First Evidence on the Validity of the Complexity Index Derived from the Resident Assessment Instrument for Home Care in Home Care Patients.

OBJECTIVES: Recently, a Complexity Index (CI), based on the multidimensional complexity model and derived from the Resident Assessment Instrument for Home Care (interRAI HC) was proposed as a decision-support tool to help frontline health care professionals in their clinical evaluation to identify and analyze complex situations. This study aims to test the CI: (1) concurrent validity with another measure of complexity (ie, the COMID), (2) convergent validity with related constructs assessed by interRAI HC scales (eg, depression), (3) divergent validity (comparison between CI-COMID and scales-COMID correlations), and (4) predictive validity on coordination meetings. DESIGN: A cross-sectional observational design was used for a secondary analysis of interRAI HC and COMID data collected in routine home care nursing practice (July-December 2021). SETTING AND PARTICIPANTS: Participants were community-dwelling adults receiving home care, with full interRAI HC and COMID assessments (N = 3533). METHODS: Correlational analyses were conducted to test the concurrent validity of the CI (with the COMID) and the convergent and divergent validity of the CI (with interRAI HCSwitzerland scales, eg, Depression Rating Scale, Method for Assigning Priority Levels, and a Frailty Index). A receiver operating characteristic (ROC) analysis was conducted to test the discriminative ability of CI on specific professional team coordination meetings. RESULTS: Results showed that the CI correlated positively and strongly with the COMID (ρ = 0.691, P < .001, concurrent validity), positively with all the tested scales (P < .001, convergent validity), whereas the CI-COMID correlation was higher than the interRAI HC scales-COMID correlations (divergent validity). The ROC analysis showed the CI had a high area under the curve (AUC = 0.719, predictive validity). CONCLUSIONS AND IMPLICATIONS: The CI demonstrates good validity properties with a strong correlation with the COMID and a high predictive value for coordination meeting. It is distinct from the other interRAI HC scales and has its place among them to support the clinical analysis of complex situations.

[Healthy aging in Geneva : the innovative approach of the VieSA project]. / Vieillir en santé à Genève : l'approche novatrice du projet VieSA.

With Switzerland's population ageing, promoting healthy ageing remains a public health issue. This represents a challenge for the healthcare system, which is still mainly focused on curative or palliative care. It has been clearly established that it is possible to maintain the functional capacity of older people by taking early action on health-related behaviors. The VieSA (Vieillissement en Santé) project in the canton of Geneva, inspired by the WHO's ICOPE programme, offers innovative ways of promoting healthy ageing for and by seniors, by focusing on maintaining seniors' resources rather than targeting any deficits.

Face au vieillissement de la population en Suisse, la promotion du vieillissement en santé reste un enjeu de santé publique. Cela représente un défi pour le système de soins encore principalement orienté vers les soins curatifs ou palliatifs. Il est clairement établi qu'il est possible de maintenir les capacités fonctionnelles des seniors en agissant précocement sur les comportements liés à la santé. Le projet VieSA (Vieillissement en santé), mené dans le canton de Genève, s'inspire du programme ICOPE de l'OMS et offre des perspectives novatrices pour promouvoir le vieillissement en santé pour et par les seniors, en s'appuyant sur le maintien des ressources des seniors plutôt qu'en ciblant les déficits éventuels.

[Collaboration in home care: first interprofessional ambulatory proximity network]. / Collaboration dans les soins à domicile : un réseau interprofessionnel ambulatoire de proximité.

While interprofessionality is indispensable to respond to home care current issues, its implementation in the practice is a real challenge. The Genevan domiciliary model (reference by a nurse, targeted areas of interventions, etc.) needs to integrate all the resources of proximity. For this purpose, an interprofessional ambulatory and of proximity care network (RIAP) was created, aiming at strengthening the exchanges physicians/nurses about shared patients. RIAP benefits from an encouraging first assessment. Learnings from this experience are used to refine the modeling of this type of proximity network.

Alors que l'interprofessionnalité est indispensable pour répondre aux enjeux actuels du maintien à domicile, sa mise en œuvre dans la pratique représente un véritable défi. Le modèle domiciliaire genevois actuel (référence infirmière, zones d'interventions ciblées, etc.) nécessite d'intégrer toutes les ressources de proximité. Pour ce faire, un réseau de soins interprofessionnel ambulatoire de proximité (RIAP) a été créé, visant au renforcement de l'interprofessionnalité et résolument ancré dans la proximité des différents acteurs. Le RIAP repose notamment sur la consolidation des échanges médecins/infirmières autour de patients communs. Le premier bilan du RIAP est encourageant. Les apprentissages tirés de cette expérience permettent d'affiner la modélisation de ce type de réseau de proximité.

[Frailty and complexity indices derived from the interRAI HC Swiss]. / Indicateurs de fragilité et complexité dérivés de l'interRAI HC Suisse.

Frailty and complexity are concepts that are increasingly used by home care professionals. If the standardized global assessment as proposed by the Resident Assessment Instrument Home Care -(interRAI HC) includes aides for clinical analysis, it does not offer clinical index of frailty and complexity, which are however available in the literature. This article proposes an adaptation of the -algorithms from the fraXity study to the interRAI HCSuisse and -describes their implementation for the early detection of frailty and complexity in the routine assessment by the Geneva home care -institution (imad). These new indexes complete the panel of clinical scales and "alarms" already available and are accompanied by -recommendations for an integrated clinical practice.

La fragilité et la complexité sont des concepts de plus en plus ­mobilisés par les professionnels des soins à domicile. Si l'évaluation globale standardisée telle que proposée par le Resident Assessment Instrument Home Care (interRAI HC) inclut des aides à l'analyse clinique, elle n'offre pas d'indicateurs cliniques de fragilité et de complexité, pourtant disponibles dans la littérature. Cet article propose une adaptation des algorithmes issus de l'étude fraXity à l'interRAI HCSuisse et décrit leur implémentation pour le repérage précoce de la fragilité et la complexité dans l'évaluation de routine par l'Institution genevoise de maintien à domicile (imad). Ces nouveaux indicateurs complètent le panel d'échelles cliniques et d'« alarmes ¼ déjà disponibles et sont ­accompagnés de recommandations pour une pratique clinique intégrée.

Intrinsic Capacities, Functional Ability, Physiological Systems, and Caregiver Support: A Targeted Synthesis of Effective Interventions and International Recommendations for Older Adults.

The ageing population calls for interventions that can assist older people to age healthily. This study aimed to provide a targeted synthesis of high-level research and current evidence-based recommendations on effective interventions for maintaining or preventing the decline in intrinsic capacity, functional ability, and physiological systems, or for caregiver support. Nestled within the healthy ageing framework by the World Health Organization, available evidence was selected in a targeted manner, with the purpose of providing a synthesis that would allow the application of this knowledge in real life. As such, the outcome variables were examined through an Evidence and Gap Map of interventions for functional ability and through guidelines from leading institutions. Systematic reviews, meta-analyses, and guidelines on community-dwelling older adults with or without minor health limitations were considered. Thirty-eight documents were included and over fifty interventions identified. Physical activity interventions were consistently effective across several domains. Recommendations point to screening, whilst highlighting the importance of behavioural factors in the endeavour to age healthily. There is a wide range of activities which are likely to foster healthy ageing. To encourage their uptake, it is important for communities to offer suitable promotion and support, and to make these accessible to the public.

Assessing multidimensional complexity in home care: congruencies and discrepancies between patients and nurses.

BACKGROUND: Person-centered care allows for the inclusion of the totality of a person's needs and preferences, beyond just the clinical or medical aspect. This approach requires the development of tools to allow for the integration of the patient in his/her healthcare. Based on a 30-item tool developed for nurses to evaluate the complexity of home care situations (COMID), this study proposed a version for the patients (i.e. COMID-P). Both instruments were used, independently by nurses and patients, to rate the complexity of individual situations, in order to compare ratings. METHODS: The COMID-P and the COMID were completed during the fraXity study at the patients' homes, independently by patients (aged 65 and over) and nurses. Item-level and scale-level analyses were performed using, Kappa and McNemar tests, and intra-class correlation (ICC). RESULTS: A total of 159 pairs of COMID and COMID-P ratings were retained for analyses. Results demonstrated a high degree of patient/nurse agreement for 12/30 items, a moderate agreement for 10/30 items, and a low degree of agreement for 7/30 items. The intra-class correlation between the COMID-P and the COMID was high (ICC= .826, 95%CI [.761-.873]). CONCLUSIONS: The results demonstrate that patients and nurses can assess complexity using tools that have comparable structural properties. They also reveal congruencies and discrepancies in scoring the components of complexity, highlighting the need of reaching consensus in designing care plans. Further work is needed to demonstrate the benefits of joint assessment in developing care plans that truly meet patients' needs. TRIAL REGISTRATION: The fraXity study was registered in ClinicalTrials.gov, NCT03883425 , on March 20, 2019.

Tooling nurses to assess complexity in routine home care practice: Derivation of a complexity index from the interRAI-HC.

AIM: Home care nurses often use the Resident Assessment Instrument-Home Care (interRAI-HC) to assess health needs. However, this tool does not assess complexity. This study proposes to derive a complexity index (CI) from the interRAI-HC using the operational definition of the dedicated COMID checklist (COmplexité Multidimensionnelle des prises en soins Infirmières à Domicile). DESIGN: Data were collected at the baseline assessment of the fraXity study (N = 231, aged ≥ 65), which relied on an observational longitudinal design. METHODS: Measures were the interRAI-HC, from which the CI binary variables were computed and the COMID, used as a reference. RESULTS: Twenty-six CI variables were computed from the interRAI-HC, and all but three correlations were significant. The correlation between the CI score and the COMID score was ρ = 0.730 (p < .001). CONCLUSIONS: The study demonstrates that complexity can be assessed directly from the interRAI-HC by deriving a CI.

Nurse-led patient-centred intervention to increase written advance directives for outpatients in early-stage palliative care: study protocol for a randomised controlled trial with an embedded explanatory qualitative study.

INTRODUCTION: Discussing the evolution of life-threatening diseases and end-of-life issues remains difficult for patients, relatives and professionals. Helping people discuss and formalise their preferences in end-of-life care, as planned in the Go Wish intervention, could reduce health-related anxiety in the advance care planning (ACP) and advance directive (AD) process. The aims of this study are (1) to test the effectiveness of the Go Wish intervention among outpatients in early-stage palliative care and (2) to understand the role of defence mechanisms in end-of-life discussions among nurses, patients and relatives. METHODS AND ANALYSIS: A mixed-methods study will be performed. A cluster randomised controlled trials with three parallel arms will be conducted with 45 patients with chronic progressive diseases impacting life expectancy in each group: (1) Group A, Go Wish intervention for patients and their relatives; (2) Group A, Go Wish intervention for patients alone and (3) Group B, for patients (with a waiting list), who will receive the standardised information on ADs (usual care). Randomisation will be at the nurse level as each patient is referred to one of the 20 participating nurses (convenience sample of 20 nurses). A qualitative study will be conducted to understand the cognitive and emotional processes and experiences of nurses, patients and relatives confronted with end-of-life discussions. The outcome measurements include the completion of ADs (yes/no), anxiety, quality of communication about end-of-life care, empowerment, quality of life and attitudes towards ADs. ETHICS AND DISSEMINATION: The study protocol has been approved by the Human Research Ethics Committee of the Canton of Geneva, Switzerland (no. 2019-00922). The findings will be disseminated to practice (nurses, patients and relatives), to national and international scientific conferences, and peer-reviewed journals covering nursing science, psychology and medicine. TRIAL REGISTRATION NUMBER: NCT04065685.

[Assessing frailty in care practices†: quick reminders in the light of the Covid-19 pandemic]. / Évaluer la fragilité dans les pratiques de soins†: brefs rappels à la lumière de la pandémie de Covid-19.

The Covid-19 pandemic has brought the concept of frailty back to the centre of debate, particularly for its relevance as a determinant of health outcomes. Frailty is concept that has long been a used gerontology. Today, several theoretical models of frailty are proposed in the literature, with as many tools to operationalize it. This article provides a brief outline of the three main models of frailty and the corresponding measurement instruments. The choice of the model as well as the choice of the assessment tool are discussed in the light of the clinical objectives pursued by health professionals. More generally, this article highlights the value of assessing frailty in routine practice to determine health outcomes and adapt care to individual needs.

La pandémie de Covid-19 a ramené le concept de fragilité au centre des débats, notamment pour son intérêt dans l'évaluation du pronostic en santé dans un contexte de menace sanitaire. La fragilité est un concept reconnu en gérontologie de longue date. Aujourd'hui, plusieurs modèles théoriques de la fragilité sont proposés dans la littérature, avec autant d'instruments permettant de l'opérationnaliser. Cet article propose un bref rappel des trois principaux modèles de fragilité ainsi que des instruments de mesure correspondants et de les discuter en fonction des objectifs cliniques poursuivis par les professionnels de la santé. Plus généralement, cet article souligne l'intérêt d'évaluer la fragilité dans une pratique de routine pour déterminer le pronostic de santé et adapter les soins aux besoins des individus.

[Complexity in nursing practice : Toward a new conceptual framework in nursing care] / La complexité dans la pratique infirmière : vers un nouveau cadre conceptuel dans les soins infirmiers.

While complexity theory has gradually influenced the field of health and social sciences, it has also had an impact on nursing care by introducing a wealth of terminology into the field. The terms "complex patient," "complex case," "complex care," "complex practice," and "complex needs" have been proposed to describe different aspects of complexity in nursing care. As these qualifiers reflect, nurses become actors in multidefined care and must integrate complexity into their reflective practice. By way of a narrative literature review, this article aims to offer a new perspective on nursing by explaining the different terms used in the discipline, using a multi-level approach. At the end of this review, the authors propose a new integrative conceptual framework for complexity in nursing practice.

La complexité dans la pratique infirmière : vers un nouveau cadre conceptuel dans les soins infirmiers.

While complexity theory has gradually influenced the field of health and social sciences, it has also had an impact on nursing care by introducing a wealth of terminology into the field. The terms "complex patient," "complex case," "complex care," "complex practice," and "complex needs" have been proposed to describe different aspects of complexity in nursing care. As these qualifiers reflect, nurses become actors in multidefined care and must integrate complexity into their reflective practice. By way of a narrative literature review, this article aims to offer a new perspective on nursing by explaining the different terms used in the discipline, using a multi-level approach. At the end of this review, the authors propose a new integrative conceptual framework for complexity in nursing practice.

Protocol of a case-control longitudinal study (fraXity) assessing frailty and complexity among Swiss home service recipients using interRAI-HC assessments.

BACKGROUND: The early screening of frail individuals and of patients with complex care needs are challenges that countries witnessing population aging face. Homecare nurses are actors of choice in meeting these challenges, yet they need means of identifying frail and complex patients in their routine practice. The fraXity study's aim is to fill this gap by (1) proposing frailty and complexity computation algorithms derived from the interRAI-HC; (2) assessing the predictive validity of the proposed indices with respect to adverse health outcomes; and (3) identifying subgroups of the aged population for whom the early screening of frailty and complexity appears to be most relevant. METHODS: The study will rely on a prospective observational case-control longitudinal study. Three samples of individuals aged 65 or older living in the community will be considered: recipients of formal home care (case 1), of formal home assistance (case 2) and individuals free of formal home services (controls). All participants will receive interRAI-HC assessments at three measurement occasions, separated by six-month intervals. Baseline assessments will serve to derive frailty and complexity scores. Follow-ups will serve to assess the predictive validity of the proposed indices and to estimate the intra-individual change in frailty and complexity. Group comparisons will serve to identify subgroups of the population for whom the screening of frailty and complexity appears to be the most relevant. DISCUSSION: The expected results of the fraXity study are a) reliable computation algorithms for frailty and complexity scores derived from the interRAI-HC and b) clinical assessment protocols for use by homecare nurses. These outcomes should contribute to outfitting key actors of the health system with means of enhancing their part in a collective endeavor targeting the best care and quality of life for aged citizens. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03883425 , registered on March 20, 2019.

[Analysis of the reliability of a multidimensional complexity scale instrument (COMID) for home care nurses]. / Analyse de la fidélité d'un instrument d'évaluation de la complexité multidimensionnelle (COMID) pour les infirmières à domicile.

Introduction : The increasingly frequent mention of complexity by different health care actors challenges the measurement of this construct. The COMID, a tool that helps home nurses to identify complex situations, provides a multidimensional and operational definition of complexity.Context : While an acceptability study showed that nurses took a keen interest in the COMID, its psychometric properties have not yet been examined.Objective : This article reports on two studies testing the reliability of the scale.Method : Study 1 focuses on 5,401 COMIDs completed by home care nurses in their usual practice. The internal consistency was estimated using Cronbach's alpha. Study 2 focuses on 38 COMIDs, completed by home care nurses (rater group 1) and specialized nurses (rater group 2). Inter-rater agreement was examined using an intraclass correlation coefficient (ICC).Results : The COMID has an acceptable internal consistency α = 0.797 and an excellent inter-rater agreement ICC = 0.839.Discussion : The metrological properties of the COMID will need to be complemented by an analysis of its validity. Conclusion : The COMID has good measurement accuracy and therefore has good potential for identifying complexity in nursing practice.

[Screening for undernutrition among older adults receiving home care: an estimation of the diagnostic accuracy of indicators available in the Resident Assessment Instrument - Home Care adapted for Switzerland.] / Dépister la dénutrition chez la personne âgée bénéficiant de soins à domicile : une évaluation de la précision diagnostique des indicateurs issus du Resident Assessment Instrument - Home Care adapté pour la Suisse.

INTRODUCTION: in homecare practice, nurses are central actors for the screening of individuals at risks of undernutrition. CONTEXT: in Switzerland, homecare nurses estimate the nutritional status of care recipients by means of a standardized geriatric assessment done with the RAI-HC. AIMS: The aim of the study is to estimate the diagnostic accuracy of the « nutritional status ¼ score, the body mass index and the weight loss documented from the RAI-HC. METHOD: a sample of 267 homecare recipients aged 65 was assessed using the RAI-HC and the MNA-SF®. Sensitivity, specificity and area under the curve were estimated for the RAI-HC measures, with the MNA-SF® as the gold standard reference. RESULTS: for the scores considered, sensitivity varied between 16.51 % and 68.81 %, specificity between 66.94 % and 99.37 %, and areas under the curve between 0.579 at 0.708. DISCUSSION: the diagnostic accuracy of the RAI-HC indicators is not sufficient for an optimal screening of undernutrition in older homecare recipients. CONCLUSION: an additional assessment with the MNA-SF® is recommended to optimize the early screening of individuals at risks of undernutrition.

Derivation of a frailty index from the resident assessment instrument - home care adapted for Switzerland: a study based on retrospective data analysis.

BACKGROUND: The screening of frail individuals at risk for functional health decline and adverse health outcomes lies in the evolving agenda of home care providers. Such a screening can be based on a frailty index (FI) derived from data collected with interRAI instruments used in clinical routines to define care plans. The objective of this study was to assess the feasibility of deriving an FI from the Resident Assessment Instrument - Home Care adapted for Switzerland (Swiss RAI-HC). METHODS: Data were collected by the Geneva Institution for Homecare and Assistance in clinical routines. The sample consisted of 3714 individuals aged 65 or older (67.7% females) who had each received a Swiss RAI-HC upon admission in the year of 2015. The FI was derived from 52 variables identified and scored according to published guidelines. Adverse health outcomes were either assessed during follow-up assessments (falls, hospitalizations) or documented from administrative records (mortality). RESULTS: The results showed that the FI was distributed normally, with a mean of 0.24 (± 0.13), an interquartile range of 0.16, and values of 0.04 at percentile 1 and 0.63 at percentile 99. The effect of Age was significant (R2 = 0.011) with a slope of ß = 0.002, 95% CI = [0.001-0.002]. Sex as well as the Age × Sex interaction were not significant. The FI predicted deaths (OR = 9.99, 95% CI = [3.20-29.99]), hospitalizations (OR = 3.40, 95% CI = [1.78-6.32]), and falls (OR = 5.00, 95% CI = [2.68-9.38]). CONCLUSIONS: The results support the feasibility of an FI derivation from the Swiss RAI-HC, hence replicating previous demonstrations based on interRAI instruments. The results also replicated findings showing that the FI is a good predictor of adverse health outcomes. Yet, the results suggest that home care recipients demonstrate a frailty pattern different from the one reported in community dwellers but comparable to clinical samples. Further work is needed to assess the characteristics of the proposed index in community-dwelling, non-clinical samples for comparability with the existing literature and external validation TRIAL REGISTRATION: ClinicalTrials.gov NCT03139162 . Retrospectively registered May 2, 2017.