The validity and reliability of the Health of the Nation Outcome Scales (HoNOS) in the elderly

Abstract

Background. The Health of the Nation Scales were designed to be a brief and easy to complete measure of mental health outcomes but they have not been fully evaluated in the elderly. This study investigates the validity and reliability of the HoNOS in patients over 65 in contact with mental health services. Method. One hundred patients from a rural old age psychiatry service in Essex were interviewed using the HoNOS and a selection of other scales. The sources included day hospitals, in-patient units, outpatient clinics, geriatric liaison, and residential homes. Test-retest and inter-rater reliability were measured, and qualitative and quantitative aspects of validity were assessed. Results. One hundred patients were assessed using the package of rating scales. The HoNOS showed moderate to good interrater and test-retest reliability and Cronbach's alpha was 0.61. The HoNOS had good criterion validity and was able to predict placement, day patients and out-patients had lower scores than in-patients who had lower scores than residential and nursing home residents. The construct validity was adequate with correlations in line with clinical expectations. It also had good concurrent validity correlating well with other scales. The consensual and content validity suggested that the HoNOS was a useful well-constructed scale. The major areas requiring consideration were: (a) lack of carer's views, (b) safety and risk issues; (c) modification of cognitive scale for dementia, (d) modification of depression scale, (e) separating basic and complex skills in activities of daily living. Conclusion. The HoNOS has good validity and reliability within an elderly population with mental health problems but minor modifications may make it better suited to this group.