Utilizing Standardized Tools
for Recreational Therapy
Treatment With Geriatric
Clients
Jo Lewis, MS/CTRS
Megan Janke, Ph.D., LRT/CTRS
Upon successful completion of this session, the
participant will be able to:
 Identify 3 standardized assessment tools that
may be utilized in Recreational Therapy
treatment with older adults.
 Verbalize 2 benefits of utilizing standardized
assessments during Recreational Therapy
treatment
 Utilize internet resources for standardized
assessment tools in Recreational Therapy
practice with older adults.
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Validity
◦ Does it measure what it is intended to measure?
 External
 Internal
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Reliability
◦ Does it consistently measure what is intended?
 Internal Consistency
 Inter-rater Reliability
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Responsiveness
 Can it detect real change when it happens?
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Measure what you intend to measure
Justification of Services
Accepted across discipline boundaries
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Brief Interview for Mental Status
Short Portable Mental Status Questionnaire
Blessed Orientation-Memory-Concentration Test
Global Deterioration Scale
Brief Cognitive Rating Scale
Clock Drawing Test
Montreal Cognitive
Assessment (MoCA)
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Utilized for the MDS 3.0
Areas measured:
◦ attention
◦ orientation
◦ the ability to register and recall new information
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Maximum Score: 15
◦ 13-15
◦ 8-12
◦ 0-7
Cognitively intact
Moderate impairment
Severe impairment
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10 Items
Maximum Score: 10
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0-2 errors
3-4 errors
5-7 errors
8-10 errors
Intact
Mild impairment
Moderate impairment
Severe impairment
5-10 minutes to administer
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Domains assessed
◦ Orientation
◦ Immediate and delayed episodic recall
◦ Working memory
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6 Items
Maximum Score- 28
Higher score indicates greater impairment
3-6 minutes to administer
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Rating scale
 1:
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 7:
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No cognitive impairment
Very mild cognitive decline
Mild cognitive decline
Moderate cognitive decline
Moderately severe cognitive decline
Severe cognitive decline
Very severe cognitive decline
Used with Brief Cognitive Rating Scale
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5 Axes
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Concentration
Recent Memory
Past Memory
Orientation
ADL & Functional Abilities
Each axis is measured on a scale of 1-7
◦ Scores from each axis added then divided by 5
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Higher scores indicate higher level of
impairment
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Correlates well with other cognitive
assessment instruments
Visuospatial Assessment of Cognitive
Functioning
6 point scoring system
The higher the score, the greater the degree
of impairment
Score of 3 or more indicative of cognitive loss
Completed in about 5 minutes
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Screening tool for mild cognitive dysfunction
Cognitive Domains
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Attention and concentration
Executive functioning
Memory
Language
Visuoconstructional skills
Conceptual thinking
Calculations
Orientation
10 Minutes to Administer
Possible score of 30
◦ 26 or above is considered normal
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Barthel Index
Berg Balance Scale
Katz Index of Independence in
Activities of Daily Living
Lawton Instrumental Activities of Daily Living
Tinetti Mobility Scale
◦ Performance-Oriented Assessment of Balance
◦ Performance-Oriented Assessment of Gait
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Get-Up & Go Test
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Self-report
◦ 2-3 minutes
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Trained observation
◦ 10-15 minutes
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3 point scale for each
item
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Assesses:
 Feeding
 Grooming
 Bowel & Bladder
Continence
 Dressing
 Toileting
 Walking
 Stairs
 Bathing
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Performance measure
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◦ Self-report
◦ Trained observer
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Scoring
◦ Letter score from A-G
 A= Most independent
 G= Most dependent
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Bathing
Dressing
Toilet use
Transfer ability
Feed self
Maintenance of
bowel & bladder
continence
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Self-report of
Performance
Scoring
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◦ O= Low functioning
◦ 8= High functioning
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Gender bias◦ transportation
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Telephone usage
Housekeeping*
Food preparation*
Laundry*
Transportation
Medications
Money management
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5 point scale
Higher score indicates more difficulty with
gait and balance
Scoring
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Normal
Very slightly abnormal
Mildly abnormal
Moderately abnormal
Severely abnormal
Score of greater than 3 at risk for falling
Can be performed as a timed assessment
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14 item scale
 5 point scale, ranging from 0-4
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Completion time: 15-20 minutes
Equipment needed:
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Ruler
Two standard chairs
Footstool or step
Stopwatch or wristwatch
Scoring
 41-56: Low fall risk
 21-40: Medium fall risk
 0-20: High fall risk
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3 point scale per item
Used in conjunction with Gait
Assessment
Assessment Process:
 Nudge on sternum
 Sitting in chair
 Rising from chair
 Immediate standing
balance
 Standing balance
 Balance with eyes closed
 Turning balance
 Neck turning
 One leg standing
balance
 Back extension
 Reaching up
 Bending down
 Sitting down
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8 Items
◦ 2 point scale
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Assessment Process
 Initiation of gait
 Step height
 Step length
 Step symmetry
 Step continuity
 Path deviation
 Trunk stability
 Walk stance
 Turning while walking
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PHQ-9
Geriatric Depression
Scale
Zung Self-Rating
Depression Scale
Cornell Scale for
Depression in
Dementia
Zung Self-Rating
Anxiety Scale
WHOQOL-BREF
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Part of the Patient Health Questionnaire
(PHQ)
◦ PHQ-9- Depression Module
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Self-report
Multiple choice
Measures severity of depression
Implemented in the MDS3.0
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30 Questions
◦ Short version available- 15 questions
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Administration
◦ Self –administered
◦ Rater-administered
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Questionable with older adults with severe
dementia
Scoring
◦ >5 indicates potential depressionShould have a comprehensive assessment
◦ => 10 almost always indicative of depression
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Screening tool
Self-report
20 items
◦ 4 point scale
◦ Half of the items are positively worded; half
negatively
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Respondents rate frequency of occurrence
Older adults score higher than other age
groups
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Administration
◦ Observation
◦ Interview
 Patient
 Caregiver
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3 Point Scale
◦ 0- Absent
◦ 1- Mild or intermittent
◦ 2- Severe
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Assessment Areas
◦ Mood related signs
◦ Behavioral
disturbances
◦ Physical signs
◦ Cyclic functions
◦ Ideational disturbance
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Self-report
20 items
◦ 5 affective
◦ 15 somatic
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Score range: 20-80
Administration Time: 10-15 minutes
Used in psychiatric and medical patients and
with normal older adults
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Measures the impact of disease
◦ Impact of disease and impairment of daily activities
and behavior
◦ Perceived health measures
◦ Disability/ functional status measures
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26 Questions
Self-Administered
Interviewer assisted or administered
Manual is recommended to score the
assessment
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Faces Pain Scale
Numeric Scale
Pain Thermometer
Brief Pain Inventory
Checklist of
Nonverbal Pain Indicators
Pain Assessment in Advanced Dementia Scale
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Originally developed for pediatrics
No verbal component
◦ Language impairments
◦ Difficulty with expression
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7 point scale
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Self-rating
Scale of 0-20
◦ O= No pain
◦ 20= Pain as bad as it could be
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Scores can be averaged over time
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Widely used in clinical and research settings
Originally developed for used with cancer
patients
Currently used with individuals experiencing
chronic nonmalignant pain
16 items
◦ Measures pain and impact on daily function
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Completion time: 5 minutes (short form)
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Measures pain in older adults with cognitive
impairment
Observation during movement and at rest
Scoring: 0 or 1
6 items
 Nonverbal, vocal complaints
 Facial grimacing
 Bracing
 Restlessness
 Rubbing
 Verbal, vocal complaints
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Observation
Score ranges from 0-10 points
 1-3 Mild pain
 4-6 Moderate pain
 7-10 Severe pain
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5 Areas Assessed
 Breathing
 Negative vocalization
 Facial expression
 Body language
 Consolabilty
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BANDI-RT
Utilizes information from MDS 3.0
Guides the therapist
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Identified problems
Care plan
Physician’s Orders
RT treatment
 Flow sheet
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Iowa Geriatric Education Center Geriatric
Assessment Tools
◦ http://www.healthcare.uiowa.edu/igec/tools/
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Hartford Institue of Geriatric Nursing Try This
◦ http://hartfordign.org/practice/try_this/
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Dementia Practice Guidelines for
Recreational Therapy
◦ Buettner & Fitzsimmons (2003) Available through
the ATRA Bookstore