Hostname: page-component-cd9895bd7-lnqnp Total loading time: 0 Render date: 2024-12-22T18:56:28.611Z Has data issue: false hasContentIssue false
  • English
  • Français

Recording care time in nursing homes: development and validation of the “RUD-FOCA” (Resource Utilization in Dementia – Formal Care)

Published online by Cambridge University Press:  18 May 2010

Katharina Luttenberger  and
Elmar Graessel
Katharina Luttenberger*
Affiliation:
Medical Psychology and Medical Sociology, Clinic for Psychiatry and Psychotherapy, Erlangen University Hospital, Germany
Elmar Graessel
Affiliation:
Medical Psychology and Medical Sociology, Clinic for Psychiatry and Psychotherapy, Erlangen University Hospital, Germany
*
Correspondence should be addressed to: Dipl.-Psych. Katharina Luttenberger, Clinic for Psychiatry and Psychotherapy, Erlangen University Hospital, Schwabachanlage 6, 91054 Erlangen, Germany. Phone: +49 9131-85-34650. Email: [email protected].
Get access

Abstract

Background: Currently there is no standardized procedure for recording direct care time of dementia patients in a nursing home. Recording the direct care time, however, provides an important component of both cost estimates for time-dependent reimbursement of nursing activities and for recording the degree of dependency as an outcome measure for the efficiency of new treatment methods for dementia patients. The purpose of this study is thus to develop and validate the “RUD-FOCA” (Resource Utilization in Dementia – Formal Care), based on the RUD lite, as a standardized tool to measure the direct care time actually required in the nursing home.

Methods: Based on four hypotheses, construct validity was tested within a randomized controlled trial in a sample of 148 residents in six German nursing homes. The RUD-FOCA records the care time in three areas: activities of daily living (ADL), instrumental activities of daily living (IADL) and supervision. For validation, the residents’ capabilities were examined using the Barthel Index, the Nurses’ Observation Scale on Geriatric Patients (NOSGER), the Alzheimer Disease Assessment Scale (ADAS), the Erlangen Test on Activities of Daily Living (E-ADL) and the Mini-mental State Examination (MMSE). The hypotheses assume relationships between the time required for care in the three areas and the limitations involved in these areas. The retest reliability was also determined.

Results: ADL care accounts for two-thirds of total care time in the homes. The hypotheses which refer to total time, ADL and supervision are supported by differentiated correlation profiles. The IADL hypothesis is not supported owing to even, low correlations. The retest reliability was r = 0.76 for the entire care time.

Conclusions: Overall time and the times for ADL care and supervision can be considered valid estimates. The validity is lowest for recording IADL times. Thus, the RUD-FOCA is suitable as an instrument to determine the direct care time in the nursing home. Recording IADL times should be improved by detailed operationalization.

Keywords

caregiver timeassessmenthomes for the ageddementiavalidity
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Special Issue 8: Focus on prevention in psychogeriatrics , December 2010 , pp. 1291 - 1300
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arling, G., Kane, R. L., Mueller, C. and Lewis, T. (2007). Explaining direct care resource use of nursing home residents: findings from time studies in four states. Health Services Research, 42, 827–846. doi: 10.1111/j.1475-6773.2006.00627.x.CrossRefGoogle ScholarPubMed
Arling, G. and Williams, A. R. (2003). Cognitive impairment and resource use of nursing home residents: a structural equation model. Medical Care, 41, 802–812. doi: 10.1097/01.MLR.0000068538.14414.F4.CrossRefGoogle ScholarPubMed
Bickel, H. (2001). Demenzen im höheren Lebensalter: Schätzungen des Vorkommens und der Versorgungskosten [Old age dementia: estimates of prevalence and cost]. Zeitschrift für Gerontologie und Geriatrie, 34, 108–115.CrossRefGoogle Scholar
Clipp, E. C. and Moore, M. J. (1995). Caregiver time use: an outcome measure in clinical trial research on Alzheimer's disease. Clinical Pharmacology and Therapeutics, 58, 228–236. doi: 10.1016/0009-9236(95)90201-5.CrossRefGoogle ScholarPubMed
Davis, K. L. et al. (1997). The Caregiver Activity Survey (CAS): development and validation of a new measure for caregivers of persons with Alzheimer's disease. International Journal of Geriatric Psychiatry, 12, 978–988. doi: 10.1002/(SICI)1099–1166(199710)12:10<978::AID-GPS659>3.0.CO;2-1.3.0.CO;2-1>CrossRefGoogle ScholarPubMed
Folstein, M., Folstein, S. and McHugh, P. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatry Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Fries, B. E., Mehr, D. R., Schneider, D., Foley, W. J. and Burke, R. (1993). Mental dysfunction and resource use in nursing homes. Medical Care, 31, 898–920.CrossRefGoogle ScholarPubMed
Graessel, E., Viegas, R., Stemmer, R., Küchly, B., Kornhuber, J. and Donath, C. (2009). The Erlangen Test of Activities of Daily Living: first results on reliability and validity of a short performance test to measure fundamental activities of daily living in dementia patients. International Psychogeriatrics, 21, 103–112. doi: 10.1017/S1041610208007710.CrossRefGoogle Scholar
Hébert, R., Dubois, M., Wolfson, C., Chambers, L. and Cohen, C. (2001). Factors associated with long-term institutionalization of older people with dementia: data from the Canadian Study of Health and Aging. Journals of Gerontology. Series A, Biological Sciences and Medical Sciences, 56A, M693–M699.CrossRefGoogle Scholar
Luppa, M., Luck, T., Brahler, E., Konig, H. H. and Riedel-Heller, S. G. (2008). Prediction of institutionalisation in dementia: a systematic review. Dementia and Geriatric Cognitive Disorders, 26, 65–78. doi: 10.1159/000144027.CrossRefGoogle ScholarPubMed
Mahoney, F. I. and Barthel, D. W. (1965). Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
Neubauer, S., Holle, R., Großfeld-Schmitz, M. and Gräßel, E. (2008). Measurement of informal care in a study with demented patients. International Psychogeriatrics, 20, 1160–1176. doi: 10.1017/S1041610208007564.CrossRefGoogle Scholar
Neubauer, S., Holle, R., Menn, P. and Gräßel, E. (2009). A valid instrument for measuring informal care time for people with dementia. International Journal of Geriatric Psychiatry, 24, 275–282. doi: 10.1002/gps.2103.CrossRefGoogle ScholarPubMed
Nordberg, G., von Strauss, E., Kareholt, I., Johansson, L. and Wimo, A. (2005). The amount of informal and formal care among non-demented and demented elderly persons – results from a Swedish population-based study. International Journal of Geriatric Psychiatry, 20, 862–871. doi: 10.1002/gps.1371.CrossRefGoogle ScholarPubMed
Nordberg, G. et al. (2007). Time use and costs of institutionalised elderly persons with or without dementia: results from the Nordanstig cohort in the Kungsholmen Project: a population based study in Sweden. International Journal of Geriatric Psychiatry, 22, 639–648. doi: 10.1002/gps.1724.CrossRefGoogle ScholarPubMed
O'Shea, E. and O'Reilly, S. (2000). The economic and social cost of dementia in Ireland. International Journal of Geriatric Psychiatry, 15, 208–218.3.0.CO;2-X>CrossRefGoogle ScholarPubMed
Rosen, W. G., Mohs, R. C. and Davis, K. L. (1984). A new rating scale for Alzheimer's disease. American Journal of Psychiatry, 141, 1356–1364.Google ScholarPubMed
Smith, G. E., Kokmen, E. and O'Brien, P. C. (2000). Risk factors for nursing home placement in a population-based dementia cohort. Journal of the American Geriatrics Society, 48, 519–525.CrossRefGoogle Scholar
Spiegel, R. et al. (1991). A new behavioral assessment scale for geriatric out- and in-patients: the NOSGER (Nurses’ Observation Scale for Geriatric Patients). Journal of the American Geriatrics Society, 39, 339–347.CrossRefGoogle ScholarPubMed
van den Berg, B. and Spauwen, P. (2006). Measurement of informal care: an empirical study into the valid measurement of time spent on informal caregiving. Health Economics, 15, 447–460.CrossRefGoogle ScholarPubMed
Wimo, A. (2007). Clinical and economic outcomes: friend or foe? International Psychogeriatrics, 19, 497–507.CrossRefGoogle ScholarPubMed
Wimo, A. and Nordberg, G. (2007). Validity and reliability of assessments of time comparisons of direct observations and estimates of time by the use of the resource utilization in dementia (RUD)-instrument. Archives of Gerontology and Geriatrics, 44, 71–81. doi: 10.1016/j.archger.2006.03.001.CrossRefGoogle ScholarPubMed
Wimo, A. and Winblad, B. (2003). Resource utilization in dementia: “RUD Lite”. Brain Aging, 3, 48–59Google Scholar
Wimo, A., Wetterholm, A., Mastey, V. and Winblad, B. (1998). Evaluation of the healthcare resource utilization and caregiver time in anti-dementia drug trials – a quantitative battery. In Wimo, A., Jönsson, B., Karlson, G. and Winblad, B. (eds.), Health Economics of Dementia (pp. 465–499). Chichester: John Wiley & Sons Ltd.Google ScholarPubMed
Wimo, A., von Strauss, E., Nordberg, G., Sassi, F. and Johansson, L. (2002). Time spent on informal and formal care giving for persons with dementia in Sweden. Health Policy, 61, 255–268.CrossRefGoogle ScholarPubMed
Supplementary material: PDF

Luttenberger supplementary material

Time schedule.pdf

Download Luttenberger supplementary material(PDF)
PDF 21.4 KB
Supplementary material: PDF

Luttenberger supplementary material

Questionnaire.pdf

Download Luttenberger supplementary material(PDF)
PDF 21.5 KB