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Saari ME, Giosa JL, Holyoke P, Heckman GA, Hirdes JP. Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term 'life care' at home. PLoS One 2024; 19:e0300521. [PMID: 38558082 PMCID: PMC10984553 DOI: 10.1371/journal.pone.0300521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/28/2024] [Indexed: 04/04/2024] Open
Abstract
Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data. Retrospective, cross-sectional analyses of 2017-2018 Resident Assessment Instrument Home Care (RAI-HC) assessments (n = 162,523) were completed to group home care clients by service needs and generate comprehensive profiles of each group's dominant medical, functional, cognitive, and psychosocial care needs. Six unique groups were identified, with care profiles representing home care clients living with Geriatric Syndromes, Medical Complexity, Cognitive Impairment and Behaviours, Caregiver Distress and Social Frailty. Depending on group membership, between 51% and 81% of clients had identified care needs spanning four or more Positive Health dimensions, demonstrating both the heterogeneity and complexity of clients served by home care. Comprehensive clinical profiles, developed from routinely collected assessment data, support a future-focused, evidence-informed, and community-engaged approach to research and practice in integrated home-based health and social care.
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Affiliation(s)
- Margaret E. Saari
- SE Research Centre, SE Health, Markham, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Justine L. Giosa
- SE Research Centre, SE Health, Markham, Ontario, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - George A. Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - John P. Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Schumacher CL, Correia R, Hogeveen S, Salter M, Donaldson B. Implementing the interRAI Check-Up Comprehensive Assessment: Facilitating Care Planning and Care Coordination during the Pandemic. Int J Integr Care 2023; 23:5. [PMID: 37091494 PMCID: PMC10120599 DOI: 10.5334/ijic.7007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 03/29/2023] [Indexed: 04/25/2023] Open
Abstract
Background Long-stay home care patients are a large population of older adults with multi-morbidity and frailty. The COVID-19 pandemic posed challenges to executing care coordination and completing in-home assessments due to provincial mandates restricting in-person care. We evaluated the implementation of the interRAI Check-Up Self-Report instrument administered by phone and video. Methods We report on a mixed-methods study, which involved the collection and analysis of survey and focus group data. Care coordinators from two regions in Ontario who had implemented the Check-Up at least once between March 2020 to September 2021 were recruited via convenience sampling. Results A total of 48 survey respondents and 7 focus group participants consented to the study. Advantages of completing the Check-Up over the telephone or video call included: reduced travel time, reduced risk of disease transmission, familiarity with the assessment questions, and reduced time spent administering the assessment. Limitations most frequently reported were: the inability to see the living environment, hearing impairments, inability to observe non-verbal responses or cues, language barriers, difficulty building rapport, and difficulty understanding the patient. Conclusions The Check-Up was advantageous in providing sufficient information to create a care plan when administered over the phone and by video. Implementation of the Check-Up assessment was facilitated by familiarity and alignment with other interRAI assessments. Our results indicate that population characteristics need to be taken into consideration for administration of self-report style of assessments.
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Wang S, de Almeida Mello J, Declercq A. Factors associated with informal caregiver's ability to continue care: a subgroup analysis. Age Ageing 2022; 51:6931843. [PMID: 36580387 DOI: 10.1093/ageing/afac275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND/OBJECTIVE maintaining informal caregiver's ability to continue care can prevent early institutionalisation and decrease health care costs, contributing to sustainable health care. This study aims to identify factors associated with informal caregiver's ability to continue care across several degrees of cognitive decline and risk of burden. METHODS this is a cross-sectional study that collected nationwide data on frail older people and their informal caregivers living in the community. Instruments used were InterRAI Home Care, Zarit Burden Interview and questionnaire for the informal caregiver. Multivariate logistic regression analyses and a stratification of the population were performed. RESULTS a total of 8,309 people had at least one primary caregiver, and a majority of them were able to continue care (68.2%). Cognitive impairment was a risk factor for being able to continue care, even the borderline (odds ratios (ORs): 0.72; 95% CI: 0.61-0.85) or mild condition (OR: 0.52; 95% CI: 0.43-0.61). Protective factors like social participation of older people, strong family support and availability of a secondary caregiver showed the highest association in subgroups with mild cognitive impairment (ORs: 2.20, 2.08, 1.64) and in subgroups at low risk of burden (ORs: 1.91, 2.77, 1.64). CONCLUSION factors associated with informal caregiver's ability to continue care vary across several degrees of cognitive decline and risk of burden. Interventions related to family and social support resources are recommended, and informal caregivers at a lower level of risk may benefit most. Supportive counselling should be proactively provided to informal caregivers, considering the changes of associated factors with the ongoing caregiving situation.
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Affiliation(s)
- Shanshan Wang
- LUCAS-Centre for Care Research & Consultancy KU Leuven, 3000 Leuven, Belgium
| | - Johanna de Almeida Mello
- LUCAS-Centre for Care Research & Consultancy KU Leuven, 3000 Leuven, Belgium.,Population studies Oral health, Department of Oral Health Sciences KU Leuven, 3000 Leuven, Belgium
| | - Anja Declercq
- LUCAS-Centre for Care Research & Consultancy KU Leuven, 3000 Leuven, Belgium.,CeSO-Centre for Sociological Research, Faculty of Social Sciences KU Leuven, 3000 Leuven, Belgium
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4
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Lynch-Godrei A, Doherty M, Vadeboncoeur C. interRAI Pediatric Home Care (PEDS-HC) Assessment Tool: Evaluating Ontario Healthcare Workers’ Experience. Health Serv Insights 2022; 15:11786329221078124. [PMID: 35360089 PMCID: PMC8961368 DOI: 10.1177/11786329221078124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/07/2022] [Indexed: 11/15/2022] Open
Abstract
High quality pediatric homecare requires comprehensive assessment of the needs, supports,
and health care challenges of children with special healthcare needs and their families.
There is no standardized homecare assessment system to evaluate children’s clinical needs
in the home (support services, equipment, etc.) in Ontario, Canada, which contributes to
inequitable homecare service allocation. In 2017, the interRAI Pediatric Home Care
assessment tool (PEDS-HC) was implemented on a pilot basis in several regions of Ontario.
This qualitative descriptive study explores the experiences of homecare coordinators using
the PEDS-HC, seeking to understand the utility and feasibility of this tool through focus
group discussion. Four major themes were identified including: the benefits of the tool;
areas for modification; challenges to use; and Clinical Assessment Protocols to develop.
These themes can guide modifications to the tool to improve utility and improve pediatric
home care services. The PEDS-HC is an effective tool to assess children needing homecare
in a standardized and comprehensive manner. Use of the tool can improve the quality of
homecare services by ensuring equity in service provision and facilitate early
identification of clinical issues to prevent unexpected health deteriorations.
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Affiliation(s)
- Anisha Lynch-Godrei
- CHEO Research Institute, Ottawa, ON, Canada
- Roger Neilson House, Ottawa, ON, Canada
| | - Megan Doherty
- CHEO Research Institute, Ottawa, ON, Canada
- Roger Neilson House, Ottawa, ON, Canada
- CHEO, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
| | - Christina Vadeboncoeur
- CHEO Research Institute, Ottawa, ON, Canada
- Roger Neilson House, Ottawa, ON, Canada
- CHEO, Ottawa, ON, Canada
- University of Ottawa, Ottawa, ON, Canada
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5
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Hall Y, Smith J, Turner RM, Greco P, Hau K, Barak Y. Creating opportunities to improve detection of older adult abuse: a national interRAI study. BMC Geriatr 2022; 22:220. [PMID: 35300608 PMCID: PMC8928619 DOI: 10.1186/s12877-022-02938-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 03/11/2022] [Indexed: 11/18/2022] Open
Abstract
Despite being recognized as a major global health issue, older adult abuse (OAA) remains largely undetected and under-reported. Most OAA assessment tools fail to capture true prevalence. Follow up of patients where abuse exposure is not easily determined is a necessity. The interRAI-HC (International Resident Assessment Instrument—Home Care) currently underestimates the extent of abuse. We investigated how to improve detection of OAA using the interRAI-HC. Analysis of 7 years of interRAI-HC data from an Aotearoa New Zealand cohort was completed. We identified that through altering the criteria for suspicion of OAA, capture rates of at-risk individuals could be nearly doubled from 2.6% to 4.8%. We propose that via adapting the interRAI-HC criteria to include the "unable to determine" whether abuse occurred (UDA) category, identification of OAA sufferers could be substantially improved. Improved identification will facilitate enhanced protection of this vulnerable population.
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Affiliation(s)
- Yvette Hall
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Jim Smith
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Robin M Turner
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | | | - Kenny Hau
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand
| | - Yoram Barak
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, New Zealand.
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Kristinsdottir IV, Jonsson PV, Hjaltadottir I, Bjornsdottir K. Changes in home care clients' characteristics and home care in five European countries from 2001 to 2014: comparison based on InterRAI - Home Care data. BMC Health Serv Res 2021; 21:1177. [PMID: 34715850 PMCID: PMC8555210 DOI: 10.1186/s12913-021-07197-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Policymakers advocate extended residence in private homes as people age, rather than relocation to long-term care facilities. Consequently, it is expected that older people living in their own homes will be frailer and have more complex health problems over time. Therefore, community care for aging people is becoming increasingly important to facilitate prevention of decline in physical and cognitive abilities and unnecessary hospital admission and transfer to a nursing home. The aim of this study was to examine changes in the characteristic of home care clients and home care provided in five European countries between 2001 and 2014 and to explore whether home care clients who are most in need of care receive the care required. Methods This descriptive study used data from two European research projects, Aged in Home Care (AdHOC; 2001–2002) and Identifying best practices for care-dependent elderly by Benchmarking Costs and outcomes of Community Care (IBenC; 2014–2016). In both projects, the InterRAI-Home Care assessment tool was used to assess a random sample of home care clients 65 years and older in five European countries. These data facilitate a comparison of physical and cognitive health and the provided home care between countries and study periods. Results In most participating countries, both cognitive (measured on the Cognitive Performance Scale) and functional ability (measured on the Activities of Daily Living Hierarchy scale) of home care clients deteriorated over a 10-year period. Home care provided increased between the studies. Home care clients who scored high on the physical and cognitive scales also received home care for a significantly higher duration than those who scored low. Conclusion Older people in several European countries remain living in their own homes despite deteriorating physical and cognitive skills. Home care services to this group have increased. This indicates that the government policy of long-term residence at own home among older people, even in increased frailty, has been realised.
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Affiliation(s)
- I V Kristinsdottir
- Faculty of Nursing, University of Iceland, Eiríksgata 34, 101, Reykjavík, Iceland. .,Home Care center, The Capital Area Primary Care, Álfabakki 16, 109, Reykjavík, Iceland.
| | - P V Jonsson
- Faculty of Medicine, University of Iceland, Vatnsmýrarvegur 16, 101, Reykjavík, Iceland.,Department of Geriatrics, The National University Hospital of Iceland, Túngata 26, 101, Reykjavík, Iceland
| | - I Hjaltadottir
- Faculty of Nursing, University of Iceland, Eiríksgata 34, 101, Reykjavík, Iceland.,Department of Geriatrics, The National University Hospital of Iceland, Túngata 26, 101, Reykjavík, Iceland
| | - K Bjornsdottir
- Faculty of Nursing, University of Iceland, Eiríksgata 34, 101, Reykjavík, Iceland
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Seow H, Dutta P, Johnson MJ, McMillan K, Guthrie DM, Costa AP, Currow DC. Prevalence and Risk Factors of Breathlessness Across Canada: A National Retrospective Cohort Study in Home Care and Nursing Home Populations. J Pain Symptom Manage 2021; 62:346-354.e1. [PMID: 33276042 DOI: 10.1016/j.jpainsymman.2020.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/21/2022]
Abstract
CONTEXT Breathlessness is a symptom associated with poor clinical outcomes and prognosis. Little is known about its long-term trends and associations with social factors including decline in social activities and caregiver distress. OBJECTIVES To describe factors associated with the prevalence of clinician-reported breathlessness across Canada among cohorts receiving home care or nursing home care. METHODS A retrospective observational cohort study of cross-sectional intake assessment data from Canadian interRAI Home Care and Nursing Home data sets. In each data set, we examined covariates associated with the presence of clinician-reported breathlessness using multivariate regression. RESULTS Between 2007 and 2018, we identified 1,317,117 and 469,709 individuals from the home care and nursing home data sets, respectively. Over two-thirds were aged >75 and over 60% were women. Breathlessness was present at intake in 26.0% of the home care and 8.2% of the nursing home cohorts. Between 2007 and 2018, prevalence of breathlessness increased by 10% for the home care cohort, while remaining relatively constant in nursing homes. Covariates associated with increased odds of having clinician-reported breathlessness at intake in both cohorts were moderate-severe impairment with activities of daily living, being male, older age, high pain scores, signs of depression, and decline in social activities. In the home care cohort, the presence of breathlessness was associated with a greater odds of caregiver distress (odds ratio = 1.19, 95% CI: 1.18-1.20). CONCLUSION The prevalence of clinician-reported breathlessness is higher in home care than in nursing home populations, the former having risen by 10% over the decade. Prevalence of breathlessness is associated with decline in social activities and caregiver distress. Enhanced supports may be required to meet increasing patient need in the community.
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Affiliation(s)
- Hsien Seow
- McMaster University, Hamilton, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
| | | | | | | | | | - Andrew P Costa
- McMaster University, Hamilton, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Northwood M, Ploeg J, Markle-Reid M, Sherifali D. Home-Care Nurses' Experiences of Caring for Older Adults With Type 2 Diabetes Mellitus and Urinary Incontinence: An Interpretive Description Study. SAGE Open Nurs 2021; 7:23779608211020977. [PMID: 34179458 PMCID: PMC8193650 DOI: 10.1177/23779608211020977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction A third of older adults with diabetes receiving home-care services have daily urinary incontinence. Despite this high prevalence of urinary incontinence, the condition is typically not recognized as a complication and thereby not detected or treated. Diabetes and urinary incontinence in older adults are associated with poorer functional status and lower quality of life. Home-care nurses have the potential to play an important role in supporting older adults in the management of these conditions. However, very little is known about home-care nurses’ care of this population. Objective The objective of this study was to explore how nurses care for older home-care clients with diabetes and incontinence. Methods This was an interpretive description study informed by a model of clinical complexity, and part of a convergent, mixed methods research study. Fifteen nurse participants were recruited from home-care programs in southern Ontario, Canada to participate in qualitative interviews. An interpretive description analytical process was used that involved constant comparative analysis and attention to commonalities and variance. Results The experiences of home-care nurses caring for this population is described in three themes and associated subthemes: (a) conducting a comprehensive nursing assessment with client and caregiver, (b) providing holistic treatment for multiple chronic conditions, and (c) collaborating with the interprofessional team. The provision of this care was hampered by a task-focused home-care system, limited opportunities to collaborate and communicate with other health-care providers, and the lack of health-care system integration between home care, primary care, and acute care. Conclusion The results suggest that nursing interventions for older adults with diabetes and incontinence should not only consider disease management of the individual conditions but pay attention to the broader social determinants of health in the context of multiple chronic conditions. Efforts to enhance health-care system integration would facilitate the provision of person-centred home care.
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Affiliation(s)
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | - Diana Sherifali
- School of Nursing, McMaster University, Hamilton, Ontario, Canada.,Diabetes Care and Research Program, Hamilton Health Sciences, Ontario, Canada
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Iduye S, Risling T, McKibbon S, Iduye D. Optimizing the InterRAI Assessment Tool in Care Planning Processes for Long-Term Residents: A Scoping Review. Clin Nurs Res 2021; 31:5-19. [PMID: 34056955 PMCID: PMC8652361 DOI: 10.1177/10547738211020373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this review was to chart and report on existing literature that discusses how the interRAI assessment tool drives care-planning processes for residents in long-term-care settings. This scoping review was informed by the Joanna Briggs Institute guidelines for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guideline. Relevant studies were obtained from databases search of CINAHL (EBSCO), MEDLINE (Ovid), PsycINFO (EBSCO), Academic Search Premier (EBSCO), Embase (Elsevier), ProQuest Nursing and Allied Health Database (ProQuest), Sociological Abstracts (ProQuest), and Social Services Abstracts (ProQuest). Of the 17 included studies, five (29.4%) addressed interRAI’s minimum dataset component as a clinical data-collection tool; five (29.4%) addressed interRAI’s assessment scales and its clinical-assessment protocols as viable health-assessment tools; four (23.5%) considered interRAI’s assessment scales in terms of whether this tool is capable of predicting residents’ health risks; one (5.9%) addressed the effects of interRAI’s care plans on residents’ health outcomes; and the remaining two studies (11.8%) used interRAI’s quality-indicator function for both the performance of and improvements in the quality of care. The scoping review finds that there is no substantial evidence that supports the implementation of interRAI care plans for consistent health outcomes.
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Affiliation(s)
- Steve Iduye
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Tracie Risling
- University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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10
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How Well Does Self-Reported Health Predict Mortality in an InterRAI Context? An Exploratory Analysis. J Am Med Dir Assoc 2021; 22:2216-2218.e1. [PMID: 33757724 DOI: 10.1016/j.jamda.2021.02.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/09/2021] [Accepted: 02/09/2021] [Indexed: 11/23/2022]
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Igarashi A, Yamamoto-Mitani N, Ota A, Ishibashi T, Ikegami N. Care Prevention Needs in Community-Dwelling Older Adults in Japan. Health (London) 2021. [DOI: 10.4236/health.2021.132011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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12
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Geffen LN, Kelly G, Morris JN, Hogeveen S, Hirdes J. "Establishing the criterion validity of the interRAI Check-Up Self-Report instrument". BMC Geriatr 2020; 20:260. [PMID: 32727385 PMCID: PMC7391526 DOI: 10.1186/s12877-020-01659-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background Low and middle-income countries have growing older populations and could benefit from the use of multi-domain geriatric assessments in overcoming the challenge of providing quality health services to older persons. This paper reports on the outcomes of a study carried out in Cape Town, South Africa on the validity of the interRAI Check-Up Self-Report instrument, a multi-domain assessment instrument designed to screen older persons in primary health settings. This is the first criterion validity study of the instrument. The instrument is designed to identify specific health problems and needs, including psychosocial or cognition problems and issues related to functional decline. The interRAI Check-Up Self-Report is designed to be compatible with the clinician administered instruments in the interRAI suite of assessments, but the validity of the instrument against clinician ratings has not yet been established. We therefore sought to establish whether community health workers, rather than trained healthcare professionals could reliably administer the self-report instrument to older persons. Methods We evaluated the criterion validity of the self-report instrument through comparison to assessments completed by a clinician assessor. A total of 112 participants, aged 60 or older were recruited from 7 seniors clubs in Khayelitsha, Cape Town. Each participant was assessed by one of two previously untrained, non-healthcare personnel using the Check-Up Self-report version and again by a trained assessor using the clinician version of the interRAI Check-Up within 48 h. Our analyses focused on the degree of agreement between the self-reported and clinician-rated versions of the Check-Up based on the simple or weighted kappa values for the two types of ratings. Binary variables used simple kappas, and ordinal variables with three or more levels were examined using weighted kappas with Fleiss-Cohen weights. Results Based on Cohen’s Kappa values, we were able to establish that high levels of agreement existed between clinical assessors and lay interviewers, indicating that the instrument can be validly administered by community health workers without formal healthcare training. 13% of items had kappa values ranging between 0.10 and 0.39; 51% of items had kappa values between 0.4 and 0.69; and 36% of items had values of between 0.70 and 1.00. Conclusion Our findings indicate that there is potential for the Check-Up Self-Report instrument to be implemented in under-resourced health systems such as South Africa’s.
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Affiliation(s)
- Leon N Geffen
- Samson Institute for Ageing Research, University of Cape Town, Cape Town, South Africa
| | - Gabrielle Kelly
- Samson Institute for Ageing Research, 234 Upper Buitenkant Street, Cape Town, 8001, South Africa.
| | - John N Morris
- Marcus Institute for Aging Research, Boston, MA, USA
| | - Sophie Hogeveen
- Women's College Hospital Institute for Health System Solutions and Virtual Care; McMaster Institute for Research on Aging, Hamilton, Canada
| | - John Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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13
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Jiang C, Zou M, Chen M, Jiang Y, Chang P, Cui Y, Jiang L. Reliability and validity of the Mandarin version of the Continuity Assessment Record and Evaluation for older people who are transferred between hospitals and nursing homes in China. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1180-1189. [PMID: 32048425 DOI: 10.1111/hsc.12951] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 06/10/2023]
Abstract
To date, assessment tools for older people are different between hospitals and nursing homes in China. The difference between assessment tools can lead to poor communication of information between hospitals and nursing homes, which causes discontinuity of care and adverse outcomes when older people are transferred between these different settings. Continuity Assessment Record and Evaluation (CARE) is a comprehensive geriatric assessment tool developed in the United States of America. This study aimed to evaluate the reliability and validity of the Mandarin Version of CARE for older people who are transferred between hospitals and nursing homes. Using a convenience sampling method, 120 older people in hospitals and 120 older people in nursing homes in Shanghai were selected to test the internal consistency, interrater reliability and criterion-related validity of CARE from May to November 2017. When used among hospital, 70.0% (7/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an intraclass correlation coefficient (ICC) of greater than 0.75. When used in nursing homes, 90.0% (9/10) of the subscales had a Cronbach's alpha coefficients of greater than 0.7, 94.3% (50/53) of the items had an ICC of greater than 0.75. For both settings, the correlation coefficients of the subscales with their corresponding instruments for criterion-related validity were all greater than 0.8 (p < .01). The Mandarin version of CARE exhibits good reliability and validity. It can be used as an assessment tool for transition between hospitals and nursing homes.
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Affiliation(s)
- Caixia Jiang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Min Zou
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | | | - Yijun Jiang
- Shanghai Jiao Tong University School of Nursing, Shanghai, China
| | - Polun Chang
- Institute of bioMedical Informatics, National Yang-Ming University, Taipei City, Taiwan
| | - Yanyan Cui
- Institute of bioMedical Informatics, National Yang-Ming University, Taipei City, Taiwan
| | - Liping Jiang
- Department of Nursing, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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14
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Wagner A, Schaffert R, Möckli N, Zúñiga F, Dratva J. Home care quality indicators based on the Resident Assessment Instrument-Home Care (RAI-HC): a systematic review. BMC Health Serv Res 2020; 20:366. [PMID: 32349757 PMCID: PMC7191714 DOI: 10.1186/s12913-020-05238-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 04/19/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One way of measuring the quality of home care are quality indicators (QIs) derived from data collected with the Resident Assessment Instrument-Home Care (RAI-HC). In order to produce meaningful results for quality improvement and quality comparisons across home care organizations (HCOs) and over time, RAI-HC QIs must be valid and reliable. The aim of this systematic review was to identify currently existing RAI-HC QIs and to summarize the scientific knowledge on the validity and reliability of these QIs. METHODS A systematic review was performed using the electronic databases PubMed, CINAHL, Embase, PsycINFO and Cochrane Library. Studies describing the development process or the psychometric characteristics of RAI-HC QIs were eligible. The data extraction involved a general description of the included studies as well as the identified RAI-HC QIs and information on validity and reliability. The methodological quality of the identified RAI-HC QI sets was assessed using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. RESULTS Four studies out of 659 initial hits met the inclusion criteria. The included studies described the development and validation process of three RAI-HC QI sets comprising 48 unique RAI-HC QIs, which predominantly refer to outcome of care. Overall, the validity and reliability of the identified RAI-HC QIs were not sufficiently tested. The methodological quality of the three identified RAI-HC QI sets varied across the four AIRE instrument domains. None of the QI sets reached high methodological quality, defined as scores of 50% and higher in all four AIRE instrument domains. CONCLUSIONS This is the first review that systematically summarized and appraised the available scientific evidence on the validity and reliability of RAI-HC QIs. It identified insufficient reporting of RAI-HC QIs validation processes and reliability as well as missing state-of-the-art methodologies. The review provides guidance as to what additional validity and reliability testing are needed to strengthen the scientific soundness of RAI-HC QIs. Considering that RAI-HC QIs are already implemented and used to measure and compare quality of home care, further investigations on RAI-HC QIs reliability and validity is recommended.
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Affiliation(s)
- Aylin Wagner
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Health Sciences, Technikumstrasse 71, 8401, Winterthur, Switzerland.
| | - René Schaffert
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Health Sciences, Technikumstrasse 71, 8401, Winterthur, Switzerland
| | - Nathalie Möckli
- University of Basel, Medical Faculty, Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Franziska Zúñiga
- University of Basel, Medical Faculty, Department of Public Health, Institute of Nursing Science, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Julia Dratva
- ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Health Sciences, Technikumstrasse 71, 8401, Winterthur, Switzerland.,University of Basel, Medical Faculty, Klingelbergstrasse 61, 4056, Basel, Switzerland
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15
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Geffen LN, Kelly G, Morris JN, Howard EP. Peer-to-peer support model to improve quality of life among highly vulnerable, low-income older adults in Cape Town, South Africa. BMC Geriatr 2019; 19:279. [PMID: 31640576 PMCID: PMC6805367 DOI: 10.1186/s12877-019-1310-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/10/2019] [Indexed: 11/17/2022] Open
Abstract
Background Developing countries are experiencing rapid population ageing. Many do not have the resources or formal structures available to support the health and wellbeing of people as they age. In other contexts, the use of peer support programmes have shown favourable outcomes in terms of reducing loneliness, increasing physical activity and managing chronic disease. Such programmes have not been previously developed or tested in African countries. We piloted a peer-to-peer support model among vulnerable community-dwelling adults in a developing country (South Africa) to examine the program’s effect on wellbeing and social engagement. Methods A pre-post, pilot design was used to evaluate targeted outcomes, including wellbeing, social support, social interaction, mood, loneliness and physical activity. A total of 212 persons, aged 60+ years and living independently in a low-income area in Cape Town were recruited and screened for eligibility by trained assessors. Participants were assessed using the interRAI CheckUp, WHO-5 Wellbeing index, and the MOS-SS 8 instruments before and after the 5-month intervention, during which they received regular visits and phone calls from trained peer volunteers. During visits volunteers administered a wellness screening, made referrals to health and social services; built friendships with clients; encouraged social engagement; promoted healthy living; and provided emotional and informational support. Results Volunteer visits with clients significantly increased levels of self-reported wellbeing by 58%; improved emotional and informational support by 50%; decreased reports of reduced social interaction by 91%; reduced loneliness by 70%; improved mood scores represented as anxiety, depression, lack of interest or pleasure in activities, and withdrawal from activities of interest; and increased levels of physical activity from 49 to 66%. Discussion The intervention led to demonstrable improvement in client wellbeing. Policymakers should consider integrating peer-support models into existing health programs to better address the needs of the elderly population and promote healthy ageing in resource-poor community settings. Longer-term and more rigorous studies with a control group are needed to support these findings and to investigate the potential impact of such interventions on health outcomes longitudinally.
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Affiliation(s)
- Leon N Geffen
- Samson Institute for Ageing Research, 234 Upper Buitenkant Street, Cape Town, 8001, South Africa
| | - Gabrielle Kelly
- Samson Institute for Ageing Research, 234 Upper Buitenkant Street, Cape Town, 8001, South Africa.
| | - John N Morris
- Marcus Institute for Aging Research, Boston, MA, USA
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16
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Moye J. Healthcare Systems Meet Family Systems: Improving Healthcare for Older Adults and Their Families. Clin Gerontol 2019; 42:461-462. [PMID: 31451068 DOI: 10.1080/07317115.2019.1651485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Jennifer Moye
- VA New England GRECC and Harvard Medical School , Boston and Bedford , MA , USA.,Department of Psychiatry, Harvard Medical School , Boston , MA , USA
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17
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Bala SS, Jamieson HA, Nishtala PS. Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment. Int J Geriatr Psychiatry 2019; 34:153-161. [PMID: 30251394 DOI: 10.1002/gps.5004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 09/08/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To identify the prevalence and predictors of prescribing potentially inappropriate medications (PIMs) in a nationwide cohort of community dwellers with dementia requiring complex care needs. METHODS A cross-matched data of the International Resident Assessment Instrument-Home Care (9.1) (interRAI-HC) and prescribing data obtained from the Pharmaceutical Claims Data Mart (Pharms) extract files for older adults (≥65 y) requiring complex care needs were utilized for this study. The 2015 Beers criteria were applied to identify the prevalence of PIMs in older adults with dementia. Sociodemographic and clinical predictors of PIMs were analysed using a logistic regression model. RESULTS The study population consisted of 16 568 individuals who had their first interRAI assessment from 1 January 2015 to 31 December 2015. The estimated prevalence of dementia was 13.2% (2190/16 568). 66.9% (1465/2190) of the older adults diagnosed with dementia were prescribed PIMs, of which anticholinergic medications constituted 59.6% (873/1465). Males and individuals who were prescribed a greater number of medications were more likely to be prescribed PIMs. Individuals over 85 years of age, Māori ethnic group of individuals, older adults who were being supervised with respect to their activities of daily living, and individuals who reported good or excellent self-reported health had a lesser likelihood of being prescribed PIMs. CONCLUSION We found that PIMs are prescribed frequently in older adults with dementia. Comprehensive geriatric assessments can serve as a potential tool to decrease the occurrence of PIMs in vulnerable groups with poor functional and cognitive status.
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Affiliation(s)
- Sharmin S Bala
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Hamish A Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Prasad S Nishtala
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
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