Clinical Assessment Scales for the Elderly

Definition

The Clinical Assessment Scales for the Elderly, often abbreviated as CASE, is a diagnostic tool used to deter mine the presence of mental disorders and other conditions in elderly adults.

Purpose

The CASE is used to determine the presence of mental disorders in an elderly person as defined by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (2000), which is also called DSM-IV-TR. The DSM-IV-TR is the basic reference work consulted by mental health professionals when making a diagnosis. The CASE, which is used with adults between the ages of 55 and 90, consists of a self-report form in which the person answers questions about himself or herself related to various scales. If the elderly adult is unable to complete the form because of cognitive or physical deficiencies, an other-rating form is provided for use by a knowledgeable caregiver, such as a spouse, child, or health care worker.

The CASE is not always used specifically for diagnosing mental disorders. It may be administered simply as a general assessment tool to gain insight about an elderly person. It may serve as a neurological screening tool to rule out other problems. The test makers also claim that it can be used as an early screening tool for dementia and thus allow elderly adults to receive medications to slow the progress of Alzheimer's disease.

Description

The Clinical Assessment Scales for the Elderly were written by Cecil Reynolds and Erin Bigler. The most recent version of the test was published in 2001. The CASE consists of 10 clinical scales that measure the following: Anxiety; Cognitive Competence; Depression; Fear of Aging; Obsessive-Compulsiveness; Paranoia; Psychoticism; Somatization; Mania; and Substance Abuse. The degree to which an elderly person exhibits symptoms in these areas can help a mental health professional with the process of differential diagnosis for a mental disorder.

The CASE also includes three validity scales. These are helpful in evaluating the consistency of a person's responses and whether the person is faking his or her answers.

The person who is completing the CASE, whether they are using the self-rating or the other-rating form, responds to the test's written items. The test usually takes between 20–40 minutes to finish, but it is not timed. People are generally given as much time as they need to complete it.

A shorter version of the test, called the Clinical Assessment Scales for the Elderly-Short Form (CASESF) is also available. The CASE-SF takes about 20 minutes to complete and includes all 10 of the clinical scales.

Results

Scoring for the CASE is relatively simple. Scores are calculated for each scale and then compared to age-appropriate scores to determine the presence or severity of symptoms. For example, if a person scores high on the Depression scale, this information could be used as part of an overall diagnosis for a DSM-IV depressive disorder. A person scoring high in Psychoticism may have a psychotic disorder. For any specific DSM-IV diagnosis to be made, however, all of the required criteria for that disorder must be met. The results from the CASE may satisfy only some of the requirements.

The Fear of Aging scale assesses the person's degree of apprehension or concern about the aging process. It is not necessarily related to a particular DSM-IV disorder. Information about a person's fear of aging, however, may be helpful during the diagnostic process. It may also be useful information for a psychotherapist or other counselor, to understand the patient's concerns or to measure progress in therapy.

The CASE was standardized using a sample of 2000 adults in the United States, 1000 for each of the two test forms. The test has been shown to have good reliability and validity. For example, scores from the CASE Depression scale have been shown to correlate very well with scores on the widely used Beck Depression Inventory, or BDI.

See also Figure drawings; House-Tree-Person Test

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.

Reynolds, Cecil R., and Erin D. Bigler. Clinical Assessment Scales for the Elderly. San Antonio, TX: The Psychological Corporation, 2001.

Ali Fahmy, Ph.D.