Assessment of patients in long-term care should be used to improve quality as well as allocate funds

A randomized clinical trial using an educational intervention demonstrated no effect on interobserver agreement on assessments of functional status

Aim

To evaluate the effect of an educational intervention on interobserver agreement of assess-ments of functional status performed by registered nurses and care assistants in a nursing home and to compare interobserver agreement in persons with and without cognitive impairment.

Background

High accuracy of assessments of functional status in care settings for older persons is needed for the efficacy of the planning and the evaluation of the nursing care.

Method

Randomized clinical trial. Six registered nurses and six care assistants were randomized to participate in an educational session about assessment instruments for functional status (intervention) or in a session about falls in the elderly (control). Each of the registered nurses and care assistants performed assessments on the same thirty-four residents using the Belgian Evaluation Scale (BES) and the AGGIR instrument. The kappa statistic (κ) for multiple observers (and its 95% confidence interval) was the main outcome measure.

Findings

At baseline, interobserver agreement for BES total score was: κ = 0.43 (0.35-0.51) in the intervention group and κ = 0.48 (0.39-0.57) in the control group. At the second assessment, agreement measures were: κ = 0.48 (0.41-0.57) in the intervention group and κ = 0.58 (0.50-0.66) in the control group. Results for AGGIR total scores were similar.

Conclusion

Interobserver agreement of assessments on nursing home residents was moderate and did not improve significantly after an educational session.

Variation in care home admission across areas of Northern Ireland

BACKGROUND

much has been written about the demographic and health characteristics which act as risk factors for care home admission in the UK. However, few studies have examined variation in care home admission rates across areas, whilst controlling for the demographic and health characteristics of the individuals living within these areas. This is surprising given that decisions which affect admission are often taken at the local level. The aim of the study was to determine if there were variations in care home admission rates across trusts in Northern Ireland, once adjustment had been made for the demographic and health characteristics of the individuals residing within these areas.

METHODS

a retrospective cohort study was undertaken, using data from the Data Retrieval in General Practice (DRGP) project in Northern Ireland, to identify a cohort of individuals aged 65 and over and living in the community at the outset of the study. A total of 28,064 individuals were followed up for 5 years to identify those who subsequently entered a nursing or residential care home. Controlling for the demographic, household composition and health characteristics of individuals, Poisson regression was used to estimate the incidence rate ratios of care home admission for 10 trusts.

RESULTS

a total of 24,691 of the initial cohort had complete information for all variables and were included in the final analysis; 1,313 (5.3%) had entered a care home at the end of the 5 years of follow-up. Admission increased significantly with age, and diagnoses of dementia and stroke. Controlling for the age, sex and health composition of individuals, some variations in admission rates were found across trusts.

CONCLUSIONS

the study has highlighted the importance of age and clinical conditions as risk factors for care home admission. In addition, it appears that the area of residence might be important in determining a person's risk of care home admission. Such differences may be attributable to particular characteristics of the trust, such as the level of deprivation or degree of rurality, or to differing policies in relation to services for older people. More work is required to identify the causes of the differences to allow policies to be implemented to ensure equitable access to care homes across Northern Ireland.

Medical services for older people in nursing homes--comparing services in England and the Netherlands

As Europe faces an ageing population with increasing pressure on long term care, it is important for different systems to be compared and contrasted for the benefit of all. We compare long term care in the Netherlands to England, by examining the different care models, in terms of patient outcomes, quality of care, continuity of care and funding.