Psychology RootsComprehensive Assessment and Referral Evaluation
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About Comprehensive Assessment and Referral Evaluation
Scale Name
Comprehensive Assessment and Referral Evaluation
Author Details
Barry Gurland
Translation Availability
English
Background/Description
The Comprehensive Assessment and Referral Evaluation (CARE), developed by Barry Gurland in 1977 and revised in 1983, is a semistructured interview designed to evaluate health and social problems in people aged 65 and older, assessing care needs, preventive services, and prognosis. Published in Journal of Gerontology (1977), it integrates items from tools like Wing’s Present State Examination, SSIAM, OARS OMFAQ, and ADL scales, covering psychiatric, medical, nutritional, economic, and social domains. Originally a 1,500-item interview lasting ~90 minutes, it evolved into the CORE-CARE (329 items) and SHORT-CARE (143 items), with trained interviewers adjusting question order for flow, supported by a manual with alternative phrasings.
The CORE-CARE yields 22 indicator scales (e.g., depression, dementia, service needs) based on face validity and consistency data from 445 New York and 396 London elderly residents. The SHORT-CARE, lasting ~30 minutes plus a second part for depression/dementia intervention needs, focuses on six scales: depression/demoralization, dementia, memory, sleep, somatic symptoms, and activity limitation. Validated with elderly samples (mean age ≈ 65–85 years, mixed gender, U.S./UK-based), it correlates with health/social measures. Used in geriatrics to guide referrals and service evaluation, access requires contacting Dr. Gurland or the National Technical Information Service (NTIS).
Administration, Scoring and Interpretation
- Obtain the CARE from Gurland (1977, revised 1983) or NTIS, completing detailed interviewer training and ensuring ethical permissions.
- Explain to participants (adults 65+ with health/social concerns) that the interview assesses needs, emphasizing confidentiality and voluntary participation.
- Administer the semistructured interview: CORE-CARE (~90 minutes, 329 items) or SHORT-CARE (~30 minutes, 143 items, plus second part), adjusting question order as needed.
- Estimated time is ~90 minutes (CORE-CARE) or ~30–45 minutes (SHORT-CARE).
- Ensure a supportive environment; provide care resources (e.g., referrals) and adapt for accessibility (e.g., clear explanations, assistance) if needed.
Reliability and Validity
The CARE demonstrates solid psychometric properties (Gurland, 1983). Internal consistency is high (Cronbach’s alpha ≈ 0.80–0.90 across scales, N not specified). Test-retest reliability is moderate to high (r ≈ 0.75–0.85) over short intervals. Inter-rater reliability varies due to semistructured format but is improved by training (specific r not provided).
Convergent validity is supported by correlations with OARS OMFAQ (r ≈ 0.70–0.80) and ADL scales. Discriminant validity is evidenced by its ability to differentiate problem levels (e.g., depression vs dementia), with indicator scales reflecting distinct domains. Factor analysis supports the multi-domain structure, reinforcing construct validity. The CARE reliably assesses elderly needs. Pairing with the SPMSQ or PAMIE enhances comprehensive assessment.
Available Versions
329-Items
Reference
Gurland, B., Kuriansky, J., Sharpe, L., Simon, R., Stiller, P., & Birkett, P. (1978). The Comprehensive Assessment and Referral Evaluation (CARE)—rationale, development and reliability. The International Journal of Aging and Human Development, 8(1), 9-42.
Important Link
Scale File:
Frequently Asked Questions
What does the CARE measure?
It measures health and social problems in the elderly across psychiatric, medical, nutritional, economic, and social domains.
Who is the target population?
Adults (65+) with potential health or social needs.
How long does it take to administer?
Approximately 90 minutes (CORE-CARE) or 30–45 minutes (SHORT-CARE).
Can it inform interventions?
Yes, it assesses needs to guide referrals and evaluate service effectiveness.
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