Date of Award

Fall 2011

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Rehabilitation Science

Supervisor

Lori Letts

Co-Supervisor

Kevin Eva

Language

English

Committee Member

Julie Richardson

Abstract

Older adults admitted to hospital often must make discharge decisions about whether they will be able to safely manage at home. Decision-making for clients and teams is supported by occupational therapy assessment. This thesis presents three manuscripts from a single study that was designed to address a need for evidence of validity of two measures for predicting harm.

The design was a prospective observational study in which older adults from an inpatient unit (n=47) were followed for six months for reports of incidents of harm. Baseline data included independent variables (e.g. age, sex, education, living alone, comorbidities, caregiving hours, ADL score) and scores on two measures: the Assessment of Motor and Process Skills (AMPS) and the Cognitive Performance Test (CPT).

The first manuscript contributed needed validation evidence for the CPT. The CPT correlated moderately with cognitive measures, and scores were not affected by age, and years of education. The CPT differentiated impaired persons differently from other measures. Results highlighted that further evidence to test the CPT against a criterion related to outcomes in the community was needed.

The second manuscript tested the trustworthiness of the outcome “incidents of harm”. Test-retest reliability was high and validation against daily logs and medical charts supported this method of measurement of incident of harm.

The third manuscript determined whether the AMPS and CPT were valid for predicting incidents of harm after discharge. The results showed that, compared with all independent variables, AMPS-Process scores were the most significant predictor of harm outcome. The CPT had a high specificity for identifying persons who did not have harm. Living alone, age and sex contributed to the prediction of harm. The implications of these results are that scores on the measures can inform patients, families and the team about older adults’ risk of incidents of harm after discharge.

McMaster University Library

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