G. Iain Carpenter

Comprehensive clinical assessment in community setting: Applicability of the MDS-HC

OBJECTIVE: To describe the results of an international trial of the home care version of the MDS assessment and problem identification system (the MDS‐HC), including reliability estimates, a comparison of MDS‐HC reliabilities with reliabilities of the same items in the MDS 2.0 nursing home assessment instrument, and an examination of the types of problems found in home care clients using the MDS‐HC.

Measuring change in activities of daily living in nursing home residents with moderate to severe cognitive impairment

BackgroundThe objective of this study was to assess the responsiveness of the Minimum Data Set Activities of Daily Living (MDS-ADL) Scale to change over time by examining the change in physical function in adults with moderate to severe dementia with no comorbid illness who had been resident in a nursing home for over 90 days.MethodsLongitudinal data were collected on nursing home residents with moderate (n = 7001) or severe (n = 4616) dementia in one US state from the US national Minimum Data Set (MDS). Severity of dementia was determined by the MDS Cognitive Performance Scale (CPS). Physical function was assessed by summing the seven items (bed mobility, transfer, locomotion, dressing, eating, toilet use, personal hygiene) on the MDS activities of daily living (ADL) Long Form scale. Mean change over time of MDS-ADL scores were estimated at three and six months for residents with moderate (CPS score of 3) and severe (CPS score of 4 or 5) dementia.ResultsPhysical function in residents with moderate cognitive impairment deteriorated over six months by an average of 1.78 points on the MDS-ADL Long Form scale, while those with severe cognitive impairment declined by an average of 1.70 points. Approximately one quarter of residents in both groups showed some improvement in physical function over the six month period. Residents with moderate cognitive impairment experienced the greatest deterioration in early-loss and mid-loss ADL items (personal hygiene, dressing, toilet use) and residents with severe cognitive impairment showed the greatest deterioration in activities related to eating, a late loss ADL.ConclusionThe MDS-ADL Long Form scale detected clinically meaningful change in physical function in a large cohort of long-stay nursing home residents with moderate to severe dementia, supporting its use as a research tool in future studies.

Measuring depression in nursing home residents with the MDS and GDS: an observational psychometric study

BackgroundThe objective of this study was to examine the Minimum Data Set (MDS) and Geriatric Depression Scale (GDS) as measures of depression among nursing home residents.MethodsThe data for this study were baseline, pre-intervention assessment data from a research study involving nine nursing homes and 704 residents in Massachusetts. Trained research nurses assessed residents using the MDS and the GDS 15-item version. Demographic, psychiatric, and cognitive data were obtained using the MDS. Level of depression was operationalized as: (1) a sum of the MDS Depression items; (2) the MDS Depression Rating Scale; (3) the 15-item GDS; and (4) the five-item GDS. We compared missing data, floor effects, means, internal consistency reliability, scale score correlation, and ability to identify residents with conspicuous depression (chart diagnosis or use of antidepressant) across cognitive impairment strata.ResultsThe GDS and MDS Depression scales were uncorrelated. Nevertheless, both MDS and GDS measures demonstrated adequate internal consistency reliability. The MDS suggested greater depression among those with cognitive impairment, whereas the GDS suggested a more severe depression among those with better cognitive functioning. The GDS was limited by missing data; the DRS by a larger floor effect. The DRS was more strongly correlated with conspicuous depression, but only among those with cognitive impairment.ConclusionsThe MDS Depression items and GDS identify different elements of depression. This may be due to differences in the manifest symptom content and/or the self-report nature of the GDS versus the observer-rated MDS. Our findings suggest that the GDS and the MDS are not interchangeable measures of depression.

Case Management and Risk of Nursing Home Admission for Older Adults in Home Care: Results of the AgeD in HOme Care Study

OBJECTIVES: To explore the relationship between a case management approach and the risk of institutionalization in a large European population of frail, old people in home care.

Variations in quality of Home Care between sites across Europe, as measured by Home Care Quality Indicators

Background and aims: The increase in the proportion of elderly people and a consequent increase in the demand for care have caused healthcare systems to become overloaded. This paper describes the use of Home Care Quality Indicators (HCQIs), derived from the Minimum Data Set for Home Care, for monitoring quality of care. Research questions were, “Do HCQI scores vary between home care organizations in different countries?” and “Are one or more country-specific sites consistently scoring better on most or all HCQIs”? Methods: a cross-sectional observational study of 65+ randomly selected clients of home care organizations in urban areas in 11 European countries who had been receiving home care for at least two weeks. Data were collected with the MDS-HC. The scoring of 16 prevalent quality indicators for home care, adjusted for population differences, was calculated with baseline data. Results: Population size at baseline was 4,007 clients. Among home care clients in Europe, “rehabilitation potential in Activities of Daily Living and no therapies” (average 75.9%) and “inadequate pain control” were the most common quality problems. The prevalence between populations studied in various countries varied substantially. No country-specific site consistently scored worst or best. Conclusions: HCQIs derived from the MDS-HC detect variance in quality scores between home care in the 11 partner countries. The highest prevalence of unwanted outcomes were most often found in the Czech Republic, Italy and Germany. Although further research is necessary, we believe that HCQIs may be of great value for quality improvement in home care.

Health outcomes among the frail elderly in communities and institutions: Use of the Minimum Data Set (MDS) to create effective linkages between research and policy

Researchers and policy-makers interested in the needs of the frail elderly in community and institutional settings have had limited success in forming policy based on empirical evidence. The reasons for this have included a variety of organizational and political considerations (e.g., lack of effective communication mechanisms), conceptual and methodological issues (e.g., problems with reliability and validity of existing data sources) and limitations in knowledge (e.g., lack of longitudinal data across health care sectors). The Minimum Data Set (MDS) series of instruments may prove useful in dealing with these difficulties. The MDS instruments have multiple uses for different audiences (e.g., care provision, funding and quality improvement). Extensive international testing has shown the MDS to be valid and reliable, and translations are available in 11 different languages. As implementation of the MDS begins in Canada, a number of new concerns will need to be addressed (e.g., confidentiality and access to data).

Identifying elderly depression using the Depression Rating Scale as part of comprehensive standardised care assessment in nursing homes

Objectives: This study used data from the SHELTER (Services and Health for Elderly in Long TERm care) project to explore the benefits of using the Depression Rating Scale (DRS) as part of a standardised needs assessment in UK nursing homes, including a statistical method of effectively identifying characteristics linking to residents’ depression. Method: About 499 residents in nine nursing homes in south-east England were assessed with interRAI Long Term Care Facilities (interRAI LTCF), a standardised assessment tool containing the validated DRS residents who scored 3 or more on the DRS were considered ‘might suffer from depression’. A list of characteristics associated with depression was then examined using bivariate analysis and logistic regression. Results: Among the 499 residents assessed, 67.5% were not depressed (DRS < 3) and 32.3% might suffer from depression (DRS ≥ 3). The final logistic model showed ‘never married’ (p = 0.019), ‘diagnosis of COPD’ (COPD, chronic obstructive pulmonary disease) (p = 0.015), ‘feelings of pain’ (p = 0.015) and ‘trouble sleeping’ (p < 0.001) were significantly associated with reporting of DRS score of 3 and more. Conclusion: The article argued that DRS has distinctive advantages for using in UK nursing homes where a preponderance of residents is cognitively impaired, the procedure of screening depression is not regulated and resources to treat depression is relatively scarce. This article also demonstrated how using the DRS as part of a comprehensive standardised needs assessment facilitates analysis of characteristics linking to depression, which has significant policy implications in improving care quality and management.

Profiling Intermediate Care Patients using the Single Assessment Process: A Road to Better Service Provision?

This paper demonstrates that three intermediate care services in Shepway, East Kent each cater for distinct patient groups, and that data from a single assessment process (SAP) tool can be used to differentiate between them. By applying statistical techniques, inferences can be made about the likelihood of admission to a particular service, given specific health characteristics. In conclusion, we highlight the utility of standardised assessment as a means of providing data for audit and planning, and stress the importance of the SAP as a means of developing care services.

Recuperative Care: an example of partnership care which works for patients

Purpose – The purpose of this paper is to evaluate the role of Recuperative Care after hospital discharge.Design/methodology/approach – A combined qualitative and quantitative study. The quantitative study was a concurrent, parallel, geographically controlled trial of Recuperative Care versus standard NHS hospital rehabilitation. Recuperative Care is rehabilitation in a residential care home with no on‐site medical or nursing staff. A daily programme of exercises and activities to improve independence is provided by two in‐house occupational therapists. The primary outcome measures were discharge destination, domicile 3 and 12 months post‐discharge and mortality. A purposefully selected sample of 20 recuperative care patients was interviewed after discharge.Findings – There was a small difference of borderline significance in initial discharge destination (slightly more patients were discharged home from recuperative care than from Hospital). However, at 3 months and 12 months there was no significant dif...

Aging and community care

Aging Clin Exp Res, Vol. 16, No. 4 257 The World Health Report 2000 produced by the World Health Organisation illustrated the variance in performance of health care systems between nations (1). That the league tables in this report generated so much controversy demonstrated the high levels of interest and concern about matters of health in the minds of those who govern and those who are governed. The proportion of population aged over 65 in most European nations will be around 20% by 2015 and nearly 25% by 2030. The increase in the number of people reaching old age is accelerating fastest in developing nations. These facts have profound implications for nations’ economies and health and social care systems, facts that are presented in stark numerical descriptions by Kinsella and Velkoff (2). Performance of health and social care services becomes critically important as the proportion of older people increases, as it is in older age that chronic diseases and disability are most prevalent. Evidence-Based Medicine (EBM) is today’s health care mantra, but the evidence upon which we can base decisions intended to produce best outcomes for whole systems of health and social care is sorely lacking. In reporting ‘the state of the art’, the OECD noted that most health systems are still at an early stage in implementing effective methods of performance measurement and improvement (3). This is especially true when addressing the needs of people with physical and cognitive impairment and those with multiple pathologies, nearly all of whom will be living in community-based or long-term care settings. The challenges are complex, the solutions are multi-factorial, and the research is difficult and expensive to conduct. This issue of the journal reports 11 projects on the care of older people in the community and long-term care from 8 different countries, from Bahrain to the United States, and the first 11 country comparative analysis of the recipients of community care in 11 European countries. The variety of methodologies applied and the focus of the studAging and community care