Reliable integrative assessment of health care needs in elderly persons: The INTERMED for the Elderly (IM-E)
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.
References (26)
- et al.
Role of depressive symptoms and comorbid chronic disease on health-related quality of life among community-dwelling older adults
J Psychosom Res
(2009) - et al.
Somatic and psychiatric comorbidity in the general elderly population: results from the ZARADEMP Project
J Psychosom Res
(2008) - et al.
“INTERMED”: a method to assess health service needs: I. Development and reliability
Gen Hosp Psychiatry
(1999) - et al.
Operationalizing integrated care on a clinical level: the INTERMED project
Med Clin North Am
(2006) - et al.
Identifiers, or “red flags,” of complexity and need for integrated care
Med Clin North Am
(2006) - et al.
Case and care complexity in the medically ill
Med Clin North Am
(2006) - et al.
Interrater reliability of the INTERMED in a heterogeneous somatic population
J Psychosom Res
(2002) - et al.
“INTERMED”: a method to assess health service needs: II. Results on its validity and clinical use
Gen Hosp Psychiatry
(1999) The complexity of communication in an environment with multiple disciplines and professionals: communimetrics and decision support
Med Clin North Am
(2006)- et al.
Internal consistency of the INTERMED in patients with somatic diseases
J Psychosom Res
(2003)