This instrument is designed to support comprehensive geriatric assessment (CGA) in the acute hospital setting. It is suitable for use in acute geriatric units, as well as for those patients in mixed ward settings who require CGA. It can be applied in 2 formats – to support an entire episode of care, when it comprises pre-morbid, admission, review and discharge profiles or geriatric consultation when it comprises pre-morbid and current status.

It can be applied by any health professional, most typically nurses with gerontic expertise. To secure good instrument performance, two days’ training is recommended.

The interRAI consortium

This instrument is in an advanced stage of development. There are numerous demonstrations in progress around the world. It is in routine use in several Australian hospitals.

Older patients requiring CGA in the acute hospital setting.

Patients requiring CGA.

Acute geriatric units; orthopaedic units; general internal medicine units; selective use in other units.

No

Frequency distributions and inter-rater reliability has been tested in a 9 nation study involving 553 cases. Results are currently being prepared for publication. Inter-rater reliability for both the pre-morbid and admission items is demonstrated to be very satisfactory. Poorly rating items in the field study were eliminated or modified for the final instrument. Validation studies of the in-built scales are planned or in progress.

There are 62 clinical items across 11 domains including cognition, communication, mood and behaviour, instrumental and basic activities of daily living, continence, nutrition, falls, medical diagnoses, medications, advance directives and discharge potential.

The majority of items are observation based. Several involve direct questions and responses from patients.

The following outcome scales are built into the instrument, at each observation period unless otherwise stated:

Cognitive performance score

Communication score

Instrumental ADL performance (pre-morbid only)

Instrumental ADL capacity (discharge only)

ADL hierarchy scale

ADL short scale

Pain scale

Body mass index (admission only)

There are 22 algorithms that underpin problem definition and diagnostic screening (e.g., dementia and delirium).

There are 21 algorithms that identify clinical problems or risks that indicate a prevention or treatment strategy, known in interRAI as “Clinical Assessment Protocols”. Typical examples are prevention of delirium and opportunity to improve communication.

Is the instrument being used outside the original target population? No

There is a base international version. Limited variations may occur at local or national level after negotiation with interRAI.

There is no charge for clinical or research use but interRAI has owns the copyright and enters into agreement for software and manual publication to ensure quality.

Carpenter GI, Teare GF, Steel K, et al.: A new assessment for elders admitted to acute care: reliability of the MDS-AC. Aging Milano, Italy 2001; 13(4): 316-30

Jonsson PV, Finne-Soveri H, Jensdottir AB, et al.: Co-morbidity and functional limitation in older patients underreported in medical records in Nordic Acute Care Hospitals when compared with the MDS-AC instrument. Age Ageing 2006; 35(4): 434-8.

interRAI Assessment Instruments CCD

This instrument is an integral part of the interRAI suite of assessment tools for people with chronic illness, disability or mental health problems. It shares many items and scalar measures with other instruments in the suite.

The interRAI AC aims to compile necessary information to support CGA and to provide a single comprehensive technology to perform patient profiling, severity measurement, diagnostic and risk profiling and recommendations for intervention.