In recent years there has been a growing emphasis on evidencebased medicine and measuring outcomes of health care. The evaluation of health interventions for older people has increasingly relied upon the use of standardized assessment instruments, which are seen as providing detailed, holistic and patient-centred information. This article argues that such an approach has several drawbacks which may have serious implications for the evaluation and provision of health care. Standardized assessment instruments ignore the social dimensions of interviewing, decontextualize scores and contain an implicitly individualistic biomedical ideology of health. These factors undermine the effective evaluation of interventions. This is particularly significant when health care is purchased on the basis of delivering demonstrable gains. Provision for older people may be under threat if methods of evaluating its efficacy are inadequate.
Blaxter, M. (1982). Mothers and daughters: a three generation study of health attitudes and behaviours. London: Heinmann Educational Books.
2.
Bowling, A. (1991). Measuring health: a review of quality of life measurement scales. Buckingham: Open University Press.
3.
Bury, M. (1985). Dilemmas facing patients and providers in disablement. International Rehabilitation Medicine, 7, 162–166.
4.
Carr, L.T. (1994). The strengths and weaknesses of quantitative and qualitative research: what method for nursing?Journal of Advanced Nursing, 20, 716–721.
5.
Cornwell J. (1984). Hard earned lives. London: Tavistock Publications.
6.
Cytrynbaum, S. , Ginath, Y., Birdwell, J. and Brandt, L. (1979). Goal attainment scaling: a critical review. Evaluation Quarterly, 3, 5–40.
7.
Duffy, M.E. (1985). Designing nursing research: the qualitative–quantitative debate. Journal of Advanced Nursing, 10(3), 225–232.
8.
Duggan, C. , Marks, I. and Richards, D. (1993). Clinical audit of behaviour therapy training of nurses. Health Trends, 25, 25–30.
9.
Eagle, D.J. , Guyatt, D.H., Patterson, C., Turpie, I., Sackett, B. and Singer, J. (1991). Effectiveness of a geriatric day hospital. Canadian Medical Association Journal, 144(6), 699–704.
10.
Fitzpatrick, R. (1991). Surveys of patient satisfaction. I: important general considerations. British Medical Journal, 302, 887–889.
11.
Fitzpatrick, R. , Fletcher, A., Gore, S., Jones, D., Spiegelhalter, D. and Cox, D. (1992). Quality of life measures in health care. I: applications and issues in assessment. British Medical Journal, 305, 1074–1077.
12.
Fries, J. (1983). Towards an understanding of patient outcome measurement. Arthritis & Rheumatism, 26, 697–704.
13.
Geigle, R. and Jones, S.B. (1990). Outcomes measurement: a report from the front. Inquiry, 27, 7-7.
14.
Gerritsen, J.C. and Van der Ende, P.C. (1994). The development of a care-giving burden scale. Age and Ageing, 23, 483–491.
15.
Goffman, E. (1969). The presentation of self in everyday life. London: Allen Lane.
16.
Gompertz, P. , Pound, P. and Ebrahim, S. (1994). Validity of the extended activity of daily living scale. Clinical Rehabilitation, 8, 275–278.
17.
Grenville, J. and Lyne, P. (1995) Patient-centred evaluation and rehabilitative care. Journal of Advanced Nursing, 22, 965–972.
18.
Hammersley, M. (1992). Deconstructing the qualitative–quantitative divide. In J. Brannen (Ed.), Mixing methods: Qualitative and quantitative research, pp. 39–56. Aldershot: Ashgate Publishing Ltd.
19.
Harrison, S. (1998). The politics of evidence-based medicine in the United Kingdom. Policy & Politics, 26(1), 15–31.
20.
Hopkins, A. and Costain, D. (Eds.). (1990). Measuring the outcomes of medical care. London: Royal College of Physicians.
21.
Hunt, S.M. , McKenna, S.P., McEwen, J., Backett, E.M., Williams, J. and Papp, E. (1980). A quantitative approach to perceived health status: a validation study. Journal of Epidemiology and Community Health, 34, 281–286.
22.
Hyden, L. (1997). Illness and narrative. Sociology of Health and Illness, 19(1), 48–69.
23.
Ikegami, N. (1995). Functional assessment and its place in health care. New England Journal of Medicine, 332(9), 598–599.
24.
Jenkins, C.D. (1992). Assessment of outcomes of health intervention. Social Science and Medicine, 35(4), 367–375.
25.
Jylha, M. (1994). Self-rated health revisited: exploring survey interview episodes with elderly respondents. Social Science and Medicine, 39(7), 983–990.
26.
Kiresuk, T.J. and Sherman, R.T. (1968) Goal attainment scaling: a general method for evaluating comprehensive community mental health programs. Community Mental Health Journal, 4, 443–453.
27.
Martin, J. , Meltzer, H. and Elliot, D. (1988). The prevalence of disability in Great Britain. OPCS surveys of disability in Great Britain, Report 1. London: HMSO.
28.
Mishler, E.G. (1986). Research interviewing, context and narrative. Cambridge, MA: Harvard University Press.
29.
NHS Executive (1996). Promoting clinical effectiveness: a framework for action in and through the NHS. London: Department of Health.
30.
Nouri, F.M. and Lincoln, N.B. (1987). An extended activities of daily living scale for stroke patients. Clinical Rehabilitation, 1, 301–305.
31.
Oakley, A. (1981). Interviewing women: a contradiction in terms. In H. Roberts (Ed.), Doing feminist research. London: Routledge & Kegan Paul.
32.
Parker, S.G. , Du, X., Bardsley, M.J., Goodfellow, J., Cooper, R.G., Cleary, R., Broughton, D., Striet, C. and James, O.F.W. (1994). Measuring outcomes in care of the elderly. Journal of the Royal College of Physicians, 28(5), 428–433.
33.
Powell-Lawton, M. (1975). The Philadelphia Geriatric Center morale scale: a revision. Journal of Gerontology, 30, 85–89.
34.
Radley, A. and Billig, M. (1996). Accounts of health and illness: dilemmas and representations. Sociology of Health and Illness, 18(2), 220–240.
35.
Report of joint workshops of the Research Unit of the Royal College of Physicians and the British Geriatrics Society (1992). Standardised assessment scales for elderly people. London: Royal College of Physicians.
36.
Robinson, B.C. (1983). Validation of a caregiver strain index. Journal of Gerontology, 38(3), 344–348.
37.
Rockwood, K. , Stolee, P. and Fox, R.A. (1993). Use of goal attainment scaling in measuring clinically important change in the frail elderly. Journal of Clinical Epidemiology, 46(10), 1113–1118.
38.
Seed, A. (1995). Conducting a longitudinal study: an unsanitized account. Journal of Advanced Nursing, 21, 845–852.
39.
Tucker, M.A. , Davison, J.G. and Ogle, S.J. (1984). Day hospital rehabilitation: effectiveness and cost in the elderly: a randomized controlled trial. British Medical Journal, 289, 1209–1212.
40.
Vincent, J. (1995). Inequality in old age. London: UCL Press.
41.
Vincent, J. (1996). Who’s afraid of an ageing population? Nationalism, the free market, and the construction of old age as an issue. Critical Social Policy, 47(16), 3–26.
42.
Walker, A. (1993). Poverty and inequality in old age. In J. Bond, P. Coleman and S. Peace (Eds.), Ageing in society: an introduction to social gerontology, pp. 280–303. London: Sage.
43.
Walker, A. (1996). The new generational contract. London: UCL Press.
44.
Williams, G. (1984). The genesis of chronic illness: narrative reconstruction. Sociology of Health and Illness, 6(2), 175–199.
45.
Williamson, J. (1981). Screening, surveillance and case finding. In T. Arie (Ed.), Health care of the elderly, pp. 194–213. Beckenham, Kent: Croom Helm.
46.
Young, J.B. and Forster, A. (1992). The Bradford community stroke trial: results at six months. British Medical Journal, 304(6834), 1085–1089.
