Hospitalization can be hazardous for older people, but most hospitals in Europe are not prepared to meet the unique needs of older adult inpatients. Adaptations of the physical environment, care processes, and staff knowledge and skills in geriatric care are essential to improve the quality of care for older people. An assessment of baseline organizational approaches to older adult care is an important first step toward recognizing the challenges organizations face when delivering acute care services to older adults and attempting to improve them. The Geriatric Institutional Assessment Profile could be a promising tool for this endeavor.
To describe a systematic process implemented across seven countries and languages that sought to develop valid and culturally-appropriate translations of the Geriatric Institutional Assessment Profile.
Cross-cultural instrument translation and content validation study.
Setting and participants
Expert review panels comprised of 68 practicing nurses from seven European or EU associated countries (Austria (German), Belgium (Dutch), Denmark (Danish), Israel (Hebrew), Poland (Polish), Switzerland (German, French), and Turkey (Turkish)) evaluated cross-cultural relevance, including translation, of the Geriatric Institutional Assessment Profile.
A systematic approach to translating and validating a cross-cultural survey instrument, including back-to-back translation, adaptation, and evaluation of content validity using content validity indexing (CVI) techniques for each country and language, assessing translation and relevance content validity separately. The item, subscale and domain content validity index scores were calculated and adjusted for chance agreement among raters for all parts of the Geriatric Institutional Assessment Profile: the four subscales of geriatric care environment, the general knowledge about older adults subscale, and the clinical geriatric knowledge subscale. Consensus discussions among the raters then finalized translations.
CVI scores for relevance and translation were all in the “good” to “excellent” range. The geriatric care environment scale's CVI scores were 0.84 to 0.94 for relevance and 0.82 to 0.98 for translation. The clinical geriatric knowledge subscale's CVI scores were 0.83 to 0.97 for relevance and 0.94 to 0.98 for translation. The general knowledge about older adults subscale received high translation agreement (0.93 to 0.99) but slightly lower scores for relevance, ranging from 0.46 to 0.94.
Study results provided preliminary evidence of the applicability and validity of a multi-factor measure of age-friendly care in diverse health care systems, in German, Dutch, Danish, Hebrew, Polish, French, and Turkish languages.
The COVID-19 pandemic has highlighted health system vulnerabilities in every country around the world, especially in the delivery of care for older adults - from primary care through end of life care (Lal et al., 2021). The World Health Organization (WHO) defines older adults as those aged 60 and over. WHO further stratifies them into age cohorts based on common conditions and issues that arise with progressive age, with those over 85 years of age considered “elderly” (World Health Organization, 2021). Even before the pandemic, WHO recognized it was time for health systems to acknowledge the unique care needs of older adults and normal aging processes (World Health Organization, 2004, 2015). The movement was spurred by the aging populations in middle- and high-income countries where citizens are living longer, yet often have chronic illnesses that affect the aging process (Bezerra de Souza et al., 2021; Conde-Sala et al., 2017).
For health and care providers to deliver age-friendly care, they need measures that are applicable, practical, and valid to provide baseline data, as well as assessment tools for programs and interventions. To date, very few measures combining organizational aspects of care with knowledge in geriatric care are aimed at all types of care-related staff. This study provides preliminary evidence of the applicability and content validity of a multi-factor measure of age-friendly care, based on ratings by top professionals in each country participating in the study. The process resulted in measure versions that will not only be applicable in different cultures, languages, and health care settings but will also provide a unified platform for data comparison across nations and settings.