Development of a modified Winchester disability scale--the elderly at risk rating scale.

OBJECTIVE To show that the elderly at risk rating scale (EARRS) satisfies the requirements of an assessment tool for routine health checks in people over 75 and would also be suitable as a method of collecting epidemiological data on the needs of the elderly in a locality. DESIGN Development and validation of a questionnaire based on a modification of the Winchester rating scale, by a series of prospective, comparative studies before the use of the instrument in a community survey. SETTING Elderly care day hospital and the community. SUBJECTS Elderly patients referred to an elderly care day hospital; population survey of subjects over 75 living at home. MAIN OUTCOME MEASURES Reliability of responses using the kappa statistic; comparison of the scale with the Barthel index of daily living. RESULTS EARRS has satisfactory validity and reliability when repeated by the same observer or a different observer, with a mean weighted kappa score above 0.80 in both instances. As a measure of disability in the community, it is better than the Barthel score in that it avoids the ceiling effect. The score is correlated with age, social situation, and receipt of support services, and individual questions scale appropriately to adverse outcomes. CONCLUSION The EARRS satisfies the requirements of an assessment tool for health checks in the elderly, It is suitable for both population surveys and routine practice in primary care, has proved popular with practice nurses, and is easy to complete.