Abstract
BackgroundThe Indicator of Relative Need (IoRN) instrument is designed for both health and social care services to measure function and dependency in older people. To date, the tool has not undergone assessment of validity. We report two studies aimed to evaluate psychometric properties of the IoRN.MethodsThe first study recruited patients receiving social care at discharge from hospital, those rehabilitating in intermediate care, and those in a rehabilitation at home service. Participants were assessed using the IoRN by a single researcher and by the clinical team at baseline and 8 weeks. Comparator instruments (Barthel ADL, Nottingham Extended ADL and Townsend Disability Scale) were also administered. Overall change in ability was assessed with a 7 point Likert scale at 8 weeks. The second study analysed linked routinely collected, health and social care data (including IoRN scores) to assess the relationship between IoRN category and death, hospitalisation and care home admission as a test of external validity.ResultsNinety participants were included in the first study, mean age 77.9 (SD 12.0). Cronbach’s alpha for IoRN subscales was high (0.87 to 0.93); subscales showed moderate correlation with comparator tools (r = 0.43 to 0.63). Cohen’s weighted kappa showed moderate agreement between researcher and clinician IoRN category (0.49 to 0.53). Two-way intraclass correlation coefficients for IoRN subscales in participants reporting no change in ability were high (0.88 to 0.98) suggesting good stability; responsiveness coefficients in participants reporting overall change were equal to or better than comparator tools. 1712 patients were included in the second study, mean age 81.0 years (SD 7.7). Adjusted hazard ratios for death, care home admission and hospitalisation in the most dependent category compared to the least dependent IoRN category were 5.9 (95 % CI 2.0–17.0); 7.2 (95 % CI 4.4–12.0); 1.1 (95 % CI 0.5–2.6) respectively. The mean number of allocated hours of care 6 months after assessment was higher in the most dependent group compared to the least dependent group (5.6 vs 1.4 h, p = 0.005).ConclusionsFindings from these analyses support the use of the IoRN across a range of clinical environments although some limitations are highlighted.
Highlights
The Indicator of Relative Need (IoRN) instrument is designed for both health and social care services to measure function and dependency in older people
Findings from these analyses support the use of the IoRN across a range of clinical environments some limitations are highlighted
Group A comprised those admitted to rehabilitation or intermediate care; group B comprised those admitted to an intermediate care at home scheme, and Group C comprised those discharged from hospital with a package of care
Summary
The Indicator of Relative Need (IoRN) instrument is designed for both health and social care services to measure function and dependency in older people. The United Kingdom (UK) is no exception to this growth, meaning that demands for health and social care systems are rising [2]. The UK Government has made health and social care integration a priority to improve outcomes for people who use their services and to maximize finite resources [3]. Joined-up services are required to coordinate person-centred and holistic care needs across more than one agency or discipline [4]. For health and social care integration to prove successful, shared knowledge, resources, and learning are required [5]. One way to help facilitate this is through shared assessment tools
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