P. Andrew Clifford, PhD, Kristi, D Roper, PhD and Daisha J. Cipher, PhD
The GRRAS is designed to assess emotional and behavioural dysfunction that is associated with medical and psychiatric comorbidities of geriatric individuals who reside in long-term care (LTC) settings. It is intended to be used by psychologists, psychiatrists, psychiatric nurse practitioners, clinical social workers, and geriatric psychotherapists for the evaluation of LTC (i.e. nursing home, assisted living facility, rehabilitation setting) residents who display emotional and behavioural dysfunction associated with chronic medical conditions and psychiatric syndromes.
Because the GRRAS documents the frequency, duration, and intensity of symptoms of psychiatric conditions and medical-psychiatric comorbidities, it plays an important role in establishing the medical necessity for mental health services for this population.
The GRRAS is composed of three clinician rating forms. These three forms may be used jointly as part of a comprehensive rehabilitation and restorative assessment evaluation and/or they may be used in treatment planning, in establishing medical necessity, and for monitoring response to intervention.
The Psychosocial Resistance to Activities of Daily Living Index (PRADLI) Rating Form is an 8-item measure that assesses the level of LTC residents' resistance to and cooperation with staff in performing ADLs (on a 7-point scale) that, when resisted, commonly triggers a psychiatric or psychological referral. The Geriatric Multi-dimensional Pain/Illness Inventory (GMPI) Rating Form is a 14-item measure that assesses (on a 10-point scale) the perceptual, functional, and emotional concomitants of pain and illness as they have affected the resident's abilities to perform activities within the past 7 days. The Geriatric Level of Dysfunction Scale (GLDS) Rating Form assesses the intensity, frequency, and duration (each on a 7-point scale) of 20 behaviours that may potentially interfere with care provided in the LTC setting, such as agitation, wandering, unsafe/impulsive behaviours, and low activity levels.
For each of the three GRRAS measures, percentile ranks and pre-determined clinical raw score ranges were established based on a criterion-referenced approach. A raw score of a specific magnitude on the GRRAS reflects a particular level of pain severity, behavioural disturbance, or activity impairment. Item and scale analyses enable ease of tracking progress over time and monitoring of response to intervention. Using the GRRAS Profile Form, visual profiles of single or repeated administrations enable the easy identification of trends in an individual's rehabilitation process.
Reliability and Validity
- Internal consistency for the PRADLI and the GMPI ranges from .71 to .93; for the GLDS, the range is from .68 to .80.
- Inter-rater reliability for all GRRAS Total and Cluster scores range from .87-.97.
- Validity of the GRRAS measures was examined in terms of concurrent validity, content validity, construct validity, convergent and divergent validity, clinical group contrasts and treatment utility.
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