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Int Psychogeriatr. 2009 Dec;21(6):1041-50. doi: 10.1017/S1041610209990135. Epub 2009 Jul 10.

The Environmental Cleanliness and Clutter Scale (ECCS).

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  • 1Sydney South West Area Health Service, Concord Hospital, Sydney, Australia.



Development of a scale to rate the degree and various aspects of uncleanliness will facilitate description and research in cases of severe domestic squalor.


Discussion with representatives of relevant agencies led to selection of various aspects of domestic uncleanliness and clutter to be assessed when describing cases of squalor. Rooms and areas with varying functions (toilet, kitchen, bedroom, etc.) were all to be rated, along with other indicators of squalor (e.g. odor, vermin). Trial use and further discussion resulted in reduction to ten items, each rated on a four-point scale, with succinct descriptions of anchor-points. Two experienced psychogeriatricians then used this new Environmental Cleanliness and Clutter Scale (ECCS) to rate independently 55 dwellings which had been reported by Aged Care staff as cluttered or unclean, and also rated overall degree of squalor. Reliability and indications of validity were analyzed.


The inter-rater reliability for the ten items was considered satisfactory (kappa 0.48, varying from 0.31 to 0.58). Cronbach's alpha for the new scale was 0.94, demonstrating high internal consistency. Each author's ratings of degree of squalor (none to severe) matched well with the other's ratings on the scale; a score of >12 usually indicated moderate or severe squalor.


The ECCS proved reliable and useful in rating cases where elderly people were living in severe domestic squalor.

[PubMed - indexed for MEDLINE]
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