Psychometric Properties of the Proxy-Reported Life-Space Assessment in Institutionalized Settings (LSA-IS-Proxy) for Older Persons with and without Cognitive Impairment

Connect-Home transitional care from skilled nursing facilities to home: A stepped wedge, cluster randomized trial

BACKGROUND

Skilled nursing facility (SNF) patients and their caregivers who transition to home experience complications and frequently return to acute care. We tested the efficacy of the Connect-Home transitional care intervention on patient and caregiver preparedness for care at home, and other patient and caregiver-reported outcomes.

METHODS

We used a stepped wedge, cluster-randomized trial design to test the intervention against standard discharge planning (control). The setting was six SNFs and six home health offices in one agency. Participants were 327 dyads of patients discharged from SNF to home and their caregivers; 11.1% of dyads in the control condition and 81.2% in the intervention condition were enrolled after onset of COVID-19. Patients were 63.9% female and mean age was 76.5 years. Caregivers were 73.7% female and mean age was 59.5 years. The Connect-Home intervention includes tools, training, and technical assistance to deliver transitional care in SNFs and patients' homes. Primary outcomes measured at 7 days included patient and caregiver measures of preparedness for care at home, the Care Transitions Measure-15 (patient) and the Preparedness for Caregiving Scale (caregiver). Secondary outcomes measured at 30 and 60 days included the McGill Quality of Life Questionnaire, Life Space Assessment, Zarit Caregiver Burden Scale, Distress Thermometer, and self-reported number of patient days in the ED or hospital in 30 and 60 days following SNF discharge.

RESULTS

The intervention was not associated with improvement in patient or caregiver outcomes in the planned analyses. Post-hoc analyses that distinguished between pre- and post-pandemic effects suggest the intervention may be associated with increased patient preparedness for discharge and decreased number of acute care days.

CONCLUSIONS

Connect-Home transitional care did not improve outcomes in the planned statistical analysis. Post-hoc findings accounting for COVID-19 impact suggest SNF transitional care has potential to increase patient preparedness and decrease return to acute care.

Assessing life-space mobility : A systematic review of questionnaires and their psychometric properties

BACKGROUND

Life-space mobility (LSM), as the extent of mobility within one's environment, is a key for successful aging and has become a relevant concept in gerontology and geriatric research. Adequate assessment instruments are needed to identify older persons with LSM restrictions, and to initiate, adapt or evaluate intervention strategies.

OBJECTIVE

To systematically identify, describe and analyze the psychometric properties of LSM questionnaires, with a special focus on their availability in the German language.

METHODS

A systematic literature search was conducted in PubMed, PsycINFO, Cochrane Library, CINAHL, and Web of Science. Studies that examined at least one psychometric property of LSM questionnaires published up to August 2021 were included and evaluated based on the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines.

RESULTS

This study included 37 validation studies describing 13 different LSM questionnaires. Methodological quality and comprehensiveness of validations were heterogeneous. Based on comprehensive and high-quality results, four LSM questionnaires stood out: the University of Alabama at Birmingham life-space assessment (UAB-LSA), life-space assessment in persons with cognitive impairment (LSA-CI), interview-based and proxy-based versions of the life-space assessment in institutionalized settings (LSA-IS), all of them available in the German language.

CONCLUSION

This systematic review provides a concise overview of available LSM questionnaires and their psychometric properties to facilitate the selection for use in clinical practice and research. The UAB-LSA and LSA-CI for community settings and the interview-based or proxy-based LSA-IS for institutional settings were found to be the most appropriate LSM questionnaires.

Validation of the German Life-Space Assessment (LSA-D): cross-sectional validation study in urban and rural community-dwelling older adults

OBJECTIVES

To develop a German version of the original University of Alabama at Birmingham Study of Aging Life-Space Assessment (LSA-D) for measurement of community mobility in older adults within the past 4 weeks and to evaluate its construct validity for urban and rural populations of older adults.

DESIGN

Cross-sectional validation study.

SETTING

Two study centres in urban and rural German outpatient hospital settings.

PARTICIPANTS

In total, N=83 community-dwelling older adults were recruited (n=40 from urban and n=43 from rural areas; mean age was 78.5 years (SD=5.4); 49.4% men).

PRIMARY AND SECONDARY OUTCOME MEASURES

The final version of the translated LSA-D was related to limitations in activities and instrumental activities of daily living (ADL/iADL) as primary outcome measure (primary hypothesis); and with sociodemographic factors, functional mobility, self-rated health, balance confidence and history of falls as secondary outcome measures to obtain construct validity. Further descriptive measurements of health included hand grip strength, screening of cognitive function, comorbidities and use of transportation. To assess construct validity, correlations between LSA-D and the primary and secondary outcome measures were examined for the total sample, and urban and rural subsamples using bivariate regression and multiple adjusted regression models. Descriptive analyses of LSA-D included different scoring methods for each region. All parameters were estimated using non-parametric bootstrapping procedure.

RESULTS

In the multiple adjusted model for the total sample, number of ADL/iADL limitations (β=-0.26; 95% CI=-0.42 to -0.08), Timed Up and Go Test (β=-0.37; 95% CI=-0.68 to -0.14), shared living arrangements (β=0.22; 95% CI=0.01 to 0.44) and history of falls in the past 6 months (β=-0.22; 95% CI=-0.41 to -0.05) showed significant associations with the LSA-D composite score, while living in urban area (β=-0.19; 95% CI=-0.42 to 0.03) and male gender (β=0.15; 95% CI=-0.04 to 0.35) were not significant.

CONCLUSION

The LSA-D is a valid tool for measuring life-space mobility in German community-dwelling older adults within the past 4 weeks in ambulant urban and rural settings.

TRIAL REGISTRATION NUMBER

DRKS00019023.