| Objective: To construct a comprehensive assessment tool for referral between hospitals and nursing homes for older adults with chronic diseases,and to explore the characteristics of different types of older adults with chronic diseases in order to provide reference for the formulation of targeted transitional care programs.Methods:(1)Translate the English version of CARE and construct the Chinese version of CARE through expert meetings.Using convenience sampling method,120 older adults from hospitals and 120 older adults from nursing homes in Shanghai were selected to test the internal consistency,inter-rater reliability and criterion-related validity of CARE from May to November 2017.The paper calculated internal consistency,inter-rater reliability and criterion-related validity through Cronbach alpha coefficient,intraclass correlation coefficient(ICC)and Spearman correlation coefficient respectively.(2)Using convenient sampling method,CARE tool was used to investigate older adults with chronic diseases in 2 tertiary hospitals,2 secondary hospitals,3 nursing homes and 4 nursing homes in Shanghai from February to August,2018.Among them,392 older adults were in hospitals and 390 in nursing homes.The characteristics of complications were analyzed.(3)The K-means clustering method was used to classify older adults with chronic diseases in hospitals and nursing homes.Results:(1)For hospital older adults,Cronbach alpha coefficients of 70.0%(7/10)sub-scales were higher than 0.7.The ICC of one item was lower than 0.4,the ICCs of two items ranged from 0.4 to 0.75,and the ICCs of 94.3%(50/53)items were higher than 0.75.For long-term care institution older adults,Cronbach alpha coefficients of 90.0%(9/10)sub-scales were higher than 0.7.The ICCs of three items ranged from 0.4 to 0.75,and the ICCs of 94.3%(50/53)items were higher than 0.75.For older adults in hospitals and nursing homes,the correlation coefficients of CARE cognitive function subscale,core self care subscale and supplemental functional ability subscale with their corresponding instruments for criterion-related validity were all higher than 0.8.(2)The average age of older adults with chronic diseases in hospital was 76.96 ±10.126,with an average of 2.84±1.294 chronic diseases and 5.98±3.950 geriatric syndromes.The average age of older adults with chronic diseases in long-term care institution was 84.09±8.059,with an average of 2.97±1.404 chronic diseases and 7.76±3.059 geriatric syndromes.The most common chronic diseases of older adults in hospitals and nursing homes are cerebrovascular diseases,hypertension,diabetes,cardiovascular diseases,respiratory diseases and osteoarticular diseases.The most common geriatric syndromes of older adults in hospitals and nursing homes are the IADL decline,mobility decline,ADL decline,cognitive function decline and grip strength decline.The incidence of complications in older adults with different chronic diseases is consistent.(3)By K-means cluster analysis of geriatric syndromes,older adults with chronic diseases in hospitals and nursing homes can be divided into three groups: low-incidence group,middle-incidence group and high-incidence group.The characteristics of different types of elderly people are different.Conclusions: CARE has good reliability and validity among older adults with chronic diseases in hospitals and nursing homes in China.It can reflect the characteristics of geriatric syndromes in the process of transition,and can be used as an assessment tool for transition between hospitals and nursing homes.In the process of transition,attention should be paid to the geriatric syndromes associated with older adults.According to the characteristics of older adults with different types of geriatric syndromes,targeted transitional care programs can be formulated to improve the quality of transition. |
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