The Environmental Cleanliness and Clutter Scale (ECCS).
BACKGROUND
Development of a scale to rate the degree and various aspects of uncleanliness will facilitate description and research in cases of severe domestic squalor.


METHODS
Discussion with representatives of relevant agencies led to selection of various aspects of domestic uncleanliness and clutter to be assessed when describing cases of squalor. Rooms and areas with varying functions (toilet, kitchen, bedroom, etc.) were all to be rated, along with other indicators of squalor (e.g. odor, vermin). Trial use and further discussion resulted in reduction to ten items, each rated on a four-point scale, with succinct descriptions of anchor-points. Two experienced psychogeriatricians then used this new Environmental Cleanliness and Clutter Scale (ECCS) to rate independently 55 dwellings which had been reported by Aged Care staff as cluttered or unclean, and also rated overall degree of squalor. Reliability and indications of validity were analyzed.


RESULTS
The inter-rater reliability for the ten items was considered satisfactory (kappa 0.48, varying from 0.31 to 0.58). Cronbach's alpha for the new scale was 0.94, demonstrating high internal consistency. Each author's ratings of degree of squalor (none to severe) matched well with the other's ratings on the scale; a score of >12 usually indicated moderate or severe squalor.


CONCLUSIONS
The ECCS proved reliable and useful in rating cases where elderly people were living in severe domestic squalor.
Halliday
Graeme
G
Sydney South West Area Health Service, Concord Hospital, Sydney, Australia.
Snowdon
John
J
D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D003153:Community Health Services / Q000331:legislation & jurisprudence*; D003156:Community Mental Health Services / Q000331:legislation & jurisprudence*; D003299:Cooperative Behavior; D004282:Documentation / Q000379:methods*; D057180:Frontotemporal Dementia / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D017408:Guidelines as Topic; D016852:Housing for the Elderly / Q000331:legislation & jurisprudence*; D006801:Humans; D006920:Hygiene / Q000331:legislation & jurisprudence*; D033183:Interdisciplinary Communication; D009517:New South Wales; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D011594:Psychometrics / Q000706:statistics & numerical data; D011618:Psychotic Disorders / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation*; D011634:Public Health / Q000331:legislation & jurisprudence*; D015203:Reproducibility of Results; D012559:Schizophrenia / Q000175:diagnosis / Q000534:rehabilitation*; D012931:Social Environment; D013577:Syndrome