Helge Garåsen The Trondheim Model - NSDM

circumstances, successful diagnoses and treatment may actually reduce life expectancy or
overall life quality (157).
6.3.2 Measures of physiological functionality - ADL
In study II ADL status was tested using Gerix in accordance with the study protocol. There
are four main reasons for using Gerix to measure ADL in study II:
o All health professionals (except physicians) in the municipality are quite
familiar with Gerix, as it has been used as a registration tool since 1993.
o There are only two specially trained nurses in each municipality care unit
certified to register and/or change the scores.
o When a patient’s situation changes; socially or because of disease, the scores
are continuously re-evaluated.
o Everybody receiving any kind of community health services has their Gerix
scores recorded in the EHRs.
To evaluate the nurses’ ability to measure ADL correctly a last year medical student was
trained to use Gerix. He then tested 72 of the patients included in study II during a three
month period in autumn 2004 (158). He assessed better ADL scores in most of the fields and
found a significant difference between his assessments and those of the nurses for the
indicators ”dressing”, ”cooking”, ”shopping”, ”motivation”, self sufficiency (cognitive)”,
”outdoor mobility”, ”insight of own situation”, ”indoor mobility” and ”feeling safe”. The
differences were particularly large for the first five indicators. However, there were no
differences between the assessment of the patients in the community hospital and the general
hospital groups.
Instead of using Gerix, there are other commonly used tests that could have been used in
study II:
Resident Assessment Instrument (RAI) was developed in the USA and is in use in 30
countries. In USA, Iceland and Japan RAI is the most common functionality measurement
instrument in use (135,159).
RAI is a system of several measurement instruments for e.g. home (community) care,
sheltered housing, residential and nursing homes, palliative care, mental health and persons
with disabilities. It gives scores for medical data, physical, emotional, cognitive and social
status and uses the same assessments items for key domains. The instrument is
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