Standardization and validation of the Multidimensional Observation Scale for Elderly Subjects (MOSES).

Objective, reliable and valid means of assessing the cognitive and psychosocial functionings of elderly persons are in demand for several reasons. Clinical needs for initial assessment, placement, and treatment monitoring are supplemented by the need for research tools for program evaluation and clinical trials. The set of behavior rating scales called the Multidimensional Observation Scale for Elderly Subjects (MOSES) was developed with these needs in mind. This paper describes the development of the MOSES scale and its rationale and norming on 2,391 residents of hospitals and residential settings. Internal consistency reliabilities in the .8 range and interrater reliabilities from .58 to .97 are reported. Validity correlations with the Zung Depression, Robertson Short Mental Status, Kingston Dementia, and the Physical and Mental Impairment-of-function Evaluation (PAMIE) scales were all satisfactory. The applications and advantages of the use of MOSES are discussed.

Class change in the personal illness hierarchy.

Sixty-eight psychiatric in-patients who had completed the Delusions-Symptoms-States Inventory (D.S.S.I.) on admission were retested after one month. On first testing 92.6 per cent conformed to the hierarchy of classes of personal illness model, and on the second occasion 91.2 per cent. Of those who could improve, 72 per cent did so, most commonly by moving down one hierarchy class, e.g. from the Neurotic Symptoms class to the Dysthymic States class. (On the other hand only 30 per cent of the 61 patients who originally reported symptoms did not do so after one month.) Thus although it is clear that the patients as a group changed markedly, they have not departed from the hierarchy. These results indicate that either the symptoms further up the hierarchy remit before those lower in the hierarchy or they remit together. Certainly those lower in the hierarchy do not go first. It is suggested that the results would be difficult to accommodate within strict disease-entity models, and that they have different implications for both treatment and the assessment of change in current state.