Abstract
BackgroundAims of the present study are the following: 1. to describe the rationale and methodology of the Services and Health for Elderly in Long TERm care (SHELTER) study, a project funded by the European Union, aimed at implementing the interRAI instrument for Long Term Care Facilities (interRAI LTCF) as a tool to assess and gather uniform information about nursing home (NH) residents across different health systems in European countries; 2. to present the results about the test-retest and inter-rater reliability of the interRAI LTCF instrument translated into the languages of participating countries; 3 to illustrate the characteristics of NH residents at study entry.MethodsA 12 months prospective cohort study was conducted in 57 NH in 7 EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non EU country (Israel). Weighted kappa coefficients were used to evaluate the reliability of interRAI LTCF items.ResultsMean age of 4156 residents entering the study was 83.4 ± 9.4 years, 73% were female. ADL disability and cognitive impairment was observed in 81.3% and 68.0% of residents, respectively. Clinical complexity of residents was confirmed by a high prevalence of behavioral symptoms (27.5% of residents), falls (18.6%), pressure ulcers (10.4%), pain (36.0%) and urinary incontinence (73.5%). Overall, 197 of the 198 the items tested met or exceeded standard cut-offs for acceptable test-retest and inter-rater reliability after translation into the target languages.ConclusionThe interRAI LTCF appears to be a reliable instrument. It enables the creation of databases that can be used to govern the provision of long-term care across different health systems in Europe, to answer relevant research and policy questions and to compare characteristics of NH residents across countries, languages and cultures.
Highlights
Several steps were followed in the study: 1. Applicability of the interRAI LTCF to languages of participating countries The original version of the interRAI LTCF was translated from English version into 7 languages of participating countries (Czech, Dutch, Finnish, French, German, Hebrew, Italian) following several steps: forward translation, reconciliation, back translation, back translation review, cognitive debriefing, review of cognitive debriefing results and proof-reading
The SHELTER study shows that the interRAI LTCF 1. is a reliable instrument which can be used to assess characteristics of nursing home (NH) residents; 2. can be used to compare characteristics of NH residents across Europe; 3. may contribute to the collection of information and to the creation of large data sets
InterRAI LTCF was designed to assist clinicians in assessing the care needs of NH residents and providing a comprehensive view of the needs and strengths of the NH population, a view that is essential to the development of appropriate plans of care and allocation of resources [13]
Summary
About 20% of the population with functional limitations aged 65 and over living in European countries receives long-term care in an institution and about 30% receives formal care at home [1,2]. This rapidly increasing population with chronic disabling conditions will require long term support. The issue is seldom the disease diagnosis but rather the functional and social consequences of health conditions [4,5]
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