JCUnEpidemiolVol.46,No. 10,~~. 11134118, 1993 Printed in Great Britain. All rights reserved 0895-4356/93 56.00 + 0.00 Copyright 0 1993 Pergamon Press Ltd USE OF GOAL ATTAINMENT SCALING IN MEASURING CLINICALLY IMPORTANT CHANGE IN THE FRAIL ELDERLY KENNETH ROCKWOOD, I* PAUL STOLEE’~’ and ROY A. Fox’ ‘Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada B3H 3G2 and *Department of Health Studies, University of Waterloo, Waterloo, Ontario, Canada N2L 3Gl (Received in revised form 6 April 1993) Abstract-The selection of appropriate outcome measures is important in evaluating specialized geriatric programs, but how the various measures compare, and which are most appropriate, are matters still largely unexplored. We compared several outcome measures, including goal attainment scaling, to assess their sensitivity to changes in the health status of frail elderly patients admitted to two geriatric medicine wards. GAS is a measurement approach which accommodates multiple individual patient goals, and has a scoring system which allows for comparisons between patients. Forty-five patients (mean age 81 years, 30 females) received comprehensive assess- ments. GAS yielded a mean 5 goals per patient. The mean gain in the GAS score was 22 points (SD = 7) which was compared with the change in the Barthel Index (r = 0.59), the Functional Independence Measure (r = 0.45), the Physical Self-Maintenance Scale (r = 0.54), the Katz Activities of Daily Living Index (r = 0.49) and the Spitzer Quality of Life Index (r = 0.38). The inter-rater reliability of scoring the GAS follow-up guides was 0.91. Using a relative efficiency statistic, GAS proved more efficient than any other measure. The effect size statistic also demonstrated an increased responsiveness to change of GAS compared with standard measures. GAS is an individualized measure- ment approach which shows promise as a responsive measure in frail elderly patients. Elderly Frail Change measures Goal attainment scaling Functional capacity Relative efficiency The evaluation of specialized geriatric interven- tions is problematic [l]. A variety of beneficial outcomes have been ascribed to these pro- grams, but the selection of one or two of these as the primary goals of intervention is difficult, as few outcomes will be meaningful for all patients. Several studies of specialized geriatric interventions have used functional status scales, and a recent consensus conference, while *All correspondence should be addressed to: Dr K. Rock- wood, Division of Geriatric Medicine, Camp Hill Hospi- tal, 1763 Robie Street, Halifax, Nova Scotia, Canada B3H 3G2. suggesting more detailed and comprehensive measures, has largely endorsed this approach PI* An alternative approach to standard scales is to use individualized measures, such as goal attainment scaling (GAS), described below. We have recently examined the feasi- bility, reliability and validity of this approach in frail elderly patients admitted to specialized geriatric inpatient wards in our hospital [3]. We now report on the responsiveness of GAS to clinically important change, compare it to other standard outcome measures, and further examine the reliability of the GAS approach. CE 46,10-n 1113