[From comprehensive geriatric assessment to an integrated multidimensional assessment system : interRAI tools and their applications].

The multidimensional assessment carried out with interRAI tools constitutes an operationalization of the International Classification of Functioning, Disability and Health (ICF) and is adapted to the specificities of each place of care. From a single assessment, the interRAI approach makes it possible to conduct a multidimensional assessment of functional autonomy and to produce a series of indicators (health, areas of intervention, quality of care and consumption of resources). It helps to identify clinical needs to be the subject of a personalized care plan and the strengths and weaknesses of health organizations to modify the professional practices.

The Association of Anticholinergic Drugs and Delirium in Nursing Home Patients With Dementia: Results From the SHELTER Study.

Objectives: Drugs with anticholinergic properties are associated with an increased prevalence of delirium, especially in older persons. The aim of this study was to evaluate the association between the use of this class of drugs in nursing home (NH) patients and prevalence of delirium, particularly in people with dementia.

Design: Cross-sectional multicenter study.

Predictors of Societal Costs of Older Care-Dependent Adults Living in the Community in 11 European Countries.

Background: The objective was to identify predictors of societal costs covering formal and informal care utilization by older home care clients in 11 European countries.

Methods: Societal costs of 1907 older clients receiving home care for 12 months from the Aged in Home care (AdHoc) study were estimated using the InterRAI Minimum Data Set for Home Care's (MDS-HC) resource use items. Predictors (medical, functional, and psychosocial domains) of societal costs were identified by performing univariate and multivariate generalized linear model analyses.

Implementation of a Standardized Comprehensive Assessment Tool in France: A Case Using the InterRAI Instruments.

Background: The improvement of quality of care requires a standardized and comprehensive assessment tool but implementation is challenging.

Purpose: We have reported on the development of the interRAI instruments in France from the onset to the mandatory use at the national level. We also have identified in the literature and in practices, incentives and barriers for the implementation of this integrated clinical information system in long term care.

Updating the Cognitive Performance Scale.

This study presents the first update of the Cognitive Performance Scale (CPS) in 20 years. Its goals are 3-fold: extend category options; characterize how the new scale variant tracks with the Mini-Mental State Examination; and present a series of associative findings. Secondary analysis of data from 3733 older adults from 8 countries was completed.

Dual Sensory Impairment and Cognitive Decline: The Results From the Shelter Study.

Objectives: To examine whether nursing home residents with concurrent vision and hearing impairment, dual sensory impairment (DSI), have a greater cognitive decline over time than do those without sensory impairment and whether social engagement modifies this association.

Methods: Based on the Services and Health for Elderly in Long TERm Care study, 1,989 nursing home residents who were assessed using the interRAI LTCF at 6-month intervals over 1 year were included. Multivariate linear regression models with time-variant exposure variables of sensory impairment and social engagement using generalized estimating equations were performed to predict cognitive function measured by the Cognitive Performance Scale (range 0-6).

Insomnia in long-term care facilities: a comparison of seven European countries and Israel: the Services and Health for Elderly in Long TERm care study.

Objectives: To assess insomnia and its correlates as part of the Services and Health for Elderly in Long TERm care (SHELTER) study, funded by the 7th Framework Programme of the European Union.

Design: Cross-cultural investigation.

Setting: Long-term care facilities (LTCFs) in eight European countries (Czech Republic, France, Finland, Germany, England, the Netherlands, Italy) and one non-European country (Israel).

Use of antipsychotic drugs among residents with dementia in European long-term care facilities: results from the SHELTER study.

Background: Behavioral and psychological symptoms of dementia (BPSD) are common reasons for use of antipsychotic drugs among older individuals with dementia. These drugs are not approved for such use and both the Food and Drug Administration and European Medicines Agency have issued warnings to limit such use.

Objectives: This study aimed to describe patterns of antipsychotic drug use in a sample of nursing home residents with dementia in 7 European countries and Israel.

[Single entry point in a gerontological network for addressing the needs of older people].

Introduction: A single entry point for the elderly is important for the integration of services and for standardizing needs assessment processes. The role of a single entry point role is to refer older persons to the appropriate social and/or health services. The purpose of this paper is to describe the relationships between institutional partners and their use of the single entry point in a gerontological network.

The calculation of quality indicators for long term care facilities in 8 countries (SHELTER project).

Background: Performance indicators in the long term care sector are important to evaluate the efficiency and quality of care delivery. We are, however, still far from being able to refer to a common set of indicators at the European level.We therefore demonstrate the calculation of Long Term Care Facility Quality Indicators (LTCFQIs) from data of the European Services and Health for Elderly in Long TERm Care (SHELTER) project.

Assessment of nursing home residents in Europe: the Services and Health for Elderly in Long TERm care (SHELTER) study.

Background: Aims 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.

Diagnostic study, design and implementation of an integrated model of care in France: a bottom-up process with continuous leadership.

Background: Sustaining integrated care is difficult, in large part because of problems encountered securing the participation of health care and social service professionals and, in particular, general practitioners (GPs).

Purpose: To present an innovative bottom-up and pragmatic strategy used to implement a new integrated care model in France for community-dwelling elderly people with complex needs.

Results: In the first step, a diagnostic study was conducted with face-to-face interviews to gather data on current practices from a sample of health and social stakeholders working with elderly people.

Sharing clinical information across care settings: the birth of an integrated assessment system.

Background: Population ageing, the emergence of chronic illness, and the shift away from institutional care challenge conventional approaches to assessment systems which traditionally are problem and setting specific.

Methods: From 2002, the interRAI research collaborative undertook development of a suite of assessment tools to support assessment and care planning of persons with chronic illness, frailty, disability, or mental health problems across care settings. The suite constitutes an early example of a "third generation" assessment system.

Relationship between interRAI HC and the ICF: opportunity for operationalizing the ICF.

Background: The International Classification of Functioning, Disability and Health (ICF) is embraced as a framework to conceptualize human functioning and disability. Health professionals choose measures to represent the domains of the framework. The ICF coding classification is an administrative system but multiple studies have linked diverse clinical assessments to ICF codes.

Shaping home care in Europe: the contribution of the Aged in Home Care project.

Objectives: During the 1990s, use of home care sector has increased substantially in Europe. However, research on home care continues to be underreported. This article summarizes the findings from the "Aged in Home Care" (ADHOC) study - carried out from 2001 to 2004 in Europe - and women's situation in European Home Care.

Variations in quality of Home Care between sites across Europe, as measured by Home Care Quality Indicators.

Background And Aims: The increase in the proportion of elderly people and a consequent increase in the demand for care have caused healthcare systems to become overloaded. This paper describes the use of Home Care Quality Indicators (HCQIs), derived from the Minimum Data Set for Home Care, for monitoring quality of care. Research questions were, "Do HCQI scores vary between home care organizations in different countries?" and "Are one or more country-specific sites consistently scoring better on most or all HCQIs"?

Methods: a cross-sectional observational study of 65+ randomly selected clients of home care organizations in urban areas in 11 European countries who had been receiving home care for at least two weeks.

Proposal of a service delivery integration index of home care for older persons: application in several European cities.

Purpose: To propose an integration index of home care delivery to older persons, to study its validity and to apply it to home care services of European cities.

Theory: Home care delivery integration was based on two dimensions referring to process-centred integration and organisational structure approach.

Method: Items considered as part of both dimensions according to an expert consensus (face validity) were extracted from a standardised questionnaire used in "Aged in Home care" (AdHoc) study to capture basic characteristics of home care services.