Application of the Medical Research Council guidance for complex interventions in the development of VIeSA, an intervention to support healthy ageing among community-dwelling older adults.

BACKGROUND: The ageing population, coupled with the desire to age-in-place, highlight the need for programs that target health promotion as a means of maintaining functional ability, autonomy, and independence among community-dwelling older adults. This paper describes the development of the VIeSA intervention, which aimed to model a healthy ageing trajectory, including the identification of the necessary tools and methods, that would allow people older people, in partnership with health and social care professionals, to define personal health-related goals and the actions to achieve them. A key element of the intervention development was the creation of a support tool intended to assist this process. METHODS: The UK Medical Research Council (MRC) guidance on developing and evaluating complex interventions was applied in the development of the intervention and of the support tool. A participatory approach was selected, with stakeholders engaged on different occasions to allow the refinement of the intervention and of the support tool. Following the steps and suggested actions in the MRC development phase, the development process was conducted by identifying (1) the evidence base and (2) the theoretical framework and (3) by modelling the process and outcomes of the intervention. RESULTS: Following a literature review on effective interventions for functional ability, draft 1 of the support tool was designed. Focus groups with stakeholders provided feedback on this draft allowing for its refinement in terms of content, language use, and structure (draft 2). A review of the approaches for health promotion delivery led to further additions to the tool (draft 3) and informed the content of the training of health and social care professionals. After their training, professionals provided feedback on the acceptability, appropriateness, and feasibility of different elements of the intervention. Results suggested that no further major refinement to the intervention or support tool was necessary. CONCLUSIONS: The design and development of the VIeSA intervention using the MRC guidance allowed for a clarity of direction, an optimised content in terms of usefulness and accessibility for all concerned stakeholders, and greater opportunities for its implementation and uptake.

[Frailty and complexity indices derived from the interRAI HC Swiss]. / Indicateurs de fragilité et complexité dérivés de l'interRAI HC Suisse.

Frailty and complexity are concepts that are increasingly used by home care professionals. If the standardized global assessment as proposed by the Resident Assessment Instrument Home Care -(interRAI HC) includes aides for clinical analysis, it does not offer clinical index of frailty and complexity, which are however available in the literature. This article proposes an adaptation of the -algorithms from the fraXity study to the interRAI HCSuisse and -describes their implementation for the early detection of frailty and complexity in the routine assessment by the Geneva home care -institution (imad). These new indexes complete the panel of clinical scales and "alarms" already available and are accompanied by -recommendations for an integrated clinical practice.

La fragilité et la complexité sont des concepts de plus en plus ­mobilisés par les professionnels des soins à domicile. Si l'évaluation globale standardisée telle que proposée par le Resident Assessment Instrument Home Care (interRAI HC) inclut des aides à l'analyse clinique, elle n'offre pas d'indicateurs cliniques de fragilité et de complexité, pourtant disponibles dans la littérature. Cet article propose une adaptation des algorithmes issus de l'étude fraXity à l'interRAI HCSuisse et décrit leur implémentation pour le repérage précoce de la fragilité et la complexité dans l'évaluation de routine par l'Institution genevoise de maintien à domicile (imad). Ces nouveaux indicateurs complètent le panel d'échelles cliniques et d'« alarmes ¼ déjà disponibles et sont ­accompagnés de recommandations pour une pratique clinique intégrée.

[Healthy aging in Geneva : the innovative approach of the VieSA project]. / Vieillir en santé à Genève : l'approche novatrice du projet VieSA.

With Switzerland's population ageing, promoting healthy ageing remains a public health issue. This represents a challenge for the healthcare system, which is still mainly focused on curative or palliative care. It has been clearly established that it is possible to maintain the functional capacity of older people by taking early action on health-related behaviors. The VieSA (Vieillissement en Santé) project in the canton of Geneva, inspired by the WHO's ICOPE programme, offers innovative ways of promoting healthy ageing for and by seniors, by focusing on maintaining seniors' resources rather than targeting any deficits.

Face au vieillissement de la population en Suisse, la promotion du vieillissement en santé reste un enjeu de santé publique. Cela représente un défi pour le système de soins encore principalement orienté vers les soins curatifs ou palliatifs. Il est clairement établi qu'il est possible de maintenir les capacités fonctionnelles des seniors en agissant précocement sur les comportements liés à la santé. Le projet VieSA (Vieillissement en santé), mené dans le canton de Genève, s'inspire du programme ICOPE de l'OMS et offre des perspectives novatrices pour promouvoir le vieillissement en santé pour et par les seniors, en s'appuyant sur le maintien des ressources des seniors plutôt qu'en ciblant les déficits éventuels.

Needs, benefits, and issues related to home adaptation: a user-centered case series applying a mixed-methods design.

INTRODUCTION: Home adaptation can be a key contributor to successfully aging at home, allowing older adults to remain in a familiar environment while maintaining their quality of life and well-being despite progressing functional difficulties. Although several theoretical studies on home adaptations exist, the benefits of custom home adaptations remain poorly evaluated. The present study's primary aims were to explore older adults' expectations and needs regarding home adaptations and evaluate the impact of individualized home adaptations on quality of life, fear of falling, independence, and difficulties using adapted rooms. Its secondary aim was to describe the barriers and facilitators of home adaptation. METHOD: The 15 homes in this case series were adapted using an inclusive, interdisciplinary approach. Adaptations' effects were assessed using a parallel mixed-methods design. Quantitative and qualitative data were collected using questionnaires and semi-structured interviews. An architect and a health professional visited each home twice to assess the older adult's expectations and needs, evaluate the home's technical aspects, and co-create an adaptation plan with that study participant. They assessed the older adult's perceived quality of life, fear of falling, independence, and difficulties using the rooms needing adaptations. Inhabitants received two more visits after the adaptations (one or two months and six months later) to assess their benefits. RESULTS: Most homes had their bathroom adapted. Participants reported improved safety, independence, ease of use, positive feelings, and comfort. They also reported lower perceived levels of difficulties during the activities of daily living in the adapted rooms (reductions of 93.4% [SD = 12.7] of bathrooms and 100% of kitchens), an improvement in quality of life of 9.8% (SD = 27.6), and a reduction in fear of falling of 12.5% (SD = 9.7). CONCLUSION: Home adaptations are beneficial to older adults' activities of daily living and improve their quality of life; however, several factors hinder the implementation of those adaptations.

Assessing multidimensional complexity in home care: congruencies and discrepancies between patients and nurses.

BACKGROUND: Person-centered care allows for the inclusion of the totality of a person's needs and preferences, beyond just the clinical or medical aspect. This approach requires the development of tools to allow for the integration of the patient in his/her healthcare. Based on a 30-item tool developed for nurses to evaluate the complexity of home care situations (COMID), this study proposed a version for the patients (i.e. COMID-P). Both instruments were used, independently by nurses and patients, to rate the complexity of individual situations, in order to compare ratings. METHODS: The COMID-P and the COMID were completed during the fraXity study at the patients' homes, independently by patients (aged 65 and over) and nurses. Item-level and scale-level analyses were performed using, Kappa and McNemar tests, and intra-class correlation (ICC). RESULTS: A total of 159 pairs of COMID and COMID-P ratings were retained for analyses. Results demonstrated a high degree of patient/nurse agreement for 12/30 items, a moderate agreement for 10/30 items, and a low degree of agreement for 7/30 items. The intra-class correlation between the COMID-P and the COMID was high (ICC= .826, 95%CI [.761-.873]). CONCLUSIONS: The results demonstrate that patients and nurses can assess complexity using tools that have comparable structural properties. They also reveal congruencies and discrepancies in scoring the components of complexity, highlighting the need of reaching consensus in designing care plans. Further work is needed to demonstrate the benefits of joint assessment in developing care plans that truly meet patients' needs. TRIAL REGISTRATION: The fraXity study was registered in ClinicalTrials.gov, NCT03883425 , on March 20, 2019.

Alleviating and exacerbating foods in hidradenitis suppurativa.

While dietary triggers have been investigated in acne and other inflammatory follicular dermatoses, there is a paucity of data on diet and hidradenitis suppurativa (HS). We sought to identify exacerbating and alleviating foods in HS patients. An anonymous survey was distributed via HS Facebook support groups and in person at HS specialty clinics. Participants were asked to select all that apply from a list to indicate foods that worsen and make HS better including sweet foods, breads and pasta, red meat, chicken, fish, canned foods, fruits, vegetables, dairy, high-fat foods, I do not know, and no. Only 12.0% (n = 89/744) identified alleviating foods while 32.6% (n = 237/728) identified HS-symptom-exacerbating foods. The most commonly reported exacerbating foods were sweets (67.9%), bread/pasta/rice (51.1%), dairy (50.6%), and high-fat foods (44.2%). The most commonly reported alleviating foods included vegetables (78.7%), fruit (56.2%), chicken (51.7%), and fish (42.7%). Further studies are required to evaluate the mechanistic links between diet and HS. HS patients may benefit from receiving dietary counseling as part of a comprehensive HS management plan.

Allergenic potential, marketing claims, and pricing of facial moisturizers.

Ingredients found in facial moisturizers can impact a myriad of skin conditions, including sensitive skin syndrome and contact dermatitis. There is a paucity of evidence on the allergenic potential and marketing claims of facial moisturizers, posing challenges to clinician recommendation and consumer selection. In this study, we systematically evaluate the 100 top-selling sun protective facial moisturizers that claim to be natural, fragrance free, expert-approved, age preventing, beneficial for sensitive skin, and sun protective. Allergenic potential of these moisturizers is evaluated based on ingredients used and prices and consumer ratings are compared. Accordingly, 75 of 100 marketed at least one additional benefit. "Anti-aging" products had the highest average price ($14.99/oz) and "expert-approved" had the lowest ($5.91/oz). Consumer rating was highest for facial moisturizers that were "fragrance-free" (4.35/5.00) whereas products that were "natural" received the lowest ratings (3.49/5.00). The most prevalent allergens found in these moisturizers were ethylenediamine tetraacetic acid (EDTA), phenoxyethanol, and cetyl alcohol. "Expert-approved" products had the fewest average allergens in their ingredient lists (P=0.033), whereas products advertising "SPF" had significantly more (P<0.001). Marketing claims play a role in product sales and ratings. When recommending products, physicians should balance allergenic risk with affordability and consumer preferences.

[Assessing frailty in care practices†: quick reminders in the light of the Covid-19 pandemic]. / Évaluer la fragilité dans les pratiques de soins†: brefs rappels à la lumière de la pandémie de Covid-19.

The Covid-19 pandemic has brought the concept of frailty back to the centre of debate, particularly for its relevance as a determinant of health outcomes. Frailty is concept that has long been a used gerontology. Today, several theoretical models of frailty are proposed in the literature, with as many tools to operationalize it. This article provides a brief outline of the three main models of frailty and the corresponding measurement instruments. The choice of the model as well as the choice of the assessment tool are discussed in the light of the clinical objectives pursued by health professionals. More generally, this article highlights the value of assessing frailty in routine practice to determine health outcomes and adapt care to individual needs.

La pandémie de Covid-19 a ramené le concept de fragilité au centre des débats, notamment pour son intérêt dans l'évaluation du pronostic en santé dans un contexte de menace sanitaire. La fragilité est un concept reconnu en gérontologie de longue date. Aujourd'hui, plusieurs modèles théoriques de la fragilité sont proposés dans la littérature, avec autant d'instruments permettant de l'opérationnaliser. Cet article propose un bref rappel des trois principaux modèles de fragilité ainsi que des instruments de mesure correspondants et de les discuter en fonction des objectifs cliniques poursuivis par les professionnels de la santé. Plus généralement, cet article souligne l'intérêt d'évaluer la fragilité dans une pratique de routine pour déterminer le pronostic de santé et adapter les soins aux besoins des individus.

La complexité dans la pratique infirmière : vers un nouveau cadre conceptuel dans les soins infirmiers.

While complexity theory has gradually influenced the field of health and social sciences, it has also had an impact on nursing care by introducing a wealth of terminology into the field. The terms "complex patient," "complex case," "complex care," "complex practice," and "complex needs" have been proposed to describe different aspects of complexity in nursing care. As these qualifiers reflect, nurses become actors in multidefined care and must integrate complexity into their reflective practice. By way of a narrative literature review, this article aims to offer a new perspective on nursing by explaining the different terms used in the discipline, using a multi-level approach. At the end of this review, the authors propose a new integrative conceptual framework for complexity in nursing practice.

[Complexity in nursing practice : Toward a new conceptual framework in nursing care] / La complexité dans la pratique infirmière : vers un nouveau cadre conceptuel dans les soins infirmiers.

While complexity theory has gradually influenced the field of health and social sciences, it has also had an impact on nursing care by introducing a wealth of terminology into the field. The terms "complex patient," "complex case," "complex care," "complex practice," and "complex needs" have been proposed to describe different aspects of complexity in nursing care. As these qualifiers reflect, nurses become actors in multidefined care and must integrate complexity into their reflective practice. By way of a narrative literature review, this article aims to offer a new perspective on nursing by explaining the different terms used in the discipline, using a multi-level approach. At the end of this review, the authors propose a new integrative conceptual framework for complexity in nursing practice.

Protocol of a case-control longitudinal study (fraXity) assessing frailty and complexity among Swiss home service recipients using interRAI-HC assessments.

BACKGROUND: The early screening of frail individuals and of patients with complex care needs are challenges that countries witnessing population aging face. Homecare nurses are actors of choice in meeting these challenges, yet they need means of identifying frail and complex patients in their routine practice. The fraXity study's aim is to fill this gap by (1) proposing frailty and complexity computation algorithms derived from the interRAI-HC; (2) assessing the predictive validity of the proposed indices with respect to adverse health outcomes; and (3) identifying subgroups of the aged population for whom the early screening of frailty and complexity appears to be most relevant. METHODS: The study will rely on a prospective observational case-control longitudinal study. Three samples of individuals aged 65 or older living in the community will be considered: recipients of formal home care (case 1), of formal home assistance (case 2) and individuals free of formal home services (controls). All participants will receive interRAI-HC assessments at three measurement occasions, separated by six-month intervals. Baseline assessments will serve to derive frailty and complexity scores. Follow-ups will serve to assess the predictive validity of the proposed indices and to estimate the intra-individual change in frailty and complexity. Group comparisons will serve to identify subgroups of the population for whom the screening of frailty and complexity appears to be the most relevant. DISCUSSION: The expected results of the fraXity study are a) reliable computation algorithms for frailty and complexity scores derived from the interRAI-HC and b) clinical assessment protocols for use by homecare nurses. These outcomes should contribute to outfitting key actors of the health system with means of enhancing their part in a collective endeavor targeting the best care and quality of life for aged citizens. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03883425 , registered on March 20, 2019.

[Analysis of the reliability of a multidimensional complexity scale instrument (COMID) for home care nurses]. / Analyse de la fidélité d'un instrument d'évaluation de la complexité multidimensionnelle (COMID) pour les infirmières à domicile.

Introduction : The increasingly frequent mention of complexity by different health care actors challenges the measurement of this construct. The COMID, a tool that helps home nurses to identify complex situations, provides a multidimensional and operational definition of complexity.Context : While an acceptability study showed that nurses took a keen interest in the COMID, its psychometric properties have not yet been examined.Objective : This article reports on two studies testing the reliability of the scale.Method : Study 1 focuses on 5,401 COMIDs completed by home care nurses in their usual practice. The internal consistency was estimated using Cronbach's alpha. Study 2 focuses on 38 COMIDs, completed by home care nurses (rater group 1) and specialized nurses (rater group 2). Inter-rater agreement was examined using an intraclass correlation coefficient (ICC).Results : The COMID has an acceptable internal consistency α = 0.797 and an excellent inter-rater agreement ICC = 0.839.Discussion : The metrological properties of the COMID will need to be complemented by an analysis of its validity. Conclusion : The COMID has good measurement accuracy and therefore has good potential for identifying complexity in nursing practice.

Conflict Structures in Family Networks of Older Adults and Their Relationship With Health-Related Quality of Life.

This study explores the interrelationships between health-related quality of life and conflict structures in family networks of older adults. Data were derived from a sample of 2,858 elders (aged 65 years and older) from the Vivre/Leben/Vivere study, a large survey addressing family life and health conditions of older people in Switzerland. Conflict density in family networks and the betweenness centrality of respondents in family conflict are significantly associated with health-related quality of life measures. Furthermore, the results demonstrate that conflict-health associations are mediated by the level of perceived individual stress where psychological health is concerned. Family conflict structures depend to a large extent on family composition and age. This study stresses the importance of older adults actively shaping the composition of their family contexts in ways that promote both conflict and stress avoidance.

[Screening for undernutrition among older adults receiving home care: an estimation of the diagnostic accuracy of indicators available in the Resident Assessment Instrument - Home Care adapted for Switzerland.] / Dépister la dénutrition chez la personne âgée bénéficiant de soins à domicile : une évaluation de la précision diagnostique des indicateurs issus du Resident Assessment Instrument - Home Care adapté pour la Suisse.

INTRODUCTION: in homecare practice, nurses are central actors for the screening of individuals at risks of undernutrition. CONTEXT: in Switzerland, homecare nurses estimate the nutritional status of care recipients by means of a standardized geriatric assessment done with the RAI-HC. AIMS: The aim of the study is to estimate the diagnostic accuracy of the « nutritional status ¼ score, the body mass index and the weight loss documented from the RAI-HC. METHOD: a sample of 267 homecare recipients aged 65 was assessed using the RAI-HC and the MNA-SF®. Sensitivity, specificity and area under the curve were estimated for the RAI-HC measures, with the MNA-SF® as the gold standard reference. RESULTS: for the scores considered, sensitivity varied between 16.51 % and 68.81 %, specificity between 66.94 % and 99.37 %, and areas under the curve between 0.579 at 0.708. DISCUSSION: the diagnostic accuracy of the RAI-HC indicators is not sufficient for an optimal screening of undernutrition in older homecare recipients. CONCLUSION: an additional assessment with the MNA-SF® is recommended to optimize the early screening of individuals at risks of undernutrition.

Derivation of a frailty index from the resident assessment instrument - home care adapted for Switzerland: a study based on retrospective data analysis.

BACKGROUND: The screening of frail individuals at risk for functional health decline and adverse health outcomes lies in the evolving agenda of home care providers. Such a screening can be based on a frailty index (FI) derived from data collected with interRAI instruments used in clinical routines to define care plans. The objective of this study was to assess the feasibility of deriving an FI from the Resident Assessment Instrument - Home Care adapted for Switzerland (Swiss RAI-HC). METHODS: Data were collected by the Geneva Institution for Homecare and Assistance in clinical routines. The sample consisted of 3714 individuals aged 65 or older (67.7% females) who had each received a Swiss RAI-HC upon admission in the year of 2015. The FI was derived from 52 variables identified and scored according to published guidelines. Adverse health outcomes were either assessed during follow-up assessments (falls, hospitalizations) or documented from administrative records (mortality). RESULTS: The results showed that the FI was distributed normally, with a mean of 0.24 (± 0.13), an interquartile range of 0.16, and values of 0.04 at percentile 1 and 0.63 at percentile 99. The effect of Age was significant (R2 = 0.011) with a slope of ß = 0.002, 95% CI = [0.001-0.002]. Sex as well as the Age × Sex interaction were not significant. The FI predicted deaths (OR = 9.99, 95% CI = [3.20-29.99]), hospitalizations (OR = 3.40, 95% CI = [1.78-6.32]), and falls (OR = 5.00, 95% CI = [2.68-9.38]). CONCLUSIONS: The results support the feasibility of an FI derivation from the Swiss RAI-HC, hence replicating previous demonstrations based on interRAI instruments. The results also replicated findings showing that the FI is a good predictor of adverse health outcomes. Yet, the results suggest that home care recipients demonstrate a frailty pattern different from the one reported in community dwellers but comparable to clinical samples. Further work is needed to assess the characteristics of the proposed index in community-dwelling, non-clinical samples for comparability with the existing literature and external validation TRIAL REGISTRATION: ClinicalTrials.gov NCT03139162 . Retrospectively registered May 2, 2017.

Health status and quality of life: results from a national survey in a community-dwelling sample of elderly people.

PURPOSE: To investigate the relation between age and HRQoL indicators in a community-dwelling population aged 65 years and older. METHODS: Data were collected within a sample stratified by age (65-69; 70-74; 75-79; 80-84; 85-89; 90 years and above) and sex and randomly selected in the population records in Switzerland. The EQ-5D was used to assess HRQoL. Analyses were conducted on the entire available sample (N = 3,073) and on the subsample with no missing data in the EQ-5D (N = 2,888), considering age, gender, education and region. RESULTS: Results of multiple regression analyses showed different age-related patterns across the EQ-5D. The proportion of respondents reporting no problems ranged from 51 % in the 65- to 69-year age group to 20 % in the 90 years and above age group. Odds ratio (OR) for Mobility problems increased from 2.04 in the 75- to 79-year age group to 13.34 in the 90 years and above age group; OR for Usual Activities increased from 1.76 to 11.68 and from 1.55 to 2.32 for Pain/Discomfort; OR for Self-Care increased from 5.26 in the 80- to 84-year age group to 30.36 in the 90 years and above age group. Problems with Self-Care remained low, increasing from 6.22 % in the 80- to 84-year age group to 26.21 % in the oldest age group. The magnitude of the gender, region and education effects was much lower than that of age. CONCLUSION: HRQoL is globally preserved in older adults in Switzerland, even if substantial impairment is reported in very old age affecting mainly functional health dimensions. Anxiety/Depression and Pain/Discomfort did not appear to be affected by age; high rates of difficulties were reported for Pain/Discomfort but not for Anxiety/Depression.

Age-related changes in the bimanual advantage and in brain oscillatory activity during tapping movements suggest a decline in processing sensory reafference.

Deficits in the processing of sensory reafferences have been suggested as accounting for age-related decline in motor coordination. Whether sensory reafferences are accurately processed can be assessed based on the bimanual advantage in tapping: because of tapping with an additional hand increases kinesthetic reafferences, bimanual tapping is characterized by a reduced inter-tap interval variability than unimanual tapping. A suppression of the bimanual advantage would thus indicate a deficit in sensory reafference. We tested whether elderly indeed show a reduced bimanual advantage by measuring unimanual (UM) and bimanual (BM) self-paced tapping performance in groups of young (n = 29) and old (n = 27) healthy adults. Electroencephalogram was recorded to assess the underlying patterns of oscillatory activity, a neurophysiological mechanism advanced to support the integration of sensory reafferences. Behaviorally, there was a significant interaction between the factors tapping condition and age group at the level of the inter-tap interval variability, driven by a lower variability in BM than UM tapping in the young, but not in the elderly group. This result indicates that in self-paced tapping, the bimanual advantage is absent in elderly. Electrophysiological results revealed an interaction between tapping condition and age group on low beta band (14-20 Hz) activity. Beta activity varied depending on the tapping condition in the elderly but not in the young group. Source estimations localized this effect within left superior parietal and left occipital areas. We interpret our results in terms of engagement of different mechanisms in the elderly depending on the tapping mode: a 'kinesthetic' mechanism for UM and a 'visual imagery' mechanism for BM tapping movement.

Individual differences in cognitive plasticity: an investigation of training curves in younger and older adults.

To date, cognitive intervention research has provided mixed but nevertheless promising evidence with respect to the effects of cognitive training on untrained tasks (transfer). However, the mechanisms behind learning, training effects and their predictors are not fully understood. Moreover, individual differences, which may constitute an important factor impacting training outcome, are usually neglected. We suggest investigating individual training performance across training sessions in order to gain finer-grained knowledge of training gains, on the one hand, and assessing the potential impact of predictors such as age and fluid intelligence on learning rate, on the other hand. To this aim, we propose to model individual learning curves to examine the intra-individual change in training as well as inter-individual differences in intra-individual change. We recommend introducing a latent growth curve model (LGCM) analysis, a method frequently applied to learning data but rarely used in cognitive training research. Such advanced analyses of the training phase allow identifying factors to be respected when designing effective tailor-made training interventions. To illustrate the proposed approach, a LGCM analysis using data of a 10-day working memory training study in younger and older adults is reported.

First Evidence on the Validity of the Complexity Index Derived from the Resident Assessment Instrument for Home Care in Home Care Patients.

OBJECTIVES: Recently, a Complexity Index (CI), based on the multidimensional complexity model and derived from the Resident Assessment Instrument for Home Care (interRAI HC) was proposed as a decision-support tool to help frontline health care professionals in their clinical evaluation to identify and analyze complex situations. This study aims to test the CI: (1) concurrent validity with another measure of complexity (ie, the COMID), (2) convergent validity with related constructs assessed by interRAI HC scales (eg, depression), (3) divergent validity (comparison between CI-COMID and scales-COMID correlations), and (4) predictive validity on coordination meetings. DESIGN: A cross-sectional observational design was used for a secondary analysis of interRAI HC and COMID data collected in routine home care nursing practice (July-December 2021). SETTING AND PARTICIPANTS: Participants were community-dwelling adults receiving home care, with full interRAI HC and COMID assessments (N = 3533). METHODS: Correlational analyses were conducted to test the concurrent validity of the CI (with the COMID) and the convergent and divergent validity of the CI (with interRAI HCSwitzerland scales, eg, Depression Rating Scale, Method for Assigning Priority Levels, and a Frailty Index). A receiver operating characteristic (ROC) analysis was conducted to test the discriminative ability of CI on specific professional team coordination meetings. RESULTS: Results showed that the CI correlated positively and strongly with the COMID (ρ = 0.691, P < .001, concurrent validity), positively with all the tested scales (P < .001, convergent validity), whereas the CI-COMID correlation was higher than the interRAI HC scales-COMID correlations (divergent validity). The ROC analysis showed the CI had a high area under the curve (AUC = 0.719, predictive validity). CONCLUSIONS AND IMPLICATIONS: The CI demonstrates good validity properties with a strong correlation with the COMID and a high predictive value for coordination meeting. It is distinct from the other interRAI HC scales and has its place among them to support the clinical analysis of complex situations.