Abstract
Objectives
Capacity for safe and independent living (SAIL) refers to an individual's ability
to solve problems associated with everyday life and perform activities necessary for
living independently. Little guidance exists on the assessment of capacity for SAIL
among nursing home residents. As a result, capacity for SAIL is not fully considered
in the development of discharge plans to ensure safety and independence in the community.
We reasoned that this problem could be addressed with the Making and Executing Decisions
for Safe and Independent Living (MEDSAIL) tool, developed to screen for capacity for
SAIL among community-dwelling older adults. In this report, we describe findings on
the validity of the MEDSAIL when used with nursing home residents.
Design
Prospective cross-sectional pilot study.
Setting and Participants
Twenty-four residents of a Veterans Health Affairs Community Living Center (CLC; nursing
home); exclusion criteria were cognitive impairment too severe to complete the protocol,
diagnosis of serious mental illness or developmental disability, inability to hear,
or inability to communicate verbally.
Methods
Participants completed 2 assessments: the MEDSAIL interview administered by a research
assistant and the criterion standard capacity interview administered by a geriatric
psychiatrist. We examined internal consistency, divergent validity, and criterion-based
validity.
Results
Five of 7 MEDSAIL scenarios approximated acceptable levels of internal consistency
(α >0.70). MEDSAIL scores were highly positively correlated with criterion standard
capacity determination (0.88, P = .001), and the Wilcoxon rank-sum test statistic for the 2 assessments was also
statistically significant (P = .001).
Conclusions and Implications
MEDSAIL has promise as a user-friendly brief screening tool for use by nursing home
staff to understand resident capacity for SAIL. This information can be used in the
development of discharge plans to keep the resident safe and independent in the community.
In addition, tailoring the MEDSAIL scenarios specifically to the nursing home setting
may further enhance the tool's validity and utility in this new application.
Keywords
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Article info
Publication history
Published online: July 04, 2020
Footnotes
This work was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Rehabilitation Research and Development (IK2RX001241). The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.
The authors declare no conflicts of interest.
Identification
Copyright
Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.
