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Multidimensional Geriatric Assessment: Back to the Future Second and Third Generation Assessment Instruments: The Birth of Standardization in Geriatric Care

Centro Medicina Invecchiamento, Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, Rome, Italy.

Address correspondence to Francesco Landi, MD, PhD, Centro Medicina dell'Invecchiamento (CEMI), Dipartimento di Scienze Gerontologiche, Geriatriche e Fisiatriche, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168 Rome, Italy. E-mail: francesco_landi{at}rm.unicatt.it

The systematic adoption of "second-generation" comprehensive geriatric assessment instruments, initiated with the Minimum Data Set (MDS) implementation in U.S. nursing homes, and continued with the uptake of related MDS instruments internationally, has contributed to the creation of large patient-level data sets. In the present special article, we illustrate the potential of analyses using the MDS data to: (a) identify novel prognostic factors; (b) explore outcomes of interventions in relatively unselected clinical populations; (c) monitor quality of care; and (d) conduct comparisons of case mix, outcomes, and quality of care. To illustrate these applications, we use a sample of elderly patients admitted to home care in 11 European Home Health Agencies that participated in the AgeD in HOme Care (AD-HOC) project, sponsored by the European Union. The participants were assessed by trained staff using the MDS for Home Care, 2.0 version. We argue that the harmonization by InterRAI of the MDS forms for different health settings, referred to as "the third generation of assessment," has produced the first scientific, standardized methodology in the approach to effective geriatric care.

Key Words: Comprehensive geriatric assessment • Minimum data set • Scales • Older adults • Nursing homes • Resident assessment instrument • Home care