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Welcome everyone to 2010. This promises to be a very productive year for interRAI in our region. The Asia-Oceania Regional conference will be highlight, with a large group of international interRAI members contributing to the meeting. The Acute Care research and development work in Australia will begin to yield results. Rollout of the Home Care instrument in New Zealand will continue. New start-ups with the Long Term Care, and Emergency Department instruments are anticipated. There is new emerging interest in China, India and Singapore.
I hope to see you all in Brisbane in May!
A large contingent of senior interRAI Fellows from around the world will attend the conference, contributing keynotes and workshops. There is an opportunity for delegates to submit papers for paper or poster presentation – these can be research oriented or report demonstration projects. Delegates are expected from India, through SE Asia to New Zealand.
In the Lake Taupo region in rural New Zealand, interRAI is being used in an innovative way to drive the local, Primary Health Care Organisation(PHO) based Community Rehabilitation Team (CRT). The use of interRAI has added validation to our underlying passion for comprehensive assessment as a tool for proactive referrals and care.
The interRAI MDS Home Care assessment is done in the clients own environment by Lakes Needs Assessment and Service Coordination staff and if the assessment triggers appropriate CAPS (clinical assessment protocols), they are referred to the CRT. The main CAP’s regularly referred are: ADL rehab potential, IADL assessment, health promotion (deconditioning), institutional risk, cardio-respiratory, cognition, falls and pain. It is a proactive response to some of the needs identified by the Lakes NASC team through InterRAI.
Using the CAP’s as a basis for referral ensures that all clients are appropriate and this increases efficiencies in the CRT. Traditionally, community teams are swamped by referrals from a multitude of providers and often many of these referrals are not appropriate and waste precious time and resources.
All members of the Community Rehab Team have ‘read-only’ rights to the full assessment and can access the comments, medical and functional information in the assessment. In practical terms, the therapist (physio or occupational therapist) has a clear idea of the clients needs before assessment. The medical information can be transposed into our records and checked at the clients’ home. This reduces the tradition of health professionals asking the same questions and constantly over-assessing our older people.
In short, using the interRAI assessment tool has revolutionised proactive referral for the Lakes NASC. The interRAI assessment has become the catalyst for creating a strong, multi disciplinary approach between the NASC and CRT. This close working relationship facilitates an early response as well as effective, robust outcomes for the older people in our area.
We are pleased to announce the launch of www.LTCfocUS.org, a new long-term care research and policy website. The website is sponsored by the National Institute on Aging funded Shaping Long-Term Care in America project housed at the Brown University Center for Gerontology and Healthcare Research. LTCFocUS.org is an exciting new resource for long-term care researchers and policy analysts because users can interact with the website in two ways: 1) by creating interactive maps and tables and, 2) by downloading all data available on the site.
LTCfocUS.org incorporates professional and graphically sophisticated maps, tables, and other visualizations of data related to nursing home care in the US. It provides users with research abstracts and publications and allows users to create linked maps to gather information about states, counties, or individual nursing homes. All data provided on the website are also available to download.
The website provides data gathered from existing federal sources including Medicare reimbursement claims, Online Survey Certification and Reporting (OSCAR) data, Minimum Data Set (MDS) data, as well as our own survey of state Medicaid policies. The goal of the website is to allow researchers to trace clear relationships between state policies and local market forces and the quality of long-term care. Policymakers will also be able to use the information to craft state and local guidelines that promote high-quality, cost-effective, equitable care to older Americans.
Directions: Canadian Institute for Helath Information quarterly newsletter
Queen Beatrix honours Miel Ribbe, founder of Nursing Home Medicine of VU Medical Centre, Amsterdam The Department of Nursing Home Medicine of VU medical Centre in Amsterdam, Netherlands has celebrated its 20th anniversary on October 1. The celebration became extra festive when Professor Miel Ribbe, founder of the department and leader during its 20 years, was decorated and appointed by the Dean of the University, Professor Wim Stalman, on behalf of Her Majesty Queen Beatrix of Netherlands as "Officer in the Order of Orange-Nassau". Orange-Nassau is the name of the Royal Family of Netherlands.
In addition, on that day Miel officially announced that two senior researchers of the Department of Nursing Home Medicine VUmc were appointed as professor: Professor Cees MPM Hertogh, PhD, MD, nursing home physician and ethicist as Full Professor in "Ethics of Care for Frail Elderly". Professor. Rose Marie Droes, PhD and epidemiologist as Full Professor in "Psychosocial Care for People with Dementia".
Quality of Life Research on both sides of the Tasman...
interRAI Quality of Life Research
interRAI are developing a QOL assessment that has two versions, one for Home Care and one for Residential Care. The quality of life (QOL) tool is a self –reported survey which focuses on the persons own perspectives of their current life and care experiences. The assessment is not a generic QOL tool as such, rather it explores the quality of life of clients who are receiving formal services. The research originates in the United States by Dr John Morris from the Hebrew Rehabilitation Center for the Aged, in Boston, USA. The NZ study is focusing on a small group (n30-50) of older persons that are living in their own homes with some sort of publicly funded health care, social or community support such as meals on wheels, personal care and so on.
Participants are people who have had their needs assessed recently by a Canterbury District Health Board Clinical Assessor who used the interRAI home care assessment.
Subsequently, after agreeing to participate, they are interviewed by the researcher who uses the QOL survey. The project has recently completed the data collection phase and is currently at the overview analysis of findings stage. Initial results are showing that the assessment is generally suitable for the NZ population and that combining the results of both the HC assessment with the QOL survey can provide a more holistic view of a persons needs. Preliminary findings seem to be highlighting quality of life issues around autonomy and personal relationships. Several interviewed were quite worried about the potential effects of the current economic climate and its possible ramifications for them. It is likely that the project will recommend that expanded pilot studies throughout the DHB’s are required for further analysis of the potential for the QOL survey’s impact in NZ. The study is due to be completed by March 10.
interRAI Quality of Life Research in Residential Aged Care By Nancye M. Peel, Research Fellow, Centre for Research in Geriatric Medicine, The University of Queensland, Queensland, AustraliaLen Gray, Professor of Geriatric Medicine, Centre for Research in Geriatric Medicine, The University of Queensland, Queensland, Australia
An Australian study aims to measure the aspect of quality concerning resident’s satisfaction with their life in Residential Aged Care Facilities (RACFs). An instrument, Self-Report of Nursing Home Quality of Life, has been specifically developed by interRAI to give residents of long term care facilities the opportunity to share their perceptions about their satisfaction with services and quality of life. The survey will be undertaken in two RACFs in Brisbane, Australia who are using the interRAI MDS 2.0 / LTC assessment instruments. The MDS is a standardized assessment of each resident’s health, psycho-social, and functional status that is performed by trained assessors on every resident at standard times throughout the person’s nursing facility stay.
The targeted sample size is 100 cases with paired MDS 2.0 / LTC and Quality of Life (QOL) assessments. Residents will be identified for inclusion in the survey according to their most recent score on the interRAI Cognitive Performance Scale (CPS) (3 or less, as well as a subset of those with a CPS score of 4) and length of stay in the facility of at least 90 days. Following ethics approval, the Self-Report of Nursing Home Quality of Life instrument will be administered to consenting residents by research health care professionals who are trained in administering the interRAI assessment instruments. The researchers are independent of the RACFs to avoid possible bias and conflict of interest.
In addition to the QOL survey, data collection will include a copy of the most recent interRAI MDS 2.0 or LTCF assessment. If this assessment was performed over 6 months ago arrangements will be made to complete another assessment. Data will be analysed and compared with international findings  on:
(a) response rates and reasons for non-participation, particularly in relation to
(b) correlations between items on the MDS 2.0 / LTC Assessment and
QOL scores; and
(c) QOL survey items with a high negative response (where 25% of participants
respond negatively) to ‘flag’ areas for possible quality improvement.
The expected timeframe of the project is one year with data collection to commence in early 2010.
1. Morris, J. (2009). Resident Self Report Quality of Life. Paper presented at the Canadian RAI Conference - Pulling It All Together: Integrating Health Information for Planning, Policy, and Practice. from http://www.gov.ns.ca/health/RAI2009/QR3S1NXJK10IJZON/Plenary/RIA09_Plenary3_interRAI_initiatives_Quality_Life.pdf.
Baller M, Boorsma M, Frijters DHM, Marwijk WJ van, Nijpels G, Hout PJ van. (2009) "Depression in Dutch homes for the elderly: under-diagnosis in demented residents?" International Journal Geriatric Psychiatry. Published Before Print 5 Oct 2009.
Leung A.,Chi, I., Lou, V. Q. W., Chan, K. S. (in press) "Psychosocial risk factors associated with falls among Chinese community-dwelling older adults in Hong Kong." Health and Social Care in the Community.
Volicer L, Steen JT vd, Frijters DHM. (2009) "Modifiable factors related to abusive behaviors in nursing home residents with dementia." Journal of the American Medical Directors Association. 10(9):617-622.