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Standardizing Assessment of Elderly People in Acute Care: The interRAI Acute Care Instrument

Authors

  • Len C. Gray MD, PhD,

    1. From the aAcademic Unit in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, AustraliabDepartment of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, ItalycDepartment of Gerontology, Geriatrics, and Rehabilitative Medicine, A. Gemelli University Hospital, Rome, ItalydDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, CanadaeNational Research and Development Centre for Welfare and Health, Helsinki, FinlandfInstitute of Gerontology, University of Michigan, Ann Arbor, MichigangHealth Systems Research, Veterans Affairs Healthcare System, Ann Arbor, MichiganhHomewood Research Institute, Guelph, Ontario, CanadaiDepartment of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, CanadajDepartment of Geriatrics, Landspitali University Hospital, Reykjavik, IcelandkDepartment of Geriatrics, School of Medicine, University of Iceland, Reykjavik, IcelandlInstitute for Aging Research, Hebrew Senior Life, Boston, MassachusettsmDepartment of Geriatric Medicine, Hackensack University Medical Center, Hackensack, New JerseynInstitute for Incentives in Health Care, Guttenberg, New JerseyoDepartment of Geriatrics, Hospital General of Granollers, Barcelona, Spain.
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  • a Roberto Bernabei MD,

    1. From the aAcademic Unit in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, AustraliabDepartment of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, ItalycDepartment of Gerontology, Geriatrics, and Rehabilitative Medicine, A. Gemelli University Hospital, Rome, ItalydDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, CanadaeNational Research and Development Centre for Welfare and Health, Helsinki, FinlandfInstitute of Gerontology, University of Michigan, Ann Arbor, MichigangHealth Systems Research, Veterans Affairs Healthcare System, Ann Arbor, MichiganhHomewood Research Institute, Guelph, Ontario, CanadaiDepartment of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, CanadajDepartment of Geriatrics, Landspitali University Hospital, Reykjavik, IcelandkDepartment of Geriatrics, School of Medicine, University of Iceland, Reykjavik, IcelandlInstitute for Aging Research, Hebrew Senior Life, Boston, MassachusettsmDepartment of Geriatric Medicine, Hackensack University Medical Center, Hackensack, New JerseynInstitute for Incentives in Health Care, Guttenberg, New JerseyoDepartment of Geriatrics, Hospital General of Granollers, Barcelona, Spain.
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  • bc Katherine Berg PhD, PT,

    1. From the aAcademic Unit in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, AustraliabDepartment of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, ItalycDepartment of Gerontology, Geriatrics, and Rehabilitative Medicine, A. Gemelli University Hospital, Rome, ItalydDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, CanadaeNational Research and Development Centre for Welfare and Health, Helsinki, FinlandfInstitute of Gerontology, University of Michigan, Ann Arbor, MichigangHealth Systems Research, Veterans Affairs Healthcare System, Ann Arbor, MichiganhHomewood Research Institute, Guelph, Ontario, CanadaiDepartment of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, CanadajDepartment of Geriatrics, Landspitali University Hospital, Reykjavik, IcelandkDepartment of Geriatrics, School of Medicine, University of Iceland, Reykjavik, IcelandlInstitute for Aging Research, Hebrew Senior Life, Boston, MassachusettsmDepartment of Geriatric Medicine, Hackensack University Medical Center, Hackensack, New JerseynInstitute for Incentives in Health Care, Guttenberg, New JerseyoDepartment of Geriatrics, Hospital General of Granollers, Barcelona, Spain.
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  • d Harriet Finne-Soveri MD, PhD,

    1. From the aAcademic Unit in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, AustraliabDepartment of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, ItalycDepartment of Gerontology, Geriatrics, and Rehabilitative Medicine, A. Gemelli University Hospital, Rome, ItalydDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, CanadaeNational Research and Development Centre for Welfare and Health, Helsinki, FinlandfInstitute of Gerontology, University of Michigan, Ann Arbor, MichigangHealth Systems Research, Veterans Affairs Healthcare System, Ann Arbor, MichiganhHomewood Research Institute, Guelph, Ontario, CanadaiDepartment of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, CanadajDepartment of Geriatrics, Landspitali University Hospital, Reykjavik, IcelandkDepartment of Geriatrics, School of Medicine, University of Iceland, Reykjavik, IcelandlInstitute for Aging Research, Hebrew Senior Life, Boston, MassachusettsmDepartment of Geriatric Medicine, Hackensack University Medical Center, Hackensack, New JerseynInstitute for Incentives in Health Care, Guttenberg, New JerseyoDepartment of Geriatrics, Hospital General of Granollers, Barcelona, Spain.
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  • e Brant E. Fries PhD,

    1. From the aAcademic Unit in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, AustraliabDepartment of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, ItalycDepartment of Gerontology, Geriatrics, and Rehabilitative Medicine, A. Gemelli University Hospital, Rome, ItalydDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, CanadaeNational Research and Development Centre for Welfare and Health, Helsinki, FinlandfInstitute of Gerontology, University of Michigan, Ann Arbor, MichigangHealth Systems Research, Veterans Affairs Healthcare System, Ann Arbor, MichiganhHomewood Research Institute, Guelph, Ontario, CanadaiDepartment of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, CanadajDepartment of Geriatrics, Landspitali University Hospital, Reykjavik, IcelandkDepartment of Geriatrics, School of Medicine, University of Iceland, Reykjavik, IcelandlInstitute for Aging Research, Hebrew Senior Life, Boston, MassachusettsmDepartment of Geriatric Medicine, Hackensack University Medical Center, Hackensack, New JerseynInstitute for Incentives in Health Care, Guttenberg, New JerseyoDepartment of Geriatrics, Hospital General of Granollers, Barcelona, Spain.
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  • fg John P. Hirdes PhD,

    1. From the aAcademic Unit in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, AustraliabDepartment of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, ItalycDepartment of Gerontology, Geriatrics, and Rehabilitative Medicine, A. Gemelli University Hospital, Rome, ItalydDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, CanadaeNational Research and Development Centre for Welfare and Health, Helsinki, FinlandfInstitute of Gerontology, University of Michigan, Ann Arbor, MichigangHealth Systems Research, Veterans Affairs Healthcare System, Ann Arbor, MichiganhHomewood Research Institute, Guelph, Ontario, CanadaiDepartment of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, CanadajDepartment of Geriatrics, Landspitali University Hospital, Reykjavik, IcelandkDepartment of Geriatrics, School of Medicine, University of Iceland, Reykjavik, IcelandlInstitute for Aging Research, Hebrew Senior Life, Boston, MassachusettsmDepartment of Geriatric Medicine, Hackensack University Medical Center, Hackensack, New JerseynInstitute for Incentives in Health Care, Guttenberg, New JerseyoDepartment of Geriatrics, Hospital General of Granollers, Barcelona, Spain.
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  • hi Pálmi V. Jónsson MD,

    1. From the aAcademic Unit in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, AustraliabDepartment of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, ItalycDepartment of Gerontology, Geriatrics, and Rehabilitative Medicine, A. Gemelli University Hospital, Rome, ItalydDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, CanadaeNational Research and Development Centre for Welfare and Health, Helsinki, FinlandfInstitute of Gerontology, University of Michigan, Ann Arbor, MichigangHealth Systems Research, Veterans Affairs Healthcare System, Ann Arbor, MichiganhHomewood Research Institute, Guelph, Ontario, CanadaiDepartment of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, CanadajDepartment of Geriatrics, Landspitali University Hospital, Reykjavik, IcelandkDepartment of Geriatrics, School of Medicine, University of Iceland, Reykjavik, IcelandlInstitute for Aging Research, Hebrew Senior Life, Boston, MassachusettsmDepartment of Geriatric Medicine, Hackensack University Medical Center, Hackensack, New JerseynInstitute for Incentives in Health Care, Guttenberg, New JerseyoDepartment of Geriatrics, Hospital General of Granollers, Barcelona, Spain.
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  • jk John N. Morris PhD,

    1. From the aAcademic Unit in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, AustraliabDepartment of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, ItalycDepartment of Gerontology, Geriatrics, and Rehabilitative Medicine, A. Gemelli University Hospital, Rome, ItalydDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, CanadaeNational Research and Development Centre for Welfare and Health, Helsinki, FinlandfInstitute of Gerontology, University of Michigan, Ann Arbor, MichigangHealth Systems Research, Veterans Affairs Healthcare System, Ann Arbor, MichiganhHomewood Research Institute, Guelph, Ontario, CanadaiDepartment of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, CanadajDepartment of Geriatrics, Landspitali University Hospital, Reykjavik, IcelandkDepartment of Geriatrics, School of Medicine, University of Iceland, Reykjavik, IcelandlInstitute for Aging Research, Hebrew Senior Life, Boston, MassachusettsmDepartment of Geriatric Medicine, Hackensack University Medical Center, Hackensack, New JerseynInstitute for Incentives in Health Care, Guttenberg, New JerseyoDepartment of Geriatrics, Hospital General of Granollers, Barcelona, Spain.
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  • l Knight Steel MD,

    1. From the aAcademic Unit in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, AustraliabDepartment of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, ItalycDepartment of Gerontology, Geriatrics, and Rehabilitative Medicine, A. Gemelli University Hospital, Rome, ItalydDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, CanadaeNational Research and Development Centre for Welfare and Health, Helsinki, FinlandfInstitute of Gerontology, University of Michigan, Ann Arbor, MichigangHealth Systems Research, Veterans Affairs Healthcare System, Ann Arbor, MichiganhHomewood Research Institute, Guelph, Ontario, CanadaiDepartment of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, CanadajDepartment of Geriatrics, Landspitali University Hospital, Reykjavik, IcelandkDepartment of Geriatrics, School of Medicine, University of Iceland, Reykjavik, IcelandlInstitute for Aging Research, Hebrew Senior Life, Boston, MassachusettsmDepartment of Geriatric Medicine, Hackensack University Medical Center, Hackensack, New JerseynInstitute for Incentives in Health Care, Guttenberg, New JerseyoDepartment of Geriatrics, Hospital General of Granollers, Barcelona, Spain.
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  • and mn Sergio Ariño-Blasco MD o

    1. From the aAcademic Unit in Geriatric Medicine, School of Medicine, University of Queensland, Brisbane, AustraliabDepartment of Internal Medicine and Geriatrics, Università Cattolica del Sacro Cuore, Rome, ItalycDepartment of Gerontology, Geriatrics, and Rehabilitative Medicine, A. Gemelli University Hospital, Rome, ItalydDepartment of Physical Therapy, University of Toronto, Toronto, Ontario, CanadaeNational Research and Development Centre for Welfare and Health, Helsinki, FinlandfInstitute of Gerontology, University of Michigan, Ann Arbor, MichigangHealth Systems Research, Veterans Affairs Healthcare System, Ann Arbor, MichiganhHomewood Research Institute, Guelph, Ontario, CanadaiDepartment of Health Studies and Gerontology, University of Waterloo, Waterloo, Ontario, CanadajDepartment of Geriatrics, Landspitali University Hospital, Reykjavik, IcelandkDepartment of Geriatrics, School of Medicine, University of Iceland, Reykjavik, IcelandlInstitute for Aging Research, Hebrew Senior Life, Boston, MassachusettsmDepartment of Geriatric Medicine, Hackensack University Medical Center, Hackensack, New JerseynInstitute for Incentives in Health Care, Guttenberg, New JerseyoDepartment of Geriatrics, Hospital General of Granollers, Barcelona, Spain.
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Address correspondence to Professor Len Gray, Director, Academic Unit in Geriatric Medicine, School of Medicine, The University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane, Qld 4102, Australia. E-mail: len.gray@uq.edu.au

Abstract

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.

PARTICIPANTS: Five hundred thirty-three patients aged 70 and older (mean age 82.4, range 70–102) with an anticipated stay of 48 hours or longer of whom 161 received duplicate assessments.

MEASUREMENTS: Sixty-two clinical items across 11 domains. Premorbid (3-day observation period before onset of the acute illness) and admission (the first 24 hours of hospital stay) assessments were conducted.

RESULTS: The frequency of deficits exceeded 30% for most items, ranging from 1% for physically abusive behavior to 86% for the need for support in activities of daily living after discharge. Common deficits were in cognitive skills for daily decision-making (38% premorbid, 54% at admission), personal hygiene (37%, 65%), and walking (39%, 71%). Interrater reliability was substantial in the premorbid period (average κ=0.61) and admission period (average κ=0.66). Of the 69 items tested, less than moderate agreement (κ<0.4) was recorded for six (9%), moderate agreement (κ=0.41–0.6) for 14 (20%), substantial agreement (κ=0.61–0.8) for 40 (58%), and almost perfect agreement (κ>0.8) for nine (13%).

CONCLUSION: Initial assessment of the psychometric properties of the interRAI Acute Care instrument provided evidence that item selection and interrater reliability are appropriate for clinical application. Further studies are required to examine the validity of embedded scales, diagnostic algorithms, and clinical protocols.

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