Chapter 10: Individualized Rating Scales
Audrey Silva is 81 years old. She is relatively healthy, though she takes a number of medications to control high blood pressure, osteoporosis, and arthritis. She lives alone in the apartment where she has lived for 40 years, having lost her husband to cancer 6 years ago. She has a good social network, including her church, several neighbors with whom she is friendly, and a niece (Elaine) who lives about 30 minutes away. Mrs. S’s son (Aaron) lives on the other side of the city, approximately an hour’s drive. He is single and an attorney with a good income. Aaron, Elaine, and Mrs. S. meet with a social worker (Michael) at the Senior Center where Mrs. S. attends some activities to talk about Assisted Living. Aaron is urging his mother to move to a very nice facility near him and offering to help with expenses, but Mrs. S loves her home and neighborhood and does not want to move.
Mrs. Silva has always been an active, involved woman with many interests. Recently, her son, who calls her daily, has noticed some confusion when they speak, and on his frequent visits he has noticed that her house-keeping seems to have deteriorated. (The apartment is not unhygienic; it’s just not as immaculate as it once was.) He says his mother is not as cheerful as she once was, often sounding sad and discouraged. He has the impression that she is not getting out as much as she always has—at least once a day for a church event, shopping, or meeting with friends.
Mrs. S’s niece, who calls a couple of times of week, reports that her aunt sometimes seems confused about what day it is; Elaine recently went to take her aunt to lunch for an event they had planned, and Mrs. S had forgotten about it. Elaine thinks her aunt has seemed much frailer lately, as well, often stopping to get her balance by holding onto something. Finally, she fears that Mrs. S is depressed, often sitting in silence and staring into space, rather than chattering as she always has.
Mrs. S admits that she is physically frailer and not as “quick on the uptake” as she once was, saying “I’m 81 years old, for pete’s sake!” She is more reflective these days, she says, but she adamantly insists that she is not depressed and is happy to complete a screening measure “to prove it.” She completes the 15-item Geriatric Depression Scale (GDS, Sheikh & Yesavage ; Yesavage & Brink [1983, 2008]), which is reproduced in Appendix A. Michael selects this measure because he knows that other measures of depression may not be appropriate for use with geriatric populations for a variety of reasons (e.g., sleep difficulties and decreased energy are common in non-depressed elderly persons, and thoughts of death and hopelessness may mean something different later in life).
In some cases it is necessary and in most it is desirable to construct and use individualized rating scales (IRS) to monitor clients’ outcomes. Such measures demonstrate the practitioner’s respect for and focus on the specific issues of concern to the client, and can be used in combination with standardized scales. This chapter provides instructions and discussion about: defining target problems for monitoring using IRS; selecting the dimensions and defining equidistant response categories for the scale; defining anchors; selecting the time period, event or situation to monitor; and setting goals. In addition, we discuss deciding how, when, and how often to collect data using the IRS; engaging and preparing the client to use IRS; and the advantages and precautions involved in using IRS. The process of constructing and using IRS is illustrated using a case involving an 81-year-old woman and her family as they deal with issues related to the client’s independence.