Anxiety Instruments: Home

• Beck Anxiety Inventory (BAI)

  Developed to differentiate between anxiety and depression. It can be filled out by the respondent or interviewer. The 21 item scale has 14 items that are somatic and 7 items that reflect anxiety and panic. Each item scores the severity as 0 (not at all) to 3 (severely). Common cut-points are 0-9 = normal; 10-18 = mild/moderate anxiety; 19-29 = moderate anxiety, and 30-63 = severe anxiety.

• Generalized Anxiety Disorder 7-Item Scale (GAD7)

  A self-reported anxiety scale based on DSM diagnostic criteria. The severity of each symptom is rated from 0 (Not at all) to 3 (nearly every day) for the past two weeks. The GAD-7 has seven items with a total score of 0-21. Common cut-points are: 0-4 (minimal anxiety), 5-9 (mild anxiety), 10-14 (moderate anxiety), and 15+ (severe anxiety).

• Geriatric Anxiety Inventory (GAI)

  The Geriatric Anxiety Inventory (GAI) is a brief, 20-item measure of common symptoms of anxiety in older adults across different settings. Respondents indicate whether they agree or disagree with each of the items. The number of "agree" responses is summed to generate a total score with higher scores indicating higher anxiety.

• Geriatric Mental State Examination (GMSE)

  The Geriatric Mental State Examination (GMSE) is a semi-structured clinical interview to assess mental health in older adults. Symptoms are organized into 8 syndrome clusters and interviewers provide a confidence level for each syndrome from 0 (no symptoms) to 5 (very severely affected). A rating of 3 or higher in a cluster indicates a diagnosis. Originally 541 items, the interview has been shortened so that it could be completed in 20-50 minutes.

• Goldberg Anxiety and Depression Scale (GADS)

  The Goldberg Anxiety and Depression Scale is an 18-item, self-report questionnaire measuring symptoms of depression and anxiety experienced in the past month. Respondents indicate "Yes" (1) or "No" for each of the symptom questions. Responses for the anxiety and depression scales respectively are summed to generate a score between 0-9. For both the anxiety and depression scales, if respondents indicate "Yes" for any of the first four items, then the interviewer must ask the remaining five items.

• Penn State Worry Questionnaire (PSWQ)

  The Penn State Worry Questionnaire (PSWQ) is a 16-item questionnaire to assess worry. For each of the 16-items, respondents indicate on a 5-point scale if items are "not at all typical of me" (1) to "very typical of me" (5). Scores are then summed, with higher scores representing higher levels of worry.

• Symptom Checklist 90-Revised (SCL-90-R)

  A 90-item self-report symptom inventory to measure psychological current symptom patterns of respondents in different settings (e.g. community, medical, psychiatric)

• Worry Scale (WS)

  The Worry Scale (WS) is a 35-item scale measuring worry across three dimensions: finances, health, and social conditions. Responses range from 0 (never) to 4 (much of the time). Responses are summed to create a total score. The Worry Scale was designed with specific consideration of fears commonly experienced in aging populations.

Caregiver Burden Instruments: Home

• Caregiver Strain Index (CSI)

  The Caregiver Strain Index is a 13-item questionnaire used to screen for caregiver strain after hospital discharge of an older family member. Respondents indicate yes (1) or no (0) for each of the 13 stressors included on the index. Scores are generated by summing the responses. Higher scores indicate higher levels of caregiver strain.

• Dementia Burden Scale – Caregiver (DBS-CG)

  DBS-CG can be used as an outcome measure to assess the effect of interventions to reduce dementia caregiver burden. It is a composite measure based on the Modified Caregiver Strain Index, Neuropsychiatric Inventory Questionnaire Distress Scale, and Patient Health Questionnaire (PHQ-9).

• Modified Caregiver Strain Index (MCSI)

  The Modified Caregiver Strain Index builds off the original 13-item CSI and can be used to measure caregiver strain as it relates to long-term caregiving situations and experiences. Respondents indicate "Yes, on a regular basis" (2); "Yes, sometimes" (1); or "No" (0) for each of the 13-items. Scores are summed with higher scores representing higher caregiver strain.

• Positive Aspects of Caregiving (PAC) Scale for Dementia

  An 11-item scale used to assess caregivers of people with dementia. Caregiver respondents indicate on a 0 to 4-point scale their level of agreement for each of the 11 statements about possible positive experiences associated in giving care to a family member with memory or health problems.

• Preparedness for Caregiving Scale

  The Preparedness for Caregiving Scale is a five-item, self-rated scale that assesses a caregiver's perceived readiness to handle certain domains of caregiving (e.g., providing physical care and emotional support; setting up care; and dealing with the stress of caregiving). Respondents indicate on a scale of 0 (not at all prepared) to 4 (very well prepared) their preparedness for each of the items. A score is calculated by taking the mean of all of the responses provided. Higher scores indicate higher preparedness for caregiving.

Cognition/Dementia Instruments: Home

• Abbreviated Mental Test (AMT)

  A 10-question assessment of mental impairment. Scored by gaining 1 point for each correct answer, with a score of 0-3 = severe impariment, 4-6 = moderate impairment, and greater than 6 = non-impaired

• Addenbrooke's Cognitive Examination III (ACE-III)

  Screens dementia and early stages of cognitive dysfunction. It takes between 12 and 20 min (average 16) to administer and score in a clinical setting. It contains 5 sub-scores that total a maximum score of 100 points, with each sub-score representing one cognitive domain: attention/orientation (18 points), memory (26 points), fluency (14 points), language (26 points) and visuospatial (16 points).

• Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog)

  The Alzheimer’s Disease Assessment Scale–Cognitive Subscale (ADAS-Cog) is an 11 item scale that evaluates the severity of cognitive dysfunction in Alzheimer’s disease.

• Brief Multi-Dimensional Assessment of Dementia Severity

  The Brief Multi-Dimensional Assessment of Dementia Severity was created using item-response theory as a 19-item scale composite of 6 objective cognitive tasks: (naming a pencil and watch; reading and obeying a command; copying a geometric design; naming the year, season, date, day, and month; and registering and recalling 3 objects); 5 items measuring instrumental function (assembling records or papers; shopping alone; preparing a balanced meal; understanding TV program, book or magazine; remembering appointments, family occasions, holidays); 3 activities of daily living (getting from bed to chair, getting dressed, and bathing or showering items), and 2 items indicating late complications of dementia (problems swallowing or coughing when eating). The scale captures a broad range of impairment and independently predicts subsequently mortality.

• Clock Drawing Task

  Assesses visuo-spatial and constructional disabilities. Used as a quick screen for cognitive dysfunction. The subject draws the face of a clock. Various scoring methods have been used to rate the numbers and clock face.

• Gait Speed Dual Task Test

  The Gait Speed Dual Task Test can be used to detect dementia in older adults by having participants simultaneously walk and complete a cognitive task. Participants walk a set distance using their typical walking speed while completing a cognitive task simultaneously. The cognitive task can vary from having the participant spell a five-letter word backwards, to use of a forward digit span test. Amount of time to walk the set distance is recorded.

• General Practitioner Assessment of Cognition (GPCOG)

  Developed to facilitate primary care physicians and general practicioners in detecting dementia. Consists of both patient cognitive test items and historical questions asked of an informant, and takes less than 4 minutes to administer.

• Hopkins Verbal Learning Test Revised

  A word list measuring verbal learning and memory. The interviewer reads 12 words that measure total recall, delayed recall, and retention in order to form a recognition index.

• Informant Questionnaire on Cognitive Decline (Short Form)

  Informant questionnaire that assesses changes in patients' cognitive performance over a 5 or 10 year period. It is used to assess cognitive functioning or dementia screening. An informant for the individual rates their cognitive functioning at the time of the interview compared to 5 or 10 years ago. This is the 16 item short form of the test.

• Informant Questionnaire on Cognitive Decline in Elderly (IQCODE)

  A short questionnaire designed to assess cognitive decline and dementia in elderly people. The questionnaire is filled out by a relative or friend who has known the elderly person for 10 years or more.

• Memory Impairment Screen (MIS)

  Screening test for memory impairment, Alzheimer's disease and other dementias. Assesses delayed free and cued-recall.

• Memory Impairment Screen by Telephone (MIS-T)

  A brief measure conducted over the phone to test semantic memory by presenting four target words and corresponding category cues. After an interference period (2-3 mins) participants recall as many words as they can without cues, and when words are not recalled freely, interviewers provide category cues. Scores are generated based on doubling the number of words retrieved during a "free recall" period, and adding that to the number of words retrieved during a "cued recall" period.

• MINI-COG

  A brief screening test for dementia or mild cognitive impairment. It is administered by a trained interviewer in-person, with the subject completing two tasks: word registration/recall and clock drawing. Cognitive domains assessed include memory, executive function, attention, speed of processing, visual-context and visual-spatial.The Mini-Cog has been studied in both clinical and community settings.

• Mini-Mental State Exam (MMSE): In person

  A screening test for dementia or mild cognitive impairment. It is administered by a trained interviewer in person with items covering: orientation to time and place, recall, naming, construction of a figure, repetition, calculation, attention/concentration, reading and writing. Cognitive domains assessed include: memory, executive function, language function, attention, speed of processing, cultural experience, visual context/visual-spatial. The Mini-Mental is one of the most widely used screening instruments in clinical and community settings.

• Mini-Mental State Examination (MMSE): Telephone Version

  The telephone version of the Mini-Mental State Exam is a modified version that substitutes items that are appropriate for in-person screening dementia or mild cognitive impairment with items that can be answered over the phone. Orientation items are asked in relation to where the person lives (e.g. What state do you live in? Floor of home or building that you live on?) and naming item asks "What is it you are speaking into now?" Cognitive domains assessed include memory, executive function, language function, attention, speed of processing, cultural experience, visual context/visual-spatial.

• Modified Blessed Dementia Rating Scale

  Assesses cognitive and behavioral symptoms present in dementia.

• Modified Mini-Mental State (3MS) Examination

  The original Mini-Mental State Exam (MMSE) is a brief screening test for dementia. The modified version (3MS) was developed to extend the ceiling and the floor of the test, to sample a wider range of cognitive abilities and to enhance the reliability and the validity of the scores.

• Montreal Cognitive Assessment (MoCA)

  A 10-minute cognitive screening tool to assist first-line physicians in detection of mild cognitive impairment.

• Montreal Cognitive Assessment (MoCA): Brief Telephone Version

  3-item (i.e., verbal fluency, delayed recall, orientation) short version of the Montreal Cognitive Assessment administered to persons with dementia by telephone was highly correlated with the full MoCA.

• Rey Auditory Verbal Learning Test

  The Rey Auditory-Verbal Learning Test is a brief instrument measuring learning, recall, and recognition. A list of 15 nouns is read to a participant or patient followed by a period of free recall. A story with all of the 15 original nouns is also presented and the participant identifies any words that they recognize from the original list.

• Short Portable Mental Status Questionnaire (SPMSQ)

  A rapid short (10 items) screen for cognitive impairment. It detects intellectual deficits of orientation, memory and attention.

• Symbol Digit Modalities Test (SDMT)

  A brief screen for organic cerebral dysfunction. The test detects brain damage and changes in cognitive functioning. It tests visual acuity, figural memory, motor skills, speed of information processing, and motivation and persistence. The subject has 90 seconds to perform a simple substitution task that involves assigning numbers with figures.

• Telephone Interview for Cognitive Status (TICS)

  A screening test for cognitive impairment that was developed for use in studies where in-person administration is not feasible. Although the TICs was modeled from the Mini-Mental State Exam (MMSE), only 2 items are identical and adequate vision and the ability to read or write are not required. Eleven items cover word list memory, orientation to time and place, attention/concentration, repetition, calculation, conceptual knowledge and non-verbal praxis (tapping on phone item).

• Telephone Interview for Cognitive Status Modified (TICSM)

  A screening test for cognitive impairment based on the original Telephone Interview for Cognitive Status (TICS), but differs in the word recall tasks and omits items that were difficult to verify over the telephone. These changes were made to increase sensitivity for early dementia and avoid items that are difficult to interpret over the phone. Twelve items cover word list memory, orientation to time and personal information, attention concentration, repetition, calculation, conceptual knowledge and non-verbal praxis (tapping on phone).

• The Time and Change Test

  A performance based screen for detecting dementia in older adults. Based on real-world activities designed to minimize false negatives by identifying all cases of dementia. The subject is asked to perform activities such as telling the time and making a specific amount of change from the money he/she was given.

• Thurstone Word Fluency Test

  Measures the spontaneous production of words that begin with a given letter within a limited amount of time. The subject is given one minute to produce unique words within a semantic category or starting with a specific letter. Score is the number of unique words.

• Trail Making Test

  Sensitive and brief screen for cognitive impairment. Assesses attention, visual scanning, eye-hand coordination, information processing, and executive function. Subject is asked to connect a set of 25 dots in a specific pattern as quickly as possible.

• Verbal Fluency (VF)

  Brief cognitive assessments where participants are tasked with naming as many words from a certain category as they can within 1-minute (category fluency task) or naming as many words starting with a particular letter as they can within 1-minute (letter fluency test).

• Wechsler Digit Span Test

  The Digit Span Test is a subtest of both the Wechsler Adult Intelligence Scale (WAIS) and the Wechsler Memory Scales (WMS). Assesses attention span and immediate auditory memory. The participant is asked to repeat a string of numbers that becomes progressively longer.

Delirium Instruments: Home

• 3-Minute Confusion Assessment Method (3D-CAM)

  The 3-minute Diagnostic Assessment for Delirium (3D-CAM) is a brief, structured mental status assessment using the Confusion Assessment Method (CAM) to identify delirium in high risk patients. Totaling 20-items, the assessment uses a combination of direct questions and interviewer observations to diagnose delirium in patients.

• Confusion Assessment Method (CAM)

  Developed for nonpsychiatric clinicians to assess delirium. This version is based on an interview with the patient and measures the same dimensions as the ICU version.

• Confusion Assessment Method for ICU

  Developed for non-psychiatric clinicians to assess delirium. This is the non-verbal version to be used in the ICU. Assesses 1) acute onset; 2) inattention; 3) disorganized thinking; and 4) altered level of consciousness.

• Delirium Detection Score (DDS)

  Measures severity of delirium in the ICU using eight criteria. Scores are given for each criterion based on the presenting symptoms

• Delirium Observation Screening Scale (DOSS)

  A 25-item scale to facilitate early recognition of delirium based on nurses' observations during regular care.

• Delirium Rating Scale (DRS)

  Measures delirium symptoms as rated by a psychiatrist or trained clinician. Has a modified 7-8 item version (DRS-R-98)

• Delirium Rating Scale-Revised-98 (DRS-R-98)

  The DRS-R-98 assesses gradations of severity of delirium severity. It is a 16 item physician rated scale, with 13 items on severity and 3 items on diagnosing delirium. Rated by trained clinician.

• Memorial Delirium Assessment Scale (MDAS)

  A ten-item, four-point clinician-rated scale (possible range, 0-30) designed to quantify the severity of delirium.

• Nursing Delirium Screening Checklist (NuDESC)

  An observational five-item scale, with each item being scored from 0-2 according to the presence and intensity of symptoms. Takes an average of 1 minute to administer, and is appropriate for use in inpatient clinical and research settings.

• Richmond Agitation Sedation Scale (RASS)

  Measures the patient's level of agitation and level of sedation. It can be used in the hospital, but is primarily used in the ICU to avoid under or over sedation.

• Single Question in Delirium (SQiD)

  A simple prompt question which asks, "Is this patient more confused than before?"

Depression Instruments: Home

• 15-Item Geriatric Depression Scale (GDS-15)

  A self-report screening test for depression in the elderly. This scale is unique in that there are no somatic symptoms, and it was designed to be used with elderly adults. This is the shortened version that is only 15 items instead of 30, in part to avoid respondent fatigue. Scores of 10-15 have been used to reflect moderate to severe depression.

• 30-Item Geriatric Depression Scale (GDS-30)

  A self-report screening test for depression in the elderly. This scale is unique in that there are no somatic symptoms, and it was designed to be used with elderly adults in clinical or community settings. The time referenced is the past week and each item answer has a yes/no format. Scores of 21-30 are often used to reflect moderate to severe depression.

• Center for Epidemiological Studies Depression Scale 10-Item (CESD-10)

  A brief, self-report scale that measures current symptoms of depression in the general population

• Center for Epidemiological Studies Depression Scale 20-Item (CESD-20)

  A self-report 20-item depression screening scale for use in the general population. Each symptom is asked referring to the past week. Each symptom scores from 0 (rarely/none of the time: < 1 day) to 3 (most or all of the time: 5-7 days). Common cut-points are 16+ reflects depression, although some use 19/20 for the elderly due to the number of somatic symptoms.

• Geriatric Depression Scale (GDS-10) 10-Item

  A shorter (10-item) measure to detect depression in the elderly, adapted from the original 30-item Geriatric Depression Scale.

• Geriatric Depression Scale (GDS-4) 4-Item

  A shorter (4-item) measure to detect depression in the elderly, adapted from the original 30-item Geriatric Depression Scale.

• Hospital Anxiety and Depression Scale (HADS)

  A brief self-assessment detecting current states of depression and anxiety (7 questions per-subscale) and severity of depression and anxiety in an outpatient clinic setting

• Patient Health Questionnaire (PHQ-9)

  Brief screening questions for assessing the severity of depression that consists of 9 items from the PRIME-MD instrument. The items score each of the 9 DSM-IV criteria for depression on a scale of 0 (not at all) to 3 (nearly every day) for the past 2 weeks. The following cut-points have been used: 5 = mild, 10 = moderate, 15 = moderately severe, 20 = severe.

• Patient Health Questionnaire-2 (PHQ-2)

  Brief screening instrument for depression that consists of two items from the Patient Health Questionnaire (PHQ-9) instrument. Anhedonia and depressed mood/hopelessness are measured. Each item is scored on a scale of 0 (not at all) to 3 (nearly every day). Scores >= 3 are considered a positive screen for major depressive disorder, requiring further follow-up.

• Quick Inventory of Depressive Symptomatology (QID-SR-16)

  A self-report depression instrument that includes 9 DSM-IV domains 1) sad mood; 2) concentration; 3) self-criticism; 4) suicidal ideation; 5) interest; 6) energy/fatigue; 7) sleep disturbance (initial, middle, and late insomnia or hypersomnia); 8) decrease/increase in appetite/weight; and 9) psychomotor agitation/retardation. The total score ranges from 0 to 27.

• The Beck Depression Inventory II

  A 21-item self-report or interview based instrument designed to assess the presence and severity of depressive DSM IV symptoms. It has been used in both clinical and community settings.

• The Hamilton Rating Scale for Depression (HRSD/HAM-D)

  This instrument assesses the severity of depressive symptoms in persons already diagnosed with depression, and is administered in person by clinicians trained in its use. Twenty one items rated on a 0 (absent) to 2 (clearly present) or 4 (severe) rating scale. A score of 25 or more is used to indicate moderate to severe depression.

Frailty Instruments: Home

• Brief Frailty Instrument

  Four levels of classification, representing fitness to frailty: 0 = walk without help, perform basic activities of daily living (eating, dressing, bathing, bed transfers), are continent of bowel and bladder, and are not cognitively impaired; 1 = bladder incontinence only; 2 = one (two if incontinent) or more of needing assistance with mobility or activities of daily living, or has bowel or bladder incontinence; 3 = two (three if incontinent) or more of totally dependent for transfers or one or more activities of daily life, incontinent of bowel and bladder, and diagnosis of dementia. Authors validated by measures of hospitalization and mortality.

• Claims-Based Frailty Index (CFI)

  A claims-based index to approximate frailty phenotype using only administrative claims data to enable frailty to be assessed without physical performance measures. A parsimonious index was developed for predicting the frailty phenotype using a linear combination of diagnoses, operationalized with claims data.

• Claims-Based Frailty Index - Medicare (CFI)

  A claims-based frailty index for use in Medicare data that can capture the risk for adverse health outcomes and higher health care utilization in community-dwelling Medicare beneficiaries. Enables measurement of the risk for incident disability and skilled nursing facility stays in aging populations.

• Clinical Frailty Scale

  The Clinical Frailty Scale (CFS) ranges from 1 (very fit) to 9 (terminally ill) based on descriptors and pictographs of activity and functional status. The CFS is collapsed into three categories: non-frail (CFS 1-4), mild-to-moderately frail (CFS 5-6), and severely frail (CFS 7-8). Was developed based on a community sample.

• FRAIL Scale

  Identifies the level of frailty in older persons to determine if they are at high risk for further deterioration. Assesses frailty covering 5 domains: fatigue, resistance (ability to climb 1 flight of stairs), ambulation (ability to walk 1 block), illnesses (greater than 5) and, loss of weight (>5%).

• Frailty / Vigor assessment

  Assesses frailty and vigor using a pretermined criteria. Frailty: age (over 80), physical function (balance and gait abnormalities, decreased shoulder strength, decrease knee strength), physical activity (infrequent walking for exercise); psychological function (depressed); medications (taking sedatives); disability (lower extremity disability); sensory function (near vision loss). and Vigorous as : age (under 80), cognition (cognitively intact), physical activity (frequent exercise other than walking), sensory function (good near vision). Sample was from the community and falls were used as the outcome.

• Frailty Assessment Calculator

  Developed using Cardiovascular Health study data, frailty is identified by the presence of 3 or more of the following 5 components: shrinking, weakness, poor endurance and energy, slowness, and low physical activity level.

• Gill Frailty Measure

  Assesses data on physical frailty and cognitive status, as well as self-reported information on physician-diagnosed chronic conditions and 8 activities of daily living: walking, bathing, upper and lower-body dressing, transferring from a chair to a standing position, using the toilet, eating, and grooming. A summary disability score is calculated with a range of 0 to 16, higher scores reflecting more disability.

• Simplified Women's Health Initiative Frailty Phenotype (sWHI)

  Frailty phenotype developed to be predictive of death, hospitalizations, activities of daily living. Components of frailty include self-reported muscle weakness/impaired walking, exhaustion, low physical activity, and unintended weight loss between baseline and 3 years of follow-up. Poor physical function is scored as 2 points because this scale measures the muscle strength and walking ability components. The number of frailty components that are present are summed, yielding a range of 0 to 5. A cutpoint of 3 or more is used to define frailty. Developed using Women's Health Initiative Study.

• Vulnerable Elders Survey

  Self-reported 13-item scale that identifies community-dwelling older people at risk for death or functional decline. Function-based scoring system considers age, self-rated health, limitation in physical function, and functional disabilities. A score of 3 or higher indicated a fourfold increased risk of adverse outcomes, and identified the 1/3rd of older people who were most at risk for functional decline or death.

• Winograd Screening Instrument

  Self-reported screening instrument that determines an outcome of either frail or not frail. Predictive of hospital length of stay, nursing home admission and mortality. Examines the presence of any one of the 15 criteria, and scores on a range of 0-15: CVA, chronic and disabling illness, confusion, dependence in ADL, depression, falls, impaired mobility, incontinence, malnutrition, polypharmacy, pressure sore, prolonged bed rest, restraints, sensory impairment, socioeconomic/family problems.

General Health Status/Quality of Life Instruments: Home

• Geriatric Spiritual Well-Being (GSWB) Scale

  The Geriatric Spiritual Well-Being (GSWB) Scale is a 16-item, 6-point Likert Scale used to assess spiritual well-being in older adults using 4 subscales to be indicators of spiritual well-being (affirmative self-appraisal, connectedness, altruistic benevolence, and faith ways). Respondents indicate on a 1-6 scale to describe how much they agreed with each statement. Reverse scoring is performed on four items (one from each scale). Each subscale is summed to yield a score with a possible range of 4–24. A total religious spiritual well-being score is calculated by summing all 16 items to create a score with a possible range of 16–96.

• Maastricht Personal Autonomy Questionnaire (MPAQ)

  A 16-item measure assessing personal autonomy of older adults with a chronic physical illness in accordance with their experience of autonomy. The Maastricht Personal Autonomy Questionnaire (MPAQ) entails 16 items under 3 subscales (degree of "personal" autonomy, working on autonomy and dilemmas) and uses a 5-point Likert scale. Subscale scores can be obtained by adding up item scores 1–5 divided by number of scale items.

• Missoula-Vitas Quality of Life Index (MVQOLI) - 25 Item

  Has 25 items that was developed based on patients in hospice setting. The instrument helps in planning care by assessing patient distress, strength and satisfaction, and issues of life closure. Five domains of quality of life are measured: 1) symptoms, 2) functions; 3) interpersonal; 4) well-being and 5) transcendence.

• Missoula-Vitas Quality of Life Index (MVQOLI-R) - 15 Item

  Similar to the original MVQOLI, but uses only 15 questions as the original 25 items was considered too long by clinicians. The instrument helps in planning care by assessing patient distress, strength and satisfaction, and issues of life closure. Five domains of quality of life are measured: 1) symptoms, 2) functions; 3) interpersonal; 4) well-being and 5) transcendence.

• PROMIS Scale v1.2 – Global Health

  The 10-item PROMIS Scale - Global Health (v1.2) survey measures health status across physical, mental, and social domains from the patient perspective. The measure has been used to in a variety of settings for health-related quality of life domains of health

• Quality of Life Scale (CASP-19)

  The CASP-19 is a 19-item scale that uses four domains (i.e., control, autonomy, pleasure and self-realization) to assess the quality of life in individuals in early old age. Respondents are asked to rate items on a 4-point Likert Scale, with higher scores indicating better quality of life.

• Quality of Well-Being Scale (QWB)

  A general health quality of life questionnaire which measures overall status and well-being over the previous 3 days in 4 major areas: physical activities, social activities, mobility, and symptom/problem complexes.

• Quality of Well-Being Scale: Self-Administered (QWB-SA)

  QWB-SA is an adaptation of the QWB that allows for self-administration. Still a measure of health-related quality of life, the QWB-SA lists 58 symptoms and includes five sections: acute and chronic symptoms; self-care; mobility; physical activity; usual activity.

• Satisfaction with Life Scale (SWLS)

  The Satisfaction with Life Scale (SWLS) is a 5-item scale designed to measure global cognitive judgments of one’s life satisfaction (not a measure of either positive or negative affect). Participants indicate how much they agree or disagree with each of the 5 items using a 7-point scale that ranges from 7 strongly agree to 1 strongly disagree.

• SF-12 Health Survey

  Designed to measure general health status. The original version had 36 items; this is the abbreviated version. Scoring results in two dimensions: a physical health composite score and a mental health score.

• SF-36v2 Health Survey

  Assesses 8 health concepts using the following criteria: 1) limitations in physical activities because of health problems; 2) limitations in social activities because of physical or emotional problems; 3) limitations in usual role activities because of physical health problems; 4) bodily pain; 5) general mental health (psychological distress and well-being); 6) limitations in usual role activities because of emotional problems; 7) vitality (energy and fatigue); and 8) general health perceptions. The scoring results in a physical component score and a mental health score.

• Structured Assessment of Independent Living Skills (SAILS)

  A 50-task measure assessing older adults activities of daily living in 10 areas of everyday functioning (fine & gross motor skills, dressing, eating, expressive language, receptive language, time and orientation, money-related skills, instrumental activities, and social interaction).

• The Euro QOL Five Dimensions Questionnaire (EQ-5D)

  Defines health in terms of 5 dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has 3 response categories corresponding to no problems, some problems, and extreme problems. The instrument is designed for self-completion, and respondents also rate their overall health on the day of the interview on a 0-100 hash-marked on a vertical visual analogue scale.

Health Behaviors Instruments: Home

• The CAGE Questionnaire (Alcoholism Screen)

  Consists of 4 questions designed to help screen for a diagnosis of alcoholism. Each item is scored with 0 (no) or 1 (yes). Assesses cutting down on drinking, quitting, feeling annoyed by others criticizing drinking behavior and drinking in the morning.

• The Michigan Alcoholism Screening Test (MAST)

  The MAST is a 25 item questionnaire devised to detect alcoholism. It is a self-report instrument commonly used to assess lifetime-alcohol related problems and dependent alcohol-users.

• The Self-Administered Short Michigan Alcoholism Screening Test (SMAST)

  A shorter version of the MAST developed to assess alcoholism. It is a self-report instrument commonly used to assess lifetime-alcohol related problems and dependent drinkers. There are 13 of the original 25 items, each scored as Yes/No.

Hearing Instruments: Home

• Finger Rub Test

  A brief physical diagnostic test for hearing impairment where the examiner rubs thumb and index finger successively 1 inch from the ear, slowly withdrawing until the signal is no longer heard.

• Hearing Handicap Inventory for Elderly (HHIE)

  Assesses the effects of hearing impairment on the emotional and social adjustment of elderly people. The inventory is comprised of two subscales: a 13-item subscale that explores the emotional consequences of hearing impairment, and a 12-item subscale that explores both social and situational effects.

• Hearing Handicap Inventory for Elderly Screening Version (HHIE-S)

  A brief, 10-item self-administered questionnaire measuring the perceived impact (emotional and social) of hearing loss

• Single Question Screening

  The Single Question Screening is used to assess patient self-reports of hearing loss. The exact phrasing of the question varies across studies but in general, the question focuses on whether or not the patient feels they have difficulty hearing.

• Watch Tick Test

  The Watch Tick Test is a clinical technique for assessment of hearing and hearing loss. A watch is placed next to the patient's ear and is gradually moved away. The distance at which the patient no longer hears the tick is recorded and compared to the distance from the opposite ear.

• Whispered Voice Test

  A simple screening test for hearing impairment in which the tester stands two feet behind the individual and whispers, and the individual is asked to repeat the words. Various versions available. Designed to measure hearing loss > 25 or 30 db.

Medical Comorbidity Instruments: Home

• Adjusted Clinical Groups (ACG) System

  This is a population/patient case-mix adjustment system based on medical records or insurance claims. The ACG system measures health status by grouping diagnoses into clinically cogent groups. This categorization can be applied to research, management, and reimbursement. The ACG system was originally designed to predict future morbidity and healthcare utilization.

• American Thoracic Society Division of Lung Disease Questionnaire (ATS-DLD-78A)

  Contains questions regarding frequent and chronic respiratory symptoms, including: coughing, phlegm, wheezing and shortness of breath.

• APACHE II: Acute Physiology And Chronic Health Evaluation

  A severity of disease classification system used in an intensive care setting. Score is calculated from patient's age and 12 physiologic measurements: 1) AaDO2 or PaO2; 2) temperature (rectal); 3) mean arterial pressure; 4) pH arterial; 5) heart rate; 6) respiratory rate; 7) sodium (serum); 8) potassium (serum); 9) creatinine; 10) hematocrit; 11) WBC; and 12) Glasgow Coma Scale. Total score ranges from 0 to 71.

• APACHE III: Acute Physiology And Chronic Health Evaluation

  APACHE III is a severity of disease classification system revised from the second version. Revisions include different physiological variables, and accounts for variation across hospitals.

• Bayliss Disease Burden

  A self-report questionnaire for persons aged 65 and older with multiple chronic medical conditions to assess barriers to self-management. The instrument includes a list of 25 common chronic conditions, and for each condition, patients indicate whether or not they have the condition, and to what extent it interferes with their daily activities. The responses inform a measure of disease burden resulting from weighing each reported condition by the degree of limitation. This instrument may be beneficial for helping in care management for persons with multiple morbidities.

• Burden of Illness Score for Elderly Persons

  A risk adjustment index that predicts 1-year mortality after hospitalization. It assesses presence of diseases, physiologic abnormalities and functional impairments. Based on administrative, laboratory and medical chart data. Designed for use with hospitalized elderly patients.

• Charlson Index

  Method for classifying comorbid conditions that considers the number and the severity of a list of 19 medical conditions. Developed as a predictor of mortality. Updated version uses ICD-10 codes found in administrative data.

• Chronic Disease Score (CDS)

  A measure of chronic disease status derived from pharmacy data based on history of dispensed drugs for one year.

• Cumulative Index Illness Rating Scale (CIRS)

  Method for rating chronic illness burden-reviews by organ system. This version was developed for use with older adults. Total score ranges from 0-56. Each item is rated on a scale from 0 (no problem) to 4 (extreme problem or needs treatment).

• Disease Count

  A way of measuring medical comorbidity using a simple, unweighted sum of the number of diseases or conditions per individual. The list of diseases or conditions may vary. Disease counts can either be clinician-rated based on medical records or clinician diagnosis, or can be self-reported based on questionnaires or interviews.

• Duke Severity of Illness (DUSOI) Index

  A checklist that quantifies a patient's burden of illness as measured by the physician. The physician lists out all of the patients health problems/diagnoses that are active at that visit or during the preceding week. For each health problem, the physician selects one of five responses (none, questionable, mild, moderate, major) for each of the four non-disease-specific parameters (symptoms, complications, prognosis without treatment, and treatment potential). A DUSOI diagnosis severity score can be calculated manually or via computerized scoring. This measure may be used during a clinical consultation or from medical records. Scores are entirely based on clinical judgment.

• Elixhauser Comorbidity Index

  Includes 30 categories of comorbid conditions based on the ICD diagnosis codes. It has a high ability to predict length of stay, hospital charges, and in-hospital death.

• Functional Comorbidity Index (FCI)

  A self-administered comorbidity questionnaire. It includes 18 diagnoses and is scored by totaling the number of "yes" answers, with a score of 0 indicating no comorbid illness and 18 indicating the highest number of comorbid illnesses.

• Geriatric Index of Comorbidity

  A measure of comorbidity that takes into account both the number of diseases and disease severity. Validated for disability and mortality outcomes.

• Hierarchical Coexisting Conditions (HCCs)

  The hierarchical coexisting conditions model is a risk-adjustment model based on diagnostic information (ICD codes) used to predict Medicare payments. The HCC model uses an expanded risk-adjustment framework to account for multiple coexisting medical conditions in patients. In this model, closely related conditions are organized into hierarchies. Within the hierarchy, a patient is only categorized for the most severe condition. Across hierarchies, people may be classified as having multiple conditions. HCC models sum the incremental predicted cost (payment) for each condition to arrive at the total predicted cost (payment). Additional models include HCCs based on use of procedure codes, inpatient hospitalizations/diagnoses, and use of durable medical equipment. In future revisions of the model, HCCs in combination with demographic information are used to predict cost.

• Medication-Based Disease Burden Index

  Alternative approach to measuring comorbidity that uses medication lists (mostly medications taken chronically, used for one condition on the list, or others based on an expert panel). Includes medications for 20 chronic disease categories.

• Multimorbidity-Weighted Index (MWI)

  The Multimorbidity-Weighted Index is a patient-centered, quantitative measure of multimorbidity and disease burden. The MWI weights a set of 98 individual diseases by severity, allowing for estimations of health related quality of life burden from this disease inventory.

• Nursing Home Multimorbidity Matrix

  The Nursing Home Multimorbidity Matrix maps, quantifies and scores chronic morbidity in individual patients based on patient medical history, physical examination, labs, and all available medical records from primary and acute care encounters. A comprehensive list of a patient's current individual health problems is recorded and mapped to a list of 19-items (e.g., neuropsychiatric system, cardiovascular system etc.). This tool can generate an individual score of the number of multimorbidities (sum of conditions), and the degree of multimorbidity (grading the number of chronic health problems per matrix item). The Multimorbidity Matrix can provide an overview of an individual patient's current clinical health problems, including past disease or injury that may still be impacting current health status.

• Seattle Index of Comorbidity (SIC)

  The Seattle Index of Comorbidity (SIC) is a measure of comorbidity designed for application in the outpatient setting. The brief, self-report questionnaire contains 9 items: age, smoking status, and a list of 7 common chronic conditions (e.g., myocardial infarction, cancer, congestive heart failure etc.). Higher scores indicate increased levels of comorbidity.

• Self-Administered Comorbidity Questionnaire (SCQ)

  The Self-Administered Comorbidity Questionnaire is a brief, easily understood self-administered measure of comorbidity that can be completed by individuals without any medical background. The measure includes a list of 12 medical conditions that are similar to those included in other commonly used comorbidity instruments. Conditions are written out in simplistic terms. For each condition, respondents indicate: whether or not they have the listed condition; whether or not they receive treatment for the condition (proxy for disease severity); whether or not the condition limits their activities (proxy for burden of condition). Respondents can also write-in up to three additional conditions and answer the three questions for each additional condition. A score is generated by adding up the responses to each of the questions for each condition listed.

• The High Risk Diagnoses for the Elderly Scale

  A risk-adjustment index for 1-year mortality based on administrative discharge diagnoses. Includes 10 high-risk medical diagnoses assigned weights ranging from 1 (diabetes/pneumonia) to 6 (lymphoma/leukemia). Validated in hospital patients with the outcome of one-year mortality.

• The Index of Co-Existent Diseases (ICED)

  Stratifies patients according to their probability of experiencing full recovery from hip replacement surgery and having good functioning. Medical records were reviewed based on 3 conditions: severity of disease, co-existent disease and post-operative complications.

• The WOMAC (Western Ontario and McMaster Universities) Osteoarthritis Index

  Developed to measure symptoms and physical disability for people with osteoarthritis of the hip and/or knee.

Medication Adherence Instruments: Home

• Dexterity Test

  The Dexterity Test can be used to measure medication adherence. The test consists of five tasks that can include opening a screw-top medicine bottle and opening a child-resistant medicine bottle. Patients have to complete the task in one minute. Points are given for each completed task.

• Everyday Cognition Battery

  Consists of four tests to assess older adults' everyday cognitive ability, based in three functional domains: medication use, financial planning, and food preparation/nutrition. The four tests include the inductive reasoning test (42-items), knowledge test (30-items), declarative memory test (30-items), and working memory test.

• Functional Limitations Assessment

  A set of assessments to determine barriers older adults may encounter in taking their medications (e.g. to remember, to read small type, to differentiate meds by color and size, to open medication containers, and to interpret written instructions). Although not a standardized assessment, it is a way to identify potential problem areas for older adults.

• Medication Management Test

  A test simulating certain tasks (e.g. calculation and manipulation of meds) involved in the self-administration of medications to assess high-level adaptive functioning in early dementia

• Medication Regimen Adeherence Capacity Test

  An instrument that assesses a patient's capacity to adhere to a medication regimen before beginning the regimen

• Observed Tasks of Daily Living (OTDL)

  Observational assessment of patient's ability to complete three key activities of daily living (e.g. food preparation; medication-related tasks; phone-related tasks) in a natural setting

• Reading/Comprehension and Task Performance Tool

  A semi-structured interview and observation to identify how prescription instructions are read and medications self-administered by patients in charge of their own medication regimens

• Self-Administration of Medication Tool

  A 29-item assessment completed in the hospital setting to determine a patient's ability to manage their regularly scheduled medications after discharge.

• Self-Medication Risk Assessment Instrument

  A brief assessment to identify patients that may have difficulty managing their medication safely

• Timed Activities of Daily Living (TIADL)

  A timed assessment of older adults ability to perform tasks related to five instrumental activities of daily living (Communication, finances, food, shopping, medications)

Miscellaneous Instruments: Home

• Borg Index for Dyspnea

  The scale is commonly used for measuring angina pain and breathlessness (dyspnea), musculoskeletal pain and other kinds of somatic symptoms.

Other Instrument Libraries Instruments: Home

• ASCQ-Me: Adult Sickle Cell Quality of Life Measurement Information System

  A patient-reported outcome measurement system that evaluates and monitors the physical, mental, and social well-being of adults with sickle cell disease (SCD).

• CMS Data Element Library (DEL)

  The CMS Data Element Library (DEL) is the centralized resource for CMS assessment instrument data elements (e.g. questions and responses) and their associated health information technology standards.

• COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments)

  COSMIN aims to improve the selection of outcome measurement instruments both in research and in clinical practice by developing methodology and practical tools for selecting the most suitable outcome measurement instrument. They have developed a consensus-based taxonomy including definitions of the nine measurement properties, and consensus-based standards for assessing the quality of studies on measurement properties.

• ePROVIDE

  The aim of Mapi Research Trust is to facilitate access to information to all stakeholders in the field of Patient-Centered Outcomes, particularly for Clinical Outcome Assessments

• EveryONE Project

  This resource contains a social determinants of health (SDOH) screening tool created by the American Academy of Family Physicians (AAFP) which describes how, who and where the tool can be administered as well as how to interpret results. These tools can be used by family physicians and their practice teams to screen their patients for social determinants of health, identify community-based resources to help them, and work with patients to develop an action plan that encompasses social needs to help them overcome health risks and improve outcomes.

• Family Caregiver Alliance: National Center on Caregiving

  In 2012 The Family Caregiver Alliance: National Center on Caregiving published the "Selected Caregiver Assessment Measures (2nd Edition): A Resource Inventory for Practitioners". This updated resource includes new and adapted caregiver assessment measures that are practice-oriented, practical, applicable, and address the broadest range of caregiving experiences.

• Johns Hopkins Frailty Instruments

  The Johns Hopkins Frailty Instruments website is a collection of instruments used to assess frailty status in the research literature.

• Neuro-QoL (Quality of Life in Neurological Disorders)

  A measurement system that evaluates and monitors the physical, mental, and social effects experienced by adults and children living with neurological conditions.

• NIH Public Health Emergency and Disaster Research Response (DR2)

  Provides an array of data collection tools and resources that have been used during public health emergencies and disasters, including COVID-19-specific surveys. Hosted by the National Library of Medicine and the National Institute of Environmental Health Sciences.

• NIH Toolbox

  A comprehensive set of neuro-behavioral measurements that quickly assess cognitive, emotional, sensory, and motor functions from the convenience of an iPad.

• Patient and Caregiver Relevant Outcome (PCRO) iLibraries

  The IMPACT PCRO iLibraries hold organized information on selected outcome measures for pragmatic trials enrolling people living with Alzheimer’s disease or related dementias (AD/ADRD). Administrative Sources is a resource of outcome assessments that can be found in existing data sources. The PCRO iLibrary – Other Sources contains patient-reported outcomes (PROs), caregiver-reported outcomes (CROs), observer-reported outcomes (ObsROs), performance outcomes (PerfOs), and clinician-reported outcomes (ClinROs) that have been used in pragmatic AD/ADRD trials.

• PhenX Toolkit

  Catalog of recommended measurement protocols funded by the National Human Genome Research Institute. Addresses a wide range of research domains, including measurement protocols, modules, and tools for COVID-19 and other pandemic studies.

• PROMIS: Patient Reported Outcomes Measurement Information System

  A set of person-centered measures that evaluates and monitors physical, mental, and social health in adults and children. It can be used with the general population and with individuals living with chronic conditions.

• Quality of Life Resources: American Thoracic Society

  The goal of this web site is to provide information about quality of life and functional status instruments that have been used in the assessment of patients with pulmonary disease or critical illness.

• Rehabilitation Measures Database

  A resource database with more than 400 rehabilitation measures endorsed by doctors, clinicians, therapists and physical medicine and rehabilitation researchers.

• Rehabilitation Measures Database - Additional Resources

  A list of additional third-party and industry resources that may be useful in testing and research

• The IMPACT Collaboratory iLibrary

  The NIA IMPACT Collaboratory iLibrary holds organized information on selected outcome measures for pragmatic trials enrolling people living with Alzheimer’s disease or related dementias (AD/ADRD). It is a nationwide infrastructure funded through a cooperative agreement from the National Institute on Aging that promotes the conduct of embedded Pragmatic Clinical Trials (ePCTs) evaluating non-pharmacological approaches to care for people living with dementia (PLWD) and their care partners within healthcare systems (HCSs). The work of the IMPACT Collaboratory is accomplished by a coordinated effort of multidisciplinary experts from across the nation organized into 11 Working Cores Groups and Teams whose expert members partner with health care system leaders and other interested parties: Design and Statistics Core; Engaging Partners Team; Ethics and Regulation Core; Health Care Systems Core; Health Equity Team; Implementation Core; Patient and Caregiver Relevant Outcomes Core; Pilot Studies Core; Technical Data Core; Training Core; Administration Core.

• URI Psychological Measures - Cancer Prevention Research Center

  Provides psychological measures developed at the University of Rhode Island Cancer Prevention Center

Pain Instruments: Home

• McGill Pain Questionnaire (MPQ)

  Assesses 3 major classes of word descriptors, sensory, affective, and evaluative, that are used to measure a patient's subjective pain experience. Designed to provide quantitative measures of clinical pain that can be analyzed statistically. 20 items measure the quality and intensity of pain, 10 items measure sensory aspects, 5 items measure affective descriptors, 1 item measures evaluative, and 4 items measure miscellaneous.

• McGill Pain Questionnaire Short Form (SF-MPQ)

  Assesses the sensory, affective and evaluative dimensions of the pain experience. Useful in situations where the standard McGill Pain Questionnaire takes too long to administer. A total of 10 items measure sensory aspects, and 4 items measure affective descriptors.

• Numeric Pain Rating Scale (NPRS)

  Assesses pain using an 11-point numeric scale. Ranges from 0 (no pain) to 10 (pain as bad as you can imagine/worst pain imaginable).

• The Brief Pain Inventory (BPI)

  Assesses pain intensity, interference with activities, relief, quality and cause of pain.

• The West Haven-Yale Multidimensional Pain Inventory

  The inventory examines the impact of pain on patients' lives, the responses of others to the patients' communications of pain, and the extent to which patients participate in common daily activities.

Physical Activity/Performance Instruments: Home

• 3-Minute Walk Test

  The 3-Minute Walk Test can be used as a predictor of clinical outcomes for patients with CHF or COPD exacerbation, and as a test to inform discharge decisions. In the test, patients are asked to ambulate for 3 minutes at their own pace either with room air or on baseline home oxygen rate. Patients can use any walking aid they normally use. Measures of dyspnea, oxygen saturation, heart rate and respiratory rate were collected at baseline and at 1, 2, and 3 minutes during the walk and 1-minute post-walk. The test is discontinued if at any time the patient experiences severe shortness of breath, chest pain, or significant decrease in oxygen saturation.

• 400-Meter Fast Walk Test

  Asseses cardiorespiratory fitness. Subject is given 2 minutes for a warm up walk then told to walk 400 meters as quickly as possible. At the end of the test, heart rate, blood pressure and respiratory rate are measured. Gait speed is calculated as distance divided by time.

• 400-Meter Walk Test

  Assesses mobility limitation in older adults. Subject is asked to walk at a steady and constant pace. Usually used for older adults 75 years of age and over, whereas the fast pace walk is used for 65-74 year olds.

• 6-Minute Walk Test

  A 6-minute walk to assess the aerobic capabilities and gait speed of older adults. The subject walks as far as they can in 6 minutes. Vital signs and distance are measured at the end. The Borg Rate of Exertion Scale is often filled out as well as the Borg dyspnea measure.

• CHAMPS Activities Questionnaire for Older Adults II

  Assesses physical activity outcomes in intervention research studies. There are 41 items that ask about physical, recreational and social activities. For each item, the subject is asked the total amount of time spent on each activity per week. Score is METS-calculated from calories and frequencies of activities.

• EPESE Short Physical Performance Battery

  This battery was developed to assess lower extremity performance in individuals living in the community. Evaluates performance in 3 categories: chair stands, standing balance and walking speed.

• Fast 23-The Fitness Arthritis and Seniors Trial

  Determines the effects of structured exercise programs on self-reported disability in older adults with knee osteoarthritis. Also measures pain and physical performance.

• Grip Strength Test

  The Grip Strength Test can be implemented in a number of ways using different technology. The gold standard is through use of the Jamar Dynamometer. Using this technique, participants are positioned accordingly and instructed to squeeze as hard as they can. This is repeated for an additional two trials and then repeated again on the other hand. Grip Strength Tests measure strength of the hand and forearm muscles.

• Measure of Older Sedentary Time (MOST)

  Assesses time spent in behaviors common among older adults: watching television, computer use, reading, socializing, transport and hobbies, as well as a summary measure (total sedentary time).

• Nagi Scale of Physical Performance (Mobility)

  Assesses limitations in seven activities that reflect mobility. Final scoring results in two components: a) Index of Work Disability and b) Index of Independent Living.

• Performance Oriented Mobility Assessment (POMA)

  A set of balance and gait assessments to measure mobility. Originally used as an outcome measure for a fall intervention trial. There are 13 balance movements and 9 gait movements, and each is rated as normal (2), adaptive (1) and abnormal (0). Used to predict falls and progress in therapy

• The Berg Balance Scale

  Balance scale that was developed to assess patient status over time and the effectiveness of interventions. Assesses static and dynamic balance by using tasks performed in everyday life.

• The Physical Activity Scale for the Elderly (PASE)

  Designed to assess physical activities in older adults by including age-specific activities. Validation studies have been conducted with falls, balance, gait, and coronary heart disease.

• The Physical Performance Test

  Observed performance tests that assess different aspects of physical function. Assesses multiple domains of physical function using observed performance of tasks that simulate activities of daily living, varying in degree of difficulty.

• Yale Physical Activity Survey (YPAS)

  Measures physical function and Activities of Daily Living. There are 2 sections: the amount of activity performed during a typical week in the past month, and activities performed in the past month. The final score weights each item to create an energy expenditure index.

Physical Disability Instruments: Home

• Barthel Index (BI)

  Measures functioning in personal care and mobility. Completed from medical records, direct observation or self-report. Specifically addresses: feeding, bathing, grooming, dressing, bowel control, bladder control, toileting, bed-to-chair transfer, mobility on level surfaces and stairs.

• Brief Disability Questionnaire (BDQ)

  The Brief Disability Questionnaire is an 8-item assessment adapted from the Medical outcomes Survey short form. Subjects are asked by an interviewer if, over the past month, they were limited in 8 specific activities as a result of health problems (e.g., vigorous activities such as lifting heavy objects; moderate activities such as moving a table; climbing stairs etc.). Three response options were used for each item: "not at all", "sometimes or a little", or "moderately/definitely". Responses are added up with higher scores indicating greater disability.

• Falls Efficacy Scale (FES)-10 Category

  Measures confidence in performing daily activities without falling. This version assesses confidence for performing ten activities that require transferring, bending, reaching, or walking. Responses range from 1 to 10, with higher scores indicating greater confidence in maintaining daily living activities.

• Fillenbaum Instrumental Activities of Daily Living (IADL) Measure

  Assesses level of independence in the ability to perform 5 activities: travel, shop, prepare meals, perform housework, and manage finances. It has been used as a screening instrument to determine who may require a fuller assessment of functional capacity.

• Functional Status Questionnaire (FSQ)

  The Functional Status Questionnaire is a brief, self-administered questionnaire designed to assess physical, psychological, and social role function in ambulatory patients. This instrument can be used to either screen for, or monitor functional status. The instrument includes 34 core items with scales including: basic activities of daily living (ADLs), intermediate ADLs, mental health, work performance, social activity, and quality of interaction. The instrument can be completed by patients at the doctor's office or at home. After completion of the instrument, a single-page summary report is generated for physicians. A higher score on the FSQ indicates better functional ability.

• Groningen Activity Restriction Scale (GARS)

  The Groningen Activity Restriction Scale (GARS) is a measure of disability in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). The measure includes a list 18 ADL-IADLs (e.g., dressing, getting into/out of bed, light house cleaning, bed making etc.) For each item, respondents indicate whether they could perform the activity 1) independently and easily, 2) independently but with some difficulty, or 3) dependent on others or were supervised while executing the activity. The measure includes two distinct subscales, one for ADLs and one for IADLs. Scores are generated by summing responses to each of the ADL-IADL items.

• Guttman Scale of Functional Health

  Three questions on illness and functioning designed to be used in survey (self-report) research. These three items form a Guttman Scale range from 0 to 6. The items assess walking 1/2 mile, climbing stairs and doing heavy work.

• Katz Index of Independence in Activities of Daily Living (ADL)

  Developed to measure physical functioning of older and chronically ill patients. Used to assess severity of illness and treatment efficacy. Six activities are assessed: 1) bathing; 2) dressing; 3) using toilet; 4) transfer from bed to chair; 5) continence; and 6) feeding.

• Late-Life Function and Disability Instrument (LLFDI)

  A measure designed to assess function and disability. The LLFDI is also designed to be sensitive to change in both function and disability over time and in response to an intervention. The function component of the LLFDI includes 32-items that assess self-reported difficulty in performing specific physical activities. The disability component consists of 16-items assessing frequency of performing certain tasks and limitations in completing those tasks. Both the function and disability components include specific items that go beyond common ADLs and IADLs.

• Lawton and Brody Instrumental Activities of Daily Living Scale (LB-IADL)

  Assesses level of independence in 8 different activities, with 5 levels of descriptors given for each activity. Part of the Physical Self Maintenance Scale. Activities include using the telephone, shopping, food preparation, housekeeping, laundry, transportation, medication and finances.

• NHATS Activities of Daily Living Measure

  The NHATS Activities of Daily Living Measure (NHATS-ADL) is a 5-category scale that measures the spectrum of functional limitations in older adult populations. Respondents indicate their functional status (i.e., Fully able, Uses Assisting Devices, Performs Less Frequently, Performs with Difficulty, Impaired and received assistance) for each of the ADLS included in the measure (i.e., bathing, dressing, getting around inside, getting out of bed, toileting, eating). A disability score is generated by summing each of the individual NAHTS-ADL responses.

• OARS Multilevel Functional Assessment Questionnaire (OMFAQ)

  The first section of the OMFAQ seeks information on five dimensions of functioning: social resources, economic resources, mental health, physical health, and ability to carry out activities of daily living. For each dimension, a score representing level of function is given (1 = excellent, 6 = totally impaired). The second section of the OMFAQ inquires about the extent, intensity of utilization, and perceived need for each of 24 non-overlapping, broadly encompassing generic services.

• Pepper Assessment Tool for Disability (PAT-D)

  A self-administered questionnaire consisting of 23 items that assess mobility, activities of daily living (ADL) and instrumental activities of daily living (IADL). Responses are made on a 5-point Likert scale ranging from 1 (usually did with no difficulty) to 5 (unable to do).

• Physical Self-Maintenance Scale (PSMS)

  Disability measure for use in evaluating older adults in the community or institutions. Assesses ability to perform 6 self-maintenance activities independently. This is the original version of the scale which has 5 descriptors to use in rating each item. Items include toileting, bathing, dressing, feeding, grooming and ambulation.

• Physical Self-Maintenance Scale-Self-Rated Version (MAI)

  Assesses ability to perform different domains of overall functioning. Extracted from the Multilevel Assessment Instrument (MAI). The domains covered include health, activities of daily living, cognition, time use, social interaction, psychological wellbeing and perceived environmental quality.

• Rosow-Breslau Functional Health Scale (RBFHS)

  The Rosow-Breslau Functional Health Scale (RBFHS) uses three self-report questions to construct a six-item Guttman scale of reported functional health.

• SF-36v2 Health Survey (Physical Function Items)

  The SF-36v2 is a multi-purpose, short-form health survey that includes 8-scales measuring different health concepts. The Physical Function Scale is one of 8-scales included in the SF-36. The 10-item Physical Function Scale measures limitations in physical activities as a result of health problems. Respondents indicate: "Yes, limited a lot", "Yes, limited a little", and "No, not limited at all" for the 10 Physical Function scale items. A low score on the scale indicates that the respondent is limited in performing all physical activities, while a high score indicates that a respondent performs all types of physical activities without limitations due to health.

• Short Form of the Late-Life Function and Disability Instrument (SF-LLFDI)

  The Short Form of the Late-Life Function and Disability Instrument (SF-LLFDI) is an abbreviated measure of function and disability in older adults. The Function component of LLFDI consists of a 15-item scale (vs. 32-item in the original measure) and the Disability component consists of an 8-item scale (vs. 16-item in the original). This abbreviated version shows high correlations with the original instrument.

• The Functional Status Index

  Measure of function that can be used to assess the efficacy of the management of some chronic disabling conditions. Measures difficulty, dependence and pain in performing 18 ADLs. Designed for use on adults with arthritis living in the community.

Resilience Instruments: Home

• Connor-Davidson Resilience Scale (CD-RISC)

  The Connor-Davidson Resilience Scale (CD-RISC) is a 25-item measure used to assess resilience. Scoring of the scale is based on summing the total of all items, each of which is scored from 0-4. For the 25 item CD-RISC, the full range is therefore from 0 to 100, with higher scores reflecting greater resilience.

• Items of Resilience Scale for Older Adults (RSOA)

  Items of Resilience Scale for Older Adults (RSOA) that comprised four constructs (personal strength, meaning and purpose of life, family support, and social support) with a total of 15 items was developed with good reliability and validity. The RSOA is a reliable means of assessing psychological and physical resilience of older people as well as predicting their satisfaction with life.

• Making it CLEAR (MiC) questionnaire

  The questionnaire consists of 34 items, which assess the “individual determinants of resilience” (IDoR) and the “environmental determinants of resilience” (EDoR) across 2 subscales. 416 adults aged 66–102 years participated. The MiC questionnaire could be used to identify the resilience needs of older adults at the point of hospital discharge.

• Resilience Scale

  The Resilience Scale is a 25-item measure used to assess resilience in various populations. Respondents indicate on a scale from 1-7 the degree to which they either agree (7) or disagree (1) on each of the items. Higher scores indicate higher degrees of resilience.

Sleep Instruments: Home

• Daytime Insomnia Symptom Scale (DISS)

  The Daytime Insomnia Symptom Scale (DISS) consists of 20 visual analog scales presenting adjectives or brief phrases designed to capture the subjective experience of insomnia patients across the course of a day.

• Functional Outcomes of Sleep Questionnaire (FOSQ)

  The FOSQ measures the impact of disorders of excessive sleepiness on functional status of several activities of everyday life. The FOSQ is a 30-item questionnaire with five subscales (e.g., activity level, vigilance, intimacy and sexual relationships, general productivity, social outcomes). Items are rated on a four-point likert scale. A total score is generated by adding up each of the five subscores. The FOSQ has been translated into several other languages.

• Global Sleep Assessment Questionnaire (GSAQ)

  The GSAQ is a self-administered screening tool which was designed for use by clinicians to aid in the diagnosis of sleep-related disorders.

• Insomnia Severity Index

  A brief self-report screening instrument that measures the respondent's perception of their insomnia. Seven items are rated on a scale of 0-4: difficulty falling asleep, staying asleep, waking too early, satisfaction with sleep, how noticeable sleep problems are to others, interference with daily function, and distress caused by sleep difficulties.

• Insomnia Symptom Questionnaire (ISQ)

  The Insomnia Symptom Questionnaire (ISQ) is a self-report instrument designed to establish a clinically relevant case definition of insomnia consistent with widely used insomnia classification criteria, using methods from classical test theory and item response theory. The ISQ captures the multidimensionality of insomnia better than traditional sleep measures as it ascertains symptoms of insomnia that are based on DSM-IV and RDC criteria.

• International Restless Legs Syndrome Scale

  The International Restless Legs Syndrome Scale is a 10-item self-report measure to assess severity of Restless Legs Syndrome symptoms over the past 7 days. Respondents rate features on a five-point likert scale and a total score is created by adding up the ratings with higher scores indicating greater symptoms and impact.

• OSA50

  The OSA50 is a four-item screening tool for obstructive sleep apnea. Items include waist circumference, snoring, witnessed apneas, and age. Items are weighted differently and summed to generate a score (max. 10). Scores greater than or equal to five indicate high probability of OSA.

• Pittsburgh Insomnia Rating Scale (PIRS)

  The Pittsburgh Insomnia Rating Scale (PIRS) is a 65-item scale designed to rate the severity of insomnia in clinical trials. Subjects rate items asking about subjective distress, subject sleep parameters, and quality-of-life in the past week.

• Pittsburgh Sleep Quality Index (PSQI)

  The Pittsburgh Sleep Quality Index measures sleep quality and disturbances within the last month. The index consists of 19 self-reported questions measuring seven domains of sleep quality. There are five additional questions not included in the final score for the bedpartner to complete. The index generates a global sleep quality score with higher scores indicating worse sleep quality. The PSQI has been translated into 56 additional languages.

• The Consensus Sleep Diary

  The Consensus Sleep Diary is a subjective measure of sleep behaviors which can be used to assess for insomnia in older adults. Developed by a work group of insomnia experts, the CSD core diary collects information about sleep patterns (e.g., time to bed, time to fall asleep, number and length of awakenings, time of final awakening, rating of sleep quality). Adapted versions of the CSD include additional questions about other behaviors that may impact sleep (e.g., feelings of being well-rested, napping or dozing behavior during the day, alcohol or caffeinated beverage consumption etc.)

• The Epworth Sleepiness Scale (ESS)

  Assesses daytime sleepiness with 8 self-report items. The subject rates their usual chance of dozing off or falling asleep while carrying out 8 activities: sitting and reading, watching TV, sitting in a public place, passenger in a car for over an hour, lying down in the afternoon, sitting and talking to someone, sitting quietly after lunch, and in a car while stopped for a few minutes.

Social Determinants of Health Instruments: Home

• Accountable Health Communities Health-Related Social Needs (AHC-HRSN)

  The AHC-HRSN is a 10-item screening tool, with 16 supplemental questions, to identify patient needs that can be addressed through community services in 4 domains (economic stability, social & community context, neighborhood & physical environment, and food).

• Patient Centered Assessment Method (PCAM)

  The Patient Centered Assessment Method (PCAM) is a tool medical practitioners can use to assess patient complexity related to social determinants of health that often explain why some patients engage and respond well in managing their health needs while others with the same or similar health conditions do not experience the same outcomes. It is a 12-item assessment covering four domains (health and well-being; social environment; health literacy and communication, & service coordination) assessed on their level of severity and urgency. This assessment is then accompanied by a section to record the actions that will be taken in response to these needs. Across each domain, item questions ascertain the level of need across a four-point Likert scale, with 1 indicating no needs or issues relating to the item, through to 4, indicating urgent or serious needs or issues.

• Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE)

  PRAPARE is 21 item questionnaire that addresses needs in 5 domains (economic stability, education, social & community context, health and clinical care, and neighborhood & physical environment). It is a national standardized patient risk assessment protocol designed to engage patients in assessing & addressing social drivers of health (SDOH). PRAPARE is evidence-based, designed through stakeholder engagement, paired with an Implementation and Action Toolkit, and standardized across ICD-10, LOINC, and SNOMED. Its implementation guide includes further information on technical resources, best practices, multiple tested workflows, and other resources.

• WellRx

  A validated 11-item questionnaire designed to be utilized at every outpatient patient visit, covering the domains of food insecurity, housing, utilities, income, employment, transportation, education, substance abuse, childcare, safety, and abuse. Questions conform to “low literacy”.

Social Support Instruments: Home

• Duke Social Support and Stress Scale (DUSOCS)

  Assesses the stress and support one receives from family, neighbors, coworkers and others. Validated with several comparison instruments. Scored on a scale from 0 (None) to 2 (A lot), and calculate a score out of 100.

• MacArthur Community Study of Aging: Social Support Battery

  Assesses respondent's perceptions of their social support. Questions assess the structural, emotional, instrumental,demands/criticism and provisional dimensions of social support.

• Perceived Support Scale

  Assesses informational, tangible, emotional and integration measures of social support, as well as satisfaction with support. For use in studies of stress, social support and health among older adults.

• The Medical Outcomes Study Social Support Survey

  Self-administered social support scale that assesses five categories of support: structural, tangible, affectionate, positive social interaction and emotional/informational support.

• The Social Support Questionnaire

  Developed to measure availability and satisfaction with social support. This instrument contains 27 items and was designed for research. For each item, subject is asked to list people whom they could rely on in sets of circumstances (availability) and how satisfied they are with support given.

Treatment Burden Instruments: Home

• Patient Experience with Treatment and Self-management (PETS)

  A comprehensive patient-reported measure of treatment burden that operationalizes issues previously outlined in a patient-informed conceptual framework of general treatment burden. Includes 15 content domains: learning about health conditions and care; medications; difficulty with taking medications; medical appointments; monitoring health; exercise or physical therapy; diet; medical equipment; interpersonal challenges; medical/healthcare expenses; confusion/concern about medical information; healthcare providers; difficulty with healthcare services; role and social activity limitations; and physical/mental exhaustion

Vision Instruments: Home

• Contrast Sensitivity: Pelli-Robson Chart

  A letter chart designed to measure the subject's contrast sensitivity. Contrast sensitivity scores can be used as a screen for visual diseases which would not be picked up by visual acuity measures.

• Near Vision-Rosenbaum Card

  A screening test for visual impairment in near vision. Scores are expressed as a fraction determined by the last line read. For example 20/30 means that from 20 feet away the subject can read a line that people with normal vision can read from 30 feet.

• Snellen Eye Chart

  A screening test for impairment in visual acuity. Consists of reading lines of letters from 10 feet away. One eye is covered and the subject is asked to read the smallest letter line. Lines range from 20/200 to 20/20.