Using interRAI Assessment for Research: Developing a National Research Agenda in Aotearoa New Zealand.

interRAI provides a suite of standardized, validated instruments used to assess health and psychosocial well-being, and to inform person-centered care planning. Data obtained from these standardized tools can also be used at a population level for research and to inform policy, and interRAI is currently used in more than 40 countries globally. We present a brief overview of the use of interRAI internationally within research and policy settings, and then introduce how interRAI is used within the universal public health system in Aotearoa New Zealand (NZ), including considerations relating to Maori, the Indigenous people of NZ. In NZ, improvement in interRAI data utilization for research purposes was called for from aged care, health providers, and researchers, to better use these data for quality improvement and health advancement for New Zealanders. A national research network has been established, providing a medium for researchers to form relationships and collaborate on interRAI research with a goal of translating routinely collected interRAI data to improve clinical care, patient experience, service development, and quality improvement. In 2023, the network members met (hybrid: in-person and online) and identified research priorities. These were collated and developed into a national interRAI research agenda by the NZ interRAI Research Network Working Group. Research priorities included reviewing the interRAI assessment processes, improving methods for data linkage to national data sets, exploring how Indigenous Data Sovereignty can be upheld, as well as a variety of clinically focused research topics. Implications for Practice, Policy, and Research: This appears to be the first time national interRAI research priorities have been formally identified. Priorities identified have the potential to inform quality and clinical improvement activities and are likely of international relevance. The methodology described to cocreate the research priorities will also be of wider significance for those looking to do so in other countries.

Falls Risk in Long-Term Care Residents With Cognitive Impairment: Effects of COVID-19 Pandemic.

OBJECTIVES: The aim of this study was to investigate the impact of the COVID-19 pandemic on falls rates in long-term care residents with cognitive impairment. DESIGN: An observational study using routinely collected national interRAI data. SETTING AND PARTICIPANTS: Participants were from long-term care residents (age ≥60 years) who received an interRAI Long Term Care Facility assessment anywhere in New Zealand between August 17, 2018, and August 16, 2022. METHODS: The primary outcome was "At least 1 fall in the last 30 days." Based on the Cognitive Performance Scale (CPS), cognitive impairment was categorized into 3 levels: intact or borderline intact (0-1), mild to moderate impairment (2-3), and moderately to very severe impairment (4-6). The COVID-19 pandemic was divided into 3 periods (First wave: March 21, 2020, to June 8, 2020; Varying level of community outbreaks: June 9, 2020 to August 16, 2021; and Delta-Omicron wave: August 17, 2021, to August 16, 2021) and compared to a pre-COVID-19 period (August 17, 2018, to March 20, 2020). Cox regression modeling was used to study falls and interactions between CPS and COVID-19 pandemic periods, along with other established falls risk factors in the literature. RESULTS: A total of 282,518 interRAI-LTCF assessments from 75,132 unique residents were included. Interactions between CPS and COVID-19 pandemic periods found that cognitive impairment was associated with a higher hazard ratio (ranged from 1.22 to 1.37) in each of the 3 COVID-19 pandemic periods. We also found unstable health, unsteady gait, wandering, and moderate to severe ADL dependency were the strongest risk factors for falls. CONCLUSIONS AND IMPLICATIONS: Cognitively impaired long-term care residents had an increased risk for falls during the COVID-19 pandemic. This risk was influenced by several factors. In future pandemic or infection control related isolation, residents who are most at risk can be identified for targeted falls prevention programs.

Impacts of the COVID-19 lockdown on self-reported mood and self-rated health of community-dwelling adults with chronic illness.

AIM: To determine whether self-reported mood or self-rated health were affected in community-dwelling adults with chronic illness following COVID-19 lockdown. METHODS: This was a repeated cross-sectional study using secondary data. We included New Zealanders aged 40+ who underwent International Residential Instrument (interRAI) assessments in the year prior to COVID-19 lockdown (25 March 2019-24 March 2020) or in the year following COVID-19 lockdown (25 March 2020-24 March 2021). Pairwise comparisons were made between each pre-lockdown quarter and its respective post-lockdown quarter to account for seasonality patterns. Data from 45,553 (pre-lockdown) and 45,349 (post-lockdown) assessments were analysed. Outcomes (self-reported mood, self-rated health) were stratified by socio-demographic variables. RESULTS: Self-reported mood improved in the first quarter post-lockdown among those aged 80+, as well as among women, people of European ethnicity, those living alone and those living in more deprived areas. Self-rated health improved in these same groups, as well as among those aged 65-79, and among men. No differences in self-reported mood or self-rated health were found in the second, third, or fourth quarters post-lockdown. CONCLUSIONS: Self-reported mood and self-rated health of community-dwelling adults with chronic illness were not negatively affected following COVID-19 lockdown, and temporarily improved among some sub-groups. However, the longer-term impacts of the COVID-19 pandemic need to be closely monitored.

The Implementation of Integrated Health Information Systems - Research Studies from 7 Countries Involving the InterRAI Assessment System.

Introduction: In the past years, governments from several countries have shown interest in implementing integrated health information systems. The interRAI Suite of instruments fits this concept, as it is a set of standardised, evidence-based assessments, which have been validated for different care settings. The system allows the electronic transfer of information across care settings, enabling integration of care and providing support for care planning and quality monitoring. The main purpose of this research is to describe the recent implementation process of the interRAI instruments in seven countries: Belgium, Switzerland, France, Ireland, Iceland, Finland and New Zealand. Methods: The study applied a case study methodology with the focus on the implementation strategies in each country. Principal investigators gathered relevant information from multiple sources and summarised it according to specific aspects of the implementation process, comparing them across countries. The main implementation aspects are described, as well as the main advantages and barriers perceived by the users. Results: The seven case studies showed that adequate staffing, appropriate information technology, availability of hardware, professional collaboration and continuous training are perceived as important factors which can contribute to the implementation of the interRAI instruments. In addition, the use of electronic standardised assessment instruments such as the interRAI Suite provided evidence to improve decision-making and quality of care, enabling resource planning and benchmarking. Conclusion: In practice, the implementation of health information systems is a process that requires a cultural shift of policymakers and professional caregivers at all levels of health policy and service delivery. Information about the implementation process of the interRAI Suite in different countries can help investigators and policymakers to better plan this implementation. This research sheds light on the advantages and pitfalls of the implementation of the interRAI Suite of instruments and proposes approaches to overcome difficulties.

Impact of the first wave of COVID-19 on the health and psychosocial well-being of Maori, Pacific Peoples and New Zealand Europeans living in aged residential care.

OBJECTIVE: To investigate the impact of New Zealand's (NZ) first wave of COVID-19, which included a nationwide lockdown, on the health and psychosocial well-being of Maori, Pacific Peoples and NZ Europeans in aged residential care (ARC). METHODS: interRAI assessments of Maori, Pacific Peoples and NZ Europeans (aged 60 years and older) completed between 21/3/2020 and 8/6/2020 were compared with assessments of the same ethnicities during the same period in the previous year (21/3/2019 to 8/6/2019). Physical, cognitive, psychosocial and service utilisation indicators were included in the bivariate analyses. RESULTS: A total of 538 Maori, 276 Pacific Peoples and 11,322 NZ Europeans had an interRAI assessment during the first wave of COVID-19, while there were 549 Maori, 248 Pacific Peoples and 12,367 NZ Europeans in the comparative period. Fewer Maori reported feeling lonely (7.8% vs. 4.5%, p = 0.021), but more NZ Europeans reported severe depressive symptoms (6.9% vs. 6.3%, p = 0.028) during COVID-19. Lower rates of hospitalisation were observed in Maori (7.4% vs. 10.9%, p = 0.046) and NZ Europeans (8.1% vs. 9.4%, p < 0.001) during COVID-19. CONCLUSIONS: We found a lower rate of loneliness in Maori but a higher rate of depression in NZ European ARC populations during the first wave of COVID-19. Further research, including qualitative studies with ARC staff, residents and families, and different ethnic communities, is needed to explain these ethnic group differences. Longer-term effects from the COVID-19 pandemic on ARC populations should also be investigated.

InterRAI assessments: opportunities to recognise need for and implementation of palliative care interventions in the last year of life?

OBJECTIVES: To explore how interRAI assessments could be used to identify opportunities to integrate palliative care into a plan of care. METHODS: A population-based, cross-sectional design using unique identifiers to link deaths with a national interRAI database. Data were analysed using logistic regression models and chi-square tests. RESULTS: A total of 4869 people died over a 12-month period in one district health board area; 50.9% (n = 2478) received one or more interRAI assessments in the year before death. Diagnosis impacted on the type and timing of interRAI assessments and the recognition of end-stage disease. CONCLUSION: People in the last year of life experience frequent interRAI assessments. There are opportunities to identify people who might benefit from a palliative care approach. Future research is needed to understand how interRAI assessors can be supported in the application of assessment items related to palliative care.

Impact of COVID-19 on the health and psychosocial status of vulnerable older adults: study protocol for an observational study.

BACKGROUND: Many countries around the world have adopted social distancing as one of the public health measures to reduce COVID-19 transmissions in the community. Such measures could have negative effects on the mental health of the population. The aims of this study are to (1) track the impact of COVID-19 on self-reported mood, self-rated health, other health and psychosocial indicators, and health services utilization of people who have an interRAI assessment during the first year of COVID-19; (2) compare these indicators with the same indicators in people who had an interRAI assessment in the year before COVID-19; and (3) report these indicators publicly as soon as data analysis is completed every 3 months. METHODS: interRAI COVID-19 Study (iCoS) is an observational study on routinely collected national data using the interRAI Home Care and Contact Assessment, which are standardized geriatric assessment tools mandated for all people assessed for publicly funded home support services and aged residential care in New Zealand. Based on the 2018/19 figures, we estimated there are 36,000 interRAI assessments per annum. We will compare the four post-lockdown quarters (from 25th March 2020) with the respective pre-lockdown quarters. The primary outcomes are self-reported mood (feeling sad, depressed or hopeless: 0 = no, 1 = yes) and self-rated health (0 = excellent, 1 = good, 2 = fair, 3 = poor). We will also analyze sociodemographics, other secondary health and psychosocial indicators, and health services utilization. Descriptive statistics will be conducted for primary outcomes and other indicators for each of the eight quarters. We will compare the quarters using regression models adjusted for demographic characteristics using weights or additional variables. Key health and psychosocial indicators will be reported publicly as soon as data analysis is completed for each quarter in the 12-month post-lockdown period by using a data visualization tool. DISCUSSION: This rapid translation of routinely collected national interRAI data will provide a means to monitor the health and psychosocial well-being of vulnerable older New Zealanders. Insights from this study can be shared with other countries that use interRAI and prepare health and social services for similar epidemics/pandemics in the future.

Cross-Country Validation of the Association Between Oral Health and General Health in Community-Dwelling Older Adults.

OBJECTIVE: Oral health is known to be associated with general health, but longitudinal relationships between oral health and general health indicators have not yet been fully explored in international research. SETTING AND PARTICIPANTS: The sample consisted of 3 longitudinal databases: a sample from Belgium from the Protocol 3 project (n = 8359), a combined sample from 6 European countries (n = 2501) from the IBenC study (Belgium, Finland, Iceland, Germany, Italy, and the Netherlands), and a sample from New Zealand (n = 15,012). All clients were 65 years or older and received long-term home care services. METHODS: Bayesian models were used to analyze the associations between 3 oral health indicators (chewing difficulty, nonintact teeth, and dry mouth) and 4 aspects of general health (activities of daily living functioning, cognition, depression, and health instability). In addition, the models explored the associations between current oral health and general health status and future oral health and general health status. RESULTS: Clients who had poorer oral health had a higher risk of suffering from poor general health. Especially chewing difficulty was associated with all general health indicators in all data sets (odds ratios > 1). Dry mouth and nonintact teeth showed significant associations with almost all general health indicators. Additionally, having poor oral health (respectively general health) was predictive of poor general health (respectively oral health) at future assessments (significant cross-lagged parameters). CONCLUSIONS/IMPLICATIONS: The results point out the need of the inclusion of oral health assessment and advice from dentists or oral health practitioners into the multidisciplinary conversation. In addition, identifying older people with oral health problems is essential in order to provide treatment and monitoring. Raising awareness for oral health is important, and policy makers should foster oral health promotion and care for older adults in order to keep them in good health.