Development and validation of the multidimensional elderly health status assessment and screening (EHSAS) tool for community-dwelling older people in rural India

BACKGROUND: Comprehensive Geriatric Assessment (CGA), a cornerstone of geriatric care, is challenging to implement in low-resource settings due to workforce limitations and the absence of suitable screening tools to identify older adults who require CGA. OBJECTIVES: To develop and validate the Elderly Health Status Assessment and Screening (EHSAS) tool, a concise, culturally adapted, community-based, multidimensional screening tool, delivered by Community Health Workers (CHWs) to identify the need for CGA amongst rural older adults in India. METHODS: We employed a three-phase approach: tool development (literature review, expert consensus, face and content validation), scale development (exploratory factor analysis, convergent and discriminant validity testing), and scale evaluation (cut-off score determination, diagnostic accuracy testing, reliability assessment). The tool's performance was compared to the criterion variable of moderate/severe frailty status based on Fried's phenotype. RESULTS: The final EHSAS tool comprises 11 items spanning the key geriatric domains, plus a frailty item not included in the score. A cut-off of ≥3 demonstrated good psychometric properties, including high internal consistency (Cronbach's alpha >0.7), substantial test-retest reliability (Cohen's kappa >0.79), and balanced diagnostic accuracy (sensitivity 76.3%, specificity 76.5%, negative predictive value 93.2%). Field testing confirmed that EHSAS was usable by and acceptable to CHWs and older adults. CONCLUSION: The EHSAS tool fills a critical gap in geriatric care in low-resource settings by offering a validated, brief and culturally appropriate screening instrument for CHWs. Its adoption can strengthen timely referrals for CGA, ultimately improving health outcomes for older adults.