interRAI Assessment Research Articles

Impact of COVID-19 on the health and psychosocial status of vulnerable older adults: study protocol for an observational study

BackgroundMany countries around the world have adopted social distancing as one of the public health measures to reduce COVID-19 transmissions in the community. Such measures could have negative effects on the mental health of the population. The aims of this study are to (1) track the impact of COVID-19 on self-reported mood, self-rated health, other health and psychosocial indicators, and health services utilization of people who have an interRAI assessment during the first year of COVID-19; (2) compare these indicators with the same indicators in people who had an interRAI assessment in the year before COVID-19; and (3) report these indicators publicly as soon as data analysis is completed every 3 months.MethodsinterRAI COVID-19 Study (iCoS) is an observational study on routinely collected national data using the interRAI Home Care and Contact Assessment, which are standardized geriatric assessment tools mandated for all people assessed for publicly funded home support services and aged residential care in New Zealand. Based on the 2018/19 figures, we estimated there are 36,000 interRAI assessments per annum. We will compare the four post-lockdown quarters (from 25th March 2020) with the respective pre-lockdown quarters. The primary outcomes are self-reported mood (feeling sad, depressed or hopeless: 0 = no, 1 = yes) and self-rated health (0 = excellent, 1 = good, 2 = fair, 3 = poor). We will also analyze sociodemographics, other secondary health and psychosocial indicators, and health services utilization. Descriptive statistics will be conducted for primary outcomes and other indicators for each of the eight quarters. We will compare the quarters using regression models adjusted for demographic characteristics using weights or additional variables. Key health and psychosocial indicators will be reported publicly as soon as data analysis is completed for each quarter in the 12-month post-lockdown period by using a data visualization tool.DiscussionThis rapid translation of routinely collected national interRAI data will provide a means to monitor the health and psychosocial well-being of vulnerable older New Zealanders. Insights from this study can be shared with other countries that use interRAI and prepare health and social services for similar epidemics/pandemics in the future.

InterRAI assessments: opportunities to recognise need for and implementation of palliative care interventions in the last year of life?

To explore how interRAI assessments could be used to identify opportunities to integrate palliative care into a plan of care. A population-based, cross-sectional design using unique identifiers to link deaths with a national interRAI database. Data were analysed using logistic regression models and chi-square tests. A total of 4869 people died over a 12-month period in one district health board area; 50.9% (n=2478) received one or more interRAI assessments in the year before death. Diagnosis impacted on the type and timing of interRAI assessments and the recognition of end-stage disease. People in the last year of life experience frequent interRAI assessments. There are opportunities to identify people who might benefit from a palliative care approach. Future research is needed to understand how interRAI assessors can be supported in the application of assessment items related to palliative care.

Older adults abuse: analysis of a New Zealand national dataset.

Older adult abuse (OAA), defined as abuse, neglect, or mistreatment of persons aged 65 years or older, is a globally pervasive concern, with severe consequences for its victims. While internationally reported rates of OAA are in the range of 5-20% per annum, New Zealand lacks the necessary data to quantify the issue. However, with a growing aging population, an increase in the prevalence of OAA is predicted. We investigated the extent of OAA in New Zealand, utilizing the mandatory interRAI-HC (International Resident Assessment Instrument-home care assessment) dataset, which included 18,884 interviewees from the Southern District Health Board between 2013 and 2019. Findings confirmed our hypothesis that the interRAI assessment is neither sufficiently sensitive nor specific capturing only 3% from a population of increased frailty and thus at higher risk of abuse. We characterized OAA victims as relatively younger males, depressed, and with impaired decision-making capacity. If the interRAIs were to serve as a preliminary screening tool for OAA in New Zealand, it would be germane to implement changes to improve its detection rate. Further studies are urgently called for to test changes in the interRAI that will aid in identifying often missed cases of OAA better and thus offer protection to this vulnerable population.

Effectiveness of a Technology-Enhanced Integrated Care Model for Frail Older People: A Stepped-Wedge Cluster Randomized Trial in Nursing Homes.

Background and ObjectivesThe objective of this study was to evaluate the impact of an information and communication technologies (ICT)-enhanced, multidisciplinary integrated care model, called Systems for Person-centered Elder Care (SPEC), on frail older adults at nursing homes.Research Design and MethodsSPEC was implemented at 10 nursing homes in South Korea in random order using a stepped-wedge design. Data were collected on all participating older residents in the homes before the first implementation and until 6 months after the last implementation. The 21-month SPEC intervention guided by the chronic care model (CCM) consists of 5 strategies: comprehensive geriatric assessment, care planning, optional interdisciplinary case conferences, care coordination, and a cloud-based ICT tool along with a free messaging app. The primary outcome was quality of care measured by a composite quality indicator (QI) from the interRAI assessment system. Usual care continued over the control periods. Nursing home staff were not blinded to the intervention.ResultsThere were a total of 482 older nursing home residents included in the analysis. Overall quality of care measured by the composite QI was significantly improved (adjusted mean difference: −0.025 [95% CI: −0.037 to −0.014, p < .0001]). The intervention effect was consistent in the subgroup analysis by cognition and activities of daily living. There were no important adverse events or side effects.Discussion and ImplicationsThe SPEC, a CCM-guided, ICT-supported, multidisciplinary integrated care management intervention, can improve the quality of care measured by health and functional outcomes for frail older persons residing in nursing homes with limited health care provision.Clinical Trials Registration NumberISRCTN11972147

Quality Measurement in Assisted Living: Emerging Practices

Quality Measurement in Assisted Living: Emerging Practices

Lonely in a crowd: loneliness in New Zealand retirement village residents.

The number of older people choosing to relocate to retirement villages (RVs) is increasing rapidly. This choice is often a way to decrease social isolation while still living independently. Loneliness is a significant health issue and contributes to overall frailty, yet RV resident loneliness is poorly understood. Our aim is to describe the prevalence of loneliness and associated factors in a New Zealand RV population. A resident survey was used to collect demographics, social engagement, loneliness, and function, as well as a comprehensive geriatric assessment (international Resident Assessment Instrument [interRAI]) as part of the "Older People in Retirement Villages Study." RVs, Auckland, New Zealand. Participants included RV residents living in 33 RVs (n = 578). Two types of recruitment: randomly sampled cohort (n = 217) and volunteer sample (n = 361). Independently associated factors for loneliness were determined through multiple logistic regression with odds ratios (ORs). Of the participants, 420 (72.7%) were female, 353 (61.1%) lived alone, with the mean age of 81.3 years. InterRAI assessment loneliness (yes/no question) was 25.8% (n = 149), and the resident survey found that 37.4% (n = 216) feel lonely sometimes/often/always. Factors independently associated with interRAI loneliness included being widowed (adjusted OR 8.27; 95% confidence interval [CI] 4.15-16.48), being divorced/separated/never married (OR 4.76; 95% CI 2.15-10.54), poor/fair quality of life (OR 3.37; 95% CI 1.43-7.94), moving to an RV to gain more social connections (OR 1.55; 95% CI 0.99-2.43), and depression risk (medium risk: OR 2.58, 95% CI 1.53-4.35; high risk: OR 4.20, 95% CI 1.47-11.95). A considerable proportion of older people living in RVs reported feelings of loneliness, particularly those who were without partners, at risk of depression and decreased quality of life and those who had moved into RVs to increase social connections. Early identification of factors for loneliness in RV residents could support interventions to improve quality of life and positively impact RV resident health and well-being.

Hearing and Cognitive Impairments Increase the Risk of Long-term Care Admissions

Background and ObjectivesThe objective of the study was to understand how sensory impairments, alone or in combination with cognitive impairment (CI), relate to long-term care (LTC) admissions.Research Design and MethodsThis retrospective cohort study used existing information from two interRAI assessments; the Resident Assessment Instrument for Home Care (RAI-HC) and the Minimum Data Set 2.0 (MDS 2.0), which were linked at the individual level for 371,696 unique individuals aged 65+ years. The exposure variables of interest included hearing impairment (HI), vision impairment (VI) and dual sensory impairment (DSI) ascertained at participants’ most recent RAI-HC assessment. The main outcome was admission to LTC. Survival analysis, using Cox proportional hazards regression models and Kaplan–Meier curves, was used to identify risk factors associated with LTC admissions. Observations were censored if they remained in home care, died or were discharged somewhere other than to LTC.ResultsIn this sample, 12.7% of clients were admitted to LTC, with a mean time to admission of 49.6 months (SE = 0.20). The main risk factor for LTC admission was a diagnosis of Alzheimer’s dementia (HR = 1.87; CI: 1.83, 1.90). A significant interaction between HI and CI was found, whereby individuals with HI but no CI had a slightly faster time to admission (40.5 months; HR = 1.14) versus clients with both HI and CI (44.9 months; HR = 2.11).Discussion and ImplicationsAlthough CI increases the risk of LTC admission, HI is also important, making it is imperative to continue to screen for sensory issues among older home care clients.

Health and survival in Icelandic nursing homes 2003 - 2014, before and after the setting of stricter criteria for nursing home admission in December 2007

Many factors influence the nursing needs and survival of nursing home residents, including the admission criteria. The aim of the study was to compare health, survival and predictors for one- and two-year survival of people entering Icelandic nursing homes between 2003-2007 and 2008-2014. Retrospective, descriptive, comparative study. The data was obtained from a Directorate of Health database for all interRAI assessments of Icelandic nursing homes from January 1, 2003, to December 31, 2014 (N = 8487). There was a significant difference in the health and survival of new nursing home residents before and after December 31, 2007. In the latter period, the mean age was 82.7 years. In the previous period, it was 82.1 years, and the prevalence of Alzheimer's disease, ischemic heart disease, heart failure, diabetes and COPD increased between the periods. One-year survival decreased from 73.4% to 66.5%, and two-year survival decreased from 56.9% to 49.1%. The strongest mortality risk factors were heart failure and chronic obstructive pulmonary disease, as well as high scores on the CHESS scale and ADL long scale. After 2007, new residents were older, in poorer health, and their life expectancy was shorter than for those moving to nursing homes before that. The results suggest that the aim of the regulatory change was achieved, i.e., to prioritise those in worst health. Their care needs may therefore be different and greater than before.

Regional variations of care in home care and long-term care: a retrospective cohort study

Many aging adults undergo progressive loss of autonomy, develop increasingly complex medical needs and experience multiple care transitions. We sought to determine the degree of variation in rates of transfer from home care services and long-term care in several Canadian jurisdictions. In this retrospective cohort study, we examined transitions from home care services and long-term care to different possible end states: change in health stability (getting better or worse), transfer to hospital, transfer to another care setting or death. We used standardized interRAI assessments from long-term care and home care linked to hospital records (data from the Discharge Abstract Database and National Ambulatory Care Reporting System) from 2010 to 2016. Multistate modelling was used to adjust for patients with complex health status and transitions in care. We report data for 254 664 patients in home care programs and 162 045 residents in long-term care. Compared with patients in Ontario, patients requiring home care services in Alberta and British Columbia had increased odds of being admitted to hospital regardless of the underlying severity of illness (the adjusted odds ratios [OR] ranged from 2.08 to 3.77 in Alberta and from 1.28 to 1.46 in BC). Residents in long-term care in Alberta and BC had less than half the odds of being transferred to hospital, independent of all other factors, when compared with long-term care residents in Ontario (the adjusted OR ranged from 0.38 to 0.39 in Alberta and from 0.33 to 0.44 in BC). Significant variations in transfer rates were observed between provinces, even after controlling for individual patient characteristics. These results suggest that transfers to hospital are largely driven by health care policies, health care professional practice patterns and available infrastructure rather than individual patient needs.

Opioids, Pain Management, and Palliative Care in a Norwegian Nursing Home From 2013 to 2018

In Norway, approximately 50% of older people die in nursing homes (NH). Holistic care and pharmacological management are key factors in quality at the end of life. The purpose of this longitudinal study was to describe the use of opioids in an NH during a 5-year period. We focused on palliative care, symptoms, and suffering during the last 3 days before death. Data were collected from spring 2013 to spring 2018. We used the interRAI assessment instrument annually and when the resident died. We conducted a semi-structured interview with nurses on duty at the deathbed. At the time of death, the residents had an average age of 88.9 years and an average stay of 2.9 years (N = 100). At the first assessment, 19% of the residents used 1 or more type of opioids. On the day of death, 55% had an active prescription for opioids, mainly as subcutaneous injections. The results illustrate the different uses of opioids, including managing pain, dyspnoea, sedation, for comfort, as a prophylaxis, or a combination of reasons. Cancer- and cardiovascular diagnoses were the strongest predictor for using morphine (P < 0.05). Identification of the residents’ needs for opioids is a challenge for palliative care nurses, both ethically and legally.

Development and validation of a screener based on interRAI assessments to measure informal caregiver wellbeing in the community

BackgroundInformal caregivers are invaluable partners of the health care system. However, their caring responsibilities often affect their psychological wellbeing and ability to continue in their role. It is of paramount importance to easily identify caregivers that would benefit from immediate assistance.MethodsIn this nonexperimental cohort study, a cross-sectional analysis was conducted among 362 informal caregivers (mean age 64.1 years, SD ± 13.1) caring for persons with high care needs (mean age 78.6 years, SD ± 15.0). Caregivers were interviewed using an interRAI-based self-reported survey with 82 items covering characteristics of caregivers including key aspects of wellbeing. A factor analysis identified items in the caregiver survey dealing with subjective wellbeing that were compared against other wellbeing measures. A screener, called Caregiver Wellbeing Index (CWBI), consisting of four items with response scores ranging from 0 to 2 was created. The CWBI was validated in a follow-up study in which 1020 screeners were completed by informal caregivers of home care clients. Clinical assessments of the care recipients (n = 262) and information on long-term care home (LTCH) admission (n = 176) were linked to the screener dataset. The association between the CWBI scores and caregiver and care recipient characteristics were assessed using logistic regression models and chi-square tests. The reliability of CWBI was also measured.ResultsThe CWBI scores ranging from zero to eight were split in four ‘wellbeing’ levels (excellent, good, fair, poor). In the validation study, fair/poor psychological wellbeing was strongly associated with caregiver reports of inability to continue in their role; conflict with family; or feelings of distress, anger, or depression (P < 0.0001). Caregivers caring for a care recipient that presented changes in behavior, cognition, and mood were more likely to present fair/poor wellbeing (P < 0.0001). Additionally, caregivers with high CWBI scores (poor wellbeing) were also more likely to provide care for someone who was admitted to a LTCH (OR 3.52, CI 1.32–9.34) after controlling for care recipient and caregiver characteristics. The Cronbach alpha value 0.89 indicated high reliability.ConclusionThe CWBI is a valid screener that can easily identify caregivers that might benefit from further assessment and interventions.

Factors associated with inappropriate prescribing among older adults with complex care needs who have undergone the interRAI assessment

Aim: To identify factors associated with prescribing potentially inappropriate medications (PIMs) in older adults (≥65 years) with complex care needs, who have undertaken a comprehensive geriatric risk assessment.Methods: A nationwide cross-sectional (retrospective, observational) study was performed. The national interRAI Home Care assessments conducted in New Zealand in 2015 for older adults were linked to the national pharmaceutical prescribing data (PHARMS). The 2015 Beers criteria were applied to the cross-matched data to identify the prevalence of PIMs. The factors influencing PIMs were analyzed using a multinomial logistic regression model.Results: In total, 16,568 older adults were included in this study. Individuals diagnosed with cancer, dementia, insomnia, depression, anxiety, and who were hospitalized in the last 90 days were more likely to be prescribed PIMs than those who were not diagnosed with the above disorders, and who were not hospitalized in the last 90 days. Individuals over 75 years of age, the Māori ethnic group among other ethnicities, individuals who were diagnosed with certain clinical conditions (diabetes, chronic obstructive pulmonary disease, stroke, or congestive cardiac failure), individuals requiring assistance with activities of daily living, and better self-reported health, were associated with a lesser likelihood of being prescribed PIMs.Conclusion: The study emphasizes the identification of factors associated with the prescription of PIMs during the first completed comprehensive geriatric assessment. Targeted strategies to reduce modifiable factors associated with the prescription of PIMs in subsequent assessments has the potential to improve medication management in older adults.

Determinants of prescribing potentially inappropriate medications in a nationwide cohort of community dwellers with dementia receiving a comprehensive geriatric assessment.

To identify the prevalence and predictors of prescribing potentially inappropriate medications (PIMs) in a nationwide cohort of community dwellers with dementia requiring complex care needs. A cross-matched data of the International Resident Assessment Instrument-Home Care (9.1) (interRAI-HC) and prescribing data obtained from the Pharmaceutical Claims Data Mart (Pharms) extract files for older adults (≥65y) requiring complex care needs were utilized for this study. The 2015 Beers criteria were applied to identify the prevalence of PIMs in older adults with dementia. Sociodemographic and clinical predictors of PIMs were analysed using a logistic regression model. The study population consisted of 16568 individuals who had their first interRAI assessment from 1 January 2015 to 31 December 2015. The estimated prevalence of dementia was 13.2% (2190/16568). 66.9% (1465/2190) of the older adults diagnosed with dementia were prescribed PIMs, of which anticholinergic medications constituted 59.6% (873/1465). Males and individuals who were prescribed a greater number of medications were more likely to be prescribed PIMs. Individuals over 85years of age, Māori ethnic group of individuals, older adults who were being supervised with respect to their activities of daily living, and individuals who reported good or excellent self-reported health had a lesser likelihood of being prescribed PIMs. We found that PIMs are prescribed frequently in older adults with dementia. Comprehensive geriatric assessments can serve as a potential tool to decrease the occurrence of PIMs in vulnerable groups with poor functional and cognitive status.

Developing quality indicators for in-patient post-acute care

BackgroundThis paper describes an integrated series of functional, clinical, and discharge post-acute care (PAC) quality indicators (QIs) and an examination of the distribution of the QIs in skilled nursing facilities (SNF) across the US. The indicators use items available in interRAI based assessments including the MDS 3.0 and are designed for use in in-patient post-acute environments that use the assessments.MethodsData Source: MDS 3.0 computerized assessments mandated for all patients admitted to US skilled nursing facilities (SNF) in 2012. In total, 2,380,213 patients were admitted to SNFs for post-acute care. Definition of the QI numerator, denominator and covariate structures were based on MDS assessment items. A regression strategy modeling the “discharge to the community” PAC QI as the dependent variable was used to identify how to bring together a subset of seven candidate PAC QIs for inclusion in a summary scale. Finally, the distributional property of the summary scale (the PAC QI Summary Scale) across all facilities was explored.ResultsThe risk-adjusted PAC QIs include indicators of improved status, including measures of early, middle, and late-loss functional performance, as well as measures of walking and changed clinical status and an overall summary functional scale. Many but not all patients demonstrated improvement from baseline to follow-up. However, there was substantial inter-state variation in the summary QI scores across the SNFs.ConclusionsThe set of PAC QIs consist of five functional, two discharge and eight clinical measures, and one summary scale. All QIs can be derived from multiple interRAI assessment tools, including the MDS 2.0, interRAI-LTCF, MDS 3.0, and the interRAI-PAC-Rehab. These measures are appropriate for wide distribution in and out of the United States, allowing comparison and discussion of practices associated with better outcomes.

Measuring health related quality of life (HRQoL) in community and facility-based care settings with the interRAI assessment instruments: development of a crosswalk to HUI3

BackgroundHealth-related quality of life (HRQoL) measures are of interest because they can be used to describe health of populations and represent a broader health outcome for population health analyses than mortality rates or life expectancy. The most widely used measure of HRQoL for deriving estimates of health-adjusted life expectancy is the Health Utilities Index Mark 3 (HUI3). The HUI3 is available in most national surveys administered by Statistics Canada, and has been used as part of a microsimulation model to examine the impact of neurological conditions over the life course. Persons receiving home care and nursing home services are often not well-represented in these surveys; however, interRAI assessment instruments are now used as part of normal clinical practice in these settings for nine Canadian provinces/territories. Building on previous research that developed a HUI2 crosswalk for the interRAI assessments, the present study examined a new interRAI HRQoL index crosswalked to the HUI3.MethodsinterRAI and survey data were used to examine the distributional properties of global and domain-specific interRAI HRQoL and HUI3 index scores, respectively. Three populations were considered: well-elderly persons not receiving home care, home care clients and nursing home residents.ResultsThe mean HUI3 and interRAI HRQoL index global scores declined from independent healthy older persons to home care clients, followed by nursing home residents. For the home care and nursing home populations, the interRAI HRQoL global estimates tended to be lower than HUI3 global scores obtained from survey respondents. While there were some statistically significant age, sex and diagnostic group differences in global scores and within attributes, the most notable differences were between populations from different care settings.DiscussionThe present study provides strong evidence for the validity of the interRAI HRQoL based on comparisons of distributional properties with those obtained with survey data based on the HUI3. The results demonstrate the importance of admission criteria for home care and nursing home settings, where function plays a more important role than demographic or diagnostic criteria. The interRAI HRQoL has a distinct advantage because it is gathered as part of normal clinical practice in care settings where interRAI instruments are mandatory and are used to assess all eligible persons in those sectors. In particular, those with severe cognitive and functional impairments (who tend to be under-represented in survey data) will be evaluated using the interRAI tools. Future research should build on this work by providing direct, person-level comparisons of interRAI HRQoL index and HUI3 scores, as well as longitudinal analyses to examine responsiveness to change.

Evaluation of data quality of interRAI assessments in home and community care

BackgroundThe aim of this project is to describe the quality of assessment data regularly collected in home and community, with techniques adapted from an evaluation of the quality of long-term care data in Canada.MethodsData collected using the Resident Assessment Instrument – Home Care (RAI-HC) in Ontario and British Columbia (BC) as well as the interRAI Community Health Assessment (CHA) in Ontario were analyzed using descriptive statistics, Pearson’s r correlation, and Cronbach’s alpha in order to assess trends in population characteristics, convergent validity, and scale reliability.ResultsResults indicate that RAI-HC data from Ontario and BC behave in a consistent manner, with stable trends in internal consistency providing evidence of good reliability (alpha values range from 0.72-0.94, depending on the scale and province). The associations between various scales, such as those reflecting functional status and cognition, were found to be as expected and stable over time within each setting (r values range from 0.42-0.45 in Ontario and 0.41-0.43 in BC). These trends in convergent validity demonstrate that constructs in the data behave as they should, providing evidence of good data quality. In most cases, CHA data quality matches that of RAI-HC data quality and shows evidence of good validity and reliability. The findings are comparable to the findings observed in the evaluation of data from the long-term care sector.ConclusionsDespite an increasingly complex client population in the home and community care sectors, the results from this work indicate that data collected using the RAI-HC and the CHA are of an overall quality that may be trusted when used to inform decision-making at the organizational- or policy-level. High quality data and information are vital when used to inform steps taken to improve quality of care and enhance quality of life. This work also provides evidence that a method used to evaluate the quality of data obtained in the long-term care setting may be used to evaluate the quality of data obtained through community-based measures.

HEALTH ASSETS CAN DECREASE MORTALITY AND LENGTH OF STAY FOR HOSPITALIZED FRAIL OLDER ADULTS

AbstractBackground: Health assets are resources that individuals or communities have at their disposal, which protect against negative health outcomes and promote wellbeing. Health assets may mitigate the effects of frailty for hospitalized older adults and decrease mortality and other adverse outcomes.Methods: This secondary analysis was performed on data collected on 1418 inpatients aged over 69 using the interRAI assessment system for acute care tool. Potential health assets present in the dataset were chosen based on a literature review and expert opinion. The factors examined were gender, living arrangement, days the person left the house prior to becoming unwell, marital status and primary language. Outcomes included inpatient mortality, mortality 28 days after discharge, readmission and length of stay. Multivariate analysis was performed for all factors that had an association with a p value of <0.2 in univariate analysis in a model that accounted for frailty status.Results: Mean age of patients was 81 and 55% were women. Patients who were able to walk further had decreased mortality with OR 0.06(0.01,0.53). Patients who did not leave the house prior to admission had increased mortality with an OR 6.82(3.09,15.05). Living arrangement, person supportive of discharge and distance walked prior to hospitalisation were all associated with a decreased length of stay. None of the health assets examined were protective against readmission.Conclusion: Health assets improved outcomes across the frailty spectrum. Elucidating factors associated with recovery for hospitalized older adults can improve prognostication and guide development of interventions.

IMPROVING LONG-TERM CARE SERVICES WITH INTERNATIONAL STANDARDIZED INSTRUMENTS

This symposium will include speakers from Japan, Korea, Taiwan and Hong Kong and the focus of the symposium is on the adoption of international standardized instruments from interRAI to improve the long term care services in their respective countries and region. The presenters are researchers and/or clinicians from four Asian countries and region who have applied interRAI assessment instruments in their long term care settings for many years. The speaker from Japan will present the results of an evaluation study on the quality of Japanese home care planning agencies by the quality indicators developed from the interRAI Home Care assessment data. These results could be used to market the agency’s strengths and to focus the areas for total quality improvement. Guided by the Chronic Care Model, the Korean speaker will present the study design and preliminary results of evaluating the systems for Person-Centered Elder care management model in South Korea using interRAI LTCF and other assessment tools. The speaker from Taiwan will report the research findings on the interRAI LTCF’s Resident Assessment Protocol triggers as effective indicators for understanding the care complexity and predicting for physical functional decline of nursing home residents in Taiwan. Finally, speaker from Hong Kong will talk about applying interRAI instrument for screening and outcome measures to evaluate a Pleasant Mood and Active Life intervention to reduce the depressive symptoms among the long term care facility residents.

Statin therapy and mortality among new long-term care residents in Ontario, Canada: the contribution of clinical assessment data to a population-based cohort study

ABSTRACTObjectiveThere is limited evidence from randomized trials and observational studies to guide clinical practice regarding the use of statins in long-term care (LTC); the effectiveness of statins among those with limited life expectancy is not clear and there is concern that the risk of drug-related adverse events might outweigh any benefit. We examined the impact of initiating statin therapy on mortality for patients newly admitted to LTC.&#x0D; ApproachPopulation-based health administrative data from Ontario, Canada were used to conduct a retrospective cohort study of newly admitted LTC residents, aged 66+ years and no statin use in the previous year, between January 1 2011 and December 31 2014. This cohort was linked to Resident Assessment Instrument (interRAI) data to capture clinical and functional characteristics (including frailty, activities of daily living, and cognitive function). The primary exposure was statin use within 30 days following LTC entry; residents who died or did not receive an interRAI assessment within 30 days were excluded. A propensity score for receiving statins was computed using resident demographic, clinical and functional characteristics. We matched exposed to unexposed patients on the basis of age (±1 year), sex, prior myocardial infarction(MI)/stroke hospitalization, frailty and propensity score (±0.2 standard deviations). Patients were followed in an intention-to-treat manner from the end of the exposure window until the earliest of death or March 31 2015. Cox regression was used to compare mortality between the study groups.&#x0D; ResultsWe identified 39,560 newly admitted LTC residents aged 66+ years with no statin use in the previous year, of which 1,953 (4.9%) were prescribed a statin within 30 days of LTC entry. Propensity score matching resulted in 1,710 pairs of exposed and unexposed patients. In the matched cohort, those receiving statins had a lower rate of mortality compared with those not receiving statins (Hazard Ratio 0.77; 95% Confidence Interval [CI] 0.70-0.85). In pre-specified subgroup analyses, the association between statin use and reduced mortality persisted among those with and without a prior MI/stroke hospitalization and among those categorized as frail and not frail.&#x0D; ConclusionOur data suggest initiating statins may be beneficial in reducing mortality risk among LTC residents, despite the complexity and advanced age of the patients. By linking rich resident-level health and functional assessment data with health administrative data we were able to characterize the association between demographic and clinical characteristics (including frailty) and exposure to statins more fully than with administrative data alone.

Location, Location, Location: Characteristics and Services of Long-Stay Home Care Recipients in Retirement Homes Compared to Others in Private Homes and Long-Term Care Homes

We examine recipients of publicly funded ongoing care in a single Ontario jurisdiction who reside in three different settings: long-stay home care patients in private homes and apartments, other patients in retirement homes and residents of long-term care homes, using interRAI assessment instruments. Among home care patients, those in retirement homes have higher proportions of dementia and moderate cognitive impairment, less supportive informal care systems as well as more personal care and nursing services above those provided by the public home care system, more frequent but shorter home support visits and lower than expected public home care expenditures. These lower expenditures may be because of efficiency of care delivery or by retirement homes providing some services otherwise provided by the public home care system. Although persons in each setting are mostly older adults with high degrees of frailty and medical complexity, long-term care home residents show distinctly higher needs. We estimate that 40% of retirement home residents are long-stay home care patients, and they comprise about one in six of this Community Care Access Centre's long-stay patients.