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Pain Trajectories of Nursing Home Residents Nearing Death
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BACKGROUND/OBJECTIVES: Although examining point in time prevalence of pain among nursing home (NH) residents has value, there is a lack of evidence describing the actual changes (ie, trajectories) in pain that take place during their last 6 months of life. The main objective of this study is to describe the major pain trajectories experienced by NH residents during their last 6 months of life. DESIGN: Secondary analysis of Resident Assessment Instrument-Minimum Data Set (MDS) 2.0 data captured as part of the longitudinal Translating Research in Elder Care data repository. SETTING: Twenty-seven urban NHs in Western Canada. PARTICIPANTS: A total of 962 NH residents who died, had an MDS assessment completed within 30 days of death, and resided in a NH for at least 6 months. Pain trajectories were stratified by residents who were not severely cognitively impaired [Cognitive Performance Scale (CPS) /=4) at death. MEASUREMENTS: MDS-Pain Scale; CPS. RESULTS: In the 6 months before death, 60.1% of residents without severe cognitive impairment experienced consistently low pain; 34.6% reported experiencing either moderate to severe pain or significant increases in pain during this same period of time, and only 5.3% experienced any degree of pain improvement. When the trajectories were examined, most residents without severe cognitive impairment experienced no to mild pain in the time before their death (65.5%); however, we identified a group of residents who exhibited a pattern of pain that worsened or remained consistently high right until death (38.2%). Although the proportion of residents with “low/mild” pain trajectories was statistically greater among those who were severely impaired vs those without severe cognitive impairment, across both cognitive impairment groups, the general trend in pain trajectories is similar; with about 60% of residents experiencing either consistent low or mild pain in their last 6 months of life, and about 34% experiencing either substantially high or increasing pain levels. CONCLUSIONS: Although a majority of NH residents experienced consistently low or improved pain levels in their last 6 months of life, a substantial number experienced consistently high or substantially worsening pain levels during this same time period. These results highlight the need to better manage pain levels for some NH residents during this important period of time.
Grants & Awards
Applications open: MSFHR Reach Awards
New for 2017, the MSFHR Reach Awards will provide funding to support the dissemination and uptake of research evidence to inform and improve further research, practice and policy-making. Each award will consist of up to $10,000 to help teams of health researchers and research users collaboratively plan and implement dissemination activities, adapting messages and mode of delivery in order to reach audiences who can directly use the knowledge.
This Funding Opportunity Announcement (FOA) invites R18 grant applications for research projects to scale and spread existing clinical decision support (CDS) to facilitate the dissemination and implementation of evidence-based research findings into clinical practice. The purposes of this FOA are to extend the implementation (“scale”) and evaluation of well-established and effective CDS beyond the initial clinical setting or institution in which the CDS was originally developed and implemented, thereby extending the impact on clinical practice.
Publications
KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Practice and Methodology
Aging
KT
Perspectives of Frailty and Frailty Screening: Protocol for a Collaborative Knowledge Translation Approach and Qualitative Study of Stakeholder Understandings and Experiences
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BACKGROUND: Accompanying the unprecedented growth in the older adult population worldwide is an increase in the prevalence of frailty, an age-related clinical state of increased vulnerability to stressor events. This increased vulnerability results in lower social engagement and quality of life, increased dependency, and higher rates of morbidity, health service utilization and mortality. Early identification of frailty is necessary to guide implementation of interventions to prevent associated functional decline. Consensus is lacking on how to clinically recognize and manage frailty. It is unknown how healthcare providers and healthcare consumers understand and perceive frailty, whether or not they regard frailty as a public health concern; and information on the indirect and direct experiences of consumer and healthcare provider groups towards frailty are markedly limited. METHODS: We will conduct a qualitative study of consumer, practice nurse, general practitioner, emergency department physician, and orthopedic surgeons’ perspectives of frailty and frailty screening in metropolitan and non-metropolitan South Australia. We will use tailored combinations of semi-structured interviews and arts-based data collection methods depending on each stakeholder group, followed by inductive and iterative analysis of data using qualitative description. DISCUSSION: Using stakeholder driven approaches to understanding and addressing frailty and frailty screening in context is critical as the prevalence and burden of frailty is likely to increase worldwide. We will use the findings from the Perceptions of Frailty and Frailty Screening study to inform a context-driven identification, implementation and evaluation of a frailty-screening tool; drive awareness, knowledge, and skills development strategies across stakeholder groups; and guide future efforts to embed emerging knowledge about frailty and its management across diverse South Australian contexts using a collaborative knowledge translation approach. Study findings will help achieve a coordinated frailty and healthy ageing strategy with relevance to other jurisdictions in Australia and abroad, and application of the stakeholder driven approach will help illuminate how its applicability to other jurisdictions.
Using media to impact health policy-making: an integrative systematic review 
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INTRODUCTION: Media interventions can potentially play a major role in influencing health policies. This integrative systematic review aimed to assess the effects of planned media interventions-including social media-on the health policy-making process. METHODS: Eligible study designs included randomized and non-randomized designs, economic studies, process evaluation studies, stakeholder analyses, qualitative methods, and case studies. We electronically searched Medline, EMBASE, Communication and Mass Media Complete, Cochrane Central Register of Controlled Trials, and the WHO Global Health Library. We followed standard systematic review methodology for study selection, data abstraction, and risk of bias assessment. RESULTS: Twenty-one studies met our eligibility criteria: 10 evaluation studies using either quantitative (n = 7) or qualitative (n = 3) designs and 11 case studies. None of the evaluation studies were on social media. The findings of the evaluation studies suggest that media interventions may have a positive impact when used as accountability tools leading to prioritizing and initiating policy discussions, as tools to increase policymakers’ awareness, as tools to influence policy formulation, as awareness tools leading to policy adoption, and as awareness tools to improve compliance with laws and regulations. In one study, media-generated attention had a negative effect on policy advocacy as it mobilized opponents who defeated the passage of the bills that the media intervention advocated for. We judged the confidence in the available evidence as limited due to the risk of bias in the included studies and the indirectness of the evidence. CONCLUSION: There is currently a lack of reliable evidence to guide decisions on the use of media interventions to influence health policy-making. Additional and better-designed, conducted, and reported primary research is needed to better understand the effects of media interventions, particularly social media, on health policy-making processes, and the circumstances under which media interventions are successful. TRIAL REGISTRATION: PROSPERO 2015: CRD42015020243.
Does a quality improvement campaign accelerate take-up of new evidence? A ten-state cluster-randomized controlled trial of the Institute for Health Improvement’s Project JOINTS
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BACKGROUND: A decade ago, the Institute for Healthcare Improvement pioneered a quality improvement (QI) campaign, leveraging organizational and personal social networks to disseminate new practices. There have been few rigorous studies of the QI campaign approach. METHODS: Project JOINTS (Joining Organizations IN Tackling SSIs) engaged a network of state-based organizations and professionals in a 6-month QI campaign promoting adherence to three new evidence-based practices known to reduce the risk of infection after joint replacement. We conducted a cluster-randomized trial including ten states (five campaign states and five non-campaign states) with 188 hospitals providing joint replacement to Medicare. We measured adherence to the evidence-based practices before and after the campaign using a survey of surgical staff and a difference-in-difference design with multivariable adjustment to compare adherence to each of the relevant practices and an all-or-none composite measure of the three new practices. RESULTS: In the campaign states, there were statistically significant increases in adherence to the three new evidence-based practices promoted by the campaign. Compared to the non-campaign states, the relative increase in adherence to the three new practices in the campaign states ranged between 1.9 and 15.9 percentage points, but only one of these changes (pre-operative nasal screening for Staphylococcus aureus carriage and decolonization prior to surgery) was statistically significant (p < 0.05). On the all-or-none composite measure, adherence to all three evidence-based practices increased from 19.6 to 37.9% in the campaign states, but declined slightly in the comparison states, yielding a relative increase of 23 percentage points (p = 0.004). In the non-campaign states, changes in adherence were not statistically significant. CONCLUSIONS: Within 6 months, in a cluster-randomized trial, a multi-state campaign targeting hospitals and professionals involved in surgical care and infection control was associated with an increase in adherence to evidence-based practices that can reduce surgical site infection.
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Health Care Administration and Organization
Clinical Nursing Leadership Education in Long-Term Care: Intervention Design and Evaluation
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The main objective of the current case study was to investigate the perceived leadership learning needs and feasibility of delivering leadership education to registered staff involved in direct care in long-term care (LTC) homes. The study was conducted in Ontario, Canada, and participants included RNs, registered practical nurses, and nursing administrators. Phase 1 bilingual web-based survey and bilingual focus group needs assessment data supported a preference for external training along with in-house mentoring to support sustainability. An intervention designed using insights gained from Phase 1 data was delivered via a 2-day, in-person workshop. Phases 2 and 3 evaluation survey data identified aspects of leadership training for LTC that require ongoing refinement. Findings suggest that communication skills and managing day-to-day nursing demands in the context of regulatory frameworks were areas of particular interest for leadership training in the LTC setting.
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Health Care Innovation and Quality Assurance
Palliative Care Development in European Care Homes and Nursing Homes: Application of a Typology of Implementation
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BACKGROUND: The provision of institutional long-term care for older people varies across Europe reflecting different models of health care delivery. Care for dying residents requires integration of palliative care into current care work, but little is known internationally of the different ways in which palliative care is being implemented in the care home setting. OBJECTIVES: To identify and classify, using a new typology, the variety of different strategic, operational, and organizational activities related to palliative care implementation in care homes across Europe. DESIGN AND METHODS: We undertook a mapping exercise in 29 European countries, using 2 methods of data collection: (1) a survey of country informants, and (2) a review of data from publically available secondary data sources and published research. Through a descriptive and thematic analysis of the survey data, we identified factors that contribute to the development and implementation of palliative care into care homes at different structural levels. From these data, a typology of palliative care implementation for the care home sector was developed and applied to the countries surveyed. RESULTS: We identified 3 levels of palliative care implementation in care homes: macro (national/regional policy, legislation, financial and regulatory drivers), meso (implementation activities, such as education, tools/frameworks, service models, and research), and micro (palliative care service delivery). This typology was applied to data collected from 29 European countries and demonstrates the diversity of palliative care implementation activity across Europe with respect to the scope, type of development, and means of provision. We found that macro and meso factors at 2 levels shape palliative care implementation and provision in care homes at the micro organizational level. CONCLUSIONS: Implementation at the meso and micro levels is supported by macro-level engagement, but can happen with limited macro strategic drivers. Ensuring the delivery of consistent and high-quality palliative care in care homes is supported by implementation activity at these 3 levels. Understanding where each country is in terms of activity at these 3 levels (macro, meso, and micro) will allow strategic focus on future implementation work in each country.
Assessing the safety culture of care homes: a multimethod evaluation of the adaptation, face validity and feasibility of the Manchester Patient Safety Framework
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BACKGROUND: Understanding the cultural characteristics of healthcare organisations is widely recognised to be an important component of patient safety. A growing number of vulnerable older people are living in care homes but little attention has been paid to safety culture in this sector. In this study, we aimed to adapt the Manchester Patient Safety Framework (MaPSaF), a commonly used tool in the health sector, for use in care homes and then to test its face validity and preliminary feasibility as a tool for developing a better understanding of safety culture in the sector. METHODS: As part of a wider improvement programme to reduce the prevalence of common safety incidents among residents in 90 care homes in England, we adapted MaPSaF and carried out a multimethod participatory evaluation of its face validity and feasibility for care home staff. Data were collected using participant observation, interviews, documentary analysis and a survey, and were analysed thematically. RESULTS: MaPSaF required considerable adaptation in terms of its length, language and content in order for it to be perceived to be acceptable and useful to care home staff. The changes made reflected differences between the health and care home sectors in terms of the local context and wider policy environment, and the expectations, capacity and capabilities of the staff. Based on this preliminary study, the adapted tool, renamed ‘Culture is Key’, appears to have reasonable face validity and, with adequate facilitation, it is usable by front-line staff and useful in raising their awareness about safety issues. CONCLUSIONS: ‘Culture is Key’ is a new tool which appears to have acceptable face validity and feasibility to be used by care home staff to deepen their understanding of the safety culture of their organisations and therefore has potential to contribute to improving care for vulnerable older people.
Does a physical activity program in the nursing home impact on depressive symptoms? A generalized linear mixed-model approach
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OBJECTIVES: Physical activity (PA) may counteract depressive symptoms in nursing home (NH) residents considering biological, psychological, and person-environment transactional pathways. Empirical results, however, have remained inconsistent. Addressing potential shortcomings of previous research, we examined the effect of a whole-ecology PA intervention program on NH residents’ depressive symptoms using generalized linear mixed-models (GLMMs). METHOD: We used longitudinal data from residents of two German NHs who were included without any pre-selection regarding physical and mental functioning (n = 163, Mage = 83.1, 53-100 years; 72% female) and assessed on four occasions each three months apart. Residents willing to participate received a 12-week PA training program. Afterwards, the training was implemented in weekly activity schedules by NH staff. We ran GLMMs to account for the highly skewed depressive symptoms outcome measure (12-item Geriatric Depression Scale-Residential) by using gamma distribution. RESULTS: Exercising (n = 78) and non-exercising residents (n = 85) showed a comparable level of depressive symptoms at pretest. For exercising residents, depressive symptoms stabilized between pre-, posttest, and at follow-up, whereas an increase was observed for non-exercising residents. The intervention group’s stabilization in depressive symptoms was maintained at follow-up, but increased further for non-exercising residents. CONCLUSION: Implementing an innovative PA intervention appears to be a promising approach to prevent the increase of NH residents’ depressive symptoms. At the data-analytical level, GLMMs seem to be a promising tool for intervention research at large, because all longitudinally available data points and non-normality of outcome data can be considered.
Evaluation of a technology-enhanced integrated care model for frail older persons: protocol of the SPEC study, a stepped-wedge cluster randomized trial in nursing homes
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BACKGROUND: Limited evidence exists on the effectiveness of the chronic care model for people with multimorbidity. This study aims to evaluate the effectiveness of an information and communication technology- (ICT-)enhanced integrated care model, called Systems for Person-centered Elder Care (SPEC), for frail older adults at nursing homes. METHODS/DESIGN: SPEC is a prospective stepped-wedge cluster randomized trial conducted at 10 nursing homes in South Korea. Residents aged 65 or older meeting the inclusion/exclusion criteria in all the homes are eligible to participate. The multifaceted SPEC intervention, a geriatric care model guided by the chronic care model, consists of five components: comprehensive geriatric assessment for need/risk profiling, individual need-based care planning, interdisciplinary case conferences, person-centered care coordination, and a cloud-based information and communications technology (ICT) tool supporting the intervention process. The primary outcome is quality of care for older residents using a composite measure of quality indicators from the interRAI LTCF assessment system. Outcome assessors and data analysts will be blinded to group assignment. Secondary outcomes include quality of life, healthcare utilization, and cost. Process evaluation will be also conducted. DISCUSSION: This study is expected to provide important new evidence on the effectiveness, cost-effectiveness, and implementation process of an ICT-supported chronic care model for older persons with multiple chronic illnesses. The SPEC intervention is also unique as the first registered trial implementing an integrated care model using technology to promote person-centered care for frail older nursing home residents in South Korea, where formal LTC was recently introduced. TRIAL REGISTRATION: ISRCTN11972147.
Implementation of a Person-Centered Medical Care Model in a Skilled Nursing Facility: A Pilot Evaluation
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OBJECTIVES: The objective of this study was to evaluate the feasibility and impact of implementing a person-centered medical care model for post-acute care residents within a skilled nursing facility (SNF). DESIGN: A mixed-method (qualitative and quantitative) pilot evaluation. SETTING: An 89-bed SNF located within a large midwestern city. PARTICIPANTS: Forty SNF post-acute patients admitted to the facility during a 6-month period were enrolled in the pilot evaluation. The patients were 75% women, 57% African American, and had an average age of 73. To meet inclusion criteria, patients must have been admitted to the facility for rehabilitation with a plan for community discharge, and be cognitively able to consent as indicated by a cognitive screening tool or assent to participation with family member consent. INTERVENTION: The person-centered medical care model included (1) biweekly interdisciplinary care plan meetings, scheduled at a time of patients’ preference and held in the patient’s room; (2) patient selection of health-related goals that guide team discussions; (3) use of lay-language that facilitated patient understanding; (4) team accountability to the patient for patient care preferences; and (5) monthly care-team meetings to exchange feedback regarding the team’s performance and the model. MEASUREMENT: Evaluation data included admission and discharge Patient Activation Measure surveys; admission and discharge Care of Chronic Conditions surveys; admission and biweekly modified Castle Satisfaction Surveys; admission and discharge Patient and Caregiver Engagement surveys; and semistructured interviews with a sample of staff, family members, and patients. RESULTS: A significant (P < .01) improvement was noted between admission and discharge on both the Care for Chronic Conditions and the Patient Activation Measure surveys. Patient satisfaction surveys trended toward higher ratings over time on most questions, with significant improvement in 2 questions addressing satisfaction with their medical provider. Interviews revealed a perception that the model encouraged an environment of respect and honesty in patient communications, and an overall positive experience. The challenges of scheduling and time were noted by respondents. CONCLUSIONS: Implementation of person-centered medical care within an SNF was feasible, yet required changing care processes to better address individual goals and facilitate communication among patients, providers, and SNF staff. Overall pilot results indicated that patients and staff members viewed the person-centered care experience positively. Further research is needed to examine long-term effects of the model on resident outcomes.
Pain Intervention for people with Dementia in nursing homes (PID): study protocol for a quasi-experimental nurse intervention
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BACKGROUND: It is estimated that 19 to 83% of people with dementia suffer from pain that is inadequately treated in the last months of life. A large number of healthcare workers who care for these people in nursing homes lack appropriate expertise and may therefore not always recognise, assess and treat pain in those with dementia who have complex problems on time, properly and efficiently. The aim of this intervention trial is to identify care needs of people with dementia suffering from pain living in a nursing home. METHODS: A quasi-experimental nurse-led intervention trial based on a convenience sample of four nursing homes in the Swiss Canton of Zurich examines the effects on dementia patients (n = 411), the healthcare institution and the qualification level of the healthcare workers compared to historical controls, using an event analysis and a multilevel analysis. Healthcare workers will be individually trained how to assess, intervene and evaluate acute and chronic pain. There are three data-monitoring cycles (T0, T1, T2) and two intervention cycles (I1, I2) with a total study duration of 425 days. There is also a process evaluation based on Dobbins analyses that analyse in particular the potentials for change in clinical practice of change agents. DISCUSSION: The aim of the intervention trial is to improve pain management strategies in older people with dementia in nursing homes. Clinically significant findings will be expected that will help reduce suffering in the sense of “total pain” for people with dementia. The joint intra- and interdisciplinary collaboration between practice and supply-oriented (nursing) research will have both a lasting effect on the efficiency measurement and provide scientifically sound results. Nursing homes can integrate the findings from the intervention trial into their internal quality control process. The potential for improvements can be directly influenced by the nursing home itself. TRIAL REGISTRATION: Registration trial number: DRKS00009726 on DRKS, registered 10 January 2017, retrorespectively registered. Clearance certificate is available of the ethics committees of the canton of Thurgau, Switzerland, number: TG K201-02, and Zurich, Switzerland, number: ZH 01-2016.
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Research Practice and Methodology
Examining the Influence of Context and Professional Culture on Clinical Reasoning Through Rhetorical-Narrative Analysis
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According to the dual process model of reasoning, physicians make diagnostic decisions using two mental systems: System 1, which is rapid, unconscious, and intuitive, and System 2, which is slow, rational, and analytical. Currently, little is known about physicians’ use of System 1 or intuitive reasoning in practice. In a qualitative study of clinical reasoning, physicians were asked to tell stories about times when they used intuitive reasoning while working up an acutely unwell patient, and we combine socio-narratology and rhetorical theory to analyze physicians’ stories. Our analysis reveals that in describing their work, physicians draw on two competing narrative structures: one that is aligned with an evidence-based medicine approach valuing System 2 and one that is aligned with cooperative decision making involving others in the clinical environment valuing System 1. Our findings support an understanding of clinical reasoning as distributed, contextual, and influenced by professional culture.
Written informed consent in health research is outdated
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No abstract available.
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Aging
Association of a Communication Training Program With Use of Antipsychotics in Nursing Homes
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Importance: Off-label antipsychotic prescribing in nursing homes (NHs) is common and is associated with increased risk of mortality in older adults. Prior large-scale, controlled trials in the NH setting failed to show meaningful reductions in antipsychotic use. Objective: To quantify the influence of a large-scale communication training program on NH antipsychotic use called OASIS. Design, Setting, and Participants: This investigation was a quasi-experimental longitudinal study of NHs in Massachusetts enrolled in the OASIS intervention. Participants were residents living in NHs between March 1, 2011, and August 31, 2013. The data were analyzed from December 2015, to March 2016, and from November through December 2016. Exposures: The OASIS educational program targets all NH staff (direct care and nondirect care) using a train-the-trainer model. The program goals were to reframe challenging behaviors of residents with cognitive impairment as the communication of unmet needs, to train staff to anticipate resident needs, and to integrate resident strengths into daily care plans. Main Outcomes and Measures: This study used an interrupted time series model of facility-level prevalence of antipsychotic medication use, other psychotropic medication use (antidepressants, anxiolytics, and hypnotics), and behavioral disturbances to evaluate the intervention’s effectiveness in participating facilities compared with control NHs in Massachusetts and New York. The 18-month preintervention (baseline) period was compared with a 3-month training period, a 6-month implementation period, and a 3-month maintenance period. Results: This study included 93 NHs enrolled in the OASIS intervention (27 of which had a high prevalence of antipsychotic use) compared with 831 nonintervention NHs. Among OASIS facilities, prevalences of atypical antipsychotic prescribing were 34.1% at baseline and 26.5% at the study end (absolute reduction of 7.6% and relative reduction of 22.3%) compared with a drop of 22.7% to 18.8% in the comparison facilities (absolute reduction of 3.9% and relative reduction of 17.2%). In the OASIS implementation phase, NHs experienced a reduction in antipsychotic use prevalence among OASIS facilities (-1.20%; 95% CI, -1.85% to -0.09% per quarter) greater than that among non-OASIS facilities (-0.23%; 95% CI, -0.47% to 0.01% per quarter), resulting in a net OASIS influence of -0.97% (95% CI, -1.85% to -0.09%; P = .03). A difference in trend was not sustained in the maintenance phase (difference of 0.93%; 95% CI, -0.66% to 2.54%; P = .48). No increases in other psychotropic medication use or behavioral disturbances were observed. Conclusions and Relevance: Antipsychotic use prevalence declined during OASIS implementation of the intervention, but the decreases did not continue in the maintenance phase. Other psychotropic medication use and behavioral disturbances did not increase. This study adds evidence for nonpharmacological programs to treat behavioral and psychological symptoms of dementia.
Interventions to support people with dementia and their caregivers during the transition from home care to nursing home care: A systematic review
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BACKGROUND: During the transition of people with dementia from home to nursing home family caregivers often feel burdened. OBJECTIVES: We aimed to 1) identify interventions which support people with dementia and their caregivers in the transition from home care to nursing home care, 2) synthesize the evidence for efficacy of these interventions, and 3) examine whether the identified interventions have been systematically developed, evaluated and implemented according to the Medical Research Council guidance on complex interventions. DESIGN: A systematic review of randomised controlled trials was conducted according to the recommendations specified in the Cochrane Handbook for Intervention Reviews. The review protocol was registered in PROSPERO (2015: CRD42015019839). Reporting follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. DATA SOURCES: MEDLINE, CENTRAL, PsycINFO, CINAHL, OTseeker, and PEDro, were searched. Other sources included Google Scholar, and ALOIS. REVIEW METHODS: Two reviewers independently assessed the eligibility of the articles. Data extraction was performed by one reviewer and verified independently by another. The Cochrane Risk of Bias tool was used for critical appraisal. Development and evaluation of the identified interventions were assessed, taking the Medical Research Council guidance into account. Review findings were synthesized narratively. RESULTS: The search yielded 1278 records. Five studies were included, all conducted in the United States (4 RCTs and 1 cRCT with a total of 695 participants). The psychosocial interventions were individual and family counseling via telephone or ad hoc all of which addressed only informal caregivers. The intervention components, content and mode of delivery differed widely with inconsistent results. Significant intervention effects were found for the reduction of caregivers’ depressive symptoms, burden, feeling of guilt, emotional distress, overload, and interactions with staff. Other outcomes, i.e. stress, placement adaptation, role overload, and role captivity, were not statistically significantly affected. The assessment for bias risk across studies varied from moderate to low. Only two studies tested the feasibility of the intervention before full scale evaluation, none evaluated the implementation process according to the Medical Research Council framework. CONCLUSIONS: We identified only a few studies with heterogeneous outcomes; evidence regarding the effectiveness of psychosocial interventions is thus insufficient. Further research is needed focusing on the development and evaluation of complex psychosocial interventions and more well-designed RCTs with larger sample sizes based on a rigorous methodology. Reporting on feasibility and implementation processes of interventions should be guaranteed, since it is crucial to evaluate transferability across care settings.
Use of Medications of Questionable Benefit During the Last Year of Life of Older Adults With Dementia
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OBJECTIVES: To investigate the prevalence and factors associated with the use of medications of questionable benefit throughout the final year of life of older adults who died with dementia. DESIGN: Register-based, longitudinal cohort study. SETTING: Entire Sweden. PARTICIPANTS: All older adults (>/=75 years) who died with dementia between 2007 and 2013 (n = 120,067). MEASUREMENTS: Exposure to medications of questionable benefit was calculated for each of the last 12 months before death, based on longitudinal data from the Swedish Prescribed Drug Register. RESULTS: The proportion of older adults with dementia who received at least 1 medication of questionable benefit decreased from 38.6% 12 months before death to 34.7% during the final month before death (P /=1 medication of questionable benefit during the last month before death (odds ratio 0.85, 95% confidence interval 0.88-0.83). Antidementia drugs accounted for one-fifth of the total number of medications of questionable benefit. Lipid-lowering agents were used by 8.3% of individuals during their final month of life (10.2% of community-dwellers and 6.6% of institutionalized people, P < .001). CONCLUSION: Clinicians caring for older adults with advanced dementia should be provided with reliable tools to help them reduce the burden of medications of questionable benefit near the end of life.
Are Hospital/ED Transfers Less Likely Among Nursing Home Residents With Do-Not-Hospitalize Orders?
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OBJECTIVES: This study aims to examine whether an advance directive “Do Not Hospitalize” (DNH) would be effective in reducing hospital/emergency department (ED) transfers. Similar effects in residents with dementia were also examined. DESIGN: Cross-sectional study. SETTING/SUBJECTS: New York State (NYS) nursing home residents (n = 43,024). MEASUREMENTS AND ANALYSIS: The Minimum Data Set 2.0 was used to address the study aims. Advance directives with an indication of DNH and Alzheimer disease/dementia other than Alzheimer disease were coded (yes vs no). Logistic regression analyses were performed to quantify the relationship between DNH orders and hospital/ED transfers while adjusting for confounders. RESULTS: Our results show that 61% of nursing home residents had do-not-resuscitate orders, 12% had feeding restrictions, and only 6% had DNH orders. Residents with DNH orders had significantly fewer hospital stays (3.0% vs 6.8%, P <.0001) and ED visits (2.8% vs 3.6%, P = .03) in the last 90 days than those without DNH orders. Dementia residents with DNH orders had significantly fewer hospital stays (2.7% vs 6.3%, P < .0001) but not ED visits (2.8% vs 3.5%, P = .11) than those without DNH orders. After adjusting for covariates in the model, the results show that for residents without DNH orders, the odds of being transferred to a hospital was significantly higher (odds ratio = 2.23, 95% confidence interval = 1.77-2.81) than those with DNH orders. CONCLUSION: Residents with DNH orders had significantly fewer transfers. This suggests that residents’ end-of-life care decisions were respected and honored. Efforts should be made to encourage nursing home residents to complete DNH orders to promote integration of the resident’s values and goals in guiding care provision toward the end of life.
Oral health-related quality of life and prosthetic status of nursing home residents with or without dementia
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PURPOSE: The objective of this cross-sectional study was to evaluate the effect of prosthetic status on the oral health-related quality of life (OHRQoL) of nursing home residents with or without dementia. METHODS: The study was performed in 14 nursing homes across the federal state of Baden-Wurttemberg, Germany. All eligible participants were included, and general and medical information and information about their dental and prosthetic statuses were collected. The Geriatric Oral Health Assessment Index (GOHAI) was administered to evaluate OHRQoL. The Mini-Mental State Examination (MMSE) served to classify participants into living or not living with dementia according to the established cutoff value for dementia (MMSE 0.05). The number of teeth (odds ratio [OR]: 2.0), the type of prosthetic status (OR: 6.5), and denture-related treatment needs (OR: 2.4) were the major factors significantly affecting OHRQoL (P<0.05). CONCLUSION: The OHRQoL of elderly nursing home residents is substantially compromised. Several prosthetic treatment needs for residents living with or without dementia were identified. Edentulism without tooth replacement and having <5 teeth resulted in an increased risk of substantially compromised OHRQoL. Further studies should be conducted to determine whether improvements in prosthetic status can increase OHRQoL.
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Events
UofA
Register for Summer Institute 2017 where researchers, patients, clinicians, students, policy makers and more gather to share insights, connect with colleagues, and promote patient-oriented research. SPOR Summer Institute at a glance: an outstanding line-up of engaging speakers, workshops on patient-oriented research topics, networking opportunities with colleagues, capacity building opportunities for patient-oriented research.
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Social Media & Research Unconference: What works? What’s next?
Presented by AB SPOR SUPPORT Unit – Knowledge Translation Platform and the Institute for Knowledge Mobilization. This one-day event is for people who are interested in using social media for research, for knowledge mobilization, or for people who are researching social media! More specifically, this event is for people who are interested in using social media for research, for knowledge mobilization, or who are researching social media. The important part is that you want to learn from others in the field and share your own knowledge and experiences.
The Training Program is open to anyone who is collaborating, or planning to collaborate, in POR. It is intended for graduate students, trainees, community and academic researchers, patients and family members, health care professionals, decision-makers, and industry and community stakeholders who are interested in learning about, or contributing to, POR in Alberta.
The Training Program is open to anyone who is collaborating, or planning to collaborate, in POR. It is intended for graduate students, trainees, community and academic researchers, patients and family members, health care professionals, decision-makers, and industry and community stakeholders who are interested in learning about, or contributing to, POR in Alberta.
Online
Complaints: Finding the Value in this Gift
A free Leadership Program for Long-Term Care and Retirement Living webinar series is taking place during Spring 2017! These webinars are offered in partnership through the Schlegel Centre for Learning, Research and Innovation in Long-Term Care and Conestoga College. This Leadership Webinar Series will deepen the knowledge and skills of participants who work and deal with staff performance, conflict, and complaint situations in long-term care. It’s about building a workplace culture for desired outcomes. In this webinar, explore workplace complaints and why they always seem to land on your doorstep, and examine how to make each complaint be a gift to improving workplace relationships.
Do you conduct or evaluate health research? Are you interested in an overview of methods for integrating sex and gender variables in health research contexts? Join us for a webinar to learn about the Integrating Sex & Gender in Health Research Online Training Modules.
KT Canada Seminar Series
Please join us for the Knowledge Translation Canada National Seminar Series session. Dr. David Johnson from the University of Calgary will be presenting. Dr. David Johnson is a Professor in the Departments of Pediatrics and Physiology & Pharmacology in the Faculty of Medicine at the University of Calgary. He is also Co-Chair of the Healthy Living, Accident Prevention & Optimizing Health Outcomes Theme of the Alberta Children’s Hospital Research Institute, and Co-Chair of the Child Health Working Group of Alberta Health Services. Dr. Johnson’s primary research interests focus on the management of common respiratory illnesses, and he has published several large multi-centre randomized controlled trials assessing the benefit of corticosteroids for both croup and bronchiolitis in the New England Journal of Medicine. This session is offered by WebEx from St. Michael’s Hospital in Toronto. All registration requests should be sent to Meghan Storey: storeym@smh.ca by Wednesday, May 10th at 12:00 PM ET.
Frailty and the Risk of Cognitive Impairment
Presenter: Dr. Kenneth Rockwood MD, FRCPC, FRCP, Professor of Medicine. This presentation will ask (and answer) the following questions: 1. Is frailty a risk for dementia? 2. Is it important that frailty is a risk for dementia? 3. How should we approach dementia diagnosis in a person who is frail? Management needs to take various factors into account, which can modify the response to treatment, make adverse effects more likely and increase caregiver burden. All this mandates team-based systematic care.
Join us as we: introduce and explain the CARES approach, examine key results for the interprovincial CARES initiative, explore the potential and current plans for sustainability and spread.
News
Partners launch Saskatchewan Centre for Patient-Oriented Research
The Governments of Canada and Saskatchewan, along with provincial partners, announced on April 18 a combined investment of $63 million in funding and in-kind contributions for the launch of the Saskatchewan Centre for Patient-Oriented Research (SCPOR).
Long-running survey on health-care system satisfaction scrapped
The Health Quality Council of Alberta has scrapped a long-running survey on patient satisfaction with the health system, as the organization tries to fine-tune its approach moving forward.
What Will It Take to Make Our Care Systems More “Age-Friendly”?
Applying the discipline of the science of improvement will help us build the age-friendly health system we’re imagining, but we will need more than rapid-cycle testing and spread strategies to get us where we need to go. To achieve the goal of spreading age-friendly care throughout the US, we’ll also need a social movement — what Marshall Ganz defines as an “organized collective action challenging the status quo.” This means working together to reimagine and transform health care.
Seniors’ Brain Changes Could Make Them Vulnerable to Scams (US)
A pair of key differences in the brain may help distinguish which seniors are at risk of falling prey to financial scams, a small new study suggests. The first-of-its-kind study found a biological basis — rather than poor decision-making skills — underlying financial exploitation in the elderly. These findings might lead to a way to predict which seniors are susceptible to scams, the researchers said.
Pimp my zimmer: Care home staff get creative about patient safety improvements (UK)
PROSPER (Promoting Safer Provision of care for Elderly Residents) is a groundbreaking initiative which tested whether quality improvement methods could be implemented in care homes. It was initially funded through our ‘Closing the gap in patient safety’ programme and is now continuing for an additional year with funding from Essex County Council. In addition to working with care home staff, the team has nurtured good working relationships with the provider, commissioning and regulatory bodies in Essex. The Care Quality Commission (CQC) is also supportive of the project, encouraging homes to take part.
Ontario Budget to Significantly Improve Care and Support for Seniors
The Ontario Long Term Care Association is lauding the Government of Ontario’s 2017 Budget: A Stronger, Healthier Ontario, calling it a significant step forward that will greatly improve care and supports for a growing number of frail seniors with complex medical needs.
People nearing the end of life often receive medications they may no longer need, and that’s true even in nursing homes, researchers say. Nearly 9,300 Ontario nursing home residents with dementia received at least one medication of questionable benefit during the last year of life, a study found. And nearly half of these residents received potentially unnecessary drugs in the week before they died.
Seniors’ Well-Being May Get a Boost From Green Spaces (US)
Green spaces in cities benefit residents of all ages. Now, British researchers say, they may also boost older people’s mental well-being. “We found that older participants experienced beneficial effects of green space whilst walking between busy built urban environments and urban green space environments,” said study author Chris Neale.
Nursing Home Program Offers Alternatives to Antipsychotic Drugs (US)
Hoping to cut the use of antipsychotic drugs in nursing home residents, researchers tried training staff on new ways to meet the needs of residents with dementia. Although antipsychotics are often given to people with dementia, the drugs are only minimally effective at controlling behavioral problems and have been shown to increase the chances for stroke and death, the researchers said.
PubMed to Include Conflict-of-Interest Statements with Study Abstracts
PubMed, the invaluable federal database of abstracts from medical and life science journals, has started including authors’ conflict-of-interest statements beneath studies’ abstracts on search-result pages. The new policy, quietly announced in March in a Technical Bulletin from the National Library of Medicine, comes 13 months after the nonprofit Center for Science in the Public Interest and six other organizations, 62 scientists and physicians, and five United States Senators asked the NLM and the National Institutes of Health to publish the disclosures.
Resources
NEW VIDEO: Mealtimes Matter in Long-Term Care
A research team led by Heather Keller, PhD, RD, FDC (Schlegel Research Chair in Nutrition & Aging) has been exploring what residents living in long-term care eat and what factors promote better nutrient intake. The results from this national study called Making the Most of Mealtimes (M3) highlight opportunity areas to improve nutrition and the mealtime experience. A short video was created to share some of these findings.
Safer Medication Use in Older Persons Information Page
This information page is part of an awareness campaign designed to provide care team members in long term care homes, hospitals and the community with information on medications that are poorly tolerated by older persons.
Opportunities
CFN launches competition for 2017 Fellowship cohort
CFN’s Interdisciplinary Fellowship Program supports trainee academic work and furthers their knowledge of how to engage others in frailty and late life issues, and to work with interdisciplinary teams. The Program goes beyond traditional academic and clinical training opportunities by offering enriched experiential learning and interdisciplinary collaboration.
The Institute for Research on Public Policy (IRPP) is accepting applications for the position of Research Assistant. In this role, you will provide support to the Institute’s Research Directors in the publication of a variety of research materials and organizing policy events. This is a one-year, full-time position based in Montreal, with the possibility to renew.
