Short-Term Lifestyle Strategies for Sustaining Cognitive Status.

Cognitive decline impacts older adults, particularly their independence. The goal of this project was to increase understanding of how short-term, everyday lifestyle options, including physical activity, help an older adult sustain cognitive independence. Using a secondary analysis of lifestyle choices, we drew on a dataset of 4,620 community-dwelling elders in the US, assessed at baseline and one year later using 2 valid and reliable tools, the interRAI Community Health Assessment and the interRAI Wellness tool.

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.

Care planning needs of palliative home care clients: Development of the interRAI palliative care assessment clinical assessment protocols (CAPs).

Background: The interRAI Palliative Care (interRAI PC) assessment instrument provides a standardized, comprehensive means to identify person-specific need and supports clinicians to address important factors such as aspects of function, health, and social support. The interRAI Clinical Assessment Protocols (CAPs) inform clinicians of priority issues requiring further investigation where specific intervention may be warranted and equip clinicians with evidence to better inform development of a person-specific plan of care. This is the first study to describe the interRAI PC CAP development process and provide an overview of distributional properties of the eight interRAI PC CAPs among community dwelling adults receiving palliative home care services.

Predicting risk of hospital and emergency department use for home care elderly persons through a secondary analysis of cross-national data.

Background: Older adults remain the highest utilization group with unplanned visits to emergency departments and hospital admissions. Many have considered what leads to this high utilization and the answers provided have depended upon the independent measures available in the datasets used. This project was designed to further understanding of the reasons for older adult ED visits and admissions to acute care hospitals.

Scaling functional status within the interRAI suite of assessment instruments.

Background: As one ages, physical, cognitive, and clinical problems accumulate and the pattern of loss follows a distinct progression. The first areas requiring outside support are the Instrumental Activities of Daily Living and over time there is a need for support in performing the Activities of Daily Living. Two new functional hierarchies are presented, an IADL hierarchical capacity scale and a combination scale integrating both IADL and ADL hierarchies.

interRAI home care quality indicators.

Background: This paper describe the development of interRAI's second-generation home care quality indicators (HC-QIs). They are derived from two of interRAI's widely used community assessments: the Community Health Assessment and the Home Care Assessment. In this work the form in which the quality problem is specified has been refined, the covariate structure updated, and two summary scales introduced.

A doctor in the house: rationale for providing on-site urological consultation to geriatric patients in nursing health care facilities.

Objectives: To establish a rationale for providing on-site urological care on a regular basis in the nursing health care center setting and to share "lessons learned," which we have garnered in providing that care over a 5-year experience.

Methods: We have reviewed and assessed our experiences in providing urological outreach to nursing health care center patients.

Results: Our outreach program has been well received both by patients and by health care center personnel.

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.

Standardizing assessment of elderly people in acute care: the interRAI Acute Care instrument.

Objectives: To examine the frequency distributions and interrater reliability of individual items of the interRAI Acute Care instrument.

Design: Observational study of a representative sample of older inpatients; duplicate assessments conducted on a subsample by independent assessors to examine interrater reliability.

Setting: Acute medical, acute geriatric and orthopedic units in 13 hospitals in nine countries.

Case management and risk of nursing home admission for older adults in home care: results of the AgeD in HOme Care Study.

Objectives: To explore the relationship between a case management approach and the risk of institutionalization in a large European population of frail, old people in home care.

Design: Retrospective cohort study.

Setting: Eleven European countries.

Predictors of influenza immunization among home care clients in Ontario.

Background: This study examined factors associated with the receipt of influenza vaccination among Ontario home care clients.

Methods: Home care clients were assessed, as part of a routine home visit, during a pilot study of the Resident Assessment Instrument - Home Care (RAI-HC) in 12 Ontario Community Care Access Centres (CCACs). The RAI-HC is a multidimensional assessment that identifies clients' needs and level of functional ability.

The old-old-old.

Geriatricians have long distinguished aging from disease. Yet the separation of these two processes and these in turn from the effects of the environment is most difficult. Therefore, as the possibility of manipulating the aging process is considered, what the elder of tomorrow will look like can only be speculated about.

A journey in reversing practice patterns: a multidisciplinary experience in implementing DOQI guidelines for vascular access.

Background: The National Kidney Foundation has established detailed guidelines due to increasing morbidity and costs related to haemodialysis vascular access in the end-stage renal disease population.

Methods: A quality assurance multidisciplinary committee was formed to implement the Dialysis Outcome Quality Initiative (DOQI) guidelines in September, 1999. Beginning January 2000, a 'Save the Vein Programme' was implemented and native fistulae became the angioaccess of first choice for new patients.