Reliable integrative assessment of health care needs in elderly persons: The INTERMED for the Elderly (IM-E)

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Abstract

Objective

With the increasing prevalence of multiple conditions in older age, the high prevalence of mental disorders, and the many social challenges facing elderly people, a high-risk patient group in need of interdisciplinary (biological, psychological, and social) care is emerging. The INTERMED interview is an integrative assessment method that identifies patients with complex health care needs. The aim of this study was to develop and evaluate the INTERMED for the Elderly (IM-E), specifically for use in populations of elderly persons.

Methods

In focus groups conducted with the authors of the original INTERMED, the variables and anchor points that had to be adjusted to the needs and situation of the elderly and to the demands of a population-based study were discussed and altered. The final version of the IM-E was conducted with 42 elderly persons. Participants were doubly scored by two trained raters; the interrater reliability [intraclass correlation coefficient (ICC) (2,1)] was calculated.

Results

The IM-E was well accepted by the elderly persons interviewed. ICCs for the various domains of the IM-E ranged between .87 and .95, while the ICC for the sum score was .95. Regarding the cutoff point of 20/21 for patients with complex health care needs, a κ of .75 was achieved.

Conclusions

The IM-E is a reliable integrative assessment instrument. It is well suited for epidemiological settings to adequately describe the percentage of elderly patients with complex health care needs. In clinical settings, it can be used to identify elderly patients in need of interdisciplinary care.

Introduction

Over the past years, the proportion of elderly people in many countries has increased dramatically. Population projections show that in the EU-25 states, the proportion of people aged 65 years or older is expected to rise substantially, from 16.4% in 2004 to 29.9% in 2050 [1]. These demographic changes go hand in hand with an increase in the prevalence of chronic diseases, presenting a challenge for health care systems. Among aging people, it is common to have more than one chronic condition. Results from a population-based study indicate that 67.3% of the German population aged between 50 and 75 years suffers from multimorbidity [2]. The co-occurrence of mental disorders frequently aggravates the course of multimorbidity in older age [3], [4]. In addition, elderly people face many social challenges. This emphasizes the claim that, in general, health care in the elderly should integrate biological, psychological, and social perspectives. Effective community-based care for older people requires an assessment of the biopsychosocial health care needs in this population. Therefore, a reliable, integrative assessment method that can easily be used in epidemiological and clinical settings is necessary.

The INTERMED interview is a method that reflects a biopsychosocial approach to the integrative assessment of health care needs of patients with a physical illness [5]. The INTERMED was developed by an international working group over the past 10 years, and has proven to be a valid and reliable instrument to identify elevated health care needs [6], [7], [8], [9], [10], [11]. The assessment method is based on a semistructured interview that classifies the information into the four domains of a patient's biological, psychological, social, and health care-related characteristics. The questions and ratings in each domain are related to a time axis that is divided into past, present, and future. The interview results in an assessment of the four domains (over three periods); the respective scores of the four domains are added to give a total score reflecting the amount of health care needs of the participant. The main goal of the clinical use of the INTERMED is the identification of patients with complex (biopsychosocial) health care needs who are in need of interdisciplinary care. An additional goal is the improvement of communication between the patients and their providers, as well as among the providers themselves—both of which are necessary for the delivery of integrated care [12], [13].

As the interview provides a systematic approach to patients' health risks and needs in the biological, psychological, social, and health care-related domains, it is not only an important clinical screening instrument but also a very useful research tool. However, for studies that focus on elderly participants, some rating categories and anchor points for the scoring of the original instrument are not appropriate because they do not explicitly consider the different or changing work and social situations of elderly persons. Also, as an interview originally developed for medical and surgical patients, the INTERMED refers to a clinical context in some of the questions and scorings. Therefore, several adjustments had to be made in order to be applicable to epidemiological and clinical settings. This study presents the development and psychometric properties of the INTERMED for the Elderly (IM-E)—an INTERMED-based interview developed specifically for use in elderly populations that facilitates application to population-based studies.

Section snippets

Methods

In focus groups conducted in conjunction with the international authors of the original INTERMED, the variables, lead questions, anchor points, and scorings that had to be adjusted to the needs and situations of the elderly were discussed. Some lead questions and anchor points were altered. A first version of the IM-E was developed and approved by all the participants of the study group of the INTERMED Foundation1

Variables, lead questions, and anchor points of the IM-E

Table 1 shows the scoring grid of the IM-E. As in the original INTERMED, the information gathered from the IM-E interview is classified with respect to the four domains regarding biological, psychological, social, and health care-related characteristics. In each domain, five variables are rated on a scale ranging from 0 to 3. The scores range from zero evidence for a symptom disturbance or health service need (0) to a clear and serious disturbance of complex disease or health service needs (3).

Discussion

The results of this study show that the IM-E is a reliable tool for the assessment of integrative health care needs in elderly populations. The alterations that were made—using focus groups comprised of the authors of the original INTERMED and feedback loops with study doctors of a large epidemiological study—led to a highly structured interview and scoring guide that was recorded in a standardized blank form. Participants showed a good acceptance of being interviewed with the IM-E assessment

Acknowledgments

The study is part of the consortium “Multimorbidity and Frailty in Old Age: Epidemiology, Biology, Psychiatric Comorbidity, Medical Care and Costs” which is funded by the German Ministry of Research and Education (Grant No. 01ET0718). We thank the interview participants of the reliability study. We also thank Lena Warrington for her perceptive editing services.

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