity, reflect statistical significance at the P < .01 level. As a rapid assessment technique which is objective and easily quantified, the scale is well suited to a variety of research uses.

Effects of counseling for late stage cancer patients

Much has been written about working with the dying. Few, if any, controlled studies have examined the application of principles set forth. The authors evaluate the effectiveness of working with dying cancer patients by assessing changes in quality of life, physical functioning, and survival. One‐hundred twenty men with end‐stage cancer were randomly assigned to experimental or control groups; the 62 experimental group patients were seen regularly by a counselor. Patients were assessed before random assignment and at one, three, six, nine, and 12 months on quality of life and functional status. Experimental group patients improved significantly more than the control group on quality of life within three months. Functional status and survival did not differ between groups. A subsample of lung cancer patients provided cross‐validation of findings. Although survival was not expected to differ, it was predicted that functioning would be enhanced if quality of life improved. One interpretation is that little can be done to alter physical function and survival when intervention occurs late in the progression of a fatal disease. This in no way reduces the value of improving overall quality of life, since enhancing the quality of survival for end‐stage cancer patients is a high priority medical goal.

The rapid disability rating scale-2.

A revised version of the Rapid Disability Rating Scale (RDRS‐2) is presented. Item definitions have been sharpened and directions expanded to indicate that ratings are based upon the patients performance in regard to behavior, and that prostheses normally used by the patient should be included in the assessment. Three items have been added to increase the breadth of the scale. Response items have been changed from three‐point to four‐point ratings in order to increase group discrimination and make the scale more sensitive to changes in treatment. The new appraisals of reliability, factor structure, and validity are reported, along with the potential uses of the scale.

Objective and self-assessed health in the old and very old.

Abstract There is increasing support for the concept that persons who live into extreme old age are biologically elite. In this study, self-health assessments and eight objective health indices were studied in 286 elderly living in the community. Self-health was measured on a 5-point scale ranging from very poor to excellent. Objective health measures included impairment and disability rating; number of physician visits, days in bed, and days hospitalized for the prior six months; diagnoses; medications; and operations. The sample was divided by good (70%) and poor (30%) self-health assessments and by old (age 65–74, 66%) and very old (75 and over, 34%). The objective health measures were compared between these groups in a multivariate analysis of variance. Number of medications was less and surgical operations more for the very old than old. All but two of the eight objective measures of health (surgery and days in bed) differentiated significantly between self-assessed health groups. It therefore seems that age, by itself, is a poor indicator of health among the elderly; however, how the elderly view their own health may be an extremely useful clinical guide as to their overall health status.

Satisfaction with ambulatory care and compliance in older patients.

Predictors of satisfaction with ambulatory care and compliance in 267 older and 581 younger patients were determined. Each patient rated a 45-item satisfaction-with-care-scale. Race, SES, marital status, distance from clinic, severity of illness (as measured by physician ratings, self-health assessment, number of medications, number of diagnoses, and number of clinic visits and hospitalizations in the prior year), and physician expectations of improvement were entered as predictors into stepwise multiple regression analyses for the elderly and the young. Predictors of better satisfaction in the young were less severe conditions, being nearer to the clinic and having fewer prior clinic visits over the year. In the elderly, having fewer visits to the clinic, more expectation of improvement by the physician and less severe conditions were associated with better satisfaction. Severity and clinic visits were predictors in each age group. The young, however, were also influenced by distance from the clinic. The elderly were influenced separately by the physicians prognosis. Thus, when the more impaired elderly are seen frequently without expecting a benefit, their satisfaction with care is poor. Further, satisfaction with care was correlated significantly with compliance in the elderly but not in the young. Findings suggest that improving satisfaction with care might also improve rates of compliance with the medical regimen in older patients.

Psychosocial differences between elderly volunteers and non-volunteers.

Volunteer workers over age sixty-five were compared to retired elderly who did not engage in any type of work activity. Volunteers were found to have significantly higher degree of life satisfaction, stronger will to live, and fewer symptoms of depression, anxiety, and somatization. Since no differences were found on most demographic or background variables, participation in volunteer work appears to be the salient factor in explaining psychosocial differences between volunteers and non-volunteers.

Evaluation of results of surgical procedures in the elderly.

Authorities are not in full agreement in regard to risk of surgery in the elderly. One hundred eight studies of surgery in the elderly over the past 40 years were reviewed. The purpose was not merely to tabulate results, but to identify differences existing between reports with regard to data reported that could affect results independent of the surgical management itself. Sources of variance that need to be taken into account in comparing mortality rates between studies, such as whether mortality was computed by number of patients or operations, differing lengths of follow-up for recording mortality, proportions of emergency versus elective operations, and types of surgical procedures, were documented. A nine-item confidence in results scale was used to classify studies into high and low confidence groups. Surgical specialties scored substantially higher than general surgical studies. More recent studies received higher scores than earlier studies. Although mortality rates varied widely depending on methods of their calculation, there appeared to be a trend toward increases in elective, but not emergency, mortality rates in general surgery since 1941 that should be examined more closely. One thing that cannot be answered clearly from these studies is the relative risk of surgery with age. Some control of variations between studies and standardization of reporting surgical deaths are required before risk of surgery in the elderly can be assessed more accurately.

A Global Assessment of Recent Stress (GARS) Scale.

The Global Assessment of Recent Stress (GARS) Scale was developed to assess current stress perception. Most measurements of environment are derived from life event scales that capture amount of stress or change associated with stressful events that have occurred over the past six to twenty-four months. A scale that provides a more immediate estimate of stress is needed when physiological tests and perceived stress are studied together. The GARS has been subjected to a series of studies concerning its reliability, validity, and factor structure. Results suggest that it may be a useful instrument for helping individuals assess their current feelings of stress.

Stressful Events, Dysphoric Mood, and Immune Responsiveness

This study measured depressive symptoms in 98 men of whom 49 had and 49 had not had a recent experience of family death or serious family illness. The relationships of depression and occurrence of the stressful event to immune function was explored. Persons with higher scores on depression in both groups showed less responsiveness of their lymphocytes to phytohemagglutinin and to allogeneic cells. Data indicate that not all persons react the same way to stressful events and that those with high and low depressive features can be differentiated by their immune responses.

A SOCIAL DYSFUNCTION RATING SCALE

THE SOCIAL DYSFUNCTION RATING SCALE (SDRS) was developed primarily as a research tool to assess the dysfunctional aspects of adjustment. Most scales have been devised to explore the positive end of the adjustment continuum, yet normality itself is an elusive and ill-defined concept. SABSmN 1 has suggested that many of the parameters of abnormality are so much easier to measure. Some behavioral scientists have stressed the importance of coping, problem solving, and adaptive behavior as elements of adjustment. This is strongly reflected in the work of BENEDEK, 2 BmRING, 3 EVJKSON, 4 GRINI~R and SPIEGEL, 6 JANIS, 6 and GORDON. 7 Effective functioning would suggest equilibrium within the person and in his interaction with his environment. It would involve adequate and integrated satisfaction of the persons needs related to his own goals and how he sees himself as achieving them. Dysfunction, on the other hand, implies discontent and unhappiness, accompanied by negative selfregarding attitudes. It furthermore suggests handicapping anxiety and other pathological interpersonal functions that reduce flexibility in coping with stressful situations or achieving self-actualization in what is to that person a significant role. Dysfunction can therefore be concerned with such matters as meaning of life, style of life, situational factors that pose environmental stresses, and personal capacities that hinder the person in coping with his environment and achieving gratification in the usual ways and to the usual degrees. From this standpoint, dysfunction is seen as coping with either personal, interpersonal, or geographic environment in a maladaptive manner. In this respect, the SDRS seeks to quantify the objective observations of mans dysfunctional interaction with his environment.