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ELDAC Clinical and Practice Assessment Tools

Documenting clinical care in a standardised way ensures the multidisciplinary healthcare team have common benchmarks to identify critical points along the palliative care journey and to monitor progress. Clinical and practice assessment tools assist in reliable assessment, interpretation of clinical information, and support the decision-making process.

The ELDAC project team have identified a range of clinical and practice assessment tools that can be used for older Australians across care settings.

Where organisations already recommend clinical tools, the ELDAC clinical and practice assessment tools should be seen as complementing these.

Tools were identified through a review of the:

  • National Palliative Care Projects (NPCP) funded by the Australian Government Department of Health and Aged Care.
  • Aged Care Quality Standards (including the draft guidance available for the upcoming Strengthened Standards) funded by the Australian Government Aged Care Quality and Safety Commission.
  • Tools currently being used in the ELDAC project.

Tool Selection Criteria

  • Ability to be applied in the Australian context.
  • Can be used with older people.
  • Current and useful clinically.
  • Do not require a paid license, subscription or registration.
  • Quick to use by the relevant care providers across the aged care sector.

Palliative Care Screening and Trigger Tools

Clinical Tool Explanation
Surprise Questions

Two trigger Tool/Questions:

  • "Would you be surprised if the older person died in the next 12 months?"
  • "Would you be suprirsed if the older person died in the next days or weeks?"

Supportive and Palliative Care Indicator Tool (SPICT) (185kb pdf)

SPICTTM guidance

 Used to identify a person with deteriorating health due to a serious illness, one or more health conditions (multimorbidity), or frailty in older age so they benefit from holistic assessment, future care planning and palliative care.

Supportive and Palliative Care Indicator Tool (SPICTTM-4ALL) (185kb pdf)

SPICTTM-4ALL guidance

 An easy to understand language version of SPICTTM.
Australia-modified Karnofsky Performance Status (AKPS) (36kb pdf) Accesses overall performance status or ability to perform activities of daily living.

Clinical Frailty Scale (CFS) (131kb pdf)
(Rockwood) (182kb pdf)

CFS guidance

 Clinician judgment-based tool to screen for frailty.

Palliative Care Phase (326kb pdf)

PCOC Phase flow chart (219kb pdf)

 The palliative care phase identifies a clinically meaningful period in an older person’s condition and is determined by a holistic clinical assessment, which considers the needs of the older person and their family and carers.
Functional Assessment Staging Tool (FAST) (163kb pdf) Measures a person’s changing functional and cognitive abilities.

Stop and Watch (482kb pdf)

Stop and Watch guidance (313kb pdf)

 Early warning tool that identifies changes in a person or when they are not ‘their usual self’.

Risk Prediction Tools (Screening)

Clinical Tool Explanation

Waterlow Pressure Ulcer Scale
(revised 2005 version)

Waterlow guidance (2MB pdf)

 To assess the risk for pressure ulcer development.

Braden Scale (959kb pdf)

Braden guidance

 To assess the risk for pressure ulcer development.

Mini-Nutritional Assessment Short-Form (MNA®-SF)(68.5kb pdf)

Mini-Nutritional Assessment guidance

 Can identify an older person who is malnourished or at risk of malnutrition.

Oral Health Assessment Tool (559kb pdf)

Oral Health Assessment guidance (6MB pdf)

 Assess pain multidimensionally in a person able to communicate. This can be undertaken weekly or at longer intervals.

Symptom Assessment

Clinical Tool Explanation
Symptom Assessment Scale (SAS) (578kb pdf) A tool to report the presence of common symptoms and severity of related distress of the following symptoms: Difficultyl sleeping, appetite problems, nausea, bowel problems, breathing problems, fatigue, and pain.
Palliative Care Problem Severity Score (PCPSS) (80kb pdf) A measure of symptoms and problems experienced by the person and family/carer over last 24 hours. Supports the global screening for the overall degree of problems within four key palliative care domains: pain problems, symptoms other than pain, psychological or spiritual problems and family or carer problems.
Numerical Rating Scale for pain (NRS) (31kb pdf) Assess pain intensity in a person able to communicate verbally or point.
Verbal Descriptor Scale (Pain Thermometer) (105kb pdf) A pain scale to assess pain intensity in a person able to communicate verbally or point, including a person with moderate to severe cognitive impairment.
Abbey Pain Scale (39kb pdf) A simple observational tool to measure pain in a person with dementia who cannot communicate verbally.
Pain Assessment in Advanced Dementia Scale (PAINAD) (44kb pdf) An observational tool to assess pain where a person is not able to answer or respond meaningfully to questions about pain.
Modified Borg Scale (182kb pdf) Assess difficulty of breathing in a person able to communicate verbally or point.
Brief Fatigue Inventory (156kb pdf) A tool that can be done as self-report or by interview to rapidly assess the severity and impact of fatigue, including cancer-related fatigue.

Cognitive Screening and Assessment

Clinical Tool Explanation
Confusion Assessment Method (CAM) Shortened Version (1.9MB pdf) Identify a person with delirium.

4AT (273kb pdf)

4AT guidance

 Screening instrument designed for a rapid initial assessment for delirium and cognitive impairment.

Rowland Universal Dementia Assessment Scale (RUDAS) (24kb pdf)

RUDAS guidance

 A short cognitive screening instrument designed to minimise the effects of cultural learning and language diversity on the assessment of baseline cognitive performance.
Kimberley Indigenous Cognitive Assessment (KICA)  Culturally appropriate tool for screening for dementia among older Aboriginal and Torres Strait Islander people. There are versions for urban/regional and remote settings.

Psychological Assessment

Clinical Tool Explanation
Geriatric Depression Scale (GDS) (217kb pdf) Tool used as an initial assessment of depression.
Rating Anxiety in Dementia (RAID) (152kb pdf) Tool to assess anxiety in people with dementia.
Neuropsychiatric Inventory Questionnaire (NPI-Q) (128kb pdf) A brief assessment of neuropsychiatric symptomatology in routine clinical practice settings.