INTERMED Elderly Self Assessment

Vivian Vivian Benítez Hidalgo — 3/07/2013

Intermed Foundation

 

BIOLOGICAL 
1a Chronicity 
For how long do you experience any restrictions due to physical complaints (multiple answers 
allowed)? 
o I do not experience any restrictions or I have experienced restrictions for a period shorter than 
3 months (item 1.1) 
o I have experienced restrictions for a period longer than 3 months of in the past 5 years I have 
experienced several short periods with restrictions (item 1.2) 
Do you suffer from one or more long-lasting or chronic diseases (such as diabetes, high blood 
pressure, rheumatoid arthritis, lung disease or cancer) 
o I don’t have a long-lasting or chronic disease (item 1.3) 
o I suffer one long-lasting or chronic disease (item 1.4) 
o I suffer several long-lasting or chronic diseases (item 1.5) 
Calculate score of item 1a ‘chronicity’ with items above: 
0 Item 1.1 and item 1.3 
1 Item 1.2 and item 1.3 
2 Item 1.1 and item 1.4 
2 Item 1.2 and item 1.4 
3 Item 1.1 and item 1.5 
3 Item 1.2 and item 1.5 
1b Diagnostic dilemma 
How difficult has it been in the past 5 years to diagnose the physical problems you 
experience? 
0 I did not suffer of any physical problem in the past 5 years 
1. The reason for my problems was immediately clear 
2. After a lot of investigations the reason for my problems was identified 
3. Even though a series of investigations have been taken into effect, the origins of my problems 
were never diagnosed 
1c Severity of problems 
How much are your daily activities restricted by physical problems? 
0 My daily activities are not influenced by physical problems 
1. My daily activities are mildly influenced by physical problems 
2. My daily activities are moderately influenced by physical problems 
3. My daily activities are severely influenced by physical problems 
1d diagnostic problems 
Do you understand the origin of your physical complaints and restrictions? 
0 I do not have any physical complaints and restrictions 
0 I understand exactly the origin of my physical complaints and restrictions 
1 I understand the origin of my physical complaints and restrictions but have some questions 
2 I understand the origin of my physical complaints and restrictions but have a lot of questions 
3 I don’t understand the origin of my physical complaints and restrictions at all 
1e Complications and life treat 
In the next 6 months, do you expect your physical health to change? [Try to make the best 
estimate] 
0 In the next 6 months I expect my physical complaints or restrictions will be the same or in the 
next 6 months I still have no physical complaints or restrictions 
1 In the next 6 months I expect my physical complaints or restrictions to get better 
2 In the next 6 months I expect a slight worsening of my physical complaints or restrictions 
3 In the next 6 months I expect a considerable worsening of my physical complaints or 
restrictions PYCHOLOGICAL 
2a Restrictions in coping 
In the past 5 years, how did you cope w

The INTERMED for the Elderly Self Assessment (IM-E-SA) was developed to support health care professionals in providing demand driven elderly care. It assesses case complexity and health care needs as perceived by older adults themselves. By applying this instrument tailored care can be provided as it supports professionals in their allocation decisions. The aim was to evaluate the measurement properties of the IM-E-SA

 


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1/07/2013

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