Making and Executing Decisions for Safe and Independent Living (MED-SAIL): Development and Validation of a Brief Screening Tool

Abstract

Objectives Older adults prefer to remain in their own homes for as long as possible. The purpose of this article is to describe the development and preliminary validation of Making and Executing Decisions for Safe and Independent Living (MED-SAIL), a brief screening tool for capacity to live safely and independently in the community. Design Prospective preliminary validation study. Setting Outpatient geriatrics clinic located in a community-based hospital. Participants Forty-nine community-dwelling older adults referred to the clinic for a comprehensive capacity assessment. Measurements We examined internal consistency, criterion-based validity, concurrent validity, and accuracy of classification for MED-SAIL. Results The items included in MED-SAIL demonstrated internal consistency (5 items; α = 0.85). MED-SAIL was significantly correlated with the Independent Living Scales (r = 0.573, p ≤ 0.001) and instrumental activities of daily living (r = 0.440, p ≤ 0.01). The Mann-Whitney U test revealed significant differences between the no capacity and partial/full capacity classifications on MED-SAIL (U(48) = 60.5, Z = −0.38, p <0.0001). The area under the curve was 0.864 (95% confidence interval: 0.84–0.99). Conclusions This study demonstrated the validity of MED-SAIL as a brief screening tool to identify older adults with impaired capacity for remaining safe and independent in their current living environment. MED-SAIL is useful tool for health and social service providers in the community for the purpose of referral for definitive capacity evaluation.

Assessing Older Community Members Using a Social Work Tool: Developing an Organizational Response

“…The articles identified in the literature search provided some information on assessment tools that could be used by social workers. These included generalized assessment tools ( Craig et al, 2015 ), a screening tool to assess safety of independent living ( Mills et al, 2014 ), integrated care assessment tools ( Taylor, 2012 ; Warburton et al, 2015 ), a spiritual assessment tool ( Harrington, 2016 ), and comprehensive assessments of older people with complex needs ( Australian Government, 2018 ; Lambert et al, 2009 ; Sansoni et al, 2012 ), shown in Table 1 . There was limited access to the tools referred to in the publications, and included questions or domains were generally not provided.…”

Assessment of older adults' decision‐making capacity in relation to independent living: A scoping review

“…Though legal definitions of DMC vary internationally, most legislation and literature pertaining to DMC generally define DMC for any domain in terms of four widely accepted criteria: understanding, appreciation, reasoning and expression of choice (Grisso & Appelbaum, 1998). In relation to DMC for IL, the majority of publications in this review advocate for a functional approach to DMC assessment, incorporating these four dimensions, namely, the assessment of the person's abilities to understand relevant information about the situation, appreciate how relevant information applies to oneself in the situation, engage in rational deliberation about available options and to make and communicate a choice (Brindle & Holmes, 2005;Carrese, 2006;Clionsky et al, 2016;Cooney et al, 2004;Darzins, 2010;Emmett et al, 2013;Hughes et al, 2015;Jayes et al, 2017;Mackenzie et al, 2008;Mills et al, 2014;Naik, 2017a;Naik, Lai, et al, 2008;Stewart et al, 2005;Usher & Stapleton, 2020a).…”

“…Capacity for IL lies at the confluence of function, cognition and judgment (Mills et al, 2014). Unlike other domains of DMC, such as DMC for medical consent, which is largely a cognitive task, DMC for IL is a broad domain encompassing multiple everyday life functions and skills (Naik, Teal, et al, 2008).…”

“…Functional performance of everyday tasks may be assessed using observations and standardised assessments, and articles reviewed highlighted assessment tools such as Independent Living Scales, Functional Independence Measure, Kohlman Evaluation of Living Skills, Personal Care Participation Restriction and Resource Tool, Assessment of Motor and Process Skills and Kettle Test (Bourgeois et al, 2017;Darzins, 2010;Feng et al, 2017;Mills et al, 2014;Naik et al, 2010;Schreiber et al, 2018;Skelton et al, 2010;Usher & Stapleton, 2020a). Occupational therapy assessments of function and performance, including home visits, were highlighted in some publications (Darzins, 2010;Emmett et al, 2013;Moye & Braun, 2007;Usher & Stapleton, 2020a) as a component of multidisciplinary assessment.…”

Occupational therapy and decision‐making capacity assessment: A survey of practice in Ireland

“…DMC assessments regarding independent living must address function, cognition and judgment as overlapping domains (Mills et al, 2014). Therefore, determining if an older adult can make and execute decisions to live safely at home presents a complicated challenge to health-care professionals (Skelton et al, 2010) and the concept of DMC for independent living is frequently misunderstood.…”