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The purposive use of theory is a foundational component of research, which underpins the design, methodology, measures, interventions, and interpretation of the research project. This should be considered from the time the nascent idea of the research is born, until the final interpretation of results and write up of the discussion. Several theories relevant to telemedicine are described, discussed, and linked to typical research questions in the field. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

An online assessment system was developed as part of a geriatric profiling service. To examine efficiency, the information processing approach was compared with the conventional, paper-based assessment system. Ten cases in each group were studied. The median direct processing time was 43 min for manual assessment and 37 min for online assessment (P<0.01). Time savings in online assessment were due to reduced processing time by nurses (elimination of manual preparation of the report) and administrators (no walking to the ward to collect assessments, more rapid communication through an alert system with reporting geriatricians). There were no time savings for the geriatricians. The median time taken (during working hours) from completion of the assessment by the nurse assessors to presentation of the full report at the ward was shorter using the online assessment system – 2 hrs 17 min vs 4 h 25 min – though not significantly (P = 14; 0.17). After processing the first case, the assessing clinical staff did not want to continue to use the manual system. [ABSTRACT FROM AUTHOR]

Discusses studies that affect the classification of older hospital patients and their implications for clinical practice. Outcome of a study that examined the key attributes of acutely admitted older hospital patients, including age and gender; Background on acute medical services for older people; Implications of clinical outcomes for the quality of care provided.

Aims: To identify the views of people with Type 2 diabetes (PWD) and healthcare professionals (HCP) about diabetes care. Methods: A systematic review of qualitative studies reporting both groups' views using thematic synthesis frameworked by the eHealth Enhanced Chronic Care Model was conducted. Results: We searched six electronic databases between 2010 and 2020, identified 6999 studies and included 21. Thirty themes were identified with in general complementary views between PWD and HCP. PWD and HCP find lifestyle changes challenging and get frustrated when PWD struggle to achieve it. Good self‐management requires a trustful PWD–HCP relationship. Diabetes causes distress and often HCP focus on clinical aspects. They value diabetes education. PWD require broader, tailored, consistent and ongoing information, but HCPs do not have enough time for providing it. There is need for diabetes training for primary HCP. Shared decision making can mitigate PWD's fears. Different sources of social support can influence PWD's ability to self‐manage and PWD/HCP suggest online peer groups. PWD/HCP indicate lack of communication and collaboration between HCP. PWD's and HCP's views about quality in diabetes care differ. They believe that comprehensive, multidisciplinary and locally provided care can help to achieve better outcomes. They recognise digital health benefits, with room for personal interaction (PWD) and eHealth literacy improvements (HCP). Evidence‐based guidelines are important but can detract from personalised care. Conclusion: We hypothesise that including PWD's and HCP's complementary views, multidisciplinary teams and digital tools in the redesign of Type 2 diabetes care can help with overcoming some of the challenges and achieving common goals. [ABSTRACT FROM AUTHOR]

Background: In Australia, 243 000 individuals live in approximately 2700 residential aged care facilities yearly. In 2019, a National Aged Care Mandatory Quality Indicator programme (QI programme) was implemented to monitor the quality and safety of care in facilities. Aim: To examine the validity of the QI programme indicators using explicit measure review criteria. Methods: The QI programme manual and reports were reviewed. A modified American College of Physicians Measure Review Criteria was employed to examine the QI programme's eight indicators. Five authors rated each indicator on importance, appropriateness, clinical evidence, specifications and feasibility using a nine‐point scale. A median score of 1–3 was considered to not meet criteria, 4–6 to meet some criteria and 7–9 to meet criteria. Results: All indicators, except polypharmacy, met criteria (median scores = 7–9) for importance, appropriateness and clinical evidence. Polypharmacy met some criteria for importance (median = 6, range 2–8), appropriateness (median = 5, range 2–8) and clinical evidence (median = 6, range 3–8). Pressure injury, physical restraints, significant unplanned weight loss, consecutive unplanned weight loss, falls and polypharmacy indicators met some criteria for specifications validity (all median scores = 5) and feasibility and applicability (median scores = 4 to 6). Antipsychotic use and falls resulting in major injury met some criteria for specifications (median = 6–7, range 4–8) and met criteria for feasibility and applicability (median = 7, range 4–8). Conclusions: Australia's National QI programme is a major stride towards a culture of quality promotion, improvement and transparency. Measures' specifications, feasibility and applicability could be improved to ensure the programme delivers on its intended purposes. [ABSTRACT FROM AUTHOR]

The article focuses on hospital geriatric consultation services. It says that the efficiency of assessment, selection of patients for post-acute care in geriatric units and assist in the organization of nurse care planning and discharge planning can be improved through a systemic approach to geriatric assessment. It emphasizes the need to continue exploring practice models that will deliver geriatric specialist expertise to general ward settings.

Aim: Globally, type 2 diabetes care is often fragmented and still organised in a provider‐centred way, resulting in suboptimal care for many individuals. As healthcare systems seek to implement digital care innovations, it is timely to reassess stakeholders' priorities to guide the redesign of diabetes care. This study aimed to identify the needs and wishes of people with type 2 diabetes, and specialist and primary care teams regarding optimal diabetes care to explore how to better support people with diabetes in a metropolitan healthcare service in Australia. Methods: Our project was guided by a Participatory Design approach and this paper reports part of the first step, identification of needs. We conducted four focus groups and 16 interviews (November 2019–January 2020) with 17 adults with type 2 diabetes and seven specialist clinicians from a diabetes outpatient clinic in Brisbane, Australia, and seven primary care professionals from different clinics in Brisbane. Data were analysed using reflexive thematic analysis, building on the Capability, Opportunity, Motivation and Behaviour model. Results: People with diabetes expressed the wish to be equipped, supported and recognised for their efforts in a holistic way, receive personalised care at the right time and improved access to connected services. Healthcare professionals agreed and expressed their own burden regarding their challenging work. Overall, both groups desired holistic, personalised, supportive, proactive and coordinated care pathways. Conclusions: We conclude that there is an alignment of the perceived needs and wishes for improved diabetes care among key stakeholders, however, important gaps remain in the healthcare system. [ABSTRACT FROM AUTHOR]

Objective. The aim of this study is to identify the extent to which the Medicare item numbers and incentives, introduced in July 2011, have been effective in stimulating telehealth activity in Australia. Methods. A retrospective descriptive study utilising data on the uptake of telehealth item numbers and associated inperson services, from July 2011 to April 2014, were obtained from Medicare Australia. The main outcome measures were number of telehealth services over time, plus uptake proportionate to in-person services, by jurisdiction, by speciality, and by patient gender. Results. Specialist consultations delivered by video communication and rebated by Medicare rose to 6000 per month, which is 0.24% of the total number of specialist consultations. The highest proportional uptake was in geriatrics and psychiatry. In 52% per cent of video consultations the patient was supported by an on-site healthcare provider, most commonly a general practitioner. There were substantial jurisdictional differences. A significantly lower percentage of female patients were rebated for item 99, which is primarily used by surgeons. Conclusions. Medicare rebates and incentives, which are generous by world standards, have resulted in specialist video consultations being provided to underserved areas, although gaps still remain that need new models of care to be developed. [ABSTRACT FROM AUTHOR]

Background: Clinical practice guidelines recommend that adults with type 2 diabetes (T2D) sit less and move more throughout the day. The 18-month OPTIMISE Your Health Clinical Trial was developed to support desk-based workers with T2D achieve these recommendations. The two-arm protocol consists of an intervention and control arms. The intervention arm receives 6 months health coaching, a sit-stand desktop workstation and an activity tracker, followed by 6 months of text message support, then 6 months maintenance. The control arm receives a delayed modified intervention after 12 months of usual care. This paper describes the methods of a randomised controlled trial (RCT) evaluating the effectiveness and cost-effectiveness of the intervention, compared to a delayed intervention control.Methods: This is a two-arm RCT being conducted in Melbourne, Australia. Desk-based workers (≥0.8 full-time equivalent) aged 35-65 years, ambulatory, and with T2D and managed glycaemic control (6.5-10.0% HbA1c), are randomised to the multicomponent intervention (target n = 125) or delayed-intervention control (target n = 125) conditions. All intervention participants receive 6 months of tailored health coaching assisting them to "sit less" and "move more" at work and throughout the day, supported by a sit-stand desktop workstation and an activity tracker (Fitbit). Participants receive text message-based extended care for a further 6-months (6-12 months) followed by 6-months of non-contact (12-18 months: maintenance). Delayed intervention occurs at 12-18 months for the control arm. Assessments are undertaken at baseline, 3, 6, 12, 15 and 18-months. Primary outcomes are activPAL-measured sitting time (h/16 h day), glycosylated haemoglobin (HbA1c; %, mmol/mol) and, cognitive function measures (visual learning and new memory; Paired Associates Learning Total Errors [adjusted]). Secondary, exploratory, and process outcomes will also be collected throughout the trial.Discussion: The OPTIMISE Your Health trial will provide unique insights into the benefits of an intervention aimed at sitting less and moving more in desk-bound office workers with T2D, with outcomes relevant to glycaemic control, and to cardiometabolic and brain health. Findings will contribute new insights to add to the evidence base on initiating and maintaining behaviour change with clinical populations and inform practice in diabetes management.Trial Registration: ANZCTRN12618001159246 . [ABSTRACT FROM AUTHOR]

We conducted a systematic review to identify the extent to which the process of screening for cognitive impairment in older adults has been validated for administration by telephone. A search of electronic databases and a handsearch of relevant journals and reference lists were carried out for studies published between 1966 and 2008. The database search identified 411 studies and handsearching found another seven. Fourteen studies were finally identified as relevant to the review: three concerned a modified telephone version of the Mini-Mental State Examination (MMSE); five concerned the Telephone Interview for Cognitive Status; one study tested a telephone-administered Short Portable Mental Status Questionnaire; four studies tested the validity of newly developed tools; and the remaining study considered the Confusion Assessment Method as a means of diagnosing delirium. The quality of the reference standard varied among the papers reviewed. The limited number of high quality studies with suitable reference standards makes it difficult to recommend a specific tool which should be used to assess the cognition of older adults by telephone. In advance of further studies, the 22-item MMSE is simple to administer and was shown to correlate well with the face-to-face MMSE. It appears to be a useful technique for telephone screening for cognitive impairment or delirium, if used in conjunction with the Delirium Symptom Interview. [ABSTRACT FROM AUTHOR]

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. InterRAI-HC (home care) is an assessment designed to assist planning of care for patients receiving home care. Examining the relationship between the ICF and the interRAI HC is of particular interest because the interRAI assessments are widely used in clinical practice and research, are computerized, and uploaded to databases that serve multiple purposes including public reporting of quality in Canada and internationally. The objective of this study was to examine the relationship between the interRAI HC (home care) assessment and the ICF. Specifically, the goal was to determine the proportion of interRAI HC items that can be linked to each of the major domains of the ICF (Body Function, Body Structure, Activities and Participation, and the Environmental Factors), the chapters and the specific ICF codes. Methods: Three coders who were familiar with both the home care assessment and the ICF independently assigned ICF codes to inter-RAI HC items. Subsequently, a series of teleconference meetings were held to reach consensus on the primary code and much later consensus was used to finalize codes for additional items added to the interRAI HC. Results: Following exclusion of administrative and diagnostic sections, 175 interRAI items were examined for potential assignment of codes. Of these 52 were assigned codes related to body function, 43 to activities and participation, 34 to environment, 1 to body structure, 17 to not coded, and 26 to not defined. Considering all 3-digit ICF codes, interRAI items addressed 43.2% of Body Function and 50.6% of Activities and Participation codes. Conclusion: The conceptual overlap in content, offers an excellent opportunity to operationalize the ICF domains and the codes particularly in the areas of Body Function and Activities and Participation. Use of measures such as the interRAI assessments with common elements across settings facilitates standardized reporting for organizations, regions and nations. [ABSTRACT FROM AUTHOR]

Background: telemedicine has the potential to improve access to the specialty of geriatric medicine, particularly in rural and remote settings. While telemedicine is widely used in some specialities, this is not yet the case in geriatric medicine. Objective: to review the current literature to identify proven and potential strategies for application of telemedicine in geriatric medical practice. Method: a comprehensive review of literature pertaining to the application of telemedicine in geriatric medicine and relevant related sub-specialties was undertaken. Results: a large number of small studies of limited quality, and a small number of robust studies including randomised trials, were identified. Conclusions: there is evidence to suggest that a variety of telemedicine techniques can be applied effectively and safely in geriatric medicine across a variety of clinical settings. Patient satisfaction is generally reported as high. Howeve, caution is advised due to the paucity of robust studies in the literature. [ABSTRACT FROM AUTHOR]

Objective: To co-design, test and evaluate a health literacy, chronic disease self-management and social support intervention for older people delivered by group videoconferencing into the home.Method: The Telehealth Literacy Project (THLP) was a mixed methods, quasi-experimental, non-randomised trial nested within a telehealth remote monitoring study. An intervention group (n = 52) participated in five, weekly videoconference group meetings lasting for 1.5 h and a control group (n = 60) received remote monitoring only. Outcomes were measured using the nine-scale Health Literacy Questionnaire (HLQ) and two scales of the Health Education Impact Questionnaire (heiQ). Semi-structured interviews and focus group data were thematically analysed.Result: At 3 month follow-up, univariate analysis identified small effects in the intervention group only, with improved health literacy behaviours (five HLQ scales) and self-management skills (two heiQ scales). ANOVA of HLQ scales indicated no significant differences between the two groups over time indicating a contributing effect of the remote monitoring project. Intervention participants reported improved perception of companionship, emotional and informational support.Conclusion: The THLP delivered with telemonitoring indicates potential to improve social support and some health literacy factors in older people.Practice Implications: Patient education can be delivered by group videoconferencing. [ABSTRACT FROM AUTHOR]

Social support is a key component in managing long-term conditions. As people age in their homes, there is a greater risk of social isolation, which can be ameliorated by informal support networks. This study examined the relationship between changes in social support networks for older people living in a regional area following weekly videoconference groups delivered to the home. Between February and June 2014, we delivered 44 weekly group meetings via videoconference to participants in a regional town in Australia. The meetings provided participants with education and an opportunity to discuss health issues and connect with others in similar circumstances. An uncontrolled, pre-post-test methodology was employed. A social network tool was completed by 45 (87%) participants either pre- or post-intervention, of which 24 (46%) participants completed the tool pre- and post-intervention. In addition, 14 semi-structured interviews and 4 focus groups were conducted. Following the intervention, participants identified increased membership of their social networks, although they did not identify individuals from the weekly videoconference groups. The most important social support networks remained the same pre- and post-intervention namely, health professionals, close family and partners. However, post-intervention participants identified friends and wider family as more important to managing their chronic condition compared to pre-intervention. Participants derived social support, in particular, companionship, emotional and informational support as well as feeling more engaged with life, from the weekly videoconference meetings. Videoconference education groups delivered into the home can provide social support and enhance self-management for older people with chronic conditions. They provide the opportunity to develop a virtual social support network containing new and diverse social connections. [ABSTRACT FROM AUTHOR]

The article presents a study conducted for developing and testing an expanded version of the telehealth platform in an effort to improve the delivery of Residential Medication Management Reviews (RMMRs). Topics covered include the role of telehealth in medical reviews, the revision of the RES-e-CARE system, and the use of economic modelling for analyzing the timeliness and cost effectiveness of telehealth RMMRs conducted by pharmacists.

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. Examination of scale dimensions using older and new items was completed using a forward-entry stepwise regression. The revised scale was validated by examining the scale's distribution with a self-reported dementia diagnosis, functional problems, living status, and distress measures. Cognitive Performance Scale 2 extends the measurement metric from a range of 0 to 6 for the original CPS, to 0 to 8. Relating CPS2 to other measures of function, living status, and distress showed that changes in these external measures correspond with increased challenges in cognitive performance. Cognitive Performance Scale 2 enables repeated assessments, sensitive to detect changes particularly in early levels of cognitive decline. [ABSTRACT FROM AUTHOR]

Background: This study examined the relationships between a newly developed older person-specific non-preference-based quality of life (QoL) instrument (Older People's Quality of Life brief questionnaire (OPQoL-brief)) and two generic preference-based instruments (the EQ-5D-3L Level (EQ-5D-3 L) and the Adult Social Care Outcomes Toolkit (ASCOT) in a community-dwelling population of Australian older people receiving aged care services.Methods: We formulated hypotheses about the convergent validity between the instruments (examined by Wilcoxon-Mann Whitney, Kruskal Wallis and Spearman's correlation tests) and levels of agreement (assessed using intra class correlation (ICC) and modified Bland-Altman plots based on normalized Z EQ-5D-3 L and ASCOT utilities and OPQoL-Brief summary scores).Results: The utilities/summary scores for 87 participants (aged 65-93 years) were moderately but positively correlated. Moderate convergent validity was evident for a number of instrument dimensions with the strongest relationship (r = 0.57) between 'enjoy life' (OPQoL-Brief) and 'social contact' (ASCOT). The overall ICC was 0.54 and Bland-Altman scatter plots showed 3-6% of normalized Z-scores were outside the 95% limits of agreement suggesting moderate agreement between all three instruments (agreement highest between the OPQoL-Brief and the ASCOT).Conclusions: Our results suggest that the OPQoL-Brief, the ASCOT and the EQ-5D_3L are suitable for measuring quality of life outcomes in community-dwelling populations of older people. Given the different constructs underpinning these instruments, we recommend that choice of instrument should be guided by the context in which the instruments are being applied. Currently, the OPQoL-Brief is not suitable for use in cost-utility analyses as it is not preference-based. Given their different perspectives, we recommend that both the ASCOT and the EQ-5D are applied simultaneously to capture broader aspects of quality of life and health status within cost-utility analyses within the aged care sector. Future research directed towards the development of a new single preference-based instrument that incorporates both health status and broader aspects of quality of life within quality adjusted life year calculations for older people would be beneficial. [ABSTRACT FROM AUTHOR]

We examined the acceptability of multi-site videoconferencing as a method of providing group education to older people in their homes. There were 9 groups comprising 52 participants (mean age 73 years) with an average of four chronic conditions. Tablet computers or PCs were installed in participant’s homes and connected to the Internet by the National Broadband Network (high-speed broad band network) or by the 4G wireless network. A health literacy and self-management programme was delivered by videoconference for 5 weeks. Participants were able to view and interact with all group members and the facilitator on their devices. During the study, 44 group videoconferences were conducted. Evaluation included 16 semi-structured interviews, 3 focus groups and a journal detailing project implementation. The participants reported enjoying home-based group education by videoconference and found the technology easy to use. Using home-based groups via videoconference was acceptable for providing group education, and considered particularly valuable for people living alone and/or with limited mobility. Audio difficulties were the most commonly reported problem. Participants connected with 4G experienced more problems (audio and visual) than participants on the National Broadband Network and those living in multi-dwelling residences reported more problems than those living in single-dwelling residences. Older people with little computer experience can be supported to use telehealth equipment. Telehealth has the potential to improve access to education about chronic disease self-management. [ABSTRACT FROM PUBLISHER]

The aim of this study was to conduct a systematic literature review of research-based studies to identify practices designed to meet the specific care needs of older cognitively impaired patients in emergency departments (ED). A systematic literature review of studies was completed using PRIMSA methodology. The search criteria included articles from both emergency and acute care settings. A total of 944 articles were screened, and a total of 43 articles were identified as eligible. The review found a number of intervention studies to improve quality of care for older persons with cognitive impairment carried out or commenced in emergency settings, including interventions to improve cognitive impairment recognition (n = 9) and clinical approaches to reduce falls (n = 1 ) and both delirium incidence and prevalence (n = 2). Relevant studies carried out in acute care settings regarding cognitive impairment recognition (n = 4) and primary and secondary prevention of delirium (n = 18) and intervention studies that reduced the prescription of deliriogenic drugs (n = 1 ), reduced behavioral symptoms and discomfort (n = 7), and improved nutritional intake (n = 1 ) in hospitalized older persons with dementia were also identified. There is limited research available that reports interventions that improve the quality of care of older ED patients with cognitive impairment. Although this review found evidence obtained from the acute care setting, additional research is needed to identify whether these interventions are beneficial in fast-paced emergency settings. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this study was to describe the distribution of hospital and aged care services for older people, with a particular focus on transition care places, across Australia and to determine the relationships between the provision of these services. Methods: Aggregation of health and aged care service indicators by Aged Care Assessment Team (ACAT) region including: public and private acute and subacute (rehabilitation and geriatric evaluation and management) hospital beds, flexible and mainstream aged care places as at 30 June 2006. Results: There was marked variation in the distribution of acute and subacute hospital beds among the 79 ACAT regions. Aged care places were more evenly distributed. However, the distribution of transition care places was uneven. Rural areas had poorer provision of all beds. There was no evidence of coordination in the allocation of hospital and aged care services between the Commonwealth and state/territory governments. There was a weak relationship between the allocation of transition care places and the distribution of health and aged care services. Discussion: Overall, the distribution of services available to older persons is uneven across Australia. While the Transition Care Program is flexible and is providing rural communities with access to rehabilitation, it will not be adequate to address the increasing needs associated with the ageing of the Australian population. An integrated national plan for aged care and rehabilitation services should be considered. [ABSTRACT FROM AUTHOR]

Abstract: We examined the interrater reliability of the interRAI AC. An observational study was conducted on 3 geriatric wards. Two trained raters completed independently the interRAI AC between 24 and 48h after admission. A sample of 100 patients (age 84.5±5.6 years; 45% female) was analyzed. Interrater reliability was tested using observed agreement, kappa coefficients, and intraclass correlation coefficients. The overall kappa median value for nominal items was 0.82 (almost perfect). For items on ordinal level, both the overall weighted kappa median and the intraclass correlation coefficient median were 0.86 (almost perfect). According to conventional cut-offs for interpreting kappa statistics, reliability was almost perfect (K ≥0.81) for 60% of all items, substantial (0.60< K ≤0.80) for 26%, moderate (0.41< K ≤0.60) for 10%, and poor (K ≤0.40) for 4% of the items. The median observed agreement was 0.89. For 83% of the items, the observed agreement was greater than 0.80. This study showed substantial or almost perfect interrater reliability for 86% of the items. In addition to previous evidence, the current results suggest that the estimates of the interrater reliability of the interRAI AC are acceptable and provide preliminary evidence that the current version is appropriate for clinical application. [Copyright &y& Elsevier]

This commentary discusses how health economic techniques can usefully be applied to inform clinical and policy decision making in the aged care sector from two perspectives: firstly, in relation to the measurement and valuation of the costs and benefits of new and existing health care technologies and modes of aged care service delivery and secondly, in relation to the facilitation of autonomy and patient choice. [ABSTRACT FROM PUBLISHER]

OBJECTIVES: To investigate agreement between hospital staff on what constitutes a fall and should be recorded on an incident report, to identify factors that influence whether a scenario is classified as a fall, and to examine the effect of providing a definition of a fall on interrater agreement. DESIGN: Two interrater agreement trials with pre–postintervention design. SETTING: Seven hospitals. PARTICIPANTS: Four hundred forty-six hospital staff (nursing 76%, physiotherapy 14%, occupational therapy, 6%) working on participating wards over a 24-hour period. MEASUREMENTS: Fourteen video scenarios were played before participants, who were asked whether they would classify each scenario as a fall and whether they would complete an incident report in that scenario. A definition of a fall was then provided and the video scenarios replayed. Two definitions were investigated; the World Health Organization definition and a custom definition. RESULTS: Consensus was not evident in five of the 14 scenarios examined. Falls onto surfaces higher than the ground were less likely to be recorded on incident reports. Hospital and ward type influenced whether a scenario was classified as a fall. Overall agreement in classifying scenarios as a fall was only marginally greater after provision of the definition in both phases, although neither had an effect on whether staff would complete an incident report. CONCLUSION: Disagreement between hospital staff in what constitutes a fall may contribute to inconsistent research findings in this field and is not meaningfully improved through provision of a definition. [ABSTRACT FROM AUTHOR]

We investigated the accuracy and validity of clinical gait assessment, performed by experienced geriatricians viewing video clips of 10 s duration. Nineteen patients with normal or characteristic abnormal gait patterns were studied. The treating physician's diagnosis served as the gold standard. Another live assessment was then performed by a geriatrician blinded to the medical record to establish inter-rater reliability of live assessments. Subsequently, each gait video clip was examined by two independent geriatricians without any background clinical documentation. Diagnostic accuracy was tested at two levels – whether the gait was abnormal, and the specific gait diagnosis. The agreement of the video clip examination with the gold standard to identify abnormal gait from normal gait ranged from substantial to excellent among assessors (κ = 0.68–0.85), although low agreement with the gold standard was achieved in the detection of specific gait diagnosis (average agreement between both viewing geriatricians 50%). The technique appears to be a valid screening procedure for detecting gait abnormalities (average sensitivity 100%, specificity 70%). [ABSTRACT FROM AUTHOR]

Measurement of Health-Related Quality of Life (HRQoL) of the elderly requires instruments with demonstrated sensitivity, reliability, and validity, particularly with the increasing proportion of older people entering the health care system. This article reports the psychometric properties of the 12-item Assessment of Quality of Life (AQoL) instrument in chronically ill community-dwelling elderly people with an 18-month follow-up. Comparator instruments included the SF-36 and the OARS. Construct validity of the AQoL was strong when examined via factor analysis and convergent and divergent validity against other scales. Receiver Operator Characteristic (ROC) curve analyses and relative efficiency estimates indicated the AQoL is sensitive, responsive, and had the strongest predicative validity for nursing home entry. It was also sensitive to economic prediction over the follow-up. Given these robust psychometric properties and the brevity of the scale, AQoL appears to be a suitable instrument for epidemiologic studies where HRQoL and utility data are required from elderly populations. [Copyright &y& Elsevier]

Several letters to the editor are presented in response to articles in previous issue including "Physical Examination and Diagnosis of Dementia for Video Consultation" and "Measuring Functional Performance in Persons with Dementia."

We investigated the level of agreement between specialists conducting a cognitive assessment via videoconference compared with a face-to-face assessment. The patient and doctor were linked via a videoconference system which was located within the same hospital. To assess inter-rater reliability, paired face-to-face assessments were also carried out. There were 42 subjects, who were aged over 50 years and who had not attended a memory disorder clinic in the previous 12 months. A battery of standardized cognitive assessments was performed by a trained clinic nurse, prior to the two assessments by separate specialists. The weighted kappa score for face-to-face inter-rater reliability was 0.53. The agreement between face-to-face and videoconferencing assessment was 0.63. The present study shows that the use of videoconferencing for cognitive assessment results in assessment outcomes similar to those from face-to-face assessment. [ABSTRACT FROM AUTHOR]

Comprehensive geriatric assessment (CGA), supported by e-health, was provided to 89 frail veterans aged 70 years or older who were admitted to medical, surgical or orthopaedic units at two private hospitals in rural Queensland. Patients were screened and assessed by trained nurses using the interRAI-Acute Care tools. Data entry, validation, reporting and geriatrician comment were facilitated by an online, secure database and reporting system. The process was evaluated based on its utilization and staff satisfaction. The response to the project was generally very positive, but there were also some problems: (1) lack of staff, staff time and resources to successfully complete the assessments; (2) limited referrals from general practitioners (GPs) and difficulty with developing a sustainable communication and referral system between GPs and the hospital; (3) significant variations in caseloads between the study sites; and (4) the unfamiliarity of sufficient staff at the trial sites with the CGA process. Despite these challenges, the use of e-health-supported strategies in geriatric medicine certainly appears achievable and deserve further study. [ABSTRACT FROM AUTHOR]

Background: A multi-domain suite of instruments has been developed by the interRAI research collaborative to support assessment and care planning in mental health, aged care and disability services. Each assessment instrument comprises items common to other instruments and specialized items exclusive to that instrument. This study examined the reliability of the items from five instruments supporting home care, long term care, mental health, palliative care and post-acute care.Methods: Paired assessments on 783 individuals across 12 nations were completed within 72 hours of each other by trained assessors who were blinded to the others' assessment. Reliability was tested using weighted kappa coefficients.Results: The overall kappa mean value for 161 items which are common to 2 or more instruments was 0.75. The kappa mean value for specialized items varied among instruments from 0.63 to 0.73. Over 60% of items scored greater than 0.70.Conclusion: The vast majority of items exceeded standard cut-offs for acceptable reliability, with only modest variation among instruments. The overall performance of these instruments showed that the interRAI suite has substantial reliability according to conventional cut-offs for interpreting the kappa statistic. The results indicate that interRAI items retain reliability when used across care settings, paving the way for cross domain application of the instruments as part of an integrated health information system. [ABSTRACT FROM AUTHOR]

Background: Incident reporting is the prevailing approach to gathering data on accidental falls in hospitals for both research and quality assurance purposes, though is of questionable quality as staff time pressures, perception of blame and other factors are thought to contribute to under-reporting.Methods: This research aimed to identify contextual factors influencing recording of in-hospital falls on incident reports. A qualitative multi-centre investigation using an open written response questionnaire was undertaken. Participants were asked to describe any factors that made them feel more or less likely to record a fall on an incident report. 212 hospital staff from 30 wards in 7 hospitals in Queensland, Australia provided a response. A framework approach was employed to identify and understand inter-relationships between emergent categories.Results: Three main categories were developed. The first, determinants of reporting, describes a hierarchical structure of primary (principle of reporting), secondary (patient injury), and tertiary determinants that influenced the likelihood that an in-hospital fall would be recorded on an incident report. The tertiary determinants frequently had an inconsistent effect. The second and third main categories described environmental/cultural facilitators and barriers respectively which form a background upon which the determinants of reporting exists.Conclusion: A distinctive framework with clear differences to recording of other types of adverse events on incident reports was apparent. Providing information to hospital staff regarding the purpose of incident reporting and the usefulness of incident reporting for preventing future falls may improve incident reporting practices. [ABSTRACT FROM AUTHOR]