Use of goal attainment scaling in measuring clinically important change in the frail elderly

doi:10.1016/0895-4356(93)90110-M

Journal of Clinical Epidemiology

Volume 46, Issue 10, October 1993, Pages 1113-1118

https://doi.org/10.1016/0895-4356(93)90110-M Get rights and content

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 assessments. 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 measurement approach which shows promise as a responsive measure in frail elderly patients.

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Virtual consultation meetings facilitated by the research team at King’s College London and Guy’s and St Thomas’ NHS Foundation Trust.
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An expert informed recovery goal menu for former intensive care patients has been developed with excellent content validity. The final goal menu comprises 169 goals within 24 sub-domains grouped under 4 domains.
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This scoping review aimed to identify patient goal elicitation and evaluation methods for older adults, and to investigate which methods can be used in medication optimization interventions for nursing home residents (NHRs).
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General practices were invited to participate in this longitudinal, observational feasibility study. Practice nurses and general practitioners received training in care plans and goal attainment scaling. They were each asked to create care plans and goal attainment scales for patients (aged ≥75 years) and to carry out evaluations at three and six months. Professionals and patients both completed a short questionnaire to evaluate their experiences regarding the (dis)advantages of goal attainment scaling.
Professionals (n=10) and patients (n=23) were able to set goals and scales (n=57) for problems across five health domains (somatic, functional, social, psychological and communicative), but experienced difficulties formulating goals and corresponding goal attainment scaling levels. Reported benefits of goal attainment scaling were 1) important problems were addressed, 2) patients were involved and motivated to attain goals, and 3) evaluation was straightforward once a scale was created. Disadvantages were 1) difficult for older people, 2) time-consuming and complex for clinical practice.
Goal attainment scaling shows potential benefit for clinical practice and general practice research in terms of the setting and evaluation of goals for community-dwelling older persons. Further research is needed to develop more standardized and less time-consuming goal attainment scaling methods.
The use of goal attainment scaling during clinical medication review in older persons with polypharmacy
2019, Research in Social and Administrative Pharmacy
Studies have shown that a clinical medication review (CMR) reduces drug-related problems (DRPs), but the effects on clinical outcomes are less clear. Perhaps, CMRs in older persons could me more effective when they focus on patients’ personal goals and health-related complaints.
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This study was an analysis based on data of the intervention group of the DREAMeR-study; a randomised controlled trial investigating the effects of CMR in primary care. 315 persons aged ≥70 years using ≥7 drugs were randomised to the intervention: a CMR focused on personal goals using GAS. Outcome measures were: percentage of persons with health-related goals, attainment of goals measured with GAS-scores after three and six months, type of health-related goals and implementation rates of recommendations for GAS-related DRPs and other DRPs.
A total of 406 health-related goals were set for 283 of 315 included persons (90%). Of the 350 evaluated goals (86%), 37% was attained after three months and 43% after six months. The goals ‘reduce pain’ (n = 66, 16%), ‘improve mobility’ (n = 57, 14%) and ‘reduce number of pills’ (n = 37, 9.1%) were most prevalent. The implementation rate of recommendations for GAS-related DRPs was 81% compared to 62% for not GAS-related DRPs (p < 0.05).
Goal setting is important for prioritizing the most important problems during clinical medication review and Goal Attainment Scaling seems to be a useful tool for monitoring the attainment of these goals.
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Original articleUse of goal attainment scaling in measuring clinically important change in the frail elderly

Abstract

J Psychiatr Res

J Chron Dis

J Clin Epidemiol

J Chron Dis

J Chron Dis

Instruments for the functional assessment of older patients

N Engl J Med

The future of geriatric assessment

J Am Geristr Soc

Use of goal attainment scaling in a geriatric care setting

J Am Geriatr Soc

Outcome of comprehensive medical rehabilitation: Measurement of PULSES Profile and the Barthel Index

Arch Phys Med Rehab

Guide for the Use of the Functional Independence Measure

Original article
Use of goal attainment scaling in measuring clinically important change in the frail elderly