Elderly, multimorbid long-term residents of nursing homes, independently living relatives, nursing home staff working with nursing homes residents Not Applicable
Conditions
Interventions
The intervention includes a complex of multimodal cross-sectoral rehabilitative measures for nursing home residents. The intervention involves residents older than 65 years, (re-)admitted in the last
Sponsors
AOK
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: Residents: 1. Residents of the participating nursing homes aged over 65 years old 2. Newly admitted in the nursing home after recent hospitalisation within the last 12 months or 3. Not longer than 12 months resident of the nursing home 4. At least level 2 of care (by § 15 SGB XI) 5. Declaration of consent Relatives: 1. Being a participating resident’s relative (defined as a person with at least weekly contact) 2. Provide informed consent Employees of nursing homes: 1. Working on wards that are part of the intervention 2. Provide informed consent
Exclusion criteria
Exclusion criteria: Residents: 1. Severe dementia (MMSE <=11) 2. Lack of capacity to consent / not providing consent 3. Residents with legal care 4. Residents with private health insurance (funder requirement) Relatives: 1. Relatives of excluded residents 2. Not providing consent Employees: 1. Working on wards that are not part of the intervention 2. Not providing consent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Basal and instrumental daily living skills with the Scores of Independence for Neurologic and Geriatric Rehabilitation (SINGER) at baseline, 3 and 6 months | — |
Secondary
| Measure | Time frame |
|---|---|
| The following secondary outcome measures for nursing home residents are assessed at baseline, and after 3 and 6 months: 1. Frailty measured using the Tilburg Frailty Indicator (TFI) 2. Cognitive Function measured using the Montreal-Cognitive-Assessment-Test (MOCA) 3. Hand mobility measured using the 20 Coins Test (20-C-T) 4. Overall health status and quality of life measured using the Short Form Health Survey (SF-12) 5. Quality of Life for elderly individuals measured using the WHO Quality of Life (WHOQOL-OLD) 6. Nutritional Status of older individuals measured using the Mini Nutritional Assessment (MNA-SF) 7. Comorbidity burden measured using the Charleston Comorbidity Index (CCI) (at baseline only) 8. The number of hospitalisations (during 6 months), psychopharmacological medication defined daily dosage (at baseline, 3 and 6 months), polypharmacy (at baseline, 3 and 6 months) and proportion of patients discharged to their own home (during 6 months) measured using information from the nursing home residents´ file 9. Health economic data (e.g. hospital stays, medical aids, travel costs) measured at the resident and nursing home levels. For the subgroup of AOK insured, costs at the resident level and cost-effectiveness are assessed. Other secondary measures for different participant groups comprise the following methods: 10. Job Satisfaction of nursing home staff with the Copenhagen Psychosocial Questionnaire (COPSOQ) at baseline, and after 6, 12, 18 and 24 months. 11. Quality of life of residents´ relatives with the WHOQOL-BREF at baseline and after 6 months. | — |
Countries
Germany
Contacts
Public ContactIsabella Heller
Outcome results
None listed