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Deprescribing Interventions for Older Patients: A Systematic Review and Meta-Analysis

Deprescribing reduces polypharmacy in older adults. A thorough study of the effect of deprescribing interventions on clinical outcomes in older adults is presently lacking. As a result, we evaluated the impact of deprescribing on clinical outcomes in older patients.

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Changes in home care clients' characteristics and home care in five European countries from 2001 to 2014: comparison based on InterRAI - Home Care data

Changes in home care clients' characteristics and home care in five European countries from 2001 to 2014: comparison based on InterRAI - Home Care data | interRAI | Scoop.it



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 …

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Linking the Scores of the Montreal Cognitive Assessment 5-min and the interRAI Cognitive Performance Scale in Older Adults With Mild Physical or Cognitive Impairment

Linking the Scores of the Montreal Cognitive Assessment 5-min and the interRAI Cognitive Performance Scale in Older Adults With Mild Physical or Cognitive Impairment | interRAI | Scoop.it

 

Background: Bridging scores generated from different cognitive assessment tools is necessary to efficiently track changes in cognition across the continuum of care. This study linked scores from the Montreal Cognitive Assessment-5 min (MoCA 5-min) to the interRAI cognitive Performance Scale

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Traversing the Edge of Chaos: Phase 1 and 2 preparations for post COVID-19 world

Traversing the Edge of Chaos: Phase 1 and 2 preparations for post COVID-19 world | interRAI | Scoop.it

Kevin Kelly: What can we do now and what should prepare for for Fall 2020 and beyond with COVID-19 response? #MindWiresOnline

Read the full article at: philonedtech.com

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Newsletter January 2021

Newsletter January 2021 | interRAI | Scoop.it

From the editor Happy New Year to all. It is pleasing to see how interRAI instruments are implemented across multiple situations which confirms the versatility of our systems. This newsletter also inc

Read the full article at: myemail.constantcontact.com

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The Minimum Data Set: An Opportunity to Improve Spasticity Screening

The Minimum Data Set: An Opportunity to Improve Spasticity Screening | interRAI | Scoop.it

Spasticity is a common movement disorder that arises from trauma or disease affecting the central nervous system. Untreated spasticity can result in limitations in completing activities of daily living, painful limb contractures, and other conditions associated with loss of mobility. In the long-term care setting, this treatable condition is prevalent, yet often unrecognized likely because of a lack of spasticity-trained practitioners.
A recently published spasticity referral tool holds promise for addressing the underdiagnosisof spasticity in the long-term care population.

Read the full article at: www.jamda.com

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Are Nursing Home Residents With Dementia Appropriately Treated for Fracture Prevention?

Are Nursing Home Residents With Dementia Appropriately Treated for Fracture Prevention? | interRAI | Scoop.it
Clinicians struggle with whether to prescribe osteoporosis medications for fracture
prevention for older nursing home (NH) residents with dementia, given the lack of
evidence in this population. To better understand real-world clinical practice, we conducted a retrospective cohort study examining...
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A comparison of 3 frailty measures and adverse outcomes in the intake home care population: a retrospective cohort study

A comparison of 3 frailty measures and adverse outcomes in the intake home care population: a retrospective cohort study | interRAI | Scoop.it

Frailty measures from the interRAI CA identified patients at higher risk for death, hospital admission and perceived need for CGA. In jurisdictions where the CHESS-CA and AUA are already built into the electronic home care platform, such as Ontario, patients identified as high risk should be prioritized for proactive referral and care planning, and may benefit from greater involvement of primary care and other health professionals in the circle of care.

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Uso potencial en priorización de pacientes CIMSS para ingreso en Unidades de Larga Estancia Sociosanitaria ante la ausencia de instrumentos alternativos. Otra vez afirmamos que el uso de herramientas universales, estandarizadas y transparentes suponen un plus en el proceso de asignación de recursos. 

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The Long-term Care Pandemic: International Perspectives on COVID-19 and the Future of Nursing Homes

The Long-term Care Pandemic: International Perspectives on COVID-19 and the Future of Nursing Homes | interRAI | Scoop.it
John P. Hirdes, Anja Declercq, Harriet Finne-Soveri, Brant E. Fries, Leon Geffen, George Heckman, Terry Lum, Brigette Meehan, Nigel Millar and John N. Morris  |  Five major changes to long-term care can protect the elderly from the ravages of infectious disease and provide a greater quality of...
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Old and New Geriatric Screening Tools in a Belgian Emergency Department: A Diagnostic Accuracy Study - Heeren - - Journal of the American Geriatrics Society

Old and New Geriatric Screening Tools in a Belgian Emergency Department: A Diagnostic Accuracy Study - Heeren - - Journal of the American Geriatrics Society | interRAI | Scoop.it

OBJECTIVES To compare the diagnostic accuracy of the Identification of Seniors at Risk, the Flemish version of Triage Risk Screening Tool, and the interRAI Emergency Department

for predicting prolonged emergency department (ED) length of stay, hospitalization (following index ED stay), and unplanned ED readmission at 30 and 90 days among older (aged 70 years) community-dwelling adults admitted to the ED.

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Authors conclusion, this study reported that diagnostic charac teristics of ISAR, fTRST, and iEDS are comparable and that none of these tools accurately predicts prolonged ED LOS, hospitalization, and unplanned ED readmission at 30 and 90 days, when used as a stand-alone index.

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DIVERT | covid toolkit

DIVERT | covid toolkit | interRAI | Scoop.it
Download this DIVERT Scale SQL script and share with your IM/IT staff to generate reports to target patients using based on their most recent interRAI-HC.
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Predictors of Functional Decline in Nursing Home Residents: The Shelter Project 

Predictors of Functional Decline in Nursing Home Residents: The Shelter Project  | interRAI | Scoop.it

Fedecostante M, Onder G, Eusebi P, Dell'Aquila G, Zengarini E, Carrieri B, et al. Predictors of functional decline in nursing home residents: the Shelter project. J Gerontol A Biol Sci Med Sci. 2019.

 

The aim of our study was to identify independent predictors of functional decline in older nursing home (NH) residents, taking into account both resident and facility characteristics.

 
Methods

Longitudinal observational study involving 1,760 older (≥65 y) residents of NH participating in the SHELTER* study (57 NH in eight countries). All residents underwent a comprehensive geriatric assessment using the interRAI LTCF. Functional decline was defined as an increase of at least one point in the MDS Long Form ADL scale during a 1 year follow-up. Facility and country effects were taken into account.

 
Results

During the study period 891 (50.6%), NH residents experienced ADL decline. Residents experiencing ADL decline were older, had lower disability at baseline, were more frequently affected by severe dementia and by urinary incontinence, and used more antipsychotics. In the mixed-effect logistic regression model, factors independently associated with a higher risk of functional decline were dementia and urinary incontinence, whereas the presence of a geriatrician was a protective factor.

 
Conclusions

Both resident and facility characteristics are associated with the risk of functional decline in NH residents. Increasing the quality of healthcare by involving a geriatrician in residents’ care might be an important strategy to improve the outcome of this vulnerable population.

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Moving Towards Common Data Elements and Core Outcome Measures in Frailty Research

Moving Towards Common Data Elements and Core Outcome Measures in Frailty Research | interRAI | Scoop.it
With aging populations around the world, frailty is becoming more prevalent increasing the need for health systems and social systems to deliver optimal evidence based care. However, in spite of the...
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A Tale of 2 Assessments: Concordance Across the Minimum Data Set and Preadmission Screening and Resident Review Assessments in Recording Mental Health Diagnoses

There is growing acknowledgement that the proportion of adults with serious mental illness (SMI) in nursing homes (NHs) is increasing. SMI refers to a group of mental health conditions that result in serious functional impairment or limit participation in 1 or more major life activities.1-3 At present, there are 2 federally mandated tools that capture this information: the preadmission screening and resident review
program (PASRR) and minimum data set (MDS). PASRR is a 2-step assessment completed prior to NH admission with the intent of preventing inappropriate institutionalization, whereas the MDS is a comprehensive clinical assessment of functional capacity and
medical needs measured at admission, discharge, and periodically throughout one’s stay.

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Performance of the Cognitive Performance Scale of the Resident Assessment Instrument (interRAI) for Detecting Dementia amongst Older Adults in the Community

Performance of the Cognitive Performance Scale of the Resident Assessment Instrument (interRAI) for Detecting Dementia amongst Older Adults in the Community | interRAI | Scoop.it

The Cognitive Performance Scale (CPS) in the widely used interRAI suite of instruments is of interest to clinicians and policy makers as a potential screening mechanism for detecting dementia. 

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Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination | NEJM

Thrombosis and Thrombocytopenia after ChAdOx1 nCoV-19 Vaccination | NEJM | interRAI | Scoop.it

Summary We report findings in five patients who presented with venous thrombosis and thrombocytopenia 7 to 10 days after receiving the first dose of the ChAdOx1 nCoV-19 adenoviral vector vaccin

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Resource allocation across the dementia continuum: a mixed methods study examining decision making on optimal dementia care among health and social care professionals | BMC Health Services Research...

Resource allocation across the dementia continuum: a mixed methods study examining decision making on optimal dementia care among health and social care professionals | BMC Health Services Research... | interRAI | Scoop.it

Background The understanding of appropriate or optimal care is particularly important for dementia, characterised by multiple, long-term, changing needs and the increasing expectations of people using services. However, the response of health and social care services is limited by resource constraints in most countries. This study sought to determine the optimal level, mix and cost of services for different dementia case types across the dementia continuum, and to better understand the resource allocation decision making process among health and social care professionals (HSCPs). Methods A balance of care framework was applied to the study questions and developed in three ways; firstly by considering optimality across the course of dementia and not just at the margin with residential care; secondly, through the introduction of a fixed budget to reveal constrained optimisation strategies; and thirdly through the use of a mixed methods design whereby qualitative data was collected at workshops using nominal group technique and analysed to obtain a more detailed understanding of the decision-making process. Twenty four HSCPs from a variety of disciplines participated in the resource allocation decision-making exercise. Results HSCPs differentiated between case type severity; providing 2.6 times more resources to case types with higher level needs than those with lower level needs. When a resource constraint was introduced there was no evidence of any disproportionate rationing of services on the basis of need, i.e. more severe case types were not favoured over less severe case types. However, the fiscal constraint led to a much greater focus on meeting physical and clinical dependency needs through conventional social care provision. There was less emphasis on day care and psychosocial provision when resources were scarcer following the introduction of a fixed budget constraint. Conclusions HSCPs completed complex resource allocation exercises for people with dementia, including expected differentiation across case type severity. When rationing was introduced, HSCPs did not discriminate in favour of case types with high levels of need. They did, however, support conventional home care provision over psychosocial care, although participants were still keen to provide some residual cover for the latter, especially for case types that might benefit.

Read the full article at: bmchealthservres.biomedcentral.com

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An MDS 3.0 Distressed Behavior in Dementia Indicator (DBDI): A Clinical Tool to Capture Change - Curyto - 2021 - Journal of the American Geriatrics Society - Wiley Online Library

An MDS 3.0 Distressed Behavior in Dementia Indicator (DBDI): A Clinical Tool to Capture Change - Curyto - 2021 - Journal of the American Geriatrics Society - Wiley Online Library | interRAI | Scoop.it

Background/Objectives 

Persons with dementia frequently demonstrate distress behaviors in dementia (DBD), associated with poorer outcomes. This study aimed to create a measure of DBD from routinely administered Minimum Data Set (MDS 3.0) behavior section items that demonstrated sensitivity to change, for evaluation of intervention efforts for VA Community Living Center (CLCs) residents exhibiting DBD.

 

The Distress Behavior in Dementia Indicator (DBDI) was created as a consistent factor with internal consistency, and was related to a validated measure as predicted at baseline and post‐intervention. Sensitivity to change was demonstrated by using change score correlations (r = 0.40–0.50), effect size (d = 0.63), and reliable change indices.

 

The DBDI is recommended for routine use in CLCs to evaluate impact of intervention effectiveness and provide quality improvement feedback.

 

Read the full article at: agsjournals.onlinelibrary.wiley.com

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Development and validation of multivariable mortality risk-prediction models in older people undergoing an interRAI home-care assessment (RiskOP)

Development and validation of multivariable mortality risk-prediction models in older people undergoing an interRAI home-care assessment (RiskOP) | interRAI | Scoop.it

In this cohort of older people with complex needs who had a mandated standardised interRAI-HC assessment, predictive models with 16 and 22 variables respectively provided accurate and precise risk predictions for one-year and three-month mortality. The calibratio  was excellent and the AUCs, a measure of the ability of the model to discriminate between those who do and do not die, of 0.78 and 0.84 were good and were high compared with other similar models.

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Comparing the case-mix of frail older people at home and of those being admitted into residential care: a longitudinal study

Comparing the case-mix of frail older people at home and of those being admitted into residential care: a longitudinal study | interRAI | Scoop.it

The study showed that the RUG-III system offers possibilities for identifying persons at risk of institutionalization. Interventions designed to avoid early nursing home admission can make use of the RUG-III system to optimize care planning and the allocation of services and resources. Based on the …

 

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GERAS Frailty Rehabilitation at Home During COVID-19 - Full Text View - ClinicalTrials.gov

GERAS Frailty Rehabilitation at Home During COVID-19 - Full Text View - ClinicalTrials.gov | interRAI | Scoop.it
GERAS Frailty Rehabilitation at Home During COVID-19 - Full Text View.
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Predicting Hospital Admission for Older Emergency Department Patients: Insights From Machine Learning

Predicting Hospital Admission for Older Emergency Department Patients: Insights From Machine Learning | interRAI | Scoop.it

To the best of our knowledge, this is the first study to predict hospital admission in older ED patients using a series of geriatric syndromes and functional assessments. We were able to predict hospital admission in older ED patients with good accuracy using the items available in the interRAI ED Contact Assessment. This information can be used to inform decision-making about ED disposition and may expedite admission processes and proactive discharge planning.

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Frailty Index and functional level upon admission predict hospital outcomes: an interRAI-based cohort study of older patients in post-acute care hospitals | BMC Geriatrics | Full Text

Frailty Index and functional level upon admission predict hospital outcomes: an interRAI-based cohort study of older patients in post-acute care hospitals | BMC Geriatrics | Full Text | interRAI | Scoop.it

Geriatric assessment upon admission may reveal factors that contribute to adverse outcomes in hospitalized older patients. The purposes of this study were to derive a Frailty Index (FI-PAC) from the interRAI Post-Acute Care instrument (interRAI-PAC) and to analyse the predictive ability of the FI-PAC and interRAI scales for hospital outcomes. This retrospective cohort study was conducted by combining patient data from interRAI-PAC with discharge records from two post-acute care hospitals. The FI-PAC was derived from 57 variables that fulfilled the Frailty Index criteria. Associations of the FI-PAC and interRAI-PAC scales (ADLH for activities of daily living, CPS for cognition, DRS for mood, and CHESS for stability of health status) with hospital outcomes (prolonged hospital stay ≥90 days, emergency department admission during the stay, and in-hospital mortality) were analysed using logistic regression and ROC curves. The Frailty Index derived from interRAI-PAC predicts adverse hospital outcomes. Its predictive ability was similar to that of the ADLH scale, whereas other interRAI-PAC scales had less predictive value. In clinical practice, assessment of functional ability is a simple way to assess a patient’s prognosis.

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An Andalusian delegation visits the Basque Country to learn about the political framework and experiences regarding social and healthcare | EUROPEAN INNOVATION PARTNERSHIP

An Andalusian delegation visits the Basque Country to learn about the political framework and experiences regarding social and healthcare | EUROPEAN INNOVATION PARTNERSHIP | interRAI | Scoop.it
An Andalusian delegation visits the Basque Country to learn about the political framework and experiences regarding social and healthcare...
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DIVERT-Collaboration Action Research and Evaluation (CARE) Trial Protocol: a multiprovincial pragmatic cluster randomised trial of cardiorespiratory management in home care | BMJ Open

DIVERT-Collaboration Action Research and Evaluation (CARE) Trial Protocol: a multiprovincial pragmatic cluster randomised trial of cardiorespiratory management in home care | BMJ Open | interRAI | Scoop.it

The pragmatic attitude of the trial towards cluster

selection, cluster assignment, participant selection,

participant recruitment, informed consent and outcome

measurement supports generalisation to other

jurisdictions.

Postrandomisation selection bias is limited by the

use of existing, objective measures of eligibility.

The use of secondary data for baseline data collection

and follow-upmeasurement increases the

a ccuracy of the data collection and limits the loss

to follow-up compared with primary collection

methods.

It is not possible to conceal the treatment assignment,

which exposes half of the primary and secondary outcomes measures to placebo and observer-expectancy effects.

The jurisdictions included in the study used a convenience,

non-probability sampling approach in cluster selection, which may limit external validity.

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Andrew Costa y su equipo desarrollan un a herramienta de predicción de visitas a urgencias en la población en atención domiciliaria. 

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