Identification of quasi-in-need-of-care state (QUINOCS) among community dwelling elderly people using a seven-item subset of the Functional Independence Measure (FIM™)

Abstract

Purpose. To develop a screening test to identify community dwelling elderly people who are in need of assistive care but whose activities of daily living (ADLs) can be improved by appropriate rehabilitation intervention, so-called ‘quasi-in-need-of-care state (QUINOCS)’.

Method. A total of 32 persons (mean age 77.3 years) from the metropolitan area and 51 persons (mean age 82.7 years) from a rural area were enrolled. Two physiatrists examined them and judged whether they could benefit from rehabilitation intervention while visiting nurses evaluated their ADLs using the Functional Independence Measure (FIM™). A screening test to identify the QUINOCS was created using a seven-item subset score of the FIM™ (feeding, bathing, dressing lower-body, bladder management, bed/chair/wheel chair transfer, walking/wheel chair, stairs).

Results. Fourteen in the metropolitan and 19 in the rural inhabitants were judged as the QUINOCS by the physiatrists. Persons whose subset scores included or ran across the intermediate range of independent levels (scores 3 and 4 of the FIM™) showed tendency to be judged suitable for rehabilitation intervention. This finding was applied for screening algorism to identify the QUINOCS. Sensitivity and specificity of this test were 0.71 and 0.78 for the metropolitan, and 0.74 and 0.78 for the rural groups, respectively.

Conclusion. The screening method using the 7-item subset of the FIM™ can be used for identification of the QUINOCS among elderly people efficiently.

Keywords:

• Long-term care
• care management
• community rehabilitation