Int J Geriatr Psychiatry. 2016 Jul;31(7):755-64. doi: 10.1002/gps.4388.

Development and preliminary validation of an Observation List for detecting mental disorders and social Problems in the elderly in primary and home care (OLP).

 Tak EC1, van Hespen AT1, Verhaak PF2, Eekhof J3, Hopman-Rock M1,4.

  • 1TNO (Netherlands organisation for applied scientific research) Department Lifestyle, Leiden, The Netherlands.
  • 2NIVEL (Netherlands Institute for health services research), Utrecht, The Netherlands.
  • 3Department of Public Health and Primary Care, LUMC (Leiden University Medical Center), Leiden, The Netherlands.
  • 4Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.




Even though the prevalence of mental disorders and social problems is high among elderly patients, it is difficult to detect these in a primary (home) care setting. Goal was the development and preliminary validation of a short observation list to detect six problem areas: anxiety, depression, cognition, suspicion, loneliness, and somatisation.


A draft list of indicators identified from a short review of the literature and the opinions of 22 experts was evaluated by general practitioners (GPs) and home care organisations for feasibility. It was then used by GPs and home care personnel to observe patients, who also completed validated tests for psychological disorders (General Health Questionnaire 12 item version (GHQ-12)), depression (Geriatric Depression Scale 15-item version (GDS-15)), anxiety and suspicion (Symptom Checklist-90 (SCL-90)), loneliness (University of California, Los Angeles (UCLA)), somatisation (Illness Attitude Scale (IAS)), and cognition (Mini-Mental State Examination (MMSE)).


GPs and home care personnel observed 180 patients (mean age 78.4 years; 66% female) and evaluated the draft list during a regular visit. Cronbach’s α was 0.87 for the draft list and ≥0.80 for the draft problem areas (loneliness and suspicion excepted). Principal component analysis identified six components (cognition, depression + loneliness, somatisation, anxiety + suspicion, depression (other signs), and an ambiguous component). Convergent validity was shown for the indicators list as a whole (using the GHQ-12), and the subscales of depression, anxiety, loneliness, cognition, and somatisation. Using pre-set agreed criteria, the list was reduced to 14 final indicators divided over five problem areas.


The Observation List for mental disorders and social Problems (OLP) proved to be preliminarily valid, reliable, and feasible for use in primary and home care settings. Copyright © John Wliey & Sons, Ltd.


ageing; mental disorder; observation; primary care; social problems; validation

PMID: 26556009



After publishing our paper regarding the OLD (Observation list of early signs of dementia) in 2001 (Hopman-Rock et al. for abstract see, we continued with the development of a broader observation list regarding dementia as well as mental and social problems (the OLP). Both lists were published in The International Journal of Geriatric Psychiatry (the OLP article is free access) and have a good preliminary validity and reliability. The OLD is used in The Netherlands as well as in other countries (a.o. in Japan).

Both observation lists can be used without costs. These lists are easy to use for professionals such as GPs, home care professionals and nurses. Because it only regards observation it is not demanding for patients and clients.

Observation list (14 indicators) for detecting mental and social problems in older patients/clients (OLP see for free access) during a regular consultation or visit (GP or home care professional)



Preliminary norms (researchers are encouraged to do further research with this list with reference to our publication):

Observed indicator=1 point; when in doubt= .5 point (1 point in case of Loneliness or Somatisation); not present=0 points; not observable=NA

If sumscore ≥ 4 further diagnosis required (sensitivity 0.72, specificity 0.77)

For depression  domain score ≥ 1 further diagnosis required (sensitivity 0.68, specificity 0.81)

For cognition domain  score ≥ 2 further diagnosis required (sensitivity 0.72, specificity 0.83)

For anxiety, loneliness and  somatisation: due to low sensitivity and specificity no further action, these domains contribute to the total score.


Possible questions to ease observation: “How old are you now?” “What was the last time you was here” “How are your grandchildren” “how do you run your household” etc.

For questions please ask prof. em. dr. Marijke Hopman-Rock


The OLD ( Hopman-Rock et al., 2001): please open using the Acrobat document object link



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