February 23, 2021

Announcements

New TREC article
Psychometric properties and use of the DEMQOL suite of instruments in research: a systematic review protocol.
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M. Hoben, S. A. Chamberlain, H. M. O’Rourke, et al.
BMJ Open 2021 Feb 5;11(2):e041318-2020-041318
INTRODUCTION: Dementia is a public health issue and a major risk factor for poor quality of life among older adults. In the absence of a cure, enhancing health-related quality of life (HRQoL) of people with dementia is the primary goal of care. Robust measurement of HRQoL is a prerequisite to effective improvement. The DEMQOL suite of instruments is considered among the best available to measure HRQoL in people with dementia; however, no review has systematically and comprehensively examined the use of the DEMQOL in research and summarised evidence to determine its feasibility, acceptability and appropriateness for use in research and practice. METHODS AND ANALYSIS: We will systematically search 12 electronic databases and reference lists of all included studies. We will include systematically conducted reviews, as well as, quantitative and qualitative research studies that report on the development, validation or use in research studies of any of the DEMQOL instruments. Two reviewers will independently screen all studies for eligibility, and assess the quality of each included study using one of four validated checklists appropriate for different study designs. Discrepancies at all stages of the review will be resolved by consensus. We will use descriptive statistics (frequencies, proportions, ranges), content analysis of narrative data and vote counting (for the measures of association) to summarise the data elements. Using narrative synthesis, we will summarise what is known about the development, validation, feasibility, acceptability, appropriateness and use of the DEMQOL. Our review methods will follow the reporting and conduct guidelines of the Cochrane Handbook for Systematic Reviews of Interventions and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. ETHICS AND DISSEMINATION: Ethical approval is not required as this project does not involve primary data collection. We will disseminate our findings through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER: CRD42020157851.

New article by Anne-Marie Boström
Experiences of supporting older persons in completion of an exercise and nutrition intervention: an interview study with nursing home staff
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S. Vikström, H. K. Grönstedt, T. Cederholm, et al.
BMC Geriatr 2021 Feb 5;21(1):109-021-02039-7
BACKGROUND: The interactions between nursing home (NH) staff and their residents are crucial not only for the atmosphere at the NH but also for achieving care goals. In order to test the potential effects of daily physical activities (sit-to-stand (STS) exercises) combined with oral nutritional supplementation (ONS), a randomized intervention trial (the Older Person’s Exercise and Nutrition (OPEN) Study) was performed in NH residents. One aspect of the study was to interview and report the NH staff’s experiences of supporting the residents in fulfilling the intervention. METHODS: In this qualitative study, individual and focus group interviews were performed in eight NH facilities with NH staff who had assisted residents in performing the 12-week ONS/STS intervention. An interview guide developed for this study was used to assess staff experiences of the intervention and its feasibility. The transcribed interviews were analyzed inductively following a constant comparative method and with input from experts in the area, described in Grounded Theory as a reliable technique for researchers to form theory and hypothesis in unexplored areas. RESULTS: Three main themes relating to the health-promoting intervention emerged. These included: 1) insights into attitudes towards health in general and NH care specifically; 2) intervention-related challenges, frustrations and needs, and 3) aspects of collaboration and opportunities. The overarching hypothesis derived from the analysis reads: A health-promoting intervention such as the OPEN-concept has great potential for integration into NH life if a combined empathic and encouraging attitude, and a structure to keep it sustainable, are in place. CONCLUSIONS: NH staff experienced the health-promoting intervention as a potentially positive concept, although it was suggested that it works best if introduced as a general routine in the unit and is integrated into the daily planning of care. TRIAL REGISTRATION: ClinicalTrials.govIdentifier: NCT02702037 . Date of trial registration February 26, 2016. The trial was registered prospectively.

New from Alzheimer Society of Canada
Allocating Scarce Resources to People with Dementia During a Pandemic

Alzheimer Society of Canada
Here, we provide principles for considering dementia as a criterion for access to lifesaving care, including mechanical ventilation. The principles were generated by a task force commissioned by the Alzheimer Society of Canada that included experts in neurology, geriatrics, psychiatry, intensive care, ethics, and knowledge translation.

Resources for COVID-19 Vaccines in LTC
COVID-19 Vaccine Preparedness Resources for Long-term Care and Retirement Homes

CFHI
These resources have been curated with immunization experts from across the country, including Public Health Agency of Canada (PHAC), Solutions for Kids in Pain and #SeePainMoreClearly. These resources aim to help LTC and retirement homes plan and rollout COVID-19 vaccines to residents, staff and essential care partners. This is not an exhaustive repository and intended to complement existing provincial, territorial and jurisdictional COVID-19 vaccine planning. Information about vaccine rollout in your province or territory can be found via your public health authority’s website.

Survey for Long Term Care Administrators and Workers in Ontario
Dementia Isolation Toolkit Survey

Dr. Andrea Iaboni, University of Waterloo
The Dementia Isolation Toolkit research team, led by Dr. Andrea Iaboni, are doing a research study to better understand how to support residents of long-term care homes through isolation or quarantine.
As part of this study, they have prepared a survey of long-term care home administrators and front-line staff on the impact of isolation measures on people who live and work in long-term care homes, and to evaluate the Dementia Isolation Toolkit.
This survey is anonymous. Anyone who works in a long-term care home in Ontario is eligible to participate in this survey. The survey will take approximately 20 minutes to complete. Participants who complete the survey can choose to be entered in a draw for one of five $100 gift cards. This study has been reviewed and received ethics clearance through a University of Waterloo Research Ethics Committee and the University Health Network Research Ethics Committee.

Article recommended by Carole Estabrooks
Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths
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Zimmerman S, Dumond-Stryker C, Tandan M, Preisser JS, Wretman CJ, Howell A, Ryan S. Nontraditional Small House Nursing Homes Have Fewer COVID-19 Cases and Deaths. J Am Med Dir Assoc. 2021 Jan 26:S1525-8610(21)00120-1. doi: 10.1016/j.jamda.2021.01.069.
Green House and other small nursing home (NH) models are considered “nontraditional” due to their size (10-12 beds), universal caregivers, and other home-like features. They have garnered great interest regarding their potential benefit to limit Coronavirus Disease 2019 (COVID-19) infections due to fewer people living, working, visiting, and being admitted to Green House/small NHs, and private rooms and bathrooms, but this assumption has not been tested. If they prove advantageous compared with other NHs, they may constitute an especially promising model as policy makers and providers reinvent NHs post-COVID. DESIGN: This cohort study compared rates of COVID-19 infections, COVID-19 admissions/readmissions, and COVID-19 mortality, among Green House/small NHs with rates in other NHs between January 20, 2020 and July 31, 2020. SETTING AND PARTICIPANTS: All Green House homes that held a skilled nursing license and received Medicaid or Medicare payment were invited to participate; other small NHs that replicate Green House physical design and operational practices were eligible if they had the same licensure and payer sources. Of 57 organizations, 43 (75%) provided complete data, which included 219 NHs. Comparison NHs (referred to as “traditional NHs”) were up to 5 most geographically proximate NHs within 100 miles that had <50 beds and ≥50 beds for which data were available from the Centers for Medicare and Medicaid Services (CMS). Because Department of Veterans Affairs organizations are not required to report to CMS, they were not included. METHODS: Rates per 1000 resident days were derived for COVID-19 cases and admissions, and per 100 COVID-19 positive cases for mortality. A log-rank test compared rates between Green House/small NHs and traditional NHs with <50 beds and ≥50 beds. RESULTS: Rates of all outcomes were significantly lower in Green House/small NHs than in traditional NHs that had <50 beds and ≥50 beds (log-rank test P < .025 for all comparisons). The median (middle value) rates of COVID-19 cases per 1000 resident days were 0 in both Green House/small NHs and NHs <50 beds, while they were 0.06 in NHs ≥50 beds; in terms of COVID-19 mortality, the median rates per 100 positive residents were 0 (Green House/small NHs), 10 (<50 beds), and 12.5 (≥50 beds). Differences were most marked in the highest quartile: 25% of Green House/small NHs had COVID-19 case rates per 1000 resident days higher than 0.08, with the corresponding figures for other NHs being 0.15 (<50 beds) and 0.74 (≥50 beds). CONCLUSIONS AND IMPLICATIONS: COVID-19 incidence and mortality rates are less in Green House/small NHs than rates in traditional NHs with <50 and ≥50 beds, especially among the higher and extreme values. Green House/small NHs are a promising model of care as NHs are reinvented post-COVID.

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