Assessment Tools

The Mind Body Wellness Geriatric Rehabilitation and Restorative Assessment System (GRRAS)

The Mind Body Wellness Geriatric Rehabilitation and Restorative Assessment System (GRRAS) consists of three separate but related assessment devices, the Psychological Resistance to Activities of Daily Living Index or PRADLI, the Geriatric Multidimensional Pain Inventory or GMPI, and the Geriatric Level of Dysfunction Scale or GLDS.

Each of the measures that make up the GRRAS was designed specifically for use with a geriatric population in Long Term Care (Assisted Living and Nursing Homes) Facilities (LTCF) where a high percentage of residents suffer from disabling chronic illnesses and dementia.  The PRADLI was designed to assess patient’s level of cooperation and independence across eight activities of daily living (ADL) critical to geriatric rehabilitation, restoration and quality of life (QOL). The GMPI was designed to assess the impact of acute and chronic pain within LTCF and across progressive levels of cognitive impairment. Twelve domains assess a wide range of behaviors including level of pain and suffering, impact of pain on ADL, impact of pain on emotional wellness. The GLDS was designed to assess the intensity, frequency, and duration of 19 behavioral disturbances that frequently occur within LTCF populations and that can interfere with ADL and QOL.  Each component of the GRRAS is completed by a mental health professional (psychologist, nurse practitioner, or social worker) after observing the patient and talking with pertinent family members and appropriate health care staff (nurses and rehabilitation therapists).

The GRRAS is available through Psychological Assessment Resources (PAR) at www.parinc.com or 1-800-331-8378.

Cipher, D.J. Clifford, P.A.,& Roper, K. D. (2006). Behavioral Manifestations of Pain in the Demented Elderly. Journal of American Medical Directors Association, 7(5), 355-365.

Clifford, P.A., Cipher, D.J, & Roper, K. D. (2005). Assessing Dysfunctional Behaviors in Long-Term Care: The Geriatric Level of Dysfunction Scale. Journal of American Medical Directors Association, 6(5), 300-309.

Clifford, P.A., Cipher, D.J. & Roper, K. D. (2005). The Geriatric Multidimensional Pain and Illness Inventory: A new instrument measuring pain and illness in long-term care. Clinical Gerontologist, 28(3), 45-61

Cipher, D.J., & Clifford, P.A. (2004). Dementia, Pain, Behavioral Disturbances, and ADLs: Toward a Comprehensive Conceptualization of Quality  of Life in Long –term Care.  International Journal of Geriatric Psychiatry, 19, 741-748.

Clifford, P.A., Cipher, D.J, & Roper, K. D. (2003). Assessing resistance to activities of daily living in long-term care. Journal of American Medical Directors Association, 4, 313-319.

Clifford, P.A., Roper K.D., & Cipher, D.J. (2008). Geriatric Rehabilitation and Restorative Assessment System. Psychological Assessment Resources.

Clifford, P.A, Cipher, D.J., Roper, K.D., Snow, L, & Molinari, V. (2007). Cognitive-Behavioral Pain Management Interventions For Long-Term Care Residents With Physical And Cognitive Disabilities In Handbook of Behavioral and Cognitive Therapies with Older Adults Gallagher-Thompson, Dolores; Steffen, Ann; Thompson, Larry W. (Eds.), pp. 76-97.

Clifford, P.A., Cipher, D.J. & Roper, K.D. (2007). Efficacy of Geropsychological Treatment in Improving Pain, Depression, Behavioral Disturbances, ADLs, and Health Care Utilization in Long-Term Care. Clinical Gerontologist, 30(3), 23-40.

Psychological Resistance to Activities of Daily Living (PRADLI)

The Psychosocial Resistance to Activities of Daily Living Index (PRADLI) was developed for psychiatric nurses, geropsychologists, and clinical social workers to assess the level of long-term care (LTC) residents’ resistance to and cooperation with staff in performing activities of daily living. The PRADLI consists of 8 activities of daily living that commonly trigger a psychiatric or psychological referral when residents resist necessary care in these domains.

The PRADLI items were examined for internal consistency and test–retest reliability. Four of the 8 items (out of bed time, eating assistance, dressing, toileting, bathing, medical care, restorative care, social and recreational participation) overlap with most standard ADL scales, and convergent and discriminant validity was investigated using the ADL index from Katz, Ford, Moskowitz, and colleagues. Four hundred six residents of LTC facilities were rated for levels of the previously mentioned ADL indices. The PRADLI was evidenced to be a reliable and valid assessment tool for assessing resistance to ADLs in LTC facilities.

The PRADLI is an instrument that can potentially be used by LTC staff to assess ADLs. Research on the use of the PRADLI as a treatment outcome instrument in multidisciplinary LTC settings is warranted. Assessing ADLs within the context of residents’cooperation with LTC is an important part of understanding residents’ overall quality of life.

(J Am Med Dir Assoc 2003; 4: 313–319)

Geriatric Multidimensional Pain/Illness Inventory (GMPI)

The Geriatric Multidimensional Pain and Illness Inventory (GMPI) was developed in order to assess the perceptual, functional, and emotional concomitants of pain and illness in long-term care. The GMPI was administered to 401 adults aged 60 and older residing in one of 16 long-term care facilities. The GMPI items were analyzed for reliability, content validity, and convergent and discriminant validity. Factor analysis of the GMPI items revealed three subscales: level of pain severity, level of functional limitations associated with pain, and level of emotional distress associated with pain. The GMPI items were significantly correlated with items from the Geriatric Depression scale, the Neurobehavioral Cognitive Status Exam, and the Activities of Daily Living.

The GMPI is evidenced to be a reliable and valid assessment tool for assessing pain of residents in long term care facilities. Its brevity and clearly defined assessment criteria are assets to the administering clinician. Research on the utility of the GMPI as a treatment outcome instrument in long-term care is warranted. The potential for social workers and registered nurses to administer the GMPI in long-term care settings is discussed. [Article copies available for a fee from The Haworth Document Delivery.

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Geriatric Level of Dysfunction Scale (GLDS)

The GDLS was developed to assess the intensity, frequency, and duration of 19 behavioral disturbances:-Physical Combativeness, Verbal Aggression, Agitation/Hypomania, Hyperactivity, Non-compliant Behaviors, Distressing repetitive behaviors, Distressing delusional Behaviors, Yelling/Repetitive verbalizations, Socially Disruptive Behaviors, Depression, Withdrawal, Helplessness, Low Motivation, Suicidality, Unrealistic demands, Dysfunctional Pain/Illness behaviors, Public disrobing, Sexual Behaviors, Wanting to go home, Wandering, Distressing anxious behaviors, Loss of weight or appetite, Pillaging, Hoarding, Stealing, Unsafe Impulsive Behaviors, Low Activities, Sleep Problems--categories that can potentially interfere with long-term care. Participants were 399 adults aged 60 and older residing in one of 16 long-term care facilities.

The GLDS items were analyzed for reliability, content validity, and convergent and discriminant validity. The GLDS items were significantly correlated with items from the Geriatric Multidimensional Pain and Illness Inventory, Geriatric Depression Scale, Neurobehavioral Cognitive Status Examination, and the Psychosocial Resistance to Activities of Daily Living Index. The GLDS is evidenced to be a reliable and valid assessment tool for assessing dysfunctional behaviors of residents in long-term care facilities. Its brevity and clearly defined assessment criteria are assets to the administering clinician. Research on the utility of the GLDS as a treatment outcome instrument in long-term care is warranted.

The potential for psychologists, physicians, social workers, and registered nurses to administer the GLDS in long-term care settings is discussed.

(Journal of American Medical Director Association, 2005)