Abstract
BackgroundSelf-reported life-space assessment methods so far focus on community-dwelling persons, with a lack of validated assessment methods for institutionalized settings. This study evaluated construct validity, test-retest reliability, sensitivity to change, and feasibility of a new Life-Space Assessment for Institutionalized Settings (LSA-IS) in geriatric patients.MethodsPsychometric properties of the LSA-IS in 119 hospitalized geriatric patients (83.0 ± 6.2 years) with and without cognitive impairment (CI) [Mini-Mental State Examination: 22.4 ± 4.9 scores] were evaluated within a comprehensive validation design. For the total group and subgroups according to cognitive status, construct validity was assessed by calculating Spearman’s rank correlation coefficients (rho) with established construct variables, test–retest reliability by intra-class correlation coefficients (ICCs), sensitivity to change by standardized response means (SRMs) calculated for effects of early ward-based rehabilitation during hospital stay.ResultsThe LSA-IS (total score) demonstrated good test–retest reliability (ICC = .704), and large sensitivity to change (SRM = .806), while construct validity was small to high indicated by significant correlations of the LSA-IS to construct variables (rho = .208–716), depending on relative construct association. On average results of LSA-IS sub-scores confirmed results of the total score. Subgroups according to cognitive status did not differ for most analyzed variables. A completion rate of 100% and a completion time of 3.2 ± 1.2 min documented excellent feasibility.ConclusionsThe interview-based LSA-IS has proven to be valid, reliable, sensitive, and feasible in hospitalized, multi-morbid, geriatric patients with and without CI documenting good psychometric properties for institutionalized settings.Trial registrationDRKS00016028
Highlights
Self-reported life-space assessment methods so far focus on community-dwelling persons, with a lack of validated assessment methods for institutionalized settings
Mobility in institutionalized settings is severely restricted with the consequence of a highly sedentary behavior of older patients during hospital stay or nursing home residents spending most of their time lying or sitting [1, 2]
Apart from the classification criteria (MMSE score < 24 vs. ≥24), subsamples with and without cognitive impairment (CI) differed with respect to frailty, functional, motor, and psychological status (CFS, ADL, SPPB Apathy Evaluation Scale – Clinical version (AES-C)) indicating a reduced status in persons with CI but more apathetic symptoms in the group without CI (Table 1)
Summary
Self-reported life-space assessment methods so far focus on community-dwelling persons, with a lack of validated assessment methods for institutionalized settings. Mobility in institutionalized settings is severely restricted with the consequence of a highly sedentary behavior of older patients during hospital stay or nursing home residents spending most of their time lying or sitting [1, 2]. While mobility in community-dwelling older persons is influenced by a large number of individual as well as societal factors [6, 7], in institutionalized persons some additional factors become relevant [8] Such factors with influence on mobility status during hospitalization cover patient-related (illness severity, comorbid conditions), treatment-related (bed-rest required, hospital devices such as catheters, restraints), attitudinal (attitudes towards mobility, expectations of hospital stay), and institutional aspects (nursing to patient ratio, availability of equipment) [9].
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