BACKGROUND: Initiatives to accelerate the adoption and implementation of evidence-based practices benefit from an association with influential individuals and organizations. When opinion leaders advocate or adopt a best practice, others adopt too, resulting in diffusion. We sought to identify existing influence throughout Canada’s long-term care sector and the extent to which informal advice-seeking relationships tie the sector together as a network. METHODS: We conducted a sociometric survey of senior leaders in 958 long-term care facilities operating in 11 of Canada’s 13 provinces and territories. We used an integrated knowledge translation approach to involve knowledge users in planning and administering the survey and in analyzing and interpreting the results. Responses from 482 senior leaders generated the names of 794 individuals and 587 organizations as sources of advice for improving resident care in long-term care facilities. RESULTS: A single advice-seeking network appears to span the nation. Proximity exhibits a strong effect on network structure, with provincial inter-organizational networks having more connections and thus a denser structure than interpersonal networks. We found credible individuals and organizations within groups (opinion leaders and opinion-leading organizations) and individuals and organizations that function as weak ties across groups (boundary spanners and bridges) for all studied provinces and territories. A good deal of influence in the Canadian long-term care sector rests with professionals such as provincial health administrators not employed in long-term care facilities. CONCLUSIONS: The Canadian long-term care sector is tied together through informal advice-seeking relationships that have given rise to an emergent network structure. Knowledge of this structure and engagement with its opinion leaders and boundary spanners may provide a route for stimulating the adoption and effective implementation of best practices, improving resident care and strengthening the long-term care advice network. We conclude that informal relational pathways hold promise for helping to transform the Canadian long-term care sector.
Calls for Abstracts
CALL FOR ABSTRACTS: August 8-10, 2018, Toronto
IFA 14th Global Conference on Ageing
The International Program and Advisory Committee (IPAC) is pleased to invite authors to submit abstracts for oral, symposium, workshop, and poster presentations, to be delivered at the International Federation on Ageing 14th Global Conference: Towards a Decade of Healthy Ageing. The IFA 14th Global Conference on Ageing will be held in Toronto from August 8-10, 2018. The Global Conference will revolve around four categories of themes related to the field of ageing, and will feature prominent experts presenting upon critical issues. The conference is proud to be supported by an international network of partners.
CALL FOR ABSTRACTS: 15-16 June in Quebec City
KT Canada Scientific Meeting
We invite you to join the discussion on KT in Primary Care through attendance at the KT Canada Annual Scientific Meeting. We invite interested people to submit an abstract on any topic related to advancing KT science.
CALL FOR ABSTRACTS: 46th Annual Scientific and Educational Meeting Canadian Association on Gerontology — 19-21 October, Winnipeg
CAG2017: Evidence for Action in an Aging World
CAG2017 is the 46th Annual Scientific and Educational Meeting of the Canadian Association on Gerontology, Canada’s premier association of those who work, research or have an interest in the field of aging. CAG members receive reduced rates to attend CAG2017, among other benefits.
Grants & Awards
The specific objectives of this funding opportunity are: to support planning activities, partnership development and/or increasing understanding of the health research landscape that will contribute to the advancement of research consistent with the mandate of CIHR; and/or; to support dissemination events/activities that focus on the communication of health research evidence to the appropriate researcher and/or knowledge user audience(s), tailoring the message and medium as appropriate.
The overarching aim is to find ways to improve the health and wellbeing of older people, to enable less active elderly to be more engaged in, and more active contributors to wider society, and to do this in cost effective ways.
AGE-WELL and HACKING HEALTH have teamed up to launch a national ideathon focused on identifying and investing in great new ideas (technologies and services) to support healthy aging. The first national competition of its kind, prizes awarded at the AGE-WELL – HACKING HEALTH National Ideathon will total $75,000 in cash and in-kind services. An ideathon is a collaborative event where diverse stakeholders harness their collective knowledge and creativity to brainstorm innovative solutions to pressing challenges. Participants use user-centric design techniques and methodologies (such as ideation, journey mapping, and prototyping), and the creation of an initial business case, to propose a novel solution. Local ideathons will take place in four cities: Toronto, Montreal, Halifax and Vancouver. The national ideathon will culminate in a finale to be held in Winnipeg at the AGE-WELL 2017 Annual Conference taking place on Oct. 17-19, 2017.
Family caregivers are an integral and increasingly overburdened part of the health care system. There is a gap between what research evidence shows is beneficial to caregivers and what is actually provided. Using an integrated knowledge translation approach, a stakeholder meeting was held among researchers, family caregivers, caregiver associations, clinicians, health care administrators, and policy makers. The objectives of the meeting were to review current research evidence and conduct multi-stakeholder dialogue on the potential gaps, facilitators, and barriers to the provision of caregiver supports. A two-day meeting was attended by 123 individuals. Three target populations of family caregivers were identified for discussion: caregivers of seniors with dementia, caregivers in end-of-life care, and caregivers of frail seniors with complex health needs. The results of this meeting can and are being used to inform the development of implementation research endeavours and policies targeted at providing evidence-informed caregiver supports.
Purpose The study was done to verify evidence-based practice (EBP) readiness and factors contributing to EBP competency in general hospital nurses. Methods Participants were 219 nurses working in 7 general hospitals in G-city and J Province. Data were collected from May 12 to May 28, 2015 and analyzed using one-way ANOVA, Pearson’s correlation and stepwise multiple regression. Results Mean score for EBP competency was 3.89±0.83, for critical thinking disposition, 3.35±0.36, for EBP attitude, 3.53±0.66, for beliefs about value of EBP, 3.42±0.56, for ability in research performance, 2.86±0.57, for time to devote to EBP, 2.57±0.69 and for organization support for EBP, 3.36±0.46. EBP competency was significantly correlated with critical thinking disposition (r=.37, p<.001), beliefs about value of EBP (r=.43, p<.001), ability in research performance (r=.44, p<.001), and time to devote to EBP(r=.33, p<.001). Factors influencing EBP competency in general hospital nurses were research performance (ß=.29, p<.001), beliefs about value of EBP (ß=.24, p<.001), critical thinking disposition (ß=.15, p=.014), recognition of EBP (ß=-.18, p=.002), which together explained 35% of total variance. Conclusion Findings indicate that introduction and activation of EBP in general hospitals is essential and development of systematic training programs to strengthen critical thinking disposition and EBP competency are needed.
BACKGROUND: Systematic reviews are important for decision makers. They offer many potential benefits but are often written in technical language, are too long, and do not contain contextual details which make them hard to use for decision-making. There are many organizations that develop and disseminate derivative products, such as evidence summaries, from systematic reviews for different populations or subsets of decision makers. This systematic review aimed to (1) assess the effectiveness of evidence summaries on policymakers’ use of the evidence and (2) identify the most effective summary components for increasing policymakers’ use of the evidence. We present an overview of the available evidence on systematic review derivative products. METHODS: We included studies of policymakers at all levels as well as health system managers. We included studies examining any type of “evidence summary,” “policy brief,” or other products derived from systematic reviews that presented evidence in a summarized form. The primary outcomes were the (1) use of systematic review summaries in decision-making (e.g., self-reported use of the evidence in policymaking and decision-making) and (2) policymakers’ understanding, knowledge, and/or beliefs (e.g., changes in knowledge scores about the topic included in the summary). We also assessed perceived relevance, credibility, usefulness, understandability, and desirability (e.g., format) of the summaries. RESULTS: Our database search combined with our gray literature search yielded 10,113 references after removal of duplicates. From these, 54 were reviewed in full text, and we included six studies (reported in seven papers) as well as protocols from two ongoing studies. Two studies assessed the use of evidence summaries in decision-making and found little to no difference in effect. There was also little to no difference in effect for knowledge, understanding or beliefs (four studies), and perceived usefulness or usability (three studies). Summary of findings tables and graded entry summaries were perceived as slightly easier to understand compared to complete systematic reviews. Two studies assessed formatting changes and found that for summary of findings tables, certain elements, such as reporting study event rates and absolute differences, were preferred as well as avoiding the use of footnotes. CONCLUSIONS: Evidence summaries are likely easier to understand than complete systematic reviews. However, their ability to increase the use of systematic review evidence in policymaking is unclear. TRIAL REGISTRATION: The protocol was published in the journal Systematic Reviews (2015;4:122).
PURPOSE: The objective of this study was to identify trends and gaps in the field of implementation science in genomic medicine. METHODS: We conducted a literature review using the Centers for Disease Control and Prevention’s Public Health Genomics Knowledge Base to examine the current literature in the field of implementation science in genomic medicine. We selected original research articles based on specific inclusion criteria and then abstracted information about study design, genomic medicine, and implementation outcomes. Data were aggregated, and trends and gaps in the literature were discussed. RESULTS: Our final review encompassed 283 articles published in 2014, the majority of which described uptake (35.7%, n = 101) and preferences (36.4%, n = 103) regarding genomic technologies, particularly oncology (35%, n = 99). Key study design elements, such as racial/ethnic composition of study populations, were underreported in studies. Few studies incorporated implementation science theoretical frameworks, sustainability measures, or capacity building. CONCLUSION: Although genomic discovery provides the potential for population health benefit, the current knowledge base around implementation to turn this promise into a reality is severely limited. Current gaps in the literature demonstrate a need to apply implementation science principles to genomic medicine in order to deliver on the promise of precision medicine.
One aim of dissemination and implementation (DI) research is to study the translation of evidence-based treatments (EBTs) from the research environments of their development and testing to broader communities where they are needed. There are few behavioral medicine DI studies and none in cancer survivorship. A determinant model (Setting, Therapist, Education, imPlementation, and Sustainability (STEPS)) was used to conceptualize DI of mental health treatment and frame a longitudinal study of implementation of a behavioral medicine EBT-a biobehavioral intervention (BBI) for cancer patients. Using effective dissemination strategies, therapists were trained in the BBI and followed to determine if implementation occurred. Participants (N = 108) were psychologists, social workers, and other oncology mental health providers from diverse settings to whom the BBI had been disseminated. BBI trainers then provided 6 months of support for implementation (e.g., monthly conference calls). Therapists reported number of patients treated, with or without the BBI, at 2, 4, and 6 months; use of support strategies was tracked. Generalized linear mixed models show that the proportion of patients treated with BBI ranged from 58 to 68%, with a 2% increase across follow-ups. Therapist and setting characteristics did not predict usage. Implementation of a behavioral medicine EBT provides a “real-world” demonstration of a BBI moved from the research setting to diverse communities. As the first study in cancer, it is an encouraging example of training and supporting mental health providers to deliver evidence-based psychological treatment and finding their success in doing so.
Despite the central role of training and consultation in the implementation of evidence-based psychological interventions (EBPIs), comprehensive reviews of research on training have highlighted serious gaps in knowledge regarding best practices. Consultation after initial didactic training appears to be of critical importance, but there has been very little research to determine optimal consultation format or interventions. This observational study compared two consultation formats that included review of session audio and feedback in the context of a program to train clinicians (n = 85) in community mental health clinics to deliver cognitive therapy (CT). A “gold standard” condition in which clinicians received individual feedback after expert consultants reviewed full sessions was compared to a group consultation format in which short segments of session audio were reviewed by a group of clinicians and an expert consultant. After adjusting for potential baseline differences between individuals in the two consultation conditions, few differences were found in terms of successful completion of the consultation phase or in terms of competence in CT at the end of consultation or after a 2 year follow-up. However, analyses did not support hypotheses regarding non-inferiority of the group consultation condition. While both groups largely maintained competence, clinicians in the group consultation condition demonstrated increases in competence over the follow-up period, while a sub-group of those in the individual condition experienced decreases. These findings, if replicated, have important implications for EBP implementation programs, as they suggest that observation and feedback is feasible in community mental health setting, and that employing this method in a group format is an effective and efficient consultation strategy that may enhance the implementation and sustainability of evidence-based psychotherapies.
Abstract What challenges do researchers face when leading transdisciplinary integration? We address this question by analyzing transdisciplinary integration within four thematic synthesis processes of the Swiss National Research Programme (NRP 61) on Sustainable Water Management. We adapt an existing analytical framework to compare transdisciplinary integration across the four synthesis processes regarding different types of generated knowledge (systems, target and transformation knowledge), different types of involved actors (core team, steering committee, advisory board, scientific experts and practice experts) and different levels of actor involvement (information, consultation and collaboration) at different stages of the processes. Based on a structured ex-post self-evaluation of the four synthesis processes, we present core challenges of transdisciplinary integration as perceived by core team members of the four synthesis processes and formulate empirically derived recommendations for designing and implementing future processes. We suggest that future synthesis processes should be conceptualized and initiated concurrently with all other individual research projects, involving a phasing-in stage where leaders conceptualize transdisciplinary integration, an intermediate stage of intense knowledge integration involving all relevant actor groups in a functional and dynamic way, and a final phasing out stage, where synthesis results are consolidated within the research program, validated by different actor groups and diffused to the target audiences. We argue that transdisciplinary integration requires professional competences, management skills and enough time. Finally, we suggest fostering communities of practice (CoP) to link committed leaders and enable mutual learning processes beyond the boundaries of individual synthesis projects or research programs.
Public health and other community-based practitioners have access to a growing number of evidence-based interventions (EBIs), and yet EBIs continue to be underused. One reason for this underuse is that practitioners often lack the capacity (knowledge, skills, and motivation) to select, adapt, and implement EBIs. Training, technical assistance, and other capacity-building strategies can be effective at increasing EBI adoption and implementation. However, little is known about how to design capacity-building strategies or tailor them to differences in capacity required across varying EBIs and practice contexts. To address this need, we conducted a scoping study of frameworks and theories detailing variations in EBIs or practice contexts and how to tailor capacity-building to address those variations. Using an iterative process, we consolidated constructs and propositions across 24 frameworks and developed a beginning theory to describe salient variations in EBIs (complexity and uncertainty) and practice contexts (decision-making structure, general capacity to innovate, resource and values fit with EBI, and unity vs. polarization of stakeholder support). The theory also includes propositions for tailoring capacity-building strategies to address salient variations. To have wide-reaching and lasting impact, the dissemination of EBIs needs to be coupled with strategies that build practitioners’ capacity to adopt and implement a variety of EBIs across diverse practice contexts.
BACKGROUND: Workforce development is an important aspect of evidence-informed decision making (EIDM) interventions. The structure of formal and informal social networks can influence, and be influenced, by the implementation of EIDM interventions. METHODS: In a mixed methods study we assessed the outcomes of a targeted training intervention to promote EIDM among the staff in three public health units in Ontario, Canada. This report focuses on the qualitative phase of the study in which key staff were interviewed about the process of engagement in the intervention, communications during the intervention, and social consequences. RESULTS: Senior managers identified staff to take part in the intervention. Engagement was a top-down process determined by the way organizational leaders promoted EIDM and the relevance of staff’s jobs to EIDM. Communication among staff participating in the workshops and ongoing progress meetings was influential in overcoming personal and normative barriers to implementing EIDM, and promoted the formation of long-lasting social connections among staff. Organization-wide presentations and meetings facilitated the recognition of expertise that the trained staff gained, including their reputation as experts according to their peers in different divisions. CONCLUSION: Selective training and capacity development interventions can result in forming an elite versus ordinary pattern that facilitates the recognition of in-house qualified experts while also strengthening social status inequality. The role of leadership in public health units is pivotal in championing and overseeing the implementation process. Network analysis can guide and inform the design, process, and evaluation of the EIDM training interventions.
BACKGROUND: The Quick-EBP-VIK is a new instrument for measuring nurses’ value, implementation, and knowledge of EBP. Psychometric testing was conducted in two parts. Part 1 describes the tool development and validity testing which resulted in the development of a 25-item survey after receiving >/=0.80 Item-Level Content Validity Index for both clarity and relevance. Part 2 describes psychometric testing was necessary to assess additional types of validity and reliability. AIM: The purpose of this paper is to further describe the psychometric testing of the Quick-EBP-VIK survey instrument. METHODS: This descriptive study was designed to assess test-retest reliability, internal consistency and construct validity via a web-based survey. The survey instrument was e-mailed to all nurses at the study hospital. Nurses who responded to the first survey (Wave 1) received another e-mail invitation to complete the survey instrument again (Wave 2) for the purpose of assessing the test-retest reliability of the instrument. RESULTS: A total of 1,177 deliverable e-mails were sent to all nursing staff at one free standing pediatric hospital with Magnet(R) designation in the northeast. A total of 382 nurses returned completed surveys, indicating a 32.5% response rate for Wave 1. A total of 131 nurses responded to Wave 2 indicating a response rate of 34.3%. The intraclass correlation coefficients for the items included in the final instrument ranged from 0.43 to 0.80 and were deemed sufficient. These represent a sufficient intraclass correlation coefficient. The Cronbach’s Alpha values for each of the three domains are all higher than 0.7 indicating that the items of each of the measurement dimension are internally consistent. However, the composite reliability of the third domain was slightly lower than 0.7 when using Raykov’s Rho. LINKING EVIDENCE TO ACTION: The Quick-EBP-VIK instrument has gone through rigorous comprehensive testing and has demonstrated good psychometric properties.
Health Care Administration and Organization
As people living with HIV (PLHIV) age, knowledge of HIV and the associated care of those aging with HIV will become an increasingly important component of education for long-term care (LTC) providers. This descriptive study piloted two different approaches to distribute narrative-based HIV educational videos. Four LTC facilities were assigned to receive the videos to implement ‘as usual’ or to receive the videos in addition to blended learning sessions where the videos were shown with facilitated discussion with a nurse educator and a PLHIV. In LTC facilities where external educators were provided, a larger proportion of staff watched the videos. However, increases in staff comfort level providing care to PLHIV were comparable between both groups. Narratives of PLHIV, administrator engagement and coordination of online education were identified as facilitators to improving HIV knowledge and compassion in LTC, while fear of HIV transmission and limited time for education, especially when not mandated or identified as immediately applicable, were identified as barriers. From our findings, HIV-related stigma still exists in LTC and these videos may be a strategy for disseminating basic knowledge about HIV transmission and sensitizing staff to the experience of living with HIV.
OBJECTIVES: To determine the effect and cost-effectiveness of training nonnursing staff to provide feeding assistance for nutritionally at-risk nursing home (NH) residents. DESIGN: Randomized, controlled trial. SETTING: Five community NHs. PARTICIPANTS: Long-stay NH residents with an order for caloric supplementation (N = 122). INTERVENTION: Research staff provided an 8-hour training curriculum to nonnursing staff. Trained staff were assigned to between-meal supplement or snack delivery for the intervention group; the control group received usual care. MEASUREMENTS: Research staff used standardized observations and weighed-intake methods to measure frequency of between-meal delivery, staff assistance time, and resident caloric intake. RESULTS: Fifty staff (mean 10 per site) completed training. The intervention had a significant effect on between-meal caloric intake (F = 56.29, P < .001), with the intervention group consuming, on average, 163.33 (95% CI = 120.19-206.47) calories per person per day more than the usual care control group. The intervention costs were $1.27 per person per day higher than usual care (P < .001). The incremental cost-effectiveness ratio for the intervention was 134 kcal per dollar. The increase in cost was due to the higher frequency and number of snack items given per person per day and the associated staff time to provide assistance. CONCLUSION: It is cost effective to train nonnursing staff to provide caloric supplementation, and this practice has a positive effect on residents’ between-meal intake.
AIM: To understand nurses’ perceptions of the impact of the aged care reform on care and services for residents in multi-purpose services (MPS) and residential aged care facilities (RACF) in rural South Australia. METHODS: An interpretative study using semi-structured interviews. Participants comprised registered and enrolled nurses working with aged care residents in rural South Australia. Eleven nurses were interviewed, of these seven worked in MPS and four in RACF. RESULTS: Data were analysed for similarities and differences in participants’ experiences of care delivery between MPS and RACF. Common issues were identified relating to funding and resource shortfalls, staffing levels, skill mix and knowledge deficits. Funding and staffing shortfalls in MPS were related by participants to the lower priority given to aged care in allocating resources within MPS. Nurses in these services identified limited specialist knowledge of aged care and care deficits around basic nursing care. Nurses in RACF identified funding and staffing shortfalls arising from empty beds due to the introduction of the accommodation payment. Dependence upon care workers was associated with care deficits in complex care such as pain management, medication review and wound care. CONCLUSION: Further research is needed into the impact of recent reforms on the capacity to deliver quality aged care in rural regions.
Health Care Innovation and Quality Assurance
OBJECTIVES: This review aims to understand what elements of psychosocial interventions are associated with improved outcomes for people with dementia to inform implementation in care homes. DESIGN: A systematic review of qualitative and quantitative intervention studies was undertaken. ELIGIBILITY CRITERIA FOR INCLUDED STUDIES: We included primary research studies evaluating psychosocial interventions that trained care home staff to deliver a specific intervention or that sought to change how staff delivered care to residents with dementia and reported staff and resident qualitative or quantitative outcomes. METHODS: We searched MEDLINE, PsychINFO and EMBASE electronic databases and hand-searched references up to May 2016. Quality of included papers was rated independently by 2 authors, using operationalised checklists derived from standard criteria. We discussed discrepancies and reached consensus. We conducted a narrative synthesis of quantitative and a thematic synthesis of qualitative findings to find what was effective immediately and in sustaining change. RESULTS: We identified 49 papers fulfilling predetermined criteria. We found a lack of higher quality quantitative evidence that effects could be sustained after psychosocial interventions finished with no evidence that interventions continued to work after 6 months. Qualitative findings suggest that staff valued interventions focusing on getting to know, understand and connect with residents with dementia. Successful elements of interventions included interactive training, post-training support, aiming to train most staff, retaining written materials afterwards and building interventions into routine care. CONCLUSIONS: Psychosocial interventions can improve outcomes for staff and residents with dementia in care homes; however, many trial results are limited. Synthesis of qualitative findings highlight core components of interventions that staff value and feel improve care. These findings provide useful evidence to inform the development of sustainable, effective psychosocial interventions in care homes. TRIAL REGISTRATION NUMBER: CRD42015017621.
OBJECTIVES: The main objective was to investigate the applicability and effectiveness of quality improvement initiatives in decreasing the rate of avoidable 30-day, skilled nursing facility (SNF)-to-hospital readmissions. PROBLEM: The rate of rehospitalizations from SNF within 30 days of original discharge has increased within the last decade. SETTING: The research team participants conducted a literature review via Cumulative Index of Nursing and Allied Health Literature and PubMed to collect data about quality improvement implemented in SNFs. RESULTS: The most common facilitator was the incorporation of specialized staff. The most cited barriers were quality improvement tracking and implementation. CONCLUSION: These strategy examples can be useful to acute care hospitals attempting to lower bounce back from subacute care providers and long-term care facilities seeking quality improvement initiatives to reduce hospital readmissions.
INTRODUCTION: Government-funded quality improvement projects aimed to reduce the high psychotropic medication use in Belgian long-term care settings. DESIGN: A pilot project (2013-2014) with a pre-post and follow-up intervention design. METHODS: Two nursing homes received three educational courses. In the intervention nursing home (INH) additionally, a transition towards person-centred care through professional support was applied. Drug use was recorded at baseline, after 10 months (post) and after 22 months (follow-up), and coded into the Anatomical Therapeutic Chemical classification. RESULTS: At baseline, the INH residents’ (n = 118) mean age at baseline was 82 years, with 71% females. The control nursing home residents’ (CNH, n = 275) mean age was 82.7 years, with 75% females. At baseline, mean drug use was 9 (range 1-21) and 8 (range 0-20), predominantly with a high proportion of psychotropic drug users of 73 and 65%, in INH and CNH respectively. At the time of post-measurement, only the proportion of hypno-sedative users decreased significantly in the INH (by 13%, p = 0.048). No significant changes were found in the CNH. At time of the follow-up, the proportion of hypno-sedative (51% vs. 31%; p = 0.005) and antidepressant users (42% vs. 25%, p = 0.007) decreased significantly in the INH. The decrease of antipsychotic drug users was less distinct. In the CNH, the proportion of hypno-sedative, antidepressant and overall psychotropic drug users did not change significantly. CONCLUSION: This quality improvement initiative led to a significant decrease in the use of psychotropic drugs in the INH, even after 1-year follow-up. Education only had a limited effect.
AIM: The aim of this study was to assess the effect of Play Up humour therapy on antipsychotic, benzodiazepine and antidepressant use in Australian nursing homes. METHODS: Play Up is a humour therapy program that has been implemented in Australian nursing homes. This study was an uncontrolled retrospective review of psychotropic medication charts of 406 residents in thirty-three nursing homes before and after 12 weeks of participation in Play Up. Prevalence and mean daily equivalent doses of psychotropic medication use were analysed. RESULTS: There were significant reductions from before to after the Play Up program in the prevalence of any psychotropic medication use, antipsychotic use and benzodiazepine use (P = 0.001, 0.02, 0.007, respectively). Mean daily dose equivalents of pro re nata (PRN) antipsychotics and PRN benzodiazepines significantly reduced over time (P = 0.007; P = 0.001). CONCLUSIONS: Play Up was associated with an overall decline in the use of psychotropic medications. Further trials are required to confirm and better define this association.
BACKGROUND: The literature suggests that person-centred care can contribute to quality of life and wellbeing of nursing home residents, relatives and staff. However, there is sparse research evidence on how person-centred care can be operationalised and implemented in practice, and the extent to which it may promote wellbeing and satisfaction. Therefore, the U-Age nursing home study was initiated to deepen the understanding of how to integrate person-centred care into daily practice and to explore the effects and meanings of this. METHODS: The study aims to evaluate effects and meanings of a person-centred and thriving-promoting intervention in nursing homes through a multi-centre, non-equivalent controlled group before-after trial design. Three nursing homes across three international sites have been allocated to a person-centred and thriving-promoting intervention group, and three nursing homes have been allocated to an inert control group. Staff at intervention sites will participate in a 12-month interactive educational programme that operationalises thriving-promoting and person-centred care three dimensions: 1) Doing a little extra, 2) Developing a caring environment, and 3) Assessing and meeting highly prioritised psychosocial needs. A pedagogical framework will guide the intervention. The primary study endpoints are; residents’ thriving, relatives’ satisfaction with care and staff job satisfaction. Secondary endpoints are; resident, relative and staff experiences of the caring environment, relatives’ experience of visiting their relative and the nursing home, as well as staff stress of conscience and perceived person-centredness of care. Data on study endpoints will be collected pre-intervention, post-intervention, and at a six-month follow up. Interviews will be conducted with relatives and staff to explore experiences and meanings of the intervention. DISCUSSION: The study is expected to provide evidence that can inform further research, policy and practice development on if and how person-centred care may improve wellbeing, thriving and satisfaction for people who reside in, visit or work in nursing homes. The combination of quantitative and qualitative data will illuminate the operationalisation, effects and meaning of person-centred and thriving-promoting care.
Research Practice and Methodology
A key requirement for a useful power calculation is that the calculation mimic the data analysis that will be performed on the actual data, once it is observed. Close approximations may be difficult to achieve using analytic solutions, however, and thus Monte Carlo approaches, including both simulation and bootstrap resampling, are often attractive. One setting in which this is particularly true is cluster-randomized trial designs. However, Monte Carlo approaches are useful in many additional settings as well. Calculating power for cluster-randomized trials using analytic or simulation-based methods is frequently unsatisfactory due to the complexity of the data analysis methods to be employed and to the sparseness of data to inform the choice of important parameters in these methods.
Objective: This study examines the impact of the transition process on the mortality of elderly individuals following their first admission to nursing home from the community at 1, 3, and 6 months postadmission, and causes and risk factors for death. Method: A systematic review of relevant studies published between 2000 and 2015 was conducted using key search terms: first admission, death, and nursing homes. Results: Eleven cohort studies met the inclusion criteria. Mortality within the first 6 month postadmission varied from 0% to 34% (median = 20.2). Causes of deaths were not reported. Heightened mortality was not wholly explained by intrinsic resident factors. Only two studies investigated the influence of facility factors, and found an increased risk in facilities with high antipsychotics use. Discussion: Mortality in the immediate period following admission may not simply be due to an individual?s health status. Transition processes and facility characteristics are potentially independent and modifiable risk factors.; Objective: This study examines the impact of the transition process on the mortality of elderly individuals following their first admission to nursing home from the community at 1, 3, and 6 months postadmission, and causes and risk factors for death. Method: A systematic review of relevant studies published between 2000 and 2015 was conducted using key search terms: first admission, death, and nursing homes. Results: Eleven cohort studies met the inclusion criteria. Mortality within the first 6 month postadmission varied from 0% to 34% (median = 20.2). Causes of deaths were not reported. Heightened mortality was not wholly explained by intrinsic resident factors. Only two studies investigated the influence of facility factors, and found an increased risk in facilities with high antipsychotics use. Discussion: Mortality in the immediate period following admission may not simply be due to an individual?s health status. Transition processes and facility characteristics are potentially independent and modifiable risk factors.
Some people say the only way to manage behaviors and symptoms that have become associated with dementia is to medicate people with dementia. Those people are dead wrong. Yes, antipsychotics such as risperidone, quetiapine, and others may be used judiciously to address potentially dangerous situations and/or real psychosis. However, geriatricians and eldercare experts worldwide agree that when antipsychotic medication is given to elderly people with dementia it should be at the lowest possible dose for the shortest possible time and always after all other avenues have been tried and have failed. In other words, these medications should only be used as a last resort.
OBJECTIVE: We describe the implementation of cognitive measures within the Canadian Longitudinal Study on Aging (CLSA), a nationwide, epidemiological study of aging, and relate CLSA Tracking cohort data (n over 20,000) to previous studies using these measures. METHOD: CLSA participants (aged 45-85, n over 50,000) provided demographic, social, physical/clinical, psychological, economic, and health service utilization information relevant to health and aging through telephone interviews (Tracking cohort, n over 20,000) or in-person (i.e. Comprehensive cohort, n over 30,000) in both official languages (i.e. English, French). Cognitive measures included: the Rey Auditory Verbal Learning Test (RAVLT) – Trial 1 and five-minute delayed recall; Animal Fluency (AF), the Mental Alternation Test (MAT) (both cohorts); Controlled Oral Word Association Test, Stroop Test, Prospective Memory Test, and Choice reaction times (Comprehensive Cohort). RESULTS: Performance on the RAVLT Trial 1 and AF were very similar to comparable groups studied previously; CLSA sample sizes were far larger. Within the CLSA Tracking cohort, main effects of age and language were observed for all cognitive measures except RAVLT delayed recall. Interaction effects (language x age) were observed for AF. CONCLUSION: This preliminary examination of the CLSA Tracking cognitive measures lends support to their use in large studies of aging. The CLSA has the potential to provide the ‘best’ comparison data for adult Canadians generated to date and may also be applicable more broadly. Future studies examining relations among the psychological, biological, health, lifestyle, and social measures within the CLSA will make unique contributions to understanding aging.
BACKGROUND: Hospital readmission in older persons is common and reported as a post-discharge adverse outcome from hospitalization. Readmission relates to a mix of factors associated with increasing age, living conditions, progression of disease as well as factors related to the processes of care. To allow health professionals to focus more intensively on patients at risk of readmission, there is a need to identify the characteristics of those patients. OBJECTIVES: To identify and synthesize the best available evidence on risk factors for acute care hospital readmission within one month of discharge in older persons in Western countries. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Participants were older persons from Western countries, hospitalized and discharged home or to residential care facilities. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: The factors of interest considered generic factors related to socio-demographics, health characteristics and clinical and organizational factors related to the care pathway. TYPES OF STUDIES: The current review considered analytical and descriptive epidemiological study designs that evaluated risk factors for acute care hospital readmission. OUTCOMES: The outcome was readmission to an acute care hospital within one month of discharge. SEARCH STRATEGY: A three-step search was utilized to find published and unpublished studies in English, French, German, Norwegian, Swedish or Danish. Five electronic databases were searched from 2004 to 2013, followed by a manual search for additional studies. METHODOLOGICAL QUALITY: Methodological quality was assessed independently by two reviewers, using the standardized Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) critical appraisal tool. DATA EXTRACTION: Data were extracted verbatim using a data extraction form, which identified the components from the standardized JBI data extraction tool from JBI-MAStARI and was adapted to the needs of the present review. DATA SYNTHESIS: Due to the clinical and methodological heterogeneity of the studies included, a narrative summary and metasynthesis of the quantitative findings was conducted. RESULTS: Based on a review of nine studies from ten Western countries, we found several significant risk factors pertaining to readmission to an acute care hospital within one month of discharge in persons aged 65 years and over. Factors associated with higher risk of hospital readmission covered socio-demographics such as higher age, male gender, ethnicity, living conditions, health characteristics such as poor overall condition and functional disability as well as prior admissions. Organizational factors including length of hospital stay, method of referral and discharge destination were associated with increased risk of acute care hospital readmission. CONCLUSION: We found several significant, but inconsistent, associations between readmission to an acute care hospital within one month of discharge in persons aged 65 years and over. These associations involved a mix of socio-demographic factors, factors related to health and illness, previous hospitalizations, length of stay as well as clinical and organizational determinants related to the index admission. Although more studies concluded that certain diagnoses or comorbid conditions affected the risk of readmission, they did not agree on any disease in particular.Due to the breadth and diversity of variables examined and the lack of comparability of findings, the impact of these varying factors and their value as risk adjusters and application in different settings and populations are limited.
Despite widespread agreement that nursing homes’ use of antipsychotic medications for residents without specific psychiatric diagnoses is a marker of poor quality of care, prevalence remains high. Additionally, variation suggests continued opportunity to improve care even in countries, like the United States, that have long-standing policies designed to decrease antipsychotic medication use. In a recent Israel Journal of Health Policy Research article, Frankenthal et al. presented results linking increased antipsychotic medication use prevalence in Tel Aviv nursing homes with facility characteristics, including some that “undermine quality of care,” and called for increased national focus on this area. While we agree with the authors that government focus can help to decrease antipsychotic medication use, experience in the United States shows that such efforts may not be sufficient: we present data showing significant variation among United States nursing homes’ antipsychotic medication use prevalence after more than ten years of national warnings and programs. This suggests that United States nursing home clinicians and caregivers continue to need effective non-pharmacologic interventions to substitute for antipsychotic medications. We suggest expanded use of cluster-randomized trials to test strategies to withdraw residents from antipsychotic medications and to implement alternate, non-pharmacological approaches for addressing the behavioral and psychological symptoms of dementia.
OBJECTIVES: The aim of this study was to investigate whether twice-daily use of a rotating-oscillating power toothbrush (Oral-B Professional Care 1000 ) in nursing home (NH) residents over a 6-week period, compared to usual care (UC), would reduce periodontal inflammation. METHODS: In this repeated measures single-blinded randomized controlled trial, 59 residents of one NH in Winnipeg, Canada, were randomized to receive either twice-daily tooth brushing with a rotating-oscillating power toothbrush (PB) or UC by caregivers. Consent was obtained from residents or their proxies. Participants had some natural teeth, periodontal inflammation, non-aggressive behaviour, no communicable diseases, were non-smokers and non-comatose. Outcomes were measured at baseline and 6 weeks, which included: inflammation (MGI, Lobene), bleeding (PBI, Loesche) and Plaque (Turesky). Comparisons of group changes in outcomes were analysed using an ANOVA with a repeated measure. RESULTS: Of 59 original study participants, one withdrew, one died prior to study commencement and three died before study completion. All oral parameters improved significantly for the remaining 54 residents over time (P<.0001), with no differences between groups. CONCLUSIONS: These results demonstrate that it is possible for caregivers to improve periodontal inflammation of residents over a 6-week period. Despite no significant group differences, periodontal inflammation of all study participants improved significantly, particularly in the reduction of bleeding, a direct measure of periodontal inflammation, which is a unique finding.
BACKGROUND: There is a growing volume of research to offer improvements in nutritional care for people with dementia living in nursing homes. Whilst a number of interventions have been identified to support food and drink intake, there has been no systematic research to understand the factors for improving nutritional care from the perspectives of all those delivering care in nursing homes. The aim of this study was to develop a research informed model for understanding the complex nutritional problems associated with eating and drinking for people with dementia. METHODS: We conducted nine focus groups and five semi-structured interviews with those involved or who have a level of responsibility for providing food and drink and nutritional care in nursing homes (nurses, care workers, catering assistants, dietitians, speech and language therapists) and family carers. The resulting conceptual model was developed by eliciting care-related processes, thus supporting credibility from the perspective of the end-users. RESULTS: The seven identified domain areas were person-centred nutritional care (the overarching theme); availability of food and drink; tools, resources and environment; relationship to others when eating and drinking; participation in activities; consistency of care and provision of information. CONCLUSIONS: This collaboratively developed, person-centred model can support the design of new education and training tools and be readily translated into existing programmes. Further research is needed to evaluate whether these evidence-informed approaches have been implemented successfully and adopted into practice and policy contexts and can demonstrate effectiveness for people living with dementia.
BACKGROUND: There are approximately 426,000 people residing within care homes in the UK. Residents often have complex trajectories of dying, which make it difficult for staff to manage their end-of-life care. There is growing recognition for the need to support care homes staff in the care of these residents with increased educational initiatives. One educational initiative is The Six Steps to Success programme. METHOD: In order to evaluate the implementation of Six Steps with the first cohort of care homes to complete the end-of-life programme in the North West of England., a pragmatic evaluation methodology was implemented in 2012-2013 using multiple methods of qualitative data collection; online questionnaire with facilitators (n = 16), interviews with facilitators (n = 9) and case studies of care homes that had completed the programme (n = 6). The evaluation explored the implementation approach and experiences of the programme facilitators and obtain a detailed account of the impact of Six Steps on individual care homes. Based upon the National Health Service (NHS) End of Life Care (EoLC) Programme, The Route to Success in EoLC – Achieving Quality in Care Homes. RESULTS: The programme was flexibly designed so that it could be individually tailored to the geographical location and the individual cohort requirements. Facilitators provided comprehensive and flexible support to care homes. Challenges to programme success were noted as; lack of time allocated to champions to devote to additional programme work, inappropriate staff selected as ‘Champions’ and staff sickness/high staff turnover presented challenges to embedding programme values. Benefits to completing the programme were noted as; improvement in Advance Care Planning, improved staff communication/confidence when dealing with multi-disciplinary teams, improved end-of-life processes/documentation and increased staff confidence through acquisition of new knowledge and new processes. CONCLUSIONS: The findings suggested an overall positive impact from the programme. This flexibly designed programme continues to be dynamic, iteratively amended and improved which may affect the direct transferability of the results to future cohorts.
AIM: The objectives of the study were to investigate the lived experience of older people in residential aged care facilities (RACFs) in Australia, to explore their perceptions of their lives in RACFs and how care might be improved. METHODS: This qualitative study used a phenomenological approach to explore the lived experience of older persons in RACFs across two Australian states. In-depth interviews regarding independence, dignity, autonomy, communication and relationships were conducted with 18 participants. The interviews were audiotaped, transcribed and thematically analysed. RESULTS: Three themes emerged reflecting the reality of RACF life for these participants: (i) loss of autonomy, dignity and control; (ii) valuing important relationships; and (iii) resigned acceptance. CONCLUSION: Older people were not included in decision-making and found it difficult to maintain their autonomy and dignity, and forge meaningful relationships. They traded their independence and dignity for the safety and assistance they needed; however, they accepted this trade-off with stoicism and remained positive.
AIM: To compare the prevalence in residential aged care (RAC) of preventative and potentially inappropriate medications (PIMs) in those who died within 12 months versus those alive after 12 months. METHODS: Firstly, a cross-sectional survey of 6196 people living in RAC in Auckland. Secondly, a research physician searched electronic hospital records in one District Health Board for a sub-sample (n = 222) of these residents. Classes of medications and dates of death were obtained from the Ministry of Health databases. Those who died versus those alive at 12 months were compared. RESULTS: Over half of the 6196 participants received antihypertensives and/or antiplatelet agents. Cardiovascular preventative medications were significantly more common in those who died within 12 months. Seventy percent in high-level care received psychotropics. PIMs were commonly used. CONCLUSIONS: Use of preventative medications is common in RAC, especially during the last year of life. Psychotropics are very commonly used, despite being potentially inappropriate.
The PERFORM Centre will host its fourth annual research conference at the Oscar Peterson Concert Hall at Concordia University’s Loyola Campus in Montréal, Québec. This year’s theme is Physical Activity and Aging: Multidisciplinary Applications and will feature a series of lectures from internationally renowned scientists. Faculty, students and researchers from various disciplines and institutions across Canada are invited to participate in this multi-disciplinary event. Don’t miss this unique opportunity to network with prominent researchers in preventive health.
A leading international conference for health care professionals and academics involved in or interested in research relevant to nursing.
One of the key challenges those in residential senior living face is the presumption of absent, rather than diminished, abilities. Residents may become accustomed to being on the receiving end of services even though strong leadership abilities exist among them. Join us for part 2 of a webinar series on how to engage residents, volunteers, family and staff in building communities of purposeful living through fostering a culture of resident engagement and peer support. In this webinar, you will have an opportunity to evaluate a mixed-methods study conducted to explore the outcomes of an innovative peer mentoring program in 10 continuing-care settings in Ontario. The webinar will offer a takeaway strategy to implementing peer mentoring within an organization that encourages residents to seek out and support their lonely isolated peers.
In this webinar, co-presented by the National Collaborating Centres for Health Public Policy (NCCHPP) and Methods and Tools (NCCMT), and featuring Dr. Megan Ward from Peel Public Health, participants will discuss the evidence and ethics of a case involving choosing among interventions in order to best respond to public health priorities.
Class, retirement, and inequality in later life: Findings from the English Longitudinal Study of Ageing (ELSA), presented by James Nazroo, professor of sociology, director of the Centre on Dynamics of Ethnicity (CoDE) and co-director of the Manchester Institute for Collaborative Research on Ageing (MICRA) at the University of Manchester. He is the principal investigator of the fRaill programme, an interdisciplinary study of inequalities in later life, and co-principal investigator of ELSA, which is a multi-disciplinary panel study of those aged 50 and older, and part of an international ‘family’ of very similar studies.
This webinar is part of KT Connects Knowledge Translation Webinar Series. The presenter, Chris McBride, will discuss the role community organizations can play in integrated knowledge translation and the barriers and facilitators to community organization engagement in integrated knowledge translation projects and partnerships.
This webinar is part of the Advanced Topics in Implementation Science webinar hosted by the National Cancer Institute Division of Cancer Control & Population Sciences Implementation Science Team. The host, Dr. David Chambers, will speak with Dr. Karen Emmons and Dr. Lawrence Green about the interface between public health and implementation science, past, present, and future.
Applications are now open for the KT Canada Summer Institute. The purpose of this Summer Institute is to provide participants with the opportunity to increase their understanding of knowledge translation research as well as opportunities and challenges in this field. The Summer Institute will provide participants with the chance to network with colleagues including national and international KT experts.
$1850 workshop only, 10-12 April, Toronto — The workshop is designed for professionals in any health-related discipline (e.g., healthcare, public health, mental health) who are responsible for implementing programs. All participants must have an implementation project to work on throughout the workshop. Previous participants have come from a range of organizations (e.g., healthcare provider organizations, funding organizations, and government and quasi-government agencies) and have had a variety of backgrounds (e.g., educators, managers, clinicians, knowledge brokers, and researchers). Previous experience or training in KT or implementation science is required.
Application deadline 1 March. The UCSF Research in Implementation Science for Equity (RISE) program is part of the National Heart, Lung, and Blood Institute’s Program to Increase Diversity among Individuals Engaged in Health-Related Research (PRIDE). The goal of the PRIDE program is to enhance the diversity of the biomedical research workforce for junior faculty and transitioning post-doctorates from diverse backgrounds to enable them to become competitive independent scientists.
As a leading Canadian authority on the study of aging, McMaster University created the highly acclaimed McMaster Optimal Aging Portal in 2014 as a unique online health resource that supports the healthy aging goals of Canada’s growing senior population. The research team behind the Portal is now announcing the launch of French version of the Portal which can be found at www.mcmastervieillissementoptimal.org. The French language version of the portal is called the Portail sur le Vieillissement Optimal de McMaster.
Experts have pointed to increased drug utilization as a driver of health care spending in Canada for some years, but safety issues are increasingly salient. Seniors are five times more likely than younger Canadians to be hospitalized as a result of an adverse drug reaction (ADR). In 2011, over 27,000 Canadian seniors — that is, one in 200 — had an ADR-related hospitalization.
Pressure to bring in grants is steady and increasing, but with only 20% of US applications receiving funding, is the collective time spent writing multiple rejected applications actually worth it? Unless the pool of grant funding is massively increased at the federal level—a remote possibility—this is a zero-sum game.
With the Teaching Excellence Framework on the horizon, teaching is rightly becoming more important to universities, while students are acting more as consumers and seeking “value for money”. This means my university requires new staff like myself to gain teaching qualifications, to employ engaging teaching approaches, and become first-rate educators.
The spread of “best practices” is important in today’s rapidly evolving health care landscape where quality and outcomes matter more than ever. However, spread can be incredibly difficult to achieve.
In this study, Nicole Bernier examines the problem and consequences of unsafe and inappropriate use of prescription drugs by seniors and presents possible solutions. She observes that governments have relied heavily on the voluntary efforts of professional groups and patients to address the issue, when they could use legislation and financial instruments to much greater effect.
The Health System Impact Fellowship provides highly-qualified individuals with a doctorate degree in health services and policy research, or related fields, a unique opportunity to apply their research and analytic talents to critical challenges in health system and related organizations outside of the traditional scholarly setting (e.g., public, private for-profit, not-for-profit, and Indigenous health organizations that are not universities or research-focused institutes), and to develop professional experience, new skills, and networks. Fellows will be exposed to how the health system and related organizations work, how decisions are made, and how research and analytic skills can contribute to an organization’s performance. These awards provide fellows with a paid experiential learning opportunity within such organizations where they will dedicate between 70-100% of their time. Flexibility in the time commitment will enable fellows to make meaningful contributions to an employer’s program of work, become immersed in the culture and operations of the organization, and benefit from mentorship by executive leaders, while also making it possible to protect a portion of time for academic research.