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Background: Performance indicators in the long term care sector are important to evaluate the efficiency and quality of care delivery. We are, however, still far from being able to refer to a common set of indicators at the European level.We therefore demonstrate the calculation of Long Term Care Facility Quality Indicators (LTCFQIs) from data of the European Services and Health for Elderly in Long TERm Care (SHELTER) project. We explain how risk factors are taken into account and show how LTC facilities at facility and country level can be compared on quality of care using thresholds and a Quality Indicator sum measure., Methods: The indicators of Long Term Care Facility quality of care are calculated based on methods that have been developed in the US. The values of these Quality Indicators (QIs) are risk adjusted on the basis of covariates resulting from logistic regression analysis on each of the QIs. To enhance the comparison of QIs between facilities and countries we have used the method of percentile thresholds and developed a QI sum measure based on percentile outcomes., Results: In SHELTER data have been collected with the interRAI Long Term Care Facility instrument (interRAI-LTCF). The data came from LTC facilities in 7 European countries and Israel. The unadjusted values of the LTCF Quality Indicators differ considerably between facilities in the 8 countries. After risk adjustment the differences are less, but still considerable. Our QI sum measure facilitates the overall comparison of quality of care between facilities and countries., Conclusions: With quality indicators based on assessments with the interRAI LTCF instrument quality of care between LTC facilities in and across nations can be adequately compared.

Background: The present cross-sectional study was aimed to evaluate the association between care recipient depression and caregiver attitudes., Methods: Data were from The AgeD in HOme Care project, a study enrolling subjects aged >or=65 years receiving home care in Europe. Depression was diagnosed as a score >or=3 on the MDS Depression Rating Scale. Caregiver attitudes were assessed using two measures: 1) caregiver dissatisfaction (the caregiver was dissatisfied with the support received from family and friends); and 2) caregiver distress (the caregiver expressed feelings of distress, anger, or depression)., Results: Mean age of 3415 participants was 82.4 years, 2503 (73.3%) were women and 430 (12.6%) were depressed. Dissatisfaction was significantly more common among caregivers of depressed, compared with those of non depressed patients (32/430, 7.4% vs. 78/2985, 2.6%; p=<0.001). After adjusting for potential confounders, patient depression was still significantly associated with caregiver dissatisfaction (OR: 1.84; 95% CI: 1.12-3.03). Similarly, distress was significantly more common among caregivers of depressed patients, compared with those of non depressed patients (81/430, 18.8% vs. 175/2985, 5.9%; p<0.001). After adjusting for potential confounders, patient depression was still significantly associated with caregiver distress (OR: 2.41; 95% CI: 1.72-3.39)., Limitations: The cross-sectional design of the study cannot provide the cause-effect relationship between depression and caregiver attitude; no data were collected on caregiver characteristics., Conclusions: Among older adults depression is associated with increased caregiver dissatisfaction and distress. Knowledge of factors influencing caregiver attitudes may be valuable to study interventions aimed to promote patient and caregiver well being.

Health and social services across the more developed countries in the world are facing the problem of providing care and support for an ever increasing elderly population. It has been suggested that this challenge would best be met by performing frequent 'assessment' of the total elderly population in a country. This would be very difficult and time consuming in a large country with a high number of elderly people. Screening using a broad coarse instrument aimed at identifying variations in dependency over time would be simpler, effective and more likely to be actually performed in the greatest majority of the target population. In developing firstly the Winchester Disability Rating Scale (WDRS) and then the WDRS-2, which includes a subscale for depression, we believe to have found an effective instrument to measure dependency and with it the means to limit hospitalization. We validated the WDRS-2 on a large sample of elderly people living in local authority housing schemes, and were able to demonstrate that our instrument has both high specificity and high sensitivity for the identification of depression in elderly people living in the community. This new instrument offers primary care physicians the opportunity to rapidly and successfully assess their elderly patients living in the community.