Australia & New Zealand Newsletter  
Issue 8  -   July 2011





Research Projects

Instrument development

Recent publications









'Talking the same language
for effective care for
older people'











interRAI Australia

Coordinating Centre
Telephone: +61(7)-3176 5530
Facsimile: +61(7)-3176 6945
Email: interRAI mail





interRAI New Zealand

Coordinating Centre






















Len Gray

Please send feedback to:
Joanna Kho







From the editor

There continues to be a great deal of interRAI Activity in the Region, as you will see by perusing the articles below.  Significant implementations are occurring in Australia, New Zealand and Singapore. 

I was delighted with the appointment of Mabel Yap from Singapore as a new associate Fellow within interRAI.  I am sure her participation will strengthen Singapore’s involvement in interRAI, and, in turn, I am sure that she will make an important contribution to interRAI.

Len Gray



interRAI meeting at Nuremberg


interRAI AC available to all Queensland Public Hospitals

>> New Singaporean Associate Fellow to interRAI


interRAI Network of Excellence in Acute Care established


interRAI work in Hong Kong


interRAI and CIHI launch mental health clinical assessment protocols


Training in Singapore


interRAI ebooks Launch This Month!



interRAI meeting at Nuremberg


Nestor Hotel

A full meeting of interRAI Fellows was held in Nuremberg, Germany in May.  The meeting was attended by approximately 40 Fellows.  Guests included newly appointed fellows from the Netherlands, Singapore, Korea, Hong Kong and Lebanon. 

The meetings comprise research presentations, review of new and developing instruments, and updates on developments in all participating nations (now almost 30!).

A paper presented by Hein van Hout from the Netherlands was of particular interest: The study demonstrated that a multi-disciplinary intervention centred on the interRAI Long Term Care Facility assessment system improved the quality of care of residents of Dutch residential aged care facilities.  The study employed a cluster randomised controlled design involving 10 facilities and 340 residents, ensuring that the results are robust and convincing. 

See for the full report.

The next full meeting will be held in Helsinki in 2012.


interRAI Acute Care available to all Queensland Public Hospitals

In June, an agreement between Queensland Health and the University of Queensland will make the interRAI AC available to all public hospitals in the state.  The interRAI AC constitutes the core of a clinical decision support system developed by the University.  It facilitates geriatric consultation, online consultation to support telemedicine, and ward based comprehensive geriatric assessment.This will be the largest implementation of the interRAI AC to date.  The AC is also being implemented in Belgium and Italy, and is under careful consideration in many others. 

New Singaporean Associate Fellow to interRAI

Mabel Yap

Dr Mabel Yap is Director, Health Services Research and Evaluation, at the Singapore Ministry of Health (MOH). She established the Division to evaluate programs and generate knowledge to support evidence-based policy making. She is also Adjunct Associate Professor at the Duke–NUS Graduate Medical School, Centre for Health Services and Systems Research (HSSR). 

Her current projects include: the use of InterRAI to inform service planning and policy; providing the evidence for integrated care pathways; the national Mental Health blueprint; the longitudinal Ministry of Finance and Central Provident Fund (CPF) Retirement  and Health Study; development of clinical practice guidelines; health technology assessment; and regional planning of manpower and infrastructure needs.


She received her PhD (Nutrition) from Wageningen University in Netherlands and her Post Graduate Diploma (Human Nutrition) from Deakin University, Australia.  Dr Yap also has a Master’s degree in Science (Public Health) and medical degree from the National University of Singapore. She was instrumental in WHO revising the BMI cut-offs for obesity amongst Asians.

Her current research interests include improving care and health outcomes for Singaporeans; development and validation of assessment tools and performance indicators for measurement and relevance; economic evaluation of models of care; and health informatics (especially secondary data use).

In her spare time she enjoys photography, travel and cooking.


interRAI Network of Excellence in Acute Care established...

interRAI has established a working group, under the leadership of Prof. Len Gray, to focus on development of assessment systems in and around acute care – for older patients.  Effectively the group will concentrate on the ED Screener, the interRAI Acute Care, and a supplement to the AC called the Post-Acute Supplement (or AC-PAC).  Some attention will also be given to systems for the post-discharge community setting, which in Australia would relate to the Transition Care Program and affiliated services.  In effect, the group will try to create an integrated “mini-suite” that provides coverage of entire hospital episodes of care. 

The “iNEAC” emulates the now very successful interRAI Network of Excellence in Mental Health which was established around 4 years ago. 

The first “in person” meeting was conducted in Nuremberg in May, with around 30 delegates from 13 nations participating.  From our region, there was participation from Australia (Len Gray, Melinda Martin-Khan), New Zealand (Brigette Meehan) and Singapore (Thai Lian Tan).  The group has established 3 working groups concentrating on the ED, AC and AC-PAC, each of which will meet monthly by teleconference.  The full group will meet in person in France in December 2011.

Early objectives include:

·         Creation of “risk-screeners” to identify patients at risk if discharged home from the ED, and patients who are likely to require comprehensive geriatric assessment as inpatients.

·         Completion of the AC Clinical Assessment Protocols.

·         Development of Quality Indicators for the ED and AC.

·         In 2012, it is expected that a full AC-PAC will be released.

iNEAC members

Members of the interRAI Network of Excellence in Acute Care


interRAI work in Hong Kong

Iris Chi reports….

As for now, the RAI research team in Hong Kong has translated and validated four instruments, they are: LTCF, HC, MH and ID.  We are planning to validate the CHA in the coming year. 

Since 2001, Hong Kong Government has adopted the HC for its standardized care needs and service matching program which assesses all long term care service applicants in the territory.  On average, over 10,000 assessments are made per year.  Currently, several non-government organizations are using HC to plan and manage care for their clients.  Most of them are PointClick users except the Hong Kong Government and two non-government organizations have direct contractual relationships with interRAI. 

One of the non-government organizations in Hong Kong has adopted the RAI2.0 in their residential care homes since 2005.  This agency will be using the LTCF at the end of this year.  On average, there are about 1,300 resident records and over 4,000 assessments per year.   Another non-government organization has also signed the contract with interRAI to adopt the LTCF.  Both agencies are the leading service providers in residential care in Hong Kong.

We are very pleased that one of the non-government organizations has just signed the contracts with interRAI to apply the MH and ID to plan and manage care for their residents.  It is anticipated on average around 900 resident records and over 3,000 assessments will be collected per year.  In Hong Kong, standardized evaluation tool to identify the needs and preference of people with mental health or intellectual disability living in group settings is lacking.  In view of the potential benefits of new instruments, adopting the instruments into service settings for mental health or learning disabilities in Hong Kong can facilitate service providers to have a thorough understanding on problems and strengths of their service users and enhance the service quality in the settings accordingly. 

interRAI and CIHI Launch Mental Health Clinical Assessment Protocols

On June 1, 2011, the Canadian Institute for Health information (CIHI) will host a web conference to formally launch mental health Clinical Assessment Protocols (CAPs) in Canada. The set of 21 mental health CAPs is for use with interRAI’s mental health assessment instruments, including the Resident Assessment Instrument for Mental Health (RAI-MH), which is a core component of CIHI’s Ontario Mental Health Reporting System (OMHRS).

The mental health CAPs are grounded in international best practices, were developed using recent data and represent a significant evolution in standardized mental health assessment. The development effort was led by the interRAI Network of Excellence in Mental Health (iNEMH), chaired by Dr. John Hirdes of interRAI and of the University of Waterloo, and involved a range of CIHI partners in Ontario and beyond.

Clinicians in inpatient and community mental health settings can use the new mental health CAPs to help them identify a wide range of mental health issues that may benefit from further investigation to enable the recovery of a person living with mental illness. Clinicians can also use the mental health CAPs to target modifiable outcomes for patients likely to experience improvements in a particular area, as well as for those patients at elevated risk of further decline if effective action is not taken.


Training in Singapore

Singapore’s Agency for Integrated Care is undertaking a bold and ambitious assignment to improve assessment and services for older people across multiple care settings. The pilot project incorporates use of interRAI assessment instruments for Acute Care, Home Care, and Long Term Care Facility clients. Localisation of both manuals and instruments has occurred.

The organisation has embarked on a ‘Train the Trainer’ program supported by staff from Brisbane. In October 2010, Bonnie Pimm travelled to Singapore to provide training for a large number of enthusiastic staff from several different service providers. This learning was consolidated in March of this year with a group of ‘Master Trainers’ from each care domain now able to provide further training to other staff, ensuring long term sustainability.

Training at Singapore


interRAI ebooks Launch!

interRAI is now publishing its first ebooks. The four pilot titles are:

             interRAI Home Care (HC) Assessment Form and User’s Manual

             interRAI Mental Health (MH) Assessment Form and User’s Manual for In-patient Psychiatry

             interRAI Acute Care (AC) Assessment Form and User’s Manual

             interRAI Palliative Care (PC) Assessment Form and User’s Manual

We expect to have all interRAI’s current titles launched this spring.

The ebookstore’s ViewInside feature allows you to browse through selected contents of an ebook before deciding whether to buy it. After purchasing and downloading an ebook to your digital bookshelf (using free Adobe Digital Editions software), you can customize and annotate it using the bookmarking and notes features. However, you cannot share, copy and paste, or print the ebook. Priced at 10% below retail, the ebooks are PDF-based and are optimized for desktop machines and laptops. 

Here’s your chance to liberate yourself and your organization from paper by taking advantage of interRAI’s new digital resource! Through our ebookstore, you will receive the latest version of interRAI content rapidly, without incurring the delays and expenses of paper distribution.

As always, we welcome your input as interRAI’s ebookstore grows and develops. Our goal is for interRAI instruments to be used as extensively as possible; if you are interested in a multiple-copy purchase or a volume discount for your institution, please email us at and we will work out the details.

You can visit the new ebookstore at:

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Research projects


Developing a quality framework for the care of older patients in the Emergency Department

This project is focused on identifying predictors of quality of care for geriatric patients in Emergency Departments and in developing a suit of Quality indicators (QIs) for use in the Emergency Department care of the elderly.  The interRAI ED Screener will be one part of an extensive suite of data collection tools.  A series of outcome oriented QIs will be developed using the data derived directly from the ED Screener.  This is a Queensland Emergency Medical Research Foundation (QEMRF) funded project (2011-2013) , with 8 Australian sites and 480 patients.  The project is in the planning phase and is currently identifying, from the list of hospitals which have expressed an interest in participation, the final 8 sites.  The investigators are: Dr. Ellen Burkett (ED Specialist, PAH and PhD candidate); Professor Len Gray (Director, Centre for Research in Geriatric Medicine UQ and Geriatrician); Assistant Professor Richard Jones (Assistant Professor of Medicine, Department of Medicine, Harvard Medical School); Dr. Melinda Martin-Khan (Research Fellow, CRGM UQ), and AI Ms Linda Schnitker (PhD Candidate).  The result of this project will be a set of QIs that will be able to be utilized to allow comparison across centres and optimization of emergency care delivered to the ever-increasing elderly population.  Dr. Martin-Khan and Professor Gray are currently in discussion with interRAI collaborators on the potential of collecting data from international ED sites for a supplementary project. 


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Instrument development

The ISD recently met in Treviso Italy.  In addition to the initiative to develop a scales inventory (see separate article), the following activities are of particular interest:

Dementia assessment system

Work has commenced to develop an assessment system to support evaluation of people undergoing evaluation of cognitive status.  Variously called “Memory Clinics”, “Cognitive Disorders Services” and so forth around the world, interRAI has recognised a need for instrumentation to support functional and care planning aspects of the service.  The ultimate product is likely to be a variant of the interRAI CHA.  It is not intended to replace cognitive diagnosis tools, frequently in use in such clinics.

This effort is being lead by Joel Ankri in Paris.

Subjective quality of life instruments (SQOL)

Five variations of the SQOL have progressed through the ISD process towards publication.  These variations apply to nursing homes, home care, assisted living, continuing care retirement communities and independent living units.  There will be 2 variants within each setting – short and long versions.  An update will be provided in Nuremberg.

A system for system development!!

With the introduction of professional publication of interRAI systems, the process of publication has become more complex.  ISD is working towards development of a more rigorous and transparent process for new systems development, which should ensure more clarity around delivery dates, completeness of documentation, and reliability of the content. Brant Fries is currently leading this effort.



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Recent publications

Boorsma M, Frijters DHM, Knol DL, Ribbe ME, Nijpels G, van Hout HPJ. Effects of multidisciplinary integrated care on quality of care in residential care facilities for elderly people: a cluster randomized trial. Canadian Medical Association Journal. 2011 June 27.

van Soest-Poortvliet MC, van der Steen JT, Zimmerman S, Cohen LW, Munn J, Achterberg WP, et al. Measuring the Quality of Dying and Quality of Care When Dying in Long-Term Care Settings: A Qualitative Content Analysis of Available Instruments. J Pain Symptom Manage. 2011 May 25.

Tjam EY, Heckman GA, Smith S, Arai B, Hirdes J, Poss J, McKelvie RS. Predicting heart failure mortality in frail seniors: Comparing the NYHA functional classification with the Resident Assessment Instrument (RAI) 2.0. Int J Cardiol. 2011 Feb 1. [Epub ahead of print] PubMed PMID: 21292334.

Rabinowitz T, Martin L, Montague P, Hirdes JP. Prevalence and correlates of urinary incontinence in a large cohort of psychiatric inpatients. Psychiatr Serv. 2011 Jan;62(1):97-100. PubMed PMID: 21209308.

Jones K, Perlman CM, Hirdes JP, Scott T. Screening cognitive performance with the Resident Assessment Instrument for Mental Health Cognitive Performance Scale. Can J Psychiatry. 2010 Nov;55(11):736-40. PubMed PMID: 21070702.

Armstrong JJ, Stolee P, Hirdes JP, Poss JW. Examining three frailty conceptualizations in their ability to predict negative outcomes for home-care clients. Age Ageing. 2010 Nov;39(6):755-8. Epub 2010 Sep 21. PubMed PMID: 20858672.

Armstrong JJ, Stolee P, Hirdes JP, Poss JW. Examining three frailty conceptualizations in their ability to predict negative outcomes for home-care clients. Age Ageing. 2010 Nov;39(6):755-8. Epub 2010 Sep 21. PubMed PMID: 20858672.

Grue EV, Finne-Soveri H, Stolee P, Poss J, Sörbye LW, Noro A, Hirdes JP, Ranhoff AH. Recent visual decline-a health hazard with consequences for social life: a study of home care clients in 12 countries. Curr Gerontol Geriatr Res. 2010. pii: 503817. Epub 2010 Aug 4. PubMed PMID: 20811648; PubMed Central PMCID: PMC2929488.

Mathias K, Hirdes JP, Pittman D. A care planning strategy for traumatic life events in community mental health and inpatient psychiatry based on the InterRAI assessment instruments. Community Ment Health J. 2010 Dec; 46(6):621-7. Epub 2010 May 7. PubMed PMID: 20449657.

Jones RN, Hirdes JP, Poss JW, Kelly M, Berg K, Fries BE, Morris JN. Adjustment of nursing home quality indicators. BMC Health Serv Res. 2010 Apr 15; 10:96. PubMed PMID: 20398304; PubMed Central PMCID: PMC2881673.



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