To develop and validate an instrument that integrates functional capacity, risk of pressure ulcers and risk of falling with a more parsimonious approach towards nursing assessments in hospitalization units.

Developing and validating an integrated instrument for nursing assessments in adult hospitalization units: Study protocol

Background The BelRAI Screener is a short-form assessment consolidating internationally validated interRAI items focusing on physical and psychological aspects of functioning and problems with activities of daily living. It was fully implemented in the Flemish home care setting as of June 2021. In a biopsychosocial model for developing a personalized and effective care plan social and contextual aspects are considered equally important to biomedical ones. Thus, a social supplement to the BelRAI Screener was collaboratively developed with stakeholders and tested to gather additional information on the social context of community-dwelling adults with care needs. Objective and methods To examine the interrater reliability of the BelRAI Social Supplement in Flanders, Belgium, an observational study was conducted using a convenience sample. The method of simultaneous rating was used due to strict COVID-19 guidelines at the time and to minimize assessment burden. Fifty two community-dwelling adults requesting home care support were simultaneously assessed by two independent assessors during home visits. Interrater reliability was tested on all 80 items of the BelRAI Social Supplement using observed agreement, kappa coefficients, and intraclass correlation coefficients. Results The kappa mean (0.74) and median (0.79) values for nominal items, show substantial agreement, while the kappa mean and median values for ordinal items were 0.81 and 0.90, which correspond to almost perfect agreement. Following the traditional cut-off points for the interpretation of the kappa statistic, reliability was almost perfect (κ > 0.81) for 49% of all items, substantial (0.60 < κ ≤ 0.80) for 33%, moderate (0.40 < κ ≤ 0.60) for 8%, and poor (κ < 0.40) for 10%. The majority of items with poor kappa value, showed a high observed agreement, reflecting homogeneity of the sample rather than poor agreement. Conclusion The strength of kappa agreement for the items in this version of the BelRAI Social Supplement is generally substantial to almost perfect, with high proportions of observed agreement. COVID-19 restrictions had a large impact on the planning and execution of the home visits. A final optimization of the instrument and accompanying manual according to the findings will result in an improved version ready for nation-wide implementation.

/pdf/interrater-reliability-of-the-belrai-social-supplement-in-1kh9me5u.pdf

Interrater reliability of the BelRAI Social Supplement in Flanders, Belgium: Simultaneous rating of community-dwelling adults with care needs during COVID-19

Older adults (≥65 years old), now comprise half of the inpatient population. Catering for the needs of this group requires consideration of the processes of care, the inpatient environment and care practices operating in our hospitals. Older adults are often multimorbid, more likely than older adults in the community to be malnourished and have coexistent physical and cognitive impairments. These older adults are at great risk of suffering hospital associated harms or being designated as "bed blockers", partly due to inadequate understanding of their needs, a failure of recognition or an unwillingness to address them. The adoption of older adult friendly care presents considerable opportunity to transform the manner in which care is delivered in order to mitigate avoidable harms and optimize outcomes for older adults. This review explores the nature of our older adult inpatients, the implications of older adult friendly care, the requirement for true interprofessional care, the advantages of systematic assessment which spans pre-hospital to post-hospital care and highlights specific interventions to deal with in hospital problems which differentially impair health related outcomes for older adults. As such it raises awareness of the needs of older adults under cardiological to improve outcomes for hospitalized older adults. 

The clinical advantages of making our hospitals older adult friendly.

pdf/nenaplnene-potreby-starsich-ludi-prehlad-hodnotiacich-2ep0z3x43i.pdf

Nenaplnené potreby starších ľudí: prehľad hodnotiacich nástrojov

Objective: The demand for long-term care in community and facilitybased settings in Canada is expected to increase with population growth. The Toronto Grace Health Center piloted an intervention program that aims to support return to the community of acute hospital patients designated for LTC placement. We investigated whether this program was effective in transitioning the program patients back to their homes in the community and the factors associated with transitioning patients to different destinations. Method: We performed a competing risk multi-state analysis of 111 patients enrolled into the Harbour Light (HL) transitional unit program between January 2020 and June 2023. Results: At the time of the study, 92 enrolled patients had been discharged and of those these, 48.9% (45) were successfully transitioned back to their private home in the community. The remaining 51.1% (46) were discharged to other destinations. Being a female was the only positive predictor of transitioning back home. Higher CPS scores (HR 0.53, 95% CI 0.31-0.88), PADDRS scale of 1+, and higher ADL Hierarchy scale, strongly predicted lower odds of transitioning back to the community. Conclusion: Within the context of rising LTC bed demand and lengthy waiting time in Canada, with appropriate measures, this program successfully transitioned LTC home bound persons back to their homes. If replicable on a large scale, this could provide short and long-term solution to LTC bed demand in Canada.

Multistate Competing Risk Analysis of Transition Back to the Community Among Long-Term Care Home (LTC) Destined Patients: A Brief Report

BackgroundOlder adults are the biggest users of emergency departments and hospitals. However, healthcare professionals are often ill equipped to conduct comprehensive geriatric assessments causing ...

InterRAI Acute Care Instrument for Seniors in Canadian Hospitals: Findings of an Inter-Rater Reliability Pilot Study.

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InterRAI Acute Care Instrument for Seniors in Canadian Hospitals: Findings of an Inter-Rater Reliability Pilot Study.