International Psychogeriatrics

Research Article

Validation study of the Camberwell Assessment of Need for the Elderly (CANE) in Portugal

Lia Fernandesa1 c1, Manuel Gonçalves-Pereiraa2, António Leuschnera3, Sónia Martinsa4, Margarida Sobrala3, Luís F. Azevedoa5, Cláudia Diasa5, Raimundo Mateosa6 and Martin Orrella7

a1 Psychiatry Service of Hospital S. João / UNIFAI/ICBAS, University of Oporto, Portugal

a2 Department of Mental Health, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, FCM–UNL, Portugal

a3 Hospital Magalhães Lemos / Institute of Biomedical Sciences Abel Salazar, Portugal

a4 Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal

a5 Department of Biostatistics and Medical Informatics, Faculty of Medicine, University of Oporto, Portugal

a6 Department of Psychiatry (USC) and CHUS University Hospital, Santiago Compostela, Spain

a7 Department of Mental Health Sciences, University College London, U.K.


Background: The Camberwell Assessment of Need for the Elderly (CANE) is widely used for multidimensional evaluation of older people with mental health problems. The aim of this study was to evaluate reliability and validity of a Portuguese version of CANE.

Method: A cross-sectional multicenter study was designed using a convenience sample of elderly mental health services' users. CANE was compared with EASYCare, GHQ12, MMSE, Barthel Index and GDS15 to assess criterion and construct validity. Inter-rater and test-retest reliability were also assessed.

Results: 79 patients (76% female), with mean age of 74 (± 6.6) years were included. Most patients lived at home with a family caregiver, generally female. Only 32% had no carer. Dementia was the commonest psychiatric diagnosis (61%) and somatic comorbidity was very prevalent (85%). Kappa values (κ) for inter-rater item reliability ranged from 0.72 to 1.00 (mean values: 0.96 patient, 0.93 carer, 0.90 staff). The intraclass correlation coefficient (ICC) for total scores ranged from 0.95 to 0.98.

For test-retest item reliability, the mean κ value was: 0.80 patient, 0.77 carer, 0.81 staff. ICC for total scores ranged from 0.82 to 0.92. Given the absence of a gold standard, criterion validity was assessed by comparing CANE with EASYCare (rs0.460; p ≤ 0.01), GDS (rs0.615; p ≤ 0.01), GHQ (rs0.581; p ≤ 0.01) and Barthel Index (rs-0.435; p ≤ 0.01). Overall, inter-item and item-total correlations for CANE and item comparison with other measures indicated reasonable construct validity.

Conclusion: The psychometric proprieties of CANE seem to be consistently good, in accordance with other studies. Robust results on ecological, face, content, criterion and construct validity, as well as good reliability, were achieved. This version is a promising tool for research and practical use in Portuguese old age settings.

(Received April 28 2008)

(Revised July 03 2008)

(Revised August 19 2008)

(Accepted August 22 2008)

(Online publication November 20 2008)


c1 Correspondence should be addressed to: Lia Fernandes, Rua de Ceuta, 53-1°, 4050-191 Porto, Portugal. Phone: +351 228 319890. Email: