Mohammed T. Abou-Saleh

Principles and Practice of Geriatric Psychiatry.Editors: Professor John R. M. Copeland, Dr Mohammed T. Abou-Saleh and Professor Dan G. BlazerCopyright & 2002 John Wiley & Sons LtdPrint ISBN 0-471-98197-4 Online ISBN 0-470-84641-034Comprehensive InterviewsOARS MethodologyGerda G. FillenbaumDuke University Medical Center, Durham, NC, USAThe OARS (Older Americans Resources and Services) methodologywas developed over two decades ago in response to a request‘‘to assess alternative strategies to institutionalizing frail olderadults’’ 1 . To address this issue, a three-element model wasdeveloped, which allows one to: (a) assess adults at all levels offunctioning from excellent to totally impaired, using a multidimensionalperspective; (b) determine the extent of use of andperceived need for each of 24 broadly encompassing but nonoverlappinggenerically-defined services, which can be aggregatedinto costable packages; and consequently (c) to examine theimpact of the identified service packages on persons defined interms of their multidimensional functional profiles.The questionnaire developed to operationalize the first twoelements of the model is not restricted to it, but has enjoyed morevaried use. The questionnaire is in two parts (see summary inTable 1). Part A assesses the level of functioning in five areas.Three areas reflect personal functioning—mental health, physicalhealth, and activities of daily living; two reflect environmentalconditions—social resources and economic resources. In each areathe information obtained (from the subject or an informant) canbe summarized on a six-point scale, ranging from excellent tototally impaired functioning. Review across all five areas providesa profile, making it possible to identify where functional strengthsand weaknesses lie. Each area is itself multidimensional, soallowing users to examine specific aspects of particular areas offunctioning and permitting more accurate identification of serviceimpact.Part B focuses on services assessment. To ensure accurateidentification, each service is defined in terms of its purpose, theactivity involved, the personnel who may provide the service, andthe units in which it is to be measured (to facilitate costing). So, aresident of a nursing home would not be rated as receiving‘‘nursing home services’’, rather, the precise services received there(e.g. nursing care, meal preparation, occupational therapy), theamount, and the type of provider (formal or informal) would berecorded. Need for services is self-assessed.On average, the OARS questionnaire takes 40 min to administer(training in this is provided). Validity and reliability havebeen determined. It is available, and has been validated, in anumber of languages. The questionnaire has been used forpurposes as varied as teaching, clinical and population assessment,agency evaluation, staffing determination, service impact,prediction of service needs, determination of preferred serviceaggregation, and estimating service cost in different settings. AnTable 1. Overview of OARS multidimensional functional assessmentquestionnairePart A, Assessment of functional statusDemographicSocial resourcesInteractionAffectExtent of availability of helpEconomic resourcesOccupationIncome (by source)HousingSelf-assessed adequacy of incomeMental healthShort Portable Mental StatusQuestionnaire (to assess level ofcognitive functioning)Short Psychiatric EvaluationSchedule (to assess presence ofpsychiatric problems)Self-assessed mental healthPhysical healthPrescribed medicationsCurrent illnesses and conditions andtheir impactAlcohol useLevel of activitySelf-assessed physical healthActivities of daily living (ADL)Instrumental ADLPhysical ADLarchive of OARS-based data sets is maintained at the Duke AgingCenter.REFERENCEPart B, Services assessmentTransportationSocial/recreational servicesEmployment servicesSheltered employmentEducational services,employment-relatedRemedial trainingMental health servicesPsychotropic drugsPersonal care servicesNursing careMedical servicesSupportive devices andprosthesesPhysical therapyContinuous supervisionChecking servicesRelocation and placementservicesHomemaker–householdservicesMeal preparationAdministrative, legal andprotective servicesSystematic multidimensionalevaluationFinancial assistanceFood, groceriesLiving quarters (housing)Coordination, informationand referral services1. Maddox GL. Foreword. In Fillenbaum GG, MultidimensionalFunctional Assessment of Older Adults: The Duke Older AmericansResources and Services Procedures. Hillsdale, NJ: Erlbaum, 1988.Principles and Practice of Geriatric Psychiatry, 2nd edn. Edited by J. R. M. Copeland, M. T. Abou-Saleh and D. G. Blazer&2002 John Wiley & Sons, Ltd