Definitions for the Levels of Evidence (+, ~, x) and Grades of Recommendation (A - C, I, and Good Practice Points [GPP]) are given at the end of the Major Recommendations field.
Domains and Dimensions of Assessment
A: Screening, proactive assessment, and assessment of older people with complex needs should assess for risk factors, physical health and function; mental health; social circumstances; social support, including family/whanau; and the presence, role, and potential needs of carers.
B: Carers of older people should be assessed for health, training, and support needs.
B: Assessment of older people with pre-existing intellectual or other disabilities must detect impairment in those domains and dimensions in which they have been shown to be at particular risk in addition to those domains assessed in people without pre-existing disabilities.
GPP: Any screening and assessment should include assessment for abuse of the older person and/or their carer.
Screening
C: Screening of older people for impairment and risk factors for developing future impairment should be piloted to determine its effectiveness in the New Zealand setting.
C: Any screening tool used in New Zealand should be adapted appropriately, piloted, and evaluated before regional or national screening programmes are considered.
A: To achieve the greatest benefits in terms of improved health and well-being, screening for impairment and risk factors for developing future impairment for older people should involve all members of the defined population (e.g., all people aged 75 years and over).
A: Any screening must be performed, monitored, and evaluated systematically.
A: Any screening must be supported by appropriately planned, adequately resourced, further interventions for treatment/care for older people identified by the screening as in need.
B: Any screening should address those areas of need of most importance to older people.
A: To be effective, screening should cover both domains of potential impairment and risk factors for health or functional impairment.
Proactive Assessment
A: Proactive assessment of older people should be comprehensive and multidimensional.
B: An older person should receive a proactive assessment if the person has any risk factors: is referred after screening; is referred by community workers, family/whanau or carer; or is in contact with health or social services.
A: Proactive assessment must be supported by timely, effective interventions to address any issues identified.
A: The assessment process should use standardised tools and standard methods of collecting, reporting, and comparing data.
A: Regular follow-up should form part of the process of proactive assessment of older people.
GPP: The proactive assessment process should be used as an opportunity for health promotion, disease prevention, treatment, and care management.
Assessment of Complex Needs
A: A comprehensive, multidimensional assessment should be available for older people with complex needs.
A: Assessment must be supported by resourcing for interventions to address the needs identified.
A: Assessment must be supported with regular follow-up.
GPP: Comprehensive assessment should inform and assist an ongoing treatment, rehabilitation, and care plan that includes strategies to encourage implementation of the treatment/care plan.
Carers
B: Carers of older people should be assessed for health, training, and support needs.
B: Older people who are carers of people with intellectual or other disabilities should be assessed for health and support needs.
B: A specifically designed tool for the assessment of carer needs should be used.
I: There is insufficient evidence to determine whether carer assessment is more effective when conducted independently or as part of an assessment of the older person receiving care.
I: There is insufficient evidence to determine who should perform assessments of the needs of carers.
GPP: Assessment of the needs of carers should be linked with the assessment of older people.
Assessment Tools
A: A standardised comprehensive, multidimensional assessment tool with standard methods of collecting, reporting, and comparing data should be used for screening and assessment of older people.
B: A specifically designed assessment of carer needs should be used when assessing carers.
B: Any tools used must be able to assess the domains and dimensions indicated.
A: Screening and Proactive Assessment: the Minimum Data Set for Home Care (MDS-HC) Overview and Overview+, and EASY-Care most closely meet guideline specifications.
A: Comprehensive Assessment: The MDS-HC comprehensive assessment with additional modules for those domains not currently addressed should be used for the comprehensive assessment of older people.
B: The needs of carers should be assessed using a purpose-designed tool after adaptation for use in New Zealand where necessary.
GPP: Any screening and proactive assessment tool selected should be modified in collaboration with the developers to meet the needs of older people in New Zealand.
GPP: Before selection of a national tool, pilot studies using the tools within New Zealand should be conducted to determine costs, training needs, and any modifications of the tools required.
Location of Assessment
A: Screening should usually be located within the older person’s home.
A: Proactive assessments of people should usually take place within the older person’s home, unless the older person is in an emergency department (ED). Attendance at an ED should trigger a comprehensive assessment prior to discharge.
A: Complex needs assessment of people within hospital settings or in residential care should be initiated in that setting.
A: All complex needs assessments should include a home visit by a trained assessor.
C: Screening and assessment of older Maori should be done at the home of the older person and their whanau.
B: A specialist trained assessor must be available in or on call for any ED.
GPP: A rural network of assessors should be developed for assessment of non-urban-dwelling older people.
Assessors and Multidisciplinary Teams
A: Assessors should have specialist training in the assessment process, including training in consent issues.
B: Assessors of older people need the following attributes:
- good communication skills
- ability to facilitate the older person’s communication with other health care professionals
- good interpersonal and relationship management skills
- sensitivity to the older person’s beliefs and attitudes
- awareness of spiritual aspects of the person’s care
A: Assessors of older people should be part of (or have ready access to) a wider multidisciplinary team (MDT) to whom they can quickly refer the older person for more in-depth assessment or for help in any particular domain.
B: The MDT should comprise registered nurses with competence in gerontological nursing, geriatricians, psychogeriatricians and clinical psychologists with expertise in mental health of older people, physiotherapists, social workers with competency in working with older people, speech-language therapists, audiologists, dieticians, neurologists, occupational therapists, and pharmacists.
GPP: The core MDT for initial contact and assessment of older people with complex needs in a primary health care setting should comprise a primary care physician, a nurse, and a social worker, all with training and/or experience in working with older people.
GPP: All staff involved in screening, assessment, and treatment of older people (including ED staff) should undergo training to enhance their sensitivity, knowledge and skills in dealing with older people and their issues.
Working Together
B: Implementation of a comprehensive assessment tool must be supported by a programme of education for specialists and other health care professionals.
A: Implementation of a comprehensive assessment tool must be supported by strategies to improve physician implementation of the recommended interventions.
B: An assessment of the older person’s likelihood of following the recommendations should be made, and strategies should be initiated to support implementation of the recommendations by both the older person and health care and social service professionals.
A: Comprehensive assessment should result in a treatment/management plan that includes a process to promote concordance and implementation of that plan by the older person and health care professionals.
Older People with Pre-Existing Disabilities
A: Older people with pre-existing disabilities should be eligible for any screening programme at 55 years.
A: Assessors of people with pre-existing intellectual or other disabilities must have specialist training in the area, in addition to specialist training in the assessment process and consent issues.
A: The MDT supporting the assessment of people with pre-existing disabilities should include specialists with expertise in the disability.
B: Any assessment process for people with disabilities should be designed to ensure that the older person with disability is involved in the assessment process.
Assessment Processes for Older Maori
A: Assessment processes should be made available at age 55 years for older Maori.
A: A holistic model such as Te Whare Tapa Wha or a similar model should be used when assessing older Maori.
B: All decisions should be made collectively with the older person’s whanau or hapu.
B: Assessors of older Maori should be fluent in te reo Maori me ona tikanga where the older person and/or their whanau prefers its use.
B: Assessment of older Maori people requires mature Maori assessors who are well-known and respected within their community.
C: Where a Maori assessor with the necessary skills is not available, a skilled assessor should be supported by someone who is fluent in te reo Maori me ona tikanga and who is well-known and respected within the community.
B: When assessing older Maori the assessor should be of the same sex as the person being assessed whenever possible.
GPP: Assessment services must be equally available to older Maori who do not have Maori-specific programmes available, or choose not to access them.
Pacific Peoples
B: Assessment processes should be initiated at age 55 years for older Pacific people.
B: Information relating to an assessment should be produced in Pacific languages as well as English, and produced in oral form (through videos and radio and as part of Pacific health promotion and health education forums) rather than relying on written formats.
C: Assessment programmes for older Pacific people should be actively offered rather than being made available and expecting the older people to initiate contact.
C: Assessors of older Pacific people should as far as possible be from the same ethnic background and able to speak the same language as the person to be assessed, or be supported by someone with these attributes.
C: It should be publicised to Pacific peoples that assessors of older people have professional skills and status to encourage acceptance by the older people and their families.
C: The MDT supporting the assessor of older Pacific people should include a Pacific health care professional.
B: Consent to the process of assessment needs to be revisited periodically during the assessment process because consent is understood to be a dynamic relationship rather than a single event.
Definitions:
Levels of Evidence
+
Assigned when all or most of the criteria are met
~
Assigned when some of the criteria are met and where unmet criteria are not likely to affect the validity, magnitude or applicability of the results markedly
x
Assigned when few or none of the criteria are met
Grades of Recommendations
A
The recommendation is supported by good evidence.
B
The recommendation is supported by fair evidence.
C
The recommendation is supported by expert opinion only.
I
No recommendation can be made because the evidence is insufficient (i.e., evidence is lacking, of poor quality, or conflicting) and the balance of benefits and harms cannot be determined.
Good Practice Point
Recommended practice based on the professional experience of the Guideline Development Team
