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.