Evaluation of Geriatric Patients with Special Reference to Clinical Trials of socalled Nootropic Drugs

Abstract

This article, the first in a series, reviews some well-known difficulties involved in the assessment and evaluation of elderly patients. The various aims of assessment proper and of evaluation are delineated and a clear description of the specific purposes of assessment of the elderly is presented. These can differ considerably from the assessment aims for younger persons, for whom the tests were developed, thereby placing the use of traditional psychometric devices with the elderly in a doubtful position. An individualized, ecologically relevant approach is therefore suggested as an alternative. This position is further supported by the evidence that few of the standard psychometric criteria - validity, reliability, and representative reference groups - are met when standardized psychometric instruments are used with an older population. Evaluation of treatment effects, particularly drug effects, is elaborated with this evidence in mind, and the screening process is analyzed in terms of the special demands the characteristics of elderly subjects make on it. Later articles will also address the evaluation of treatment effects, concentrating on the selection of specific procedures and the assessment of baseline behavior and behavior change.