title: Making and Executing Decisions for Safe and Independent Living (MED-SAIL): development and validation of a brief screening tool.
abstract: OBJECTIVE
  Older adults prefer to remain in their own homes for as long as possible. The purpose of this article is to describe the development and preliminary validation of Making and Executing Decisions for Safe and Independent Living (MED-SAIL), a brief screening tool for capacity to live safely and independently in the community.
  
  
  METHODS
  Prospective preliminary validation study.
  
  
  METHODS
  Outpatient geriatrics clinic located in a community-based hospital.
  
  
  METHODS
  Forty-nine community-dwelling older adults referred to the clinic for a comprehensive capacity assessment.
  
  
  METHODS
  We examined internal consistency, criterion-based validity, concurrent validity, and accuracy of classification for MED-SAIL.
  
  
  RESULTS
  The items included in MED-SAIL demonstrated internal consistency (5 items; α = 0.85). MED-SAIL was significantly correlated with the Independent Living Scales (r = 0.573, p ≤0.001) and instrumental activities of daily living (r = 0.440, p ≤0.01). The Mann-Whitney U test revealed significant differences between the no capacity and partial/full capacity classifications on MED-SAIL (U(48) = 60.5, Z = -0.38, p <0.0001). The area under the curve was 0.864 (95% confidence interval: 0.84-0.99).
  
  
  CONCLUSIONS
  This study demonstrated the validity of MED-SAIL as a brief screening tool to identify older adults with impaired capacity for remaining safe and independent in their current living environment. MED-SAIL is useful tool for health and social service providers in the community for the purpose of referral for definitive capacity evaluation.
authors.affiliation: Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX. Electronic address: wmills@bcm.edu.
authors.forename: Whitney L
authors.initials: WL
authors.lastname: Mills
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX; Quentin Mease Community Hospital, Harris County Hospital District, Houston, TX.
authors.forename: Tziona
authors.initials: T
authors.lastname: Regev
authors.affiliation: Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Psychiatry, Baylor College of Medicine, Houston, TX; Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
authors.affiliation: Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX; Huffington Center on Aging, Baylor College of Medicine, Houston, TX.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Wilson
authors.affiliation: Veterans Affairs Boston Healthcare System and Department of Psychiatry, Harvard Medical School, Boston, MA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Moye
authors.affiliation: Department of Medicine, Baylor College of Medicine, Houston, TX; Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
authors.affiliation: Houston Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Department of Medicine, Baylor College of Medicine, Houston, TX; Department of Psychiatry, Baylor College of Medicine, Houston, TX; Veterans Affairs South Central Mental Illness Research, Education, and Clinical Center, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX; Huffington Center on Aging, Baylor College of Medicine, Houston, TX.
authors.forename: Aanand D
authors.initials: AD
authors.lastname: Naik
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D000375:Aging / Q000523:psychology*; D003657:Decision Making; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D057187:Independent Living / Q000523:psychology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity
keywords: Capacity assessment; aging in place; guardianship; screening tool