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.


METHODS
A 12 months prospective cohort study was conducted in 57 NH in 7 EU countries (Czech Republic, England, Finland, France, Germany, Italy, The Netherlands) and 1 non EU country (Israel). Weighted kappa coefficients were used to evaluate the reliability of interRAI LTCF items.


RESULTS
Mean age of 4156 residents entering the study was 83.4 ± 9.4 years, 73% were female. ADL disability and cognitive impairment was observed in 81.3% and 68.0% of residents, respectively. Clinical complexity of residents was confirmed by a high prevalence of behavioral symptoms (27.5% of residents), falls (18.6%), pressure ulcers (10.4%), pain (36.0%) and urinary incontinence (73.5%). Overall, 197 of the 198 the items tested met or exceeded standard cut-offs for acceptable test-retest and inter-rater reliability after translation into the target languages.


CONCLUSIONS
The interRAI LTCF appears to be a reliable instrument. It enables the creation of databases that can be used to govern the provision of long-term care across different health systems in Europe, to answer relevant research and policy questions and to compare characteristics of NH residents across countries, languages and cultures.
Centro Medicina dell'Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy. graziano_onder@rm.unicatt.it
Graziano
G
Onder
Iain
I
Carpenter
Harriet
H
Finne-Soveri
Jacob
J
Gindin
Dinnus
D
Frijters
Jean Claude
JC
Henrard
Thorsten
T
Nikolaus
Eva
E
Topinkova
Matteo
M
Tosato
Rosa
R
Liperoti
Francesco
F
Landi
Roberto
R
Bernabei
D000203:Activities of Daily Living; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000453:epidemiology; D003431:Cross-Cultural Comparison; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005060:Europe / Q000453:epidemiology; D005062:European Union; D005260:Female; D015577:Geriatric Assessment / Q000379:methods / Q000706:statistics & numerical data*; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D014177:Translations