Grant: Travel Awards - Institute Community Support

Prioritization of health-care services including when to transition at-risk older adults to residential care facilities is of pressing concern. Older adults with increasingly complex and unmet health-care needs, their caregivers, as well as practitioners, are faced with determining when transition from home to residential care is most appropriate. As residential care beds are a scarce and comparatively expensive resource, and considering that the majority of older adults prefer to age in their homes, objective assessment tools that combine empirically validated and clinically informed insight are of substantive benefit for care planning. The Resident Assessment Instrument Homecare (RAI-HC) is routinely administered to older adults in health-care settings to characterize their status and well-being through composite scores of physical, psychological, social and clinical issues. Although other screening instruments have been derived to predict outcome, investigations to date have typically employed single time-point evaluations, leaving large amounts of variance unexplained. In this project, we address this evaluative gap by focusing on change as a predictor of transition risk from home to subsequent levels of care, using nationally representative archival data from the RAI-HC. Preliminary analyses of approximately 2.5 million CIHI records spanning 7 Canadian provinces and territories from 2006-2015 indicate significant between-person differences in initial RAI-HC scores as well as subsequent rates of change across as many as 9 years in virtually every composite score available through conventional RAI-HC interpretation. Subsequent analyses will stratify results based on key demographic variables with an ultimate goal of establishing normative values to derive a tool that can be used to facilitate care planning. Subsequently, we aim to track additional cohorts to confirm the validity of this approach in predicting transition to residential care for the frail elderly.