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We translated the Canadian residential long term care versions of the Alberta Context Tool (ACT) and the Conceptual Research Utilization (CRU) Scale into German, to study the association between organizational context factors and research utilization in German nursing homes. The rigorous translation process was based on best practice guidelines for tool translation, and we previously published methods and results of this process in two papers. Both instruments are self-report questionnaires used with care providers working in nursing homes. The aim of this study was to assess the factor structure, reliability, and measurement invariance (MI) between care provider groups responding to these instruments. In a stratified random sample of 38 nursing homes in one German region (Metropolregion Rhein-Neckar), we collected questionnaires from 273 care aides, 196 regulated nurses, 152 allied health providers, 6 quality improvement specialists, 129 clinical leaders, and 65 nursing students. The factor structure was assessed using confirmatory factor models. The first model included all ten ACT concepts. We also decided a priori to run two separate models for the scale-based and the count-based ACT concepts as suggested by the instrument developers. The fourth model included the five CRU Scale items. Reliability scores were calculated based on the parameters of the best-fitting factor models. Multiple-group confirmatory factor models were used to assess MI between provider groups. Rather than the hypothesized ten-factor structure of the ACT, confirmatory factor models suggested thirteen factors. The one-factor solution of the CRU Scale was confirmed. The reliability was acceptable (> .7 in the entire sample and in all provider groups) for 10 of 13 ACT concepts, and high (.90–.96) for the CRU Scale. We could demonstrate partial strong MI for both ACT models and partial strict MI for the CRU Scale. Our results suggest that the scores of the German ACT and the CRU Scale for nursing homes are acceptably reliable and valid. However, as the ACT lacked strict MI, observed variables (or scale scores based on them) cannot be compared between provider groups. Rather, group comparisons should be based on latent variable models, which consider the different residual variances of each group.
New TREC Newsletter available!
September 2016 Newsletter
Read the latest news from TREC.
Calls for Abstracts
Don’t forget to submit your abstracts! NICHE is now seeking partner summit, podium, poster, and roundtable abstracts for the 2017 NICHE Conference. Clinicians, administrators, and researchers are invited to submit evidence-based, innovative approaches to promote positive outcomes and experiences for the older adult patient.
Grants & Awards
Pre-announcement: Population Health Intervention Research (PHIR) Competition
This funding opportunity will support New Investigators to conduct research on timely interventions (e.g. programs, policies, social enterprises and resource distribution approaches) that have been initiated by others (e.g., policy makers, practitioners, communities). These interventions must have the potential to impact First Nations, Inuit and Métis health and health equity at the population level, and address one or more of the four identified exemplar areas (Suicide prevention, Obesity/Diabetes, Tuberculosis and Oral Health). Available funding for this opportunity is $675,000, enough to fund approximately 3 grants. This amount may increase if additional funding partners participate. The maximum amount per grant is $225,000 for over a period of up to 2 years. This funding is non-renewable. This opportunity will be launched in August 2016 with an application deadline in the Fall of 2016. For more information, contact support@cihr-irsc.gc.ca
Operating Grant: Social Inclusion of individuals with dementia and carers
This funding opportunity falls within the scope of the Quality of Life theme of the CIHR Dementia Research Strategy. The CIHR Dementia Research Strategy is a CIHR Signature Initiative which aims to support research on the latest preventive, diagnostic, and treatment approaches to Alzheimer’s disease and related dementia. The Strategy encompasses numerous activities and funding initiatives under both its national and international components. The Canadian Consortium on Neurodegeneration in Aging (CCNA) is the national component of the Strategy and represents Canada’s centre of excellence in neurodegeneration research. The Strategy is focused around three themes: Primary Prevention, Secondary Prevention, and Quality of life.
Alzheimer Society Implementation Research Grants
Applicants can apply for grants of up to £400,000 over 36 months that will either: a) enable the scale-up of evidence based interventions that have been shown to improve care and are ready to be implemented at a larger scale, or; b) lay the foundations for the scale-up of evidence based interventions; testing the feasibility of bringing dementia research knowledge into the real world.
The Project Grant program is designed to capture ideas with the greatest potential to advance health-related fundamental or applied knowledge, health research, health care, health systems, and/or health outcomes. It supports projects with a specific purpose and a defined endpoint. The best ideas may stem from new, incremental, innovative, and/or high-risk lines of inquiry or knowledge translation approaches.
Publications
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Change
Research Practice and Methodology
Aging
KT
Enhancing the quality of oral nutrition support for hospitalized patients: a mixed methods knowledge translation study (The EQONS study)
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AIM: The aim of this study was to report a multifaceted knowledge translation intervention to facilitate use of the Malnutrition Universal Screening Tool and innovation in nutritional care for patients at risk of malnutrition. BACKGROUND: Malnutrition among hospitalized patients is a widespread problem leading to adverse health outcomes. Despite evidence of the benefits of malnutrition screening and recommendations for achieving good nutrition, shortfalls in practice continue. DESIGN: A mixed method integrated knowledge translation study. METHODS: The knowledge translation intervention comprised nutrition champions supported by knowledge translation facilitators and an action planning process. Data collection was undertaken over 18 months between 2011-2012 in a hospital in England. Data comprised observation of mealtimes, audit of patient records, survey of nurses and semi-structured interviews with nutrition champions, knowledge translation facilitators, senior ward nurses and nurse managers. FINDINGS: Statistically significant relationships (Chi Square) were observed between self-reported confidence of nurses (a) to assess patients using the Malnutrition Universal Screening Tool, (b) to teach colleagues how to use the Malnutrition Universal Screening Tool and (c) to ensure that patients were assessed within 24 hours of admission. Ward-based nutrition champions facilitated successful innovation in nutrition support. Contextual factors operating at micro (ward), meso (organization) and macro (healthcare system) levels acted as barriers and enablers for change. CONCLUSION: Nutrition champions were successful in increasing the timely assessment of patients at risk of malnutrition and promoting innovation in nutritional care. Support from knowledge translation facilitators helped nutrition champions develop their role and work collaboratively with senior ward nurses to implement action plans for improving nutrition.
Putting translational science on to a global stage 
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Global collaboration in translational science promises to accelerate the discovery, development and dissemination of new medical interventions. Here, we introduce a new international collaboration of translational science organizations and highlight our initial strategy to reduce or remove bottlenecks in translation.
How effective are interface organizations in the promotion of university-industry links? Evidence from a regional innovation system
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Purpose: The purpose of this paper is to investigate the role of the interface organizations of a regional innovation system on the dynamics of knowledge transfer between universities and firms. Design/methodology/approach: The Triple Helix approach is used as a heuristic tool. The paper is based on a face-to-face survey to a sample of 800 innovative firms in Andalusia (Spain). The analysis focusses on the effectiveness attributed by the firms to technology transfer offices (TTOs), science parks and the regional innovation agency. Findings: Different organizations have different roles in the relationships that firms maintain with universities in a regional innovation system. Firms positive perceptions of TTOs, science parks and the innovation agency in the promotion of knowledge transfer are associated to the kind of relationships maintained with universities. Research limitations/implications: The research focusses on the region of Andalusia. Further studies could consider the applicability of the findings in other regional innovation systems. Practical implications: The paper helps governments and managers of TTOs, science parks and innovation agencies to understand the real use that interface organizations have for the industrial tissue of a regional innovation system. Originality/value: There have been few studies that observe together the value attributed by firms to the several interface organizations in a specific innovation system. The analysis contributes to the debate on the adjustment of the different roles of interface organizations in the promotion of knowledge transfer and innovation dynamics.
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Health Care Administration and Organization
How does gatekeeper training improve suicide prevention for elderly people in nursing homes? A controlled study in 24 centres
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BACKGROUND: The death rate due to suicide in elderly people is particularly high. As part of suicide selective prevention measures for at-risk populations, the WHO recommends training “gatekeepers”. METHODS: In order to assess the impact of gatekeeper training for members of staff, we carried out a controlled quasi-experimental study over the course of one year, comparing 12 nursing homes where at least 30% of the staff had undergone gatekeeper training with 12 nursing homes without trained staff. We collected data about the residents considered to be suicidal, their management further to being identified, as well as measures taken at nursing home level to prevent suicide. RESULTS: The two nursing home groups did not present significantly different characteristics. In the nursing homes with trained staff, the staff were deemed to be better prepared to approach suicidal individuals. The detection of suicidal residents relied more on the whole staff and less on the psychologist alone when compared to nursing homes without trained staff. A significantly larger number of measures were taken to manage suicidal residents in the trained nursing homes. Suicidal residents were more frequently referred to the psychologist. Trained nursing homes put in place significantly more suicide prevention measures at an institutional level. CONCLUSIONS: Having trained gatekeepers has an impact not only for the trained individuals but also for the whole institution where they work, both in terms of managing suicidal residents and routine suicide prevention measures.
Work Life Stress and Career Resilience of Licensed Nursing Facility Administrators
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Career resilience provided a frame for understanding how Licensed Nursing Facility Administrators (LNFAs) sustain role performance and even thrive in stressful skilled nursing facility work environments. Quantitative and qualitative analyses of in-depth interviews with18 LNFAs, averaging 24 years of experience were conducted by a five-member research team. Analysis was informed by evidence-based frameworks for career resilience in the health professions as well as the National Association of Long-Term Care Administrator Boards’ (NAB) five domains of competent administrative practice. Findings included six sources of work stressors and six sources of professional satisfaction. Also, participants identified seven strategic principles and 10 administrative practices for addressing major sources of stress. Recommendations are provided for research and evidence-based application of the career resilience perspective to LNFA practice aimed at reducing role abandonment and energizing the delivery of the quality of care that each resident deserves.
Job strain and stress of conscience among nurse assistants working in residential care
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AIM: The aim was to investigate job strain and stress of conscience among nurse assistants working in residential care and to explore associations with personal and work-related aspects and health complaints. BACKGROUND: It is important to investigate job strain and stress of conscience, both for the well-being of the nurse assistants themselves and for the impact on the quality of care they provide. METHOD: Questionnaires measuring job strain, stress of conscience, personal and work-related aspects and health complaints were completed by NAs (n = 225). Comparisons of high and low levels of job strain and stress of conscience and multiple linear regression analyses were performed. RESULT: Organisational and environmental support and low education levels were associated with low levels of job strain and stress of conscience. Personalised care provision and leadership were related to stress of conscience and the caring climate was related to job strain. CONCLUSION: There is a need for support from the managers and a supportive organisation for reducing nurse assistants work-related stress, which in turn can create a positive caring climate where the nurse assistants are able to provide high quality care. IMPLICATIONS FOR NURSING MANAGEMENT: The managers’ role is essential when designing supportive measures and implementing a value-system that can facilitate personalised care provision.
Meaning making in long-term care: what do certified nursing assistants think?
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Certified nursing assistants (CNAs) provide up to 80% of the direct care to older adults in long-term care facilities. CNAs are perceived as being at the bottom of the hierarchy among healthcare professionals often negatively affecting their job satisfaction. However, many CNAs persevere in providing quality care and even reporting high levels of job satisfaction. The aim of the present investigation was to identify primary themes that may help CNAs make meaning of their chosen career; thus potentially partially explaining increases in job satisfaction among this group. Focus groups were conducted with CNAs at three long-term care facilities. Four themes emerged from the data: CNA work is good or special; CNA as relationship builder; CNA as expert; CNA as team member. These themes reflect the perceptions that these CNAs held in regard to themselves and their relationships to others in the work environment and, when present, can contribute to intrinsic job satisfaction. Our meaning-making themes support the premise that CNAs do not passively accept the evaluations of others but instead actively frame identities that validate their importance to residents and the institution.
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Health Care Innovation and Quality Assurance
Advance care planning for nursing home residents with dementia: Influence of ‘we DECide’ on policy and practice
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OBJECTIVES: (1) To pilot ‘we DECide’ in terms of influence on advance care planning policy and practice in nursing home dementia care units. (2) To investigate barriers and facilitators for implementing ‘we DECide’. METHODS: This was a pre-test-post-test study in 18 nursing homes. Measurements included: compliance with best practice of advance care planning policy (ACP-audit); advance care planning practice (ACP criteria: degree to which advance care planning was discussed, and OPTION scale: degree of involvement of residents and families in conversations). RESULTS: Advance care planning policy was significantly more compliant with best practice after ‘we DECide’; policy in the control group was not. Advance care planning was not discussed more frequently, nor were residents and families involved to a higher degree in conversations after ‘we DECide’. Barriers to realizing advance care planning included staff’s limited responsibilities; facilitators included support by management staff, and involvement of the whole organization. CONCLUSION: ‘We DECide’ had a positive influence on advance care planning policy. Daily practice, however, did not change. Future studies should pay more attention to long-term implementation strategies. PRACTICE IMPLICATIONS: Long-term implementation of advance care planning requires involvement of the whole organization and a continuing support system for health care professionals.
Practice Change Interventions in Long-Term Care Facilities: What Works, and Why?
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Over the past three decades, there has been a notable increase in studies of practice change interventions in long-term care (LTC) settings. This review, based on a modified realist approach, addresses the following questions: What practice change intervention characteristics work? And, in what circumstances do they work and why? A modified realist approach was applied to identify and explain the interactions among context, mechanism, and outcome. We searched electronic databases and published literature for empirical studies of practice change interventions that (a) were conducted in LTC settings, (b) involved formal care staff members, and (c) reported a formal evaluation. Ninety-four articles met the inclusion criteria. Interventions that included only predisposing factors were least likely to be effective. Interventions that included reinforcing factors were most likely to produce sustained outcomes. We concluded that interventions aimed at practice change in LTC settings should include feasible and effective enabling and reinforcing factors.
Psychometric properties of the Nursing Home Survey on Patient Safety Culture in Norwegian nursing homes
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BACKGROUND: Developing a culture where staff are actively aware of how to prevent adverse events is a challenge. The use of survey tools to assess the status of patient safety culture seems to be acceptable as an early step in improving patient safety. The Nursing Home Survey on Patient Safety Culture (NHSOPSC) includes 12 dimensions and is specifically developed for nursing homes. In this study, we describe a Norwegian version of the NHSOPSC and assess its psychometric properties when tested on a sample of healthcare staff in nursing homes. METHODS: The NHSOPSC was translated into Norwegian and pilot tested before being distributed to 12 nursing homes in Norway. Of the 671 healthcare staff invited, 466 (69 %) answered the questionnaire. SPSS 23.0 was used for descriptive data analysis and estimating internal consistency (Cronbach’s alpha). The dimensional structure of the questionnaire was tested by confirmatory factor analysis (CFA) using Mplus (version 7.2). RESULTS: The CFA testing of the original 12-factor solution suggested that some modifications were needed because of the high correlations between three of the latent factors. A subsequent analysis resulted in a final ten-factor solution. The final model showed acceptable fit to the data (root mean square error of approximation = 0.060, 90 % confidence interval: 0.057-0.063, comparative fit index = 0.934, Tucker-Lewis index = 0.926, chi (2) = 2058.33, df = 765, p < 0.001) and acceptable factor loadings ranging from 0.402 to 0.891. Moreover, moderate-to-strong correlations ranging from 0.455 to 0.812 were found between the ten latent factors. Finally, moderate-to-high correlations were found between the ten latent factors and an overall rating of patient safety in the nursing home. CONCLUSIONS: Factor analysis indicated that a modified ten-factor model fitted the data set in a Norwegian community healthcare context with acceptable goodness-of-fit values and could be recommended as a useful tool to assess staff perceptions of patient safety issues in Norwegian nursing homes.
Strengthening patient safety in transitions of care: an emerging role for local medical centres in Norway
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BACKGROUND: Patient safety has gained less attention in primary care in comparison to specialised care. We explore how local medical centres (LMCs) can play a role in strengthening patient safety, both locally and in transitions between care levels. LMCs represent a form of intermediate care organisation in Norway that is increasingly used as a strategy for integrated care policies. The analysis is based on institutional theory and general safety theories. METHODS: A qualitative design was applied, involving 20 interviews of nursing home managers, managers at local medical centres and administrative personnel. RESULTS: The LMCs mediate important information between care levels, partly by means of workarounds, but also as a result of having access to the different information and communications technology (ICT) systems in use. Their knowledge of local conditions is found to be a key asset. LMCs are providers of competence and training for the local level, as well as serving as quality assurers. CONCLUSIONS: As a growing organisational form in Norway, LMCs have to legitimise their role in the health care system. They represent an asset to the local level in terms of information, competence and quality assurance. As they have overlapping competencies, tasks and responsibilities with other parts of the health care system, they add to organisational redundancy and strengthen patient safety.
Culture change in care homes: a literature review
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This article is the first of a two-part series that explores a programme of culture change in care homes. A UK care home company sought the authors’ expertise to design and facilitate an independent programme of learning to encourage and support staff in two of its homes to become the architects of their own quality improvement. The article reviews the literature that was an essential information base for the authors in their dual roles as designers of the learning programme and facilitators of its delivery to participant staff. The literature is necessarily broad in reflecting the nature and context of care homes, residents’ needs and wants from care, and the particular challenges that might be faced by care home staff and managers when making quality improvements. In the second article, the reality of running the programme in the two homes is described.
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Research Practice and Methodology
An approach to measuring and encouraging research translation and research impact
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BACKGROUND: Research translation, particularly in the biomedical area, is often discussed but there are few methods that are routinely used to measure it or its impact. Of the impact measurement methods that are used, most aim to provide accountability – to measure and explain what was generated as a consequence of funding research. This case study reports on the development of a novel, conceptual framework that goes beyond measurement. The Framework To Assess the Impact from Translational health research, or FAIT, is a platform designed to prospectively measure and encourage research translation and research impact. A key assumption underpinning FAIT is that research translation is a prerequisite for research impact. METHODS: The research impact literature was mined to understand the range of existing frameworks and techniques employed to measure and encourage research translation and research impact. This review provided insights for the development of a FAIT prototype. A Steering Committee oversaw the project and provided the feedback that was used to refine FAIT. RESULTS: The outcome of the case study was the conceptual framework, FAIT, which is based on a modified program logic model and a hybrid of three proven methodologies for measuring research impact, namely a modified Payback method, social return on investment, and case studies or narratives of the process by which research translates and generates impact. CONCLUSION: As funders increasingly seek to understand the return on their research investments, the routine measurement of research translation and research impact is likely to become mandatory rather than optional. Measurement of research impact on its own is insufficient. There should also be a mechanism attached to measurement that encourages research translation and impact – FAIT was designed for this task.
Research culture in allied health: a systematic review
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Research evidence is required to guide optimal allied health practice and inform policymakers in primary health care. Factors that influence a positive research culture are not fully understood, and nor is the impact of a positive research culture on allied health professionals. The aim of this systematic review was to identify factors that affect allied health research culture and capacity. An extensive search of 11 databases was conducted in June 2015. Studies were included if they were published in English, had full-text availability and reported research findings relating to allied health professions. Study quality was evaluated using the McMaster Critical Review Forms. Fifteen studies were eligible for inclusion. A meta-analysis was not performed because of heterogeneity between studies. Allied health professionals perceive that their individual research skills are lower in comparison to their teams and organisation. Motivators for conducting research for allied health professionals include developing skills, increasing job satisfaction and career advancement. Barriers include a lack of time, limited research skills and other work roles taking priority. Multilayered strategies, such as collaborations with external partners and developing research leadership positions, aimed at addressing barriers and enablers, are important to enhance allied health research culture and capacity.
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Aging
Health-related quality of life, rehabilitation and mortality in a nursing home population
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BACKGROUND: Health-related quality of life (HRQOL) in nursing home residents is generally low. The purpose of this study was to investigate the associations between HRQOL and two clinically relevant outcome measures, all-cause mortality and successful rehabilitation, in a nursing home population. METHODS: In an observational prospective cohort study in a nursing home population, HRQOL was assessed with the RAND-36. A total of 184 patients were included, 159 (86%) completed the RAND-36 and were included in the study. A Cox proportional hazard model was used to investigate the independent association between HRQOL, rehabilitation and mortality with adjustment for confounders. Risk prediction capabilities were assessed with Harrell’s C statistics and the proportion of explained variance (R2). RESULTS: The median age (interquartile range) was 79 (75-85) years. The health dimensions vitality (HR 0.88 (95% CI 0.77-0.99)) and mental health (HR 0.86 (95% CI 0.75-0.98)) were inversely associated and role functioningphysical (HR 1.08 (95%CI 1.02-1.15)) was positively associated with mortality. The Harrell’s C value and the R2 were </= 0.02 and </= 0.03 higher in the adjusted models with the dimensions role functioning- physical, mental health or vitality compared with the models without these dimensions. None of the health dimensions or summary scales were related to successful rehabilitation. CONCLUSION: HRQOL was significantly associated with mortality for three dimensions, but partly in opposite directions. Additional value of HRQOL in mortality prediction is very limited. There were no independent associations between HRQOL and successful rehabilitation. Although HRQOL is an important outcome, this study did not provide evidence for an association between HRQOL and successful rehabilitation.
The use of non-pharmacological interventions for dementia behaviours in care homes: findings from four in-depth, ethnographic case studies
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BACKGROUND: antipsychotic medications have been used to manage behavioural and psychological symptoms of dementia (BPSD). Due to the potential risks associated with these medications for people with dementia, non-pharmacological interventions (NPIs) have been recommended as safer alternatives. However, it is unknown if, or how, these interventions are used in care homes to help people experiencing BPSD. AIM: to explore the use of NPIs in care homes to manage BPSD. METHODS: In-depth, ethnographic case studies were conducted in four care homes; in total, they included interviews with 40 care-home staff and 384 hours of participant observations. FINDINGS: NPIs, some of which are the focus of efficacy research, were used in care homes but predominantly as activities to improve the quality of life of all residents and not identified by staff as meeting individual needs in order to prevent or manage specific behaviours. Socially relevant activities such as offering a cup of tea were used to address behaviours in the moment. Residents with high levels of need experienced barriers to inclusion in the activities. CONCLUSIONS: there is a gap between rhetoric and practice with most NPIs in care homes used as social activities rather than as targeted interventions. If NPIs are to become viable alternatives to antipsychotic medications in care homes, further work is needed to embed them into usual care practices and routines. Training for care-home staff could also enable residents with high needs to gain better access to suitable activities.
The Structural Burden of Caregiving: Shared Challenges in the United States and Canada
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In contrasting health care structures, we each served as caregivers to elderly parents where a shared and unexpected theme in our experiences was the substantial burden of negotiating and managing long-term care (LTC) services within our respective health and social care systems. In this article, we introduce and elucidate an under recognized source of caregiver burden in the United States and Canada: the structural burden of caregiving. We draw on shared and unique experiences cross-nationally, along with the literature, to illustrate that (a) today’s caregiving is increasingly characterized by interactions with formal health and social systems in negotiating and managing services, (b) these systems are hampered by discontinuous and fragmented care which increase caregiver stress, and (c) this structural burden likely exacerbates inequity for both care recipients and caregivers. In conclusion, we call for theoretical models of caregiving to highlight health and social systems as creating burden and for measurement of caregiver burden to explicitly consider the time and stress stemming from interactions with formal health and social systems. Finally, we call for future policy evaluation to incorporate structural burden as an additional outcome in considering changes to LTC provisions and funding.
The last phase of life with dementia in Swiss nursing homes: the study protocol of the longitudinal and prospective ZULIDAD study
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BACKGROUND: The proportion of older people with advanced dementia who will die in nursing homes is constantly growing. However, little is known about the dying phase, the type of symptoms, the management of symptoms and the quality of life and dying in people with advanced dementia. The ZULIDAD (Zurich Life and Death with Advanced Dementia) study aims at extending the current scientific knowledge by providing first data from Switzerland. METHODS: The ZULIDAD study employs a prospective design to study nursing home residents with advanced dementia for three years or until their death in eleven nursing homes in Zurich. Observational data from quarterly questionnaires for relatives and primary nurses is combined with data from the Resident Assessment Instrument – Minimum Data Set (RAI-MDS). Special focus is put on 1) the cross-sectional analysis of baseline and post-mortem data regarding quality of life and quality of dying and how the perceptions of these measures differ between relatives and primary nurses, 2) the longitudinal analyses of established health outcome measures (e.g., EOLD, MSSE, BISAD, QUALID) in order to understand their trajectories and 3) international comparisons of cross-sectional and longitudinal data. DISCUSSION: The ZULIDAD study is one of the few existing prospective studies on end-of-life care in dementia and it is the first prospective study to describe the situation in Switzerland. Its multi-perspective approach allows a comprehensive approximation to central health outcome measures at the end of life such as pain, suffering or quality of life. Providing insights into the current provision of care, it can serve as a basis for improving dementia end-of-life care in Switzerland and internationally.
Informed Family Member Involvement to Improve the Quality of Dementia Care in Nursing Homes
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OBJECTIVES: To describe the extent to which nursing homes engaged families in antipsychotic initiation decisions in the year before surveyor guidance revisions were implemented. DESIGN: Mixed-methods study based on semistructured interviews. SETTING: U.S. nursing homes (N = 20) from five CMS regions (III, IV, VI, VIII, IX). PARTICIPANTS: Family members of nursing home residents (N = 41). MEASUREMENTS: Family member responses to closed- and open-ended questions regarding involvement in resident care and antipsychotic initiation. Two researchers used a content analytical approach to code open responses to themes of family involvement in behavior management, decision-making, knowledge of risks and benefits, and informed consent. RESULTS: Fifty-four percent of family members felt highly involved in decisions about behavior management. Forty-two percent recalled being asked how to manage resident behavior without medication, and 17% recalled receipt of information about antipsychotic risks and benefits. Sixty-six percent felt highly involved in the process of initiating antipsychotic medication; 24% reported being asked for input into the antipsychotic initiation decision and knowing before the antipsychotic was started. CONCLUSION: Under existing federal regulations but before guidance revisions were implemented in 2013, more than 40% of families reported being involved in nonpharmacological behavior management of family members, but fewer than one in four reported being involved throughout the entire antipsychotic prescribing process. Interventions that standardize family engagement and promote adherence to existing federal regulations are needed. This discussion builds on these findings to weigh the policy options of greater enforcement of existing regulations versus enactment of new legislation to address this challenging issue.
Prevalence of Potentially Inappropriate Medication Use in Older Adults Living in Nursing Homes: A Systematic Review
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IMPORTANCE: As older adults living in nursing homes are at a high risk of adverse drug-related events, medications with a poor benefit/risk ratio or with a safer alternative should be avoided. OBJECTIVES: To systematically evaluate the prevalence of potentially inappropriate medication use in nursing home residents. EVIDENCE REVIEW: We searched in PubMed and EMBASE databases (1990-2015) for studies reporting the prevalence of potentially inappropriate medication use in people >/=60 years of age living in nursing homes. The risk of bias was assessed with an adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. FINDINGS: A total of 91 articles were assessed for eligibility, and 48 met our inclusion criteria. These articles reported the findings from 43 distinct studies, of which 26 presented point prevalence estimates of potentially inappropriate medication use (227,534 nursing home residents). The overall weighted point prevalence of potentially inappropriate medication use in nursing homes was 43.2% [95% confidence interval (CI) 37.3%-49.1%], increasing from 30.3% in studies conducted during 1990-1999 to 49.8% in studies conducted after 2005 (P < .001). Point prevalence estimates reported in European countries were found to be higher (49.0%, 95% CI 42.5-55.5) than those reported in North America (26.8%, 95% CI 16.5-37.1) or in other countries (29.8%, 95% CI 19.3-40.3). In addition, 18 studies accounting for 326,562 nursing home residents presented 20 distinct period prevalence estimates ranging from 2.3% to 50.3%. The total number of prescribed medications was consistently reported as the main driving factor for potentially inappropriate medications use. CONCLUSIONS AND RELEVANCE: This systematic review shows that almost one-half of nursing home residents are exposed to potentially inappropriate medications and suggests an increase prevalence over time. Effective interventions to optimize drug prescribing in nursing home facilities are, therefore, needed.
Validation of the HOSPITAL Score for 30-Day All-Cause Readmissions of Patients Discharged to Skilled Nursing Facilities
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OBJECTIVES: To validate the HOSPITAL score for predicting 30-day all-cause readmission rates in a cohort of medical patients discharged to skilled nursing facilities (SNFs). DESIGN: Retrospective cohort. SETTING: Cleveland Clinic Main Campus. PARTICIPANTS: Cleveland Clinic Main Campus medicine services patients who were admitted between January 1, 2011, and December 31, 2012, and subsequently discharged to 110 SNFs within a 25-mile radius of the hospital. MEASUREMENTS: Thirty-day all-cause readmissions to any hospital in the Cleveland Clinic Health System and the HOSPITAL score. RESULTS: During the study period, 4208 medical patients were discharged to 110 SNFs; 30-day all-cause readmission rates were 40.9% for high-risk patients, 28.1% for intermediate-risk patients, and 15.4% for low-risk patients. Compared to intermediate- and low-risk patients, high-risk patients had more hospitalizations in the past year (3.6 vs 1.1 vs 0.8; P < .0001), longer hospital stays (12.0 days vs 9.9 days vs 4.9 days; P < .0001) and more comorbidities, including end-stage renal disease (18.5% vs 9.3% vs 2.5%; P < .0001), congestive heart failure (39.9% vs 33.1% vs 26.1%; P < .0001), chronic obstructive pulmonary disease (26.9% vs 21.5% vs 20.2%; P < .0001), and diabetes (46.5% vs 38.6% vs 35.3%; P < .0001). The c–statistic for the HOSPITAL score was 0.65. CONCLUSIONS: Among patients discharged to an SNF, the HOSPITAL score may be used to identify those at highest risk of readmission within 30 days.
Older people’s involvement in activities related to meals in nursing homes
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AIMS AND OBJECTIVES: To explore how residents in nursing homes perceive their participation in activities related to food and meals, and possible factors influencing their involvement. BACKGROUND: Eating and drinking are fundamental human needs and consequently essential parts of nursing and nursing care. Therefore and as part of nursing care, encouraging older people in nursing homes to engage in different mealtime activities could be one way to increase participation in activities of daily living and more optimal nutrition status among older people. DESIGN: A cross-sectional survey design was used. METHODS: A total of 204 residents (88%) in one Norwegian county agreed to participate and completed a face-to-face interview questionnaire about food and meal experiences. Descriptive and comparative statistics was used. RESULTS: Close to 30% of the residents were vulnerable to malnourishment. None of the residents were involved in menu planning, and more than 90% did not participate in food preparation or setting/clearing tables. Ten per cent were able to choose where they could eat and 5% when they could eat. Older persons living in nursing homes with more than 80 residents and those younger than 65 years of age participated the most, while older people with poor appetites were able to choose more often where they wanted to eat, compared to those with a healthy appetite. CONCLUSION: The residents in this study appeared to be vulnerable to malnourishment. The results indicated that they only to a limited extent were involved in activities concerning food and meals at the nursing homes. IMPLICATIONS FOR PRACTICE: Management and nurses should focus on residents’ eating and drinking, which are essentials of nursing care. The residents should be asked whether they would like to participate in different mealtime activities. Further, a person-centred care approach that facilitates activities concerning food and meals should be promoted.
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Events
Non UofA
The Centre for Advancement in Realist Evaluation and Synthesis (CARES) 2016 will support advancement, capacity building and training in the burgeoning areas of realist inquiry (realist evaluation, realist review and realist research). The conference theme: “Advancing Principles, Strengthening Practice” reflects the growing interest in applying realist approaches across many sectors including health, public policy, education, social welfare, criminal justice, and international development. This event will bring together key thinkers in the field and provide an accessible forum to learn about, debate and advance realist methodology. Through this call for abstracts, we invite you to share your successes, challenges and insights. This will be an inclusive event, to broaden our understanding of what it means to do realist inquiry, and to support learning from multiple forms of knowledge and ways of knowing.
2nd Canadian Alzheimer’s Disease Basic Research Symposium (CANAD)
Dedicated to finding a cure for Alzheimer’s disease and related dementias, CANAD 2016 will be devoted primarily to Canadian research, and will include fundamental, imaging and biomedical research. Researchers from coast to coast will have the opportunity to share their latest discoveries and breakthroughs from molecular mechanisms to preclinical trials.
The symposium will shed light on a variety of broad topics related to the biology of aging. Students, professors, researchers and health care professionals will be able to acquire more knowledge in this field. Speakers will be able to transmit their professional views on the current and future stakes in the field of aging, and to discuss their latest projects with those in attendance.
Online
2016 Knowledge Translation Conference: Communication Tools for Moving Research to Practice
The Center on Knowledge Translation for Disability and Rehabilitation Research (KTDRR) invites you to this year’s online conference. This conference is designed for researchers and others to learn about current and innovative communication tools, including social media, in order to increase the use of evidence-based research findings though knowledge translation (KT) activities.
CBC Radio Active: Gender Bias in Science and Research Series
This is a 4-part series that discusses the following topics: The Problem of Gender Bias, Health Research Funding & Gender Bias, Life as a Female Scientist/Researcher, and Ideas for an Equitable Future.
Quality Assessment Tool for Quantitative Studies
Are you engaged in utilizing sources of high quality literature to support your decision-making process? Are you interested in learning about critical appraisal of intervention studies? Join us for a webinar to learn how the Quality Assessment Tool for Quantitative Studies can help you.
Webcast: Assessing Empirical Evidence for KTE Readiness
You’re invited to join the KTER Center for this live webcast. Dr. Travis Sztainert, a Knowledge Broker and Content Specialist at Gambling Research Exchange Ontario (GREO), will introduce a newly created tool to help individuals interested in knowledge translation & exchange (KTE) to assess the readiness of completed research for KT potential. The tool consists of two major sections: (1) an assessment of the quality and strength of the evidence supporting the knowledge and (b) an assessment of the significance of the knowledge to stakeholders and end-users. Each section is scored, based on criteria, and the final score is used to help guide decisions about KT activities based on three broad categories of ‘readiness.’
Improving End of Life care in Long term care
Everyone wants to live well in their final years but this is a challenge, particularly for people in residential long term care settings such as nursing homes. Seniors – Adding Life To Years (SALTY) aims to add quality to late life for people living in nursing homes and for their caregivers, including family, friends, and volunteers who support their care. Our research is organized into interrelated streams: Monitor Care Practice, Map Promising Approaches to Care Relationships, Evaluate Innovative Practice, and Examine Policy Context. We give special attention to issues of dementia, gender and underrepresented voices.
Courses
Finding and Using Research Evidence to Inform Decision-making in Health Systems and Organizations
For interested individual policymakers, stakeholders and researchers, the McMaster Health Forum is offering regular in-person training workshops. Each workshop consists of a combination of online instruction and a one-day in-person workshop in Hamilton, Ontario, Canada.
Finding and Using Research Evidence to Inform Decision-making in Health Systems and Organizations
For interested individual policymakers, stakeholders and researchers, the McMaster Health Forum is offering regular in-person training workshops twice per year, in April and in October. Each workshop consists of a combination of online instruction and five days of in-person workshop in Hamilton, Ontario, Canada.
The University of Tasmania’s Massive Open Online Course (MOOC), Understanding Dementia, is an easily accessible 9 week online course that builds upon the latest in international research on dementia. It’s free and anyone can enrol.
Cochrane Standard Author Training Workshop
Take this 2.5-day session to learn the basic skills of conducting a Cochrane review. Topics include protocols, setting your question, literature searching, study selection, assessing bias, data and analysis, formulating conclusions, and a hands-on session with the Review Manager software.
EXTRA: Executive Training Program
The call for applications for EXTRA 2017-2018 (Cohort 13) opens October 13, 2016. EXTRA: Executive Training Program is a 14-month fully bilingual improvement fellowship – the only one of its kind in Canada. EXTRA: Builds the capacity of organizations to achieve and sustain improvement; Enhances the capacity of teams of existing and emerging leaders to accelerate improvement; Creates a pan-Canadian community of leaders dedicated to improvement.
The course will mix theory and practice, and give broad perspectives drawing on the participants’ own work and evaluation needs. Participants will be introduced to complex situations, complex interventions and innovative evaluation methodologies (e.g. theory-driven approaches, Realist Evaluation, & Developmental Evaluation).
News
Ana Isabel Canhoto and Sarah Quinton discuss how social features, material characteristics, and the attributes of the individuals engaged in research collaboration can support the success of a collaborative research project.
Most Sick, Aging Americans Live Far From In-Home Care (US)
At least 2 million Medicare beneficiaries are homebound, compared to fewer than 2 million beneficiaries who receive care in nursing homes, the researchers said. Yet, seven times more primary-care providers visited nursing homes than patients at home during the two-year study period.
Dementia Rates are Slowing, but Alzheimer’s Cases Continue to Rise (US)
A large new study found that although cases of Alzheimer’s are still increasing at an alarming rate, the rate of increase appears to be slowing. The findings suggest that higher levels of education and heart-healthy lifestyle measures may be helping to perhaps prevent, or at least delay, the onset of dementia.
Japanese City Takes Community Approach To Dealing With Dementia
Yamamoto volunteers with Matsudo’s Orange Patrol. The organization’s formal name in Japanese — Olenji koe kake tai — translates awkwardly into English as “Troop that calls out to the elderly.” But the name accurately describes what the members do. Yamamoto says that just a simple, “Hello, what a nice day,” can tell you if someone is OK or needs help.
Protect your brain against Alzheimer’s disease (US)
Once stigmatized, Alzheimer’s has moved into the mainstream. Over 5 million Americans have Alzheimer’s disease and almost everyone knows someone affected. But experts say that prevention is possible, and that there are things we can do now to reduce our risk of developing the disease later.
Calcium Supplements Might Raise Older Women’s Dementia Risk (US)
Taking calcium supplements with the hope of keeping osteoporosis at bay may raise an older woman’s risk of dementia, a new study suggests. And that seems particularly true if a woman has already sustained an event causing poor blood flow to the brain (cerebrovascular disease), such as from a stroke, researchers said.
The truth is the traditional “bench to bedside” health research pipeline is terribly inefficient and ineffective at embedding research evidence into health care policy and practice. Several authors have examined the time lag between peer-reviewed health research publication, textbook content, and clinical implementation. These analyses suggest that on average, it takes 17 years for established research evidence to reach practice.
Elderly with no nearby family to help them need safety net, experts say (US)
Roughly 22 percent of adults over the age of 65 are elder orphans or are at risk of becoming elder orphans because they don’t have spouses, children, or siblings who live nearby, according to an analysis by Carney and three co-authors that was presented at the American Geriatrics Society’s 2015 annual meeting.
What a medical student learned after living in a nursing home for 10 days (US)
As a participant in this project I lived the life of an elder nursing home resident complete with standard procedures of care, such as being toileted, bathed and eating pureed foods. Because of my “stroke diagnosis” — I was not able to use my dominant right side — I had to wear an oxygen tube in my nose, use a wheelchair to get around, and rely on the staff to transfer me from my bed to the chair and my chair to the toilet.
The Decline of Tube Feeding for Dementia Patients (US)
The researchers, analyzing federal nursing home data, reported that in 2000, nearly 12 percent of patients with this terminal condition had feeding tubes inserted within a year of developing eating problems. By 2014, the rate had fallen to less than 6 percent. “It’s getting much less controversial” to decline a tube and rely on hand feeding, said Dr. Susan Mitchell, a geriatrician and senior scientist at the Harvard-affiliated Hebrew SeniorLife Institute for Aging Research. “This is becoming the prevailing wisdom.”
Who Will Care For Us As We Age? New Research Raises Big Questions (US)
They help with dressing, bathing and eating, assisting older people and people with disabilities in their homes and in nursing homes—yet many live in poverty and without health insurance.
How dementia makes it harder to offer end-of-life comfort (US)
Hospice’s purpose is to ease a dying patient’s pain at the end of life and improve the quality of that life. But what’s to be done when a dementia patient in her waning days can’t communicate about her pain or help identify the cause? Or when that patient resists taking medications?
Even a Little Exercise May Help Stave Off Dementia (US)
Seniors who get little to no exercise have a 50 percent greater risk of dementia compared with those who regularly take part in moderate or heavy amounts of physical activity, the researchers found.
Alzheimer’s may affect your relationships
While your abilities may change over time with Alzheimer’s, how you continue to be a partner in your relationships can impact your ability to live well with the disease. Establishing and maintaining meaningful relationships throughout your Alzheimer’s experience can enhance your ability to stay both physically and emotionally healthy.
Feeding tubes for people with Alzheimer’s disease: When you need them – and when you don’t
Feeding tubes usually aren’t helpful for severe Alzheimer’s disease. People with severe Alzheimer’s disease can no longer communicate or do basic things. Chewing and swallowing is often hard. This can cause serious problems, such as weight loss, weakness, and pressure sores. Or food can get into the lungs, and cause pneumonia. So people often need help to eat.
Study Finds Benefits When Seniors Call Shots To Help Them (US)
A federally funded project that researchers say has potential to promote aging in place began by asking low-income seniors with disabilities how their lives at home could be better.
Researchers Confront an Epidemic of Loneliness (US)
Loneliness, which Emily Dickinson described as “the Horror not to be surveyed,” is a quiet devastation. But in Britain, it is increasingly being viewed as something more: a serious public health issue deserving of public funds and national attention.
American Sociological Association report suggests standards by which departments may consider social media activity and other public communications in tenure and promotion decisions.
Success and failure CVs: Academic accountability or smoke and mirrors?
A lot of attention has been paid recently to the notion of a “failure CV” after Princeton University professor Johannes Haushofer posted online a list he called his “CV of Failures,” (PDF) with headings like “paper rejections” and “research funding I did not get.” Many academics will have chuckled at the familiarity of the story, as we encounter such defeats with unsettling regularity.
Gender Bias and the Peer Review Process
Despite increased efforts to improve gender equality in academia, gender bias still affects many areas of science. Anecdotal evidence abounds, and recent studies demonstrate continuing discrimination against women during recruitment and underrepresentation of female researchers in positions of prestige.
Journal to rank peer reviewers to improve response times
A behavioural economics journal is trialling a novel and controversial way of making sure peer reviewers submit their reviews on time – releasing a ranking of how quickly they respond. Advocates of the pilot scheme by the Journal of Behavioral and Experimental Economics argue that it will reward speedy reviewers, but critics say that it will only make academics more “fed up” of offering “free labour” to journals.
The Insidious Imps of Writing (US)
Academics must write. Otherwise they don’t pass their grad courses, finish their dissertations, or get jobs, promotions, and raises. But barring us from success are the Imps of Inertia and the Wall of Habitual Self.
Some Things I Know About Getting Published (US)
Over the years, I’ve offered plenty of advice on being productive and writing well. So here I’d like to share some things I learned about publishing — both from working in the business and from being an author.
What Puts #seriousacademics Off Social Media?
What emerges is a clear message: social media is not a thing apart. It’s a conference (“a meeting of people with a shared interest“). It’s a publication (“the action of making something generally known“). It’s a discussion group. It’s a journals club. It’s media engagement, it’s public engagement. It’s simply a different way of facilitating the same fundamental behaviors that have always driven academia. Social media is now woven into the fabric of how we communicate.
Is it time to take PhD supervisions out of the classroom? (UK)
Walking supervision sessions around Birmingham and pub-based academic chats have won praise from PhD candidates.
Resources
A Toolkit for Reducing Inappropriate Use of Antipsychotics in Long Term Care
This toolkit was created to support interventions to reduce excessive use of antipsychotic medications in long term care facilities. Its content is derived from the Appropriate Use of Antipsychotics (AUA) Toolkit developed by Alberta Health Services. It can be used by physician groups, clinical services or organizations to help achieve reductions in antipsychotic prescribing.
Delirium, Dementia, and Depression in Older Adults: Assessment and Care
This nursing Best Practice Guideline (BPG) from the Registered Nurses’ Association of Ontario replaces the 2010 BPGs Screening for Delirium, Dementia and Depression in Older Adults and Caregiving Strategies for Older Adults with Delirium, Dementia and Depression.
We welcome the launch of the Department of Health’s new Dementia Atlas. This interactive colour-coded map will allow people with dementia, their families and carers to make meaningful comparisons about the quality of dementia care in their area.
Report of the Independent Expert on the Enjoyment of All Human Rights by Older Persons
Older persons face a number of particular challenges in the enjoyment of their human rights that need to be addressed urgently.
Quick Stats are a series of free, publicly available, reports that provide aggregate-level data about health care in Canada. There is data on Canadian continuing care facilities available. Select “Community Care” under Topic.
CCNA Discoveries Revealed at AAIC
Articles include: Nutrition, Exercise and Lifestyle in Alzheimer’s Disease Prevention; Issues in Dementia Care for Indigenous Populations; Frailty, Cognitive Decline, and Quality of Life: Does Social Context Matter?
In Canada, the number of seniors receiving care in LTC homes has risen from 203,000 in 1986 to 240,000 in 1996 (National Advisory Council on Aging, 1999) and this number is continuing to increase. Projections for 2031 suggest that the number of LTC beds will triple or even quadruple.
Opportunities
Postdoctoral Fellowship – Longitudinal Monitoring System
Under the direction of the core TREC TMS study team, the successful fellow will play a major role in analysis, interpretation and the production of scientific outputs and stakeholder dissemination and reports.
