A Systematic Review of Recent Developments in Comprehensive Geriatric Assessment Instruments in Long-term Care Facilities

doi:10.12114/j.issn.1007-9572.2019.04.019

Abstract

Abstract: Background　There are many comprehensive geriatric assessment（CGA） tools at home and abroad，but there are no unified CGA tools for older people in long-term care facilities （LTCF） delivering different qualities of care in China.Objective　To review systematically the psychometric properties of CGA tools in LTCF and choose the appropriate ones for LTCF in China.Methods　From January to June 2018，we performed an analysis of the data for CGA in LTCF published from 2008 to 2018 that were retrieved from eight databases：CNKI，Wanfang，Scopus，PubMed，Usearch，CINAHL，PsycINFO and Medline.The COSMIN checklist was used to assess the methodological quality of the eligible studies.Results　Altogether，21 papers were included.Of the papers，there were 9 kinds of CGA instruments，but only 5 instruments' psychometric properties were reported.By use of the COSMIN checklist，the internal consistency of interRAI-LTCF was rated as fair，and its retest reliability was rated as poor，fair，and fair in 3 studies，respectively.The internal consistency and retest reliability of Nottingham Health Profile was evaluated as poor.Both the validity and reliability of BGA used in Chongqing's hospitals，elderly care facilities and community-based healthcare institutions were assessed as poor.The internal consistency of Ability Assessment for Older Adults was assessed as fair.The internal consistency，content validity and construct validity of Elderly Comprehensive Health Assessment Scale were assessed as poor.Conclusion　Both the interRAI-LTCF and the Ability Assessment for Older Adults are worth promoting in LTCF in China，but their psychometric properties and feasibilities need to be tested by more high-quality studies.

Key words: Aged, Long-term care facilities, Capability level, Assessment instruments

摘要： 背景　目前国内外的老年人综合评估工具较多，但我国养老机构的照护服务质量参差不齐，尚缺乏统一的老年人能力评估工具。目的　系统评价国内外老年人综合评估工具的信效度并结合我国国情进行分析，以选择适合我国长期照护机构老年人综合评估的工具。方法　于2018年1—6月，计算机检索中国知网、万方数据知识服务平台以及Scopus、PubMed、Usearch、CINAHL、PsycINFO、Medline数据库中与老年人综合评估有关的文献（发表时间为2008—2018年），以获取老年人综合评估工具及相关资料。采用“基于共识选择健康测量工具的标准”（COSMIN）评估合格文献中老年人综合评估工具的方法学质量。结果　最终纳入合格文献21篇，涉及老年人综合评估工具9种，仅5种工具被汇报了信效度相关信息。根据COSMIN：国际居民长期照护评估工具（interRAI-LTCF）的内部一致性等级评定为一般，3篇文献中汇报的重测信度等级分别评定为差、一般、一般；诺丁汉健康量表（NHP）的内部一致性、重测信度等级评定为差；重庆市医院-养老机构-社区通用老年人健康综合评估量表（BGA）的效度和信度等级均被评定为差；老年人能力评估问卷的内部一致性等级评定为一般；老年人健康功能综合评价量表的内部一致性、内部效度、结构效度等级评定为差。结论　interRAI-LTCF和老年人能力评估问卷是未来值得在我国长期照护机构中进行推广的老年人综合评估工具，但仍需更多高质量的将评估工具应用于长期照护机构的研究来测量其信效度和可行性。

关键词: 老年人, 长期照护机构, 能力等级, 评估工具

ZHANG Qin,GUI Qian,WANG Yanjun, et al. A Systematic Review of Recent Developments in Comprehensive Geriatric Assessment Instruments in Long-term Care Facilities[J]. Chinese General Practice, 2019, 22(4): 462-467. DOI: 10.12114/j.issn.1007-9572.2019.04.019.
张沁,桂前,王燕君等. 长期照护机构老年人综合评估工具研究进展及系统评价[J]. 中国全科医学, 2019, 22(4): 462-467. DOI: 10.12114/j.issn.1007-9572.2019.04.019.

References

［1］总报告起草组.国家应对人口老龄化战略研究总报告［J］．老龄科学研究，2015，3（3）：4-38．
Drafting Group of General Research Report.The general research report of chinese strategic for dealing with population aging［J］．Scientific Research on Aging，2015，3（3）：4-38．
［2］党俊武.长期照护服务体系是应对未来失能老年人危机的根本出［J］．人口与发展，2009，15（4）：52-55.
DANG J W.Long-term care service system is the fundamental way to cope with the crisis of the elderly disabled in the future［J］．Population and Development，2009，15（4）：52-55.
［3］PILOTTO A，PANZA F.Comprehensive geriatric assessment：evidence［M］//MICHELJ P，BEATTIE B L，MARTIN F C，
et al．Oxford textbook of geriatric medicine.3rd ed.Oxford：Oxford University Press，2017.
［4］LIBERATI A，ALTMAN D G，TETZLAFF J，et al．The PRISMA statement for reporting systematic reviews and meta-analysis of studies that evaluate healthcare interventios：explanation and elaboration［J］．Annuals of Internal Medicine，2009，151（4）：66-94．DOI：10.1371/journal.pmed.1000100.
［5］MOKKINK L B，TERWEE C B，STRATFORD P W，et al．Evaluation of the methodological quality of systematic reviews of health status measurement instruments［J］．Quality of Life Research，2009，18（3）：313-333.
［6］TERWEE C B，MOKKINK L B，KNOL D L，et al．Rating the methodological quality in systematic reviews of studies on measurement properties：a scoring system for the COSMIN checklist［J］．Quality of Life Research，2012，21（4）：651-657.
［7］谢世麒，周建荣.重庆市医院-养老机构-社区通用老年健康综合评估量表的编制和信效度检验［J］．检验医学与临床，2016，13（A02）：369-372．
XIE S Q，ZHOU J R.Compilation and reliability and validity test of Chongqing Hospital-Retirement Institution-Community General Elderly Health Comprehensive Assessment Scale［J］．Lab Med Clin，2016，13（A02）：369-372．
［8］郭红艳，王黎，王志稳，等．老年人能力等级划分方式的研究［J］．中国护理管理，2013，13（9）：35-38．
GUO H Y，WANG L，WANG Z W，et al．Exploration research of older adults' ability level division［J］．Chinese Nursinng Management，2013，13（9）：35-38．
［9］胡秀英，龙纳，陈茜，等．老年人健康功能综合评价量表的研制//中华护理学会.第15届全国老年护理学术交流会议论文汇编，大连，2012.
［10］HIRDES J P，LJUNGGREN G，MORRIS J N，et al．Reliability of the interRAI suite of assessment instruments：a 12-country study of an integrated health information system［J］．BMC Health Services Research，2008，8（1）：1-11．
［11］KIM H，JUNG Y I，SUNG M，et al．Reliability of the interRAI Long Term Care Facilities（LTCF） and interRAI Home Care（HC）［J］．Geriatrics & Gerontology International，2015，15（2）：220-228．DOI：10.1111/ggi.12330.
［12］ONDER G.Assessment of nursing home residents in Europe：the Services and Health for Elderly in Long Term Care（SHELTER） study［J］．BMC Health Services Research，2012，12（1）：5.
［13］TABALI M，JESCHKE E，DASSEN T，et al．The Nottingham Health Profile：a feasible questionnaire for nursing home residents？［J］．International Psychogeriatrics，2012，24（3）：416-424．DOI：10.1017/S1041610211001931.
［14］HJALTADOTTIRH I，HALLBERG I R，EKWALL A K，et al．Predicting mortality of residents at admission to nursing home：a longitudinal cohort study ［J］．Health Service Research，2011，11：86.
［15］EENOO L V，VESENINI L，VANNESTE D，et al．The involvement of the general practitioner in an interRAI assessment for the care of elderly in Flemish nursing homes and home care：an explorative study［J］．International Journal of Integrated Care，2013，13（5）：779-800.
［16］ARLING G，KANE R L，COOKE V，et al．Targeting residents for transitions from nursing home to community［J］．Health Services Research，2010，45（3）：691-711．
［17］BOORSMA M，LANGEDIJK E，FRIJTERS D H，et al．Implementation of geriatric assessment and decision support in residential care homes：facilitating and impeding factors during initial and maintenance phase［J］．BMC Health Services Research，2013，13（1）：1-9.
［18］CAI S，MUKAMEL D B，VEAZIE P，et al．Validation of the Minimum Data Set in identifying hospitalization events and payment source［J］．Journal of the American Medical Directors Association，2011，12（1）：38-43.
［19］HOBEN M，POSS J W，NORTON P G，et al．Oral/dental items in the resident assessment instrument-Minimum Data Set 2.0 lack validity：results of a retrospective，longitudinal validation study［J］．Population Health Metrics，2016，14（1）：36.
［20］GINDIN J，Shochat T，Chetrit A，et al．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［J］．Journal of the American Geriatrics Society，2014，62（11）：2033．DOI：10.1111/jgs.13099.
［21］LEE J S，CHAU P P，HUI E，et al．Survival prediction in nursing home residents using the Minimum Data Set subscales：ADL Self-Performance Hierarchy，Cognitive Performance and the Changes in Health，End-stage Disease and Symptoms and Signs scales［J］．European Journal of Public Health，2009，19（3）：308-312.
［22］ONDER G，LIPEROTI R，RIALOVA D，et al．Polypharmacy in nursing home in Europe：results from the SHELTER Study［J］．Journals of Gerontology，2012，67（6）：698-704.
［23］SALIBA D，BUCHANAN J.Making the investment count：revision of the Minimum Data Set for nursing homes，MDS 3.0［J］．Journal of the American Medical Directors Association，2012，13（7）：602-610.
［24］SKEWINGTON S M，LOFTY M，O'CONNELL K A.The World Health Organization's WHOQOL-BREF quality of life assessment：psychometric properties and results of the international field trial.A report from the WHOQOL Group［J］．Qual Life Res，2004，13（2）：299-310.
［25］KANWAR A，SINGH M，LENNON R，et al．Frailty and health-related quality of life among residents of long-term care facilities［J］．Journal of Aging & Health，2013，25（5）：792-802.
［26］WANN-HANSSON C，KLEVSGARD R，HAGELL P.Cross-diagnostic validity of the Nottingham Health Profile Index of Distress（NHPD）［J］．Health & Quality of Life Outcomes，2008，6（1）：47.
［27］MARSHALL E G，CLARKE B S，VARATHARASAN N，et al．A Long-term Care-Comprehensive Geriatric Assessment（LTC-CGA） tool：improving care for frail older adults？［J］．2015，18（1）：2-10．DOI：10.5770/cgj.18.122.
［28］MORRIS J N，HAWES C，FRIES B E，et al．Designing the national resident assessment instrument for nursing homes［J］．Gerontologist，1990，30（3）：293-307.
［29］FRIES B E，SCHROLL M，HAWES C，et al．Approaching cross-national comparisons of nursing home residents［J］．Age & Ageing，1997，26（suppl 2）：13.
［30］GRAY L C，BERG K，FRIES B E，et al．Sharing clinical information across care settings：the birth of an integrated assessment system［J］．BMC Health Services Research，2009，9（1）：71.
［31］CARPENTER I，HIRDES J P.Using interRAI assessment systems to measure and maintain quality of long-term care//Monitoring and Improving Quality in Long-term Care OECD/European Commission.A Good Life in Older Age，2013.
［32］BODUR S，CINGILD D.Using WHOQOL-BREF to evaluate quality of life among Turkish elders in different residential environments［J］．JNHA，2009，13（7）：652-656.
［33］MCHORNEY C A，JR W J，LU J F，et al．The MOS 36-item Short-Form Health Survey （SF-36）：Ⅲ.Tests of data quality，scaling assumptions，and reliability across diverse patient groups［J］．Medical Care，1994，32（1）：40-66.
［34］POST M W，GERRITSEN J，VAN LEUSEN N D，et al．Adapting the Nottingham Health Profile for use in people with severe physical disabilities［J］．Clinical Rehabilitation，2001，15（1）：103-110.
［35］ROCKWOOD K，ABEYSUNDERA M J，MITNITSKI A.How should we grade frailty in nursing home patients? ［J］．Journal of the American Medical Directors Association，2007，8（9）：595-603.
［36］GAGE B，CONSTATINE R，AGGARWAL J，et al．The development and testing of the Continuity Assessment Record and Evaluation（CARE） item set：final report on the development of the care item set［R］．2012：464.
［37］CUI Y，GONG D，YANG B，et al．Making the CARE Comprehensive Geriatric Assessment as the core of a total mobile long term care support system in China［J］．Studies in Health Technology & Informatics，2018，247：770．DOI：10.3233/978-1-61499-852-5-770.
［38］中华人民共和国民政部.老年人能力评估 MZ/T039-2013［S］．北京：中国标准出版社，2014．
［39］王国庆，赖小星.国际居民评估工具长期照护机构评估和干预对老年慢性病患者生活质量和自护能力的影响［J］．解放军护理杂志，2017，34（12）：27-30．
WANG G Q，LAI X X.Impact of interRAI assessment and intervention on the quality of life and self-care ability of older patients with chronic diseases［J］．Mrs J Chin PLA，2017，34（12）：27-30．
［40］朱宏伟，赖小星，霍晓鹏，等．InterRAI综合评估及干预对老年住院患者营养状况的影响［J］．中华现代护理杂志，2017，23（1）：29-33．DOI：10.3760/cma.j.issn.1674-2907.2017.01.008.
ZHU H W，LAI X X，HUO X P，et al．Effect of InterRAI comprehensive assessment and intervention on nutritional status of elderly hospitalized patients［J］．Chinese Journal of Modern Nursing，2017，23（1）：29-33．DOI：10.3760/cma.j.issn.1674-2907.2017.01.008.
［41］POSS J W，JUTAN N M，HIRDES J P，et al．A review of evidence on the reliability and validity of Minimum Data Set data［J］．Healthcare Management Forum，2009，21（1）：33-39.
［42］KEE-LEE C，IRIS C，ANTONY C，et al．Validation of Minimum Data Set for nursing home in Hong Kong Chinese elders［J］．Clinical Gerontologist，2001，23（1/2）：43-54．DOI：10.1093/eurpub/ckp006.
［43］王黎，赵良羚，宋书梅，等．持续照料养老社区辅助生活区护理人力资源配置研究［J］．中国护理管理，2015，15（8）：965-987．DOI：10.3969/j.issn.1672-1756.2015.08.022.
WANG L，ZHAO L L，SONG S M，et al．Research on the allocation standards of nursing human resources in assisted living unit in long-term care facilities［J］．Chinese Nursing Management，2015，15（8）：965-987．DOI：10.3969/j.issn.1672-1756.2015.08.022.
［44］王黎，孙兆元，尹莉，等．养老机构独立生活区护理人力资源配置研究［J］．中国全科医学，2015，18（32）：3999-4003．DOI：10.3969/j.issn.1007-9572.2015.32.026.
WANG L，SUN Z Y，YIN L，et al．Research on the allocation of nursing human resources in independent living unit of geriatric nursing homes［J］．Chinese General Practice，2015，18（32）：3999-4003．DOI：10.3969/j.issn.1007-9572.2015.32.026.
［45］王黎，孙兆元，尹莉，等．养老机构长期护理区护理人力资源配置研究［J］．中华护理杂志，2016，51（1）：15-20．DOI：10.3761/j.issn.0254-1769.2016.01.003.
WANG L，SUN Z Y，YIN L，et al．Research on the allocation standards of nursing human resources in assisted living unit in long-term care facilities［J］．Chinese Journal of Nursing，2016，51（1）：15-20．DOI：10.3761/j.issn.0254-1769.2016.01.003.

[1]	FENG Xiaoyu, LI Wanling, LYU Siman, NI Cuiping, WANG Haocheng, LIU Yu. International Research Status and Hot Spot Analysis of InterRAI HC Based on Bibliometrics [J]. Chinese General Practice, 2023, 26(34): 4351-4358.
[2]	GU Hanxin, LIU Yang, LIU Yuanli. Falls Prevention Intervention for Community-dwelling Older Adults from the Perspective of Policy Tools: an International Comparative Study [J]. Chinese General Practice, 2023, 26(34): 4231-4238.
[3]	WANG Yue, CHEN Qing, LIU Lurong. Detection Rate of Depression and Its Influencing Factors in Chinese Elderly: a Meta-analysis [J]. Chinese General Practice, 2023, 26(34): 4329-4335.
[4]	XIN Gongkai, CONG Xin, YUAN Lei, CHENG Yuetong, NI Cuiping, ZHANG Weiwei, ZHANG Pingping, LIU Yu. Research Progress on Comprehensive Assessment Tools for the Elderly with Dementia [J]. Chinese General Practice, 2023, 26(33): 4103-4109.
[5]	YU Xinyan, ZHAO Jun, ZHAO Xiaoye, JIANG Qingru, CHEN Yatian, WANG Yan, ZHANG Haicheng. Application of Mobile Smart Healthcare in the Prevention and Control of Cardiovascular Diseases in Elderly Patients with Chronic Diseases in Primary Care [J]. Chinese General Practice, 2023, 26(33): 4167-4172.
[6]	JIAN Qiufeng, XU Ronghua, YAO Qian, ZHOU Yuanyuan. A Meta-analysis of the Prevalence and Influencing Factors of Post-stroke Cognitive Impairment in Chinese Elderly Patients [J]. Chinese General Practice, 2023, 26(32): 4070-4079.
[7]	ZHANG Shuai, LI Qin, LI Dongfeng, XIAO Jinping, LI Yunpeng. A Prospective Cohort Study of Solid Fuels Use and Risk of Hypertension in Chinese Older Adults [J]. Chinese General Practice, 2023, 26(32): 4001-4006.
[8]	CHEN Xi, ZHANG Juan, LI Lin, ZHANG Jiaqi, WU Yaoli, GUO Hui, WANG Chaoqun. Association between Physical Activity and Risk of All-cause Mortality in Middle-aged and Elderly People in China: a Prospective Cohort Study [J]. Chinese General Practice, 2023, 26(31): 3890-3895.
[9]	ZHANG Peng, GAO Ying, YANG Hongxi, WAN Chunxiao. Association between Serum Uric Acid Level and the Risk of Chronic Kidney Disease among the Elderly in Longevity Areas of China [J]. Chinese General Practice, 2023, 26(31): 3884-3889.
[10]	DUAN Yanqin, PENG Ying, LIU Shenglan, LIU Haijiao, YANG Huiqiong, HU Haiqing. Prevalence and Associated Factors of Potentially Inappropriate Medication among Elderly Outpatients [J]. Chinese General Practice, 2023, 26(31): 3902-3907.
[11]	ZHANG Ming, XU Jing, SUN Zhenhua, ZHAO Wenhao, MA Yingqian, ZHANG Jianqiao, SHEN Haiping. Improvement of Nutritional Status of Elderly Patients with Severe Obstruction Esophageal Carcinoma by Image-guided Photodynamic Therapy [J]. Chinese General Practice, 2023, 26(30): 3780-3784.
[12]	ZHOU Sijing, LUO Bangan, CAO Hui, ZHANG Xi, WANG Dongxin. Epidemiological Characteristics of Dementia and Its Correlation with Multimorbidity among Residents Aged 65 and Above [J]. Chinese General Practice, 2023, 26(29): 3616-3621.
[13]	WANG Xiaoran, ZHANG Dan. Influence of Multimorbidity on Anxiety Symptoms among Chinese Elderly People: a Propensity Score-matched Study [J]. Chinese General Practice, 2023, 26(29): 3622-3627.
[14]	ZHOU Xiaoqi, LIU Xinhui, ZHANG Wei, LI Changfeng, YAN Yaqiong. Association of Alanine Transaminase and Aspartate Aminotransferase/Alanine Transaminase Ratio with Type 2 Diabetes and Metabolic Syndrome in the Elderly [J]. Chinese General Practice, 2023, 26(29): 3645-3649.
[15]	PAN Yaojia, WANG Weiqiang, YI Weizhuo, GAO Bing, FU Fanglin, HAN Zheng, SUN Meng, DONG Yaqin, GU Huaicong. Relationship between Triglyceride-glucose Index and Risk of Cardiovascular Diseases in Middle-aged Obese Residents of Different Genders [J]. Chinese General Practice, 2023, 26(29): 3628-3635.