The CHESS scale was originally developed to detect frailty and instability in health in persons residing in residential or complex continuing care settings. It has since been adapted for use in home care and inpatient psychiatry settings. The CHESS attempts to identify individuals at risk of serious decline and can serve as an outcome where the objective is to minimize problems related to frailty (e.g., declines in function) in the elderly population. Higher CHESS scores are predictive of adverse outcomes like mortality and hospitalization.

The CHESS was developed by interRAI (a not-for-profit international research group with substantial experience in creating comprehensive assessment instruments for nursing homes, home care, acute care, assisted living, palliative care, and rehabilitation settings) to detect frailty and instability in health in a nursing home population. Because the items comprising the CHESS are present across many interRAI instruments, the CHESS may be used in many sectors, for assessment of individuals with a broad range of mental and physical health needs.

As stated above, because the items comprising the CHESS are present across many interRAI instruments, the CHESS may be used in many sectors, for assessment of individuals with a broad range of mental and physical health needs. Specifically, the CHESS is available for assessment of persons in the following sectors:

• Inpatient mental health (interRAI-MH)

• Community mental health (interRAI-CMH)

• Home care (RAI-HC)

• Long-term care (MDS 2.0)

• Palliative care (interRAI-PC)

• Community Health Assessment (interRAI-CHA)

The CHESS was developed in a nursing home population, but is available for use in many other sectors (see “Prevalence” above).

The CHESS is completed by relevant members of the interdisciplinary team involved in the care of the person being assessed.

The CHESS was designed for use in a nursing home population, but is available for use in many other sectors (see “Prevalence” above).

The CHESS is based on 9 items embedded within many interRAI instruments. Six items (vomiting, dehydration, decrease in food or fluid, weight loss, shortness of breath, edema) are summed to a maximum of two, then three additional items are added: decline in cognition, decline in ADL, and end-stage disease. This resulting CHESS scale has scores ranging between 0 (meaning no instability) to 5 (highly instable). In the long-term care population there is a clear differentiation of all levels of CHESS scores, and higher levels are associated with a reduction in survival over time and other adverse outcomes like hospitalization.

Yes. See reference below.

The CHESS detects frailty and instability in health.

The CHESS is completed by relevant members of the interdisciplinary team involved in the care of the person being assessed, using all available resources, including the person’s medical record, direct observation, direct questioning, and the questioning of family and friends.

CHESS scores range from 0 to 5.

The CHESS scale was originally developed to detect frailty and instability in health in persons residing in a nursing home, using the MDS 2.0. It has since been adapted for use in other settings with other interRAI instruments.

Are there different versions of the tool? Sometimes the different versions have different # of questions.

The CHESS algorithm is in the public domain. The instruments that collect the CHESS items are copyright interRAI who freely grant licences to jurisdictions.

Hirdes JP, Frijters D, Teare G. (2003) The MDS CHESS Scale: A New Measure to Predict Mortality in the Institutionalized Elderly. Journal of the American Geriatrics Society 51(1): 96-100.

Please visit interrai.org website for additional articles using CHESS scale.