Major report, policy, and research announcements
This report and its companion products can help us better understand how Canada’s seniors transition from living independently to receiving continuing care services, and what factors influence their transition into residential care.
Over the course of the past year, we asked Canadians affected by dementia—either personally or through their work—for their unanswered questions about living with dementia, dementia prevention, treatment and diagnosis. This study, also known as the Canadian Dementia Priority Setting Partnership, set out to identify the top 10 dementia research priorities, and to share them with Canadian researchers and research funding organizations. The workshop brought together 28 participants from across Canada—persons with dementia, family members, health and social care providers and members of organizations that represent persons with dementia. Participants worked in small teams and as a group to discuss each question and decide what matters most to them.
History was made as Bill C-233, the National Strategy for Alzheimer’s Disease and Other Dementias Act, became law! The Alzheimer Society has long called for a national dementia strategy to enhance research efforts and ensure access to quality care and support so that Canadians with dementia can have the best quality of life. Now, for the first time, the federal government is legally committed to action on dementia and Canada will become the 30th country in the world with a national dementia strategy! Now that it’s official, the real work begins. We look forward to continuing to collaborate with government, stakeholders and people with dementia to create and implement Canada’s first national dementia strategy. Stay tuned for more details over the coming months as the federal government moves forward with implementation.
New TREC articles
BACKGROUND: Innovative approaches are required to facilitate the adoption and sustainability of evidence-based care practices. We propose a novel implementation strategy, a peer reminder role, which involves offering a brief formal reminder to peers during structured unit meetings.
AIMS: This study aims to (a) identify healthcare aide (HCA) perceptions of a peer reminder role for HCAs, and (b) develop a conceptual framework for the role based on these perceptions.
OBJECTIVES: To evaluate the effectiveness of strategies that nursing home care providers can apply to either prevent/overcome residents’ responsive behaviors to oral care, or enable/motivate residents to perform their own oral care.
Abstract: We used a web-based mixed methods survey (HowsYourHealth – Frail) to explore the health of frail older (78% age 80 or older) adults enrolled in a home-based primary care program in Vancouver, Canada. Sixty per cent of eligible respondents participated, representing over one quarter (92/350, 26.2%) of all individuals receiving the service. Despite high levels of co-morbidity and functional dependence, 50 per cent rated their health as good, very good, or excellent. Adjusted odds ratios for positive self-rated health were 7.50, 95 per cent CI [1.09, 51.81] and 4.85, 95 per cent CI [1.02, 22.95] for absence of bothersome symptoms and being able to talk to family or friends respectively. Narrative responses to questions about end of life and living with illness are also described. Results suggest that greater focus on symptom management, and supporting social contact, may improve frail seniors’ health.
Background: The Workplace Affective Commitment Multidimensional Questionnaire (WACMQ) measures affective commitment towards eight work-related targets. While this questionnaire was developed in the business sector, we believe that the multi-target conceptualization of affective commitment has applicability to complex health care contexts where providers of care, in the production and delivery of care, likely develop commitment toward a multiplicity of targets. Affective commitment is a strong predictor of extra-role workplace behavior; indispensable behaviors which enable health systems to function. Objective: The aim of this psychometric exercise is to content validate the WACMQ questions for use in health care. Methods: Two focus groups were conducted, consisting of nurses working in acute care and emergency hospitals in Ontario. Linguistic validation and cognitive debriefing were used. Results: A total of 14 modifications to the wording of items on the original WACMQ questionnaire were made. Conclusions: This modified version of the WACMQ reflects the need for researchers in health care settings to acknowledge the complex context of health care and the attendant complexities of worker attitudes. Health care workers can experience affective commitment toward leadership (clinical or administrative), co-workers (nurses or interprofessional), patients, their profession, organization, work or tasks. Further, in some health care settings, features like union membership may have important implications when examining affective commitment or behaviors. Psychometric properties of the modified WACMQ will be established in an upcoming study that will examine the relationships between extra-role behaviors, commitment, perceived organizational support and justice within acute care and emergency departments of hospitals operating in Ontario.
TREC article Pain Trajectories of Nursing Home Residents Nearing Death (G. N. Thompson, M. Doupe, R. C. Reid, J. Baumbusch and C. A. Estabrooks, J Am Med Dir Assoc 2017 Apr 18) featured on University of Alberta homepage.
Articles by TREC researchers
A pooled analysis of the efficacy of fesoterodine for the treatment of overactive bladder, and the relationship between safety, co-morbidity and polypharmacy in patients aged 65 years or older
Non UofA Access
BACKGROUND: Overactive bladder (OAB) is a common condition in older persons. Antimuscarinic treatment remains the mainstay of treatment of OAB but clinicians have been reluctant to prescribe this to older patients. This study examined efficacy and safety information from patients >65 in fesoterodine trials to reaffirm efficacy and to explore the relationships between treatment emergent adverse events (TEAEs), coexisting medication and co-morbidity.
BACKGROUND: Assertive community treatment for first-episode psychosis programs have been shown to improve symptoms and reduce service use. There is little or no evidence on whether these programs can increase access to income assistance and improve medication adherence in first episode psychosis patients. This research examines the impact of the Early Psychosis Prevention and Intervention Service (EPPIS) on these outcomes.
No abstract available
Articles recommended by Dr. Carole Estabrooks
Purpose of the Study: Implementing quality improvement (QI) programs in nursing homes continues to encounter significant challenges, despite recognized need. QI approaches provide nursing home staff with opportunities to collaborate on developing and testing strategies for improving care delivery. We present a theory-driven and user-friendly adaptable framework and facilitation package to overcome existing challenges and guide QI efforts in nursing homes.
Are predatory journals the publishing equivalent of what Donald Trump might call “a bad hombre”? our colleague asked in a recent commentary. In research just published, we dived in to have a look.
BACKGROUND: The Internet has transformed scholarly publishing, most notably, by the introduction of open access publishing. Recently, there has been a rise of online journals characterized as ‘predatory’, which actively solicit manuscripts and charge publications fees without providing robust peer review and editorial services. We carried out a cross-sectional comparison of characteristics of potential predatory, legitimate open access, and legitimate subscription-based biomedical journals.
Grants & Awards
This KT competition is designed to advance previously CFN funded research evidence into practice, thereby ultimately strengthening Canada’s health and social care systems and improving care of Canadians living with frailty.
The Vanier Canada Graduate Scholarship (Vanier CGS) was created to attract and retain world-class doctoral students and to establish Canada as a global centre of excellence in research and higher learning. It is available to both Canadian and international PhD students studying at Canadian universities.
The program is jointly administered by Canada’s three federal granting agencies: the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council (NSERC) and the Social Sciences and Humanities Research Council (SSHRC). CIHR has been designated as the operational lead for the implementation of the program.
The Banting Postdoctoral Fellowships Program is distinguished from existing postdoctoral fellowships programs by its emphasis on the synergy between an applicant’s individual merit and potential to launch a successful research-intensive career and the host institution’s commitment to the research program and environment with which the applicant is to be affiliated. As such, an applicant’s application to the Banting Postdoctoral Fellowships Program must be completed in full collaboration with the proposed host institution.
The Strategy for Patient-Oriented Research (SPOR) is a national coalition of federal, provincial and territorial partners (patients and informal caregivers, provincial health authorities, academic health centres, charities, philanthropic organizations, private sector, etc.) dedicated to the integration of research into care.
The Canada 150 Research Chairs Program, announced in Budget 2017, invests $117.6 million to enhance Canada’s reputation as a global centre for science, research and innovation excellence, in celebration of Canada’s 150th anniversary. It provides Canadian institutions with a one-time investment to attract top-tier, internationally based scholars and researchers to Canada.
Abstract: Deploying knowledge brokers to bridge the ‘gap’ between researchers and practitioners continues to be seen as an unquestionable enabler of evidence-based practice and is often endorsed uncritically. We explore the ‘dark side’ of knowledge brokering, reflecting on its inherent challenges which we categorize as: (1) tensions between different aspects of brokering; (2) tensions between different types and sources of knowledge; and (3) tensions resulting from the ‘in-between’ position of brokers. As a result of these tensions, individual brokers may struggle to maintain their fragile and ambiguous intermediary position, and some of the knowledge may be lost in the ‘in-between world’, whereby research evidence is transferred to research users without being mobilized in their day-to-day practice. To be effective, brokering requires an amalgamation of several types of knowledge and a multidimensional skill set that needs to be sustained over time. If we want to maximize the impact of research on policy and practice, we should move from deploying individual ‘brokers’ to embracing the collective process of ‘brokering’ supported at the organizational and policy levels.
Abstract: Transdisciplinary (TD) research is increasingly suggested as a means of tackling wicked problems by providing knowledge on solutions that serve as pathways towards sustainable development. In contrast to research striving for generalizable findings, TD research produces insights for a particular case and context. TD researchers, who build on other TD projects’ results, need to know under what conditions knowledge gained from their case can be transferred to and applied in another case and context. Knowledge transfer between researchers and stakeholders is extensively discussed in the literature. However, a more profound understanding and management of the challenges related to knowledge transfer across cases, as it applies to TD research, are missing. We specify the challenges of knowledge transfer in TD research by distinguishing TD research for policy from conventional evidence-based policy, which relies on generalizing findings, such as randomized controlled trials. We also compare the functions that cases fulfil in other types of research that include basic, applied and ideographic research. We propose to conceptualize transferability of knowledge across cases as arguments by analogy. Methodologically, this would imply explicit consideration on whether the cases in question are sufficiently similar in relevant aspects while not dissimilar in other additional relevant aspects. On the one hand, this approach calls for explicit material considerations that are needed to learn about which aspects of cases are relevant. On the other hand, formal considerations on how to weigh perceived relevant similarities and dissimilarities of the cases at hand for transferability of knowledge, are needed. Empirical research on how projects in TD research deal with this problem is called for.
Abstract: Knowledge transfer and exchange (KTE) processes can facilitate evidence-informed community-based care for seniors, but understanding effective KTE in gerontology is limited. A scoping review was conducted to evaluate the current state of KTE in the community-based sector for seniors. Twelve articles met the inclusion criteria, which addressed a broad variety of topics including caregiving, elder abuse, falls prevention, home-rehabilitation, hospice and dementia care. Studies evaluated KTE practices (n = 8), developed a KTE intervention (n = 3), or explored research uptake (n = 1). Community-based initiatives for seniors informed by KTE processes are scarce, requiring further efforts at the research, practice and policy levels.
Health Care Administration and Organization
Abstract: Increasing care needs and a declining workforce put pressure on the quality and continuity of long-term elderly care. The need to attract and retain a solid workforce is increasingly acknowledged. This study reports about a change initiative that aimed to improve the quality of care and working life in residential elderly care. The research focus is on understanding the process of workforce change and development, by retrospectively exploring the experiences of care professionals. A responsive evaluation was conducted at a nursing home department in the Netherlands one year after participating in the change program. Data were gathered by participant observations, interviews and a focus and dialogue group. A thematic analysis was conducted. Care professionals reported changes in workplace climate and interpersonal interactions. We identified trust, space and connectedness as important concepts to understand perceived change. Findings suggest that the interplay between trust and space fostered interpersonal connectedness. Connectedness improved the quality of relationships, contributing to the well-being of the workforce. We consider the nature and contradictions within the process of change, and discuss how gained insights help to improve quality of working life in residential elderly care and how this may reflect in the quality of care provision.
BACKGROUND: Registered Nurses (RNs) working in UK care homes receive most of their training in acute hospitals. At present the role of care home nursing is underdeveloped and it is seen as a low status career. We describe here research to define core competencies for RNs working in UK care homes.
BACKGROUND: The home and community care sector is one of the fastest growing sectors globally and most prominently in mature industrialized countries. Personal support workers (PSWs) are the largest occupational group in the sector. This paper focuses on the emotional health of PSWs working in the home and community care sector in Ontario, Canada. The purpose of this paper is to present evidence on the associations between PSWs’ life and work stress and organizational practices of full-time and guaranteed hours, and PSWs’ perceptions of support at work and preference for hours.
This Editorial provides an overview of the European Palliare Project, before focusing on the resultant interprofessional educational framework presented in the form of a Best Practice Statement (BPS). The BPS details what practitioners need to know to deliver good quality advanced dementia care focused on living the best life possible. For care providers and managers, the BPS reveals the complexity and expert knowledge that underpins good practice and leaves no doubt that investment is required in staff development alongside a skill and discipline mix which will ensure expert practice leadership from appropriately qualified professionals.
Abstract: Work-family conflict is challenging for workers and may lead to depression, anxiety, and overall poor health. Sleep plays an important role in the maintenance of mental health; however, the role of sleep in the association between work-family conflict and mental health is not well-studied. Questionnaires were collected from 650 nursing assistants in 15 nursing homes. Multivariate linear regression modeling demonstrated that increased work-family conflict was associated with lower mental health scores (β = -2.56, p < .01). More work-family conflict was correlated with more job demands, less job control, less social support, and longer work hours. Poor sleep quality, but not short sleep duration, mediated the association between work-family conflict and mental health. Workplace interventions to improve nursing assistants' mental health should increase their control over work schedules and responsibilities, provide support to meet their work and family needs, and address healthy sleep practices.
AIM: The purpose of this study was to investigate formal caregivers’ experiences of aggressive behaviour in older people living with dementia in nursing homes.
BACKGROUND: Residential care homes (RCHs) play an important role in end-of-life care, being the most common place of death for elderly people in several European countries. Care pathways such as the Liverpool Care Pathway for the Dying Patient (LCP) are used to improve and ensure quality care at the end of life. There is a lack of scientific evidence supporting the use of care pathways.
AIMS AND OBJECTIVES: To implement and evaluate the effect of using the Person-Centred Situational Leadership Framework to develop person-centred care within nursing homes.
BACKGROUND: Many models of nursing leadership have been developed internationally in recent years but do not fit with the emergent complex philosophy of nursing home care. This study develops the Person-Centred Situational Leadership Framework that supports this philosophy. It forms the theoretical basis of the action research study described in this paper.
Abstract: This study investigated first-line managers’ experience of and responses to a concise leadership intervention to facilitate the implementation of oral care clinical practice guidelines (CPGs) in nursing homes. Leadership is known to be an important element in knowledge implementation but little is known as to what supports managers to facilitate the process. By means of a process evaluation with mixed methods, the context and a three-month leadership program was explored, including activities during and in relation to the program, and the effects in terms of oral care CPG implementation plans. While the managers appreciated the intervention and considered improved oral care to be a priority, their implementation plans mainly focused the dissemination of an oral care checklist. The findings suggest that extended implementation interventions engaging both managers and clinical staff are needed, and that a concise intervention does not facilitate first-line managers to adopt behaviors known to facilitate knowledge implementation.
Health Care Innovation and Quality Assurance
BACKGROUND: In the UK 15.8% of people aged 85 years and over live in a care home or long-stay hospital setting. With the projection of an ageing population it is realistic to expect that the number of people both living and dying in all care homes will increase. This article describes the implementation of an end-of-life care programme to empower staff to meet their resident’s end-of-life care needs.
Abstract: Mapping individual patterns of decline in older adults may aid coordinating long term aged care. This study developed a new scale (Transition Maps) to summarise the overall care pathway for long term aged care residents, in a simplified manner incorporating mapping concepts. Transition Maps were developed using mixed methods in two phases, and based on expert opinion, literature review, and input from aged care health professionals. Four professions (primary physician, nurse, allied health, lifestyle services) generated 147 Transition Maps for 38 residents living in a long term care. Preliminary construct validity and inter-rated reliability were evaluated. Results showed that Inter-rater reliability of agreement with the overall care pathway for each resident was kappa = 0.492. Consensus was lowest between nurse care managers and primary physicians (kappa = 0.384), and highest between nurse managers and Lifestyle Services (kappa = 0.77). Preliminary testing of the Transition Map scale provides initial support of construct validity and inter-rater reliability and provides some evidence that Transition Maps can improve the coordination of long term aged care.
BACKGROUND AND OBJECTIVES: U.S. Nursing homes (NH) are shifting toward a person-centered philosophy of care, where staff understand each residents preferences, goals and values, and seek to honor them throughout the care delivery process. Social interactions are a major component of life and while low rates of social interactions are typically found among NH residents, little research has examined resident preferences for specific types of social interactions. The purpose of this study is to explore, from the perspective of the NH resident, barriers to social contact preferences and situations when social preferences change.
BACKGROUND: Many nursing homes appear as multicultural workplaces where the majority of healthcare providers have an ethnic minority background. This environment creates challenges linked to communication, interaction and cultural differences. Furthermore, the healthcare providers have varied experiences and understanding of what quality care of patients with dementia involves.
PURPOSE: The aim of this study is to illuminate multi-ethnic healthcare providers’ lived experiences of their own working relationship, and its importance to quality care for people with dementia.
Abstract: Comprehensive geriatric assessment (CGA) is a multidimensional and multidisciplinary diagnostic process focused on determining the clinical profile, pathological risk, residual skills, short- and long-term prognosis, and the personalized therapeutic and care plan of the functionally compromised and frail older subjects. Previous evidence suggested that the effectiveness of CGA programs may be influenced by the settings where the CGA is performed [i.e., hospital, post-hospital discharge/ long-term care facilities (LTCF), or community/home] as well as the specific clinical conditions of older frail individuals. In this scenario, CGA and quality of care in LTCF have been a challenge for decades. In the present article, we systematically reviewed evidence coming from the last three decades of clinical research devoted to the systematic implementation of CGA programs in LTCF, i.e., nursing homes, care homes, residential homes, and rehabilitation facilities. In the United States, all LTC residents must undergo a CGA on a regular basis on admission to a facility, so prompting the development of the Resident Assessment Instrument (RAI) Minimum Data Set, a specific CGA-based assessment tool in this population. In the LTCF setting, the present reviewed evidence suggested that most complex older subjects may benefit from a CGA in terms of improved quality of care and reduced hospitalization events and that CGA must be standardized across healthcare settings to promote greater health system integration and coordination. In the LTCF setting, particularly in nursing homes, also other new and promising CGA programs have been proposed to develop rapid screening CGA-based tools to enhance in the next future the ability of primary care physicians to recognize and treat geriatric syndromes in this setting. However, at present, the interRAI suite of instruments represented an integrated health information system that has the potential to provide person-centered information transcending healthcare settings.
BACKGROUND: This systematic review identifies and reports the extent and nature of evidence to support the use of Dementia Care Mapping as an intervention in care settings.
Abstract: In recent years, there has been a gradual change in nursing home care from care providers doing as many things as possible for residents to a philosophy where patients are encouraged to become more involved in their care and activities of daily living. Function Focused Care (FFC) is a methodology to stimulate the involvement of residents on a daily basis that has shown to be safe and effective in improving ADL-functioning. We implemented FFC in four nursing homes with 53 residents. This first pilot project in Dutch nursing homes has replicated the finding that FFC inspires functional independence, but also revealed a reduction in the number of falls among fallers.
BACKGROUND: Symptom burden is common for long-term care residents with dementia which if untreated compromises quality of life. Measurement tools can support assessment of symptoms and problems but are not widely used in long-term care settings. We developed the Integrated Palliative care Outcome Scale for Dementia derived from the Palliative care Outcome Scale, Palliative care Outcome Scale-Symptom and Integrated Palliative care Outcome Scale.
PURPOSE: Inform health system improvements by summarizing components of integrated care in older populations. Identify key implementation barriers and facilitators.
PURPOSE OF THE STUDY: Engagement in meaningful activities is associated with positive outcomes for persons with dementia, yet studies demonstrating quantitative evidence for which activities can be considered meaningful are lacking. We investigated MemPics™, a program designed to promote meaningful activity for individuals with dementia through engagement and cognitive stimulation. It was compared with other recreation activities offered in U.S. long-term care facilities to determine whether MemPics™ was rated as having more meaningful activity from both the perspectives of participants and recreation staff.
PURPOSE OF THE STUDY: The nursing home (NH) culture change movement advocates for residents to be able to make choices about important aspects of their care. This study seeks to understand NH residents’ perceptions of choice that they have in the care they receive while in the NH setting. We examine the association between residents’ perceived choice and satisfaction with care preferences being met using a mixed methods approach.
BACKGROUND AND PURPOSE: Inability to obtain sufficient gains in function during a skilled nursing facility (SNF) stay impacts patients’ functional trajectories and susceptibility to adverse events. The purpose of this study was to identify predictors of functional change in patients temporarily residing in an SNF following hospitalization.
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.
Purpose of the Study: Ownership of nursing homes (NHs) has primarily focused broadly on differences between for-profit (FP), nonprofit (NFP), and government-operated facilities. Yet, among FPs, the understanding of detailed ownership structures at individual NHs is rather limited. Particularly, NH administrators may hold significant equity interests in their facilities, leading to heterogeneous financial incentives and NH outcomes. Through the principal-agent theory, this article studies how managerial ownership of individual facilities affects NH outcomes.
Abstract: This article presents cross-country comparisons of trends in for-profit nursing home chains in Canada, Norway, Sweden, United Kingdom, and the United States. Using public and private industry reports, the study describes ownership, corporate strategies, costs, and quality of the 5 largest for-profit chains in each country. The findings show that large for-profit nursing home chains are increasingly owned by private equity investors, have had many ownership changes over time, and have complex organizational structures. Large for-profit nursing home chains increasingly dominate the market and their strategies include the separation of property from operations, diversification, the expansion to many locations, and the use of tax havens. Generally, the chains have large revenues with high profit margins with some documented quality problems. The lack of adequate public information about the ownership, costs, and quality of services provided by nursing home chains is problematic in all the countries. The marketization of nursing home care poses new challenges to governments in collecting and reporting information to control costs as well as to ensure quality and public accountability.
Abstract: Implementation of major organizational change initiatives presents a challenge for long-term care leadership. Implementation of the INTERACT® (Interventions to Reduce Acute Care Transfers) quality improvement program, designed to improve the management of acute changes in condition and reduce unnecessary emergency department visits and hospitalizations of nursing home residents, serves as an example to illustrate the facilitators and barriers to major change in long-term care. As part of a larger study of the impact of INTERACT® on rates of emergency department visits and hospitalizations, staff of 71 nursing homes were called monthly to follow-up on their progress and discuss successful facilitating strategies and any challenges and barriers they encountered during the yearlong implementation period. Themes related to barriers and facilitators were identified. Six major barriers to implementation were identified: the magnitude and complexity of the change (35%), instability of facility leadership (27%), competing demands (40%), stakeholder resistance (49%), scarce resources (86%), and technical problems (31%). Six facilitating strategies were also reported: organization-wide involvement (68%), leadership support (41%), use of administrative authority (14%), adequate training (66%), persistence and oversight on the part of the champion (73%), and unfolding positive results (14%). Successful introduction of a complex change such as the INTERACT® quality improvement program in a long-term care facility requires attention to the facilitators and barriers identified in this report from those at the frontline.
Research Practice and Methodology
OBJECTIVE: To analyze the effect of using a pharmacist-initiated antipsychotic use survey tool on improving nursing home compliance for appropriate antipsychotic use in patients with dementia.
AIMS AND OBJECTIVES: In this article, we introduce care itself as a narrative practice. We emphasise that all interactions between care providers and older adults in long-term care settings are narrative in nature and foreground experience.
Objective: Quality improvement of health care requires robust measurable indicators to track performance. However identifying which indicators are supported by strong clinical evidence, typically from clinical trials, is often laborious. This study tests a novel method for automatically linking indicators to clinical trial registrations.
BACKGROUND: The worldwide number of dementia cases is increasing, and this is a trend that is expected to continue as a growing proportion of the population ages. However, conducting research with persons suffering from dementia can be fraught due to fears surrounding research risks in vulnerable populations. This can make seeking approval for studies difficult. As research directly involving persons with dementia is key for the development of evidence-based best practice, the development of a coherent ethical strategy to perform such research feasibly and effectively is of paramount importance.
Abstract: Systematic reviews and meta-analyses are increasingly common. This article aims to provide guidance for people conducting systematic reviews relevant to the healthcare of older people. An awareness of these issues will also help people reading systematic reviews to determine whether the results will influence their clinical practice. It is essential that systematic reviews are performed by a team which includes the required technical and clinical expertise. Those performing reviews for the first time should ensure they have appropriate training and support. They must be planned and performed in a transparent and methodologically robust way: guidelines are available. The protocol should be written—and if possible published—before starting the review. Geriatricians will be interested in a table of baseline characteristics, which will help to determine if the studied samples or populations are similar to their patients. Reviews of studies of older people should consider how they will manage issues such as different age cut-offs; non-specific presentations; multiple predictors and outcomes; potential biases and confounders. Systematic reviews and meta-analyses may provide evidence to improve older people’s care, or determine where new evidence is required. Newer methodologies, such as meta-analyses of individual level data, network meta-analyses and umbrella reviews, and realist synthesis, may improve the reliability and clinical utility of systematic reviews.
Abstract: Case study research is a comprehensive method that incorporates multiple sources of data to provide detailed accounts of complex research phenomena in real-life contexts. However, current models of case study research do not particularly distinguish the unique contribution observation data can make. Observation methods have the potential to reach beyond other methods that rely largely or solely on self-report. This article describes the distinctive characteristics of case study observational research, a modified form of Yin’s 2014 model of case study research the authors used in a study exploring interprofessional collaboration in primary care. In this approach, observation data are positioned as the central component of the research design. Case study observational research offers a promising approach for researchers in a wide range of health care settings seeking more complete understandings of complex topics, where contextual influences are of primary concern. Future research is needed to refine and evaluate the approach.
BACKGROUND: A wide range of initiatives on early detection and intervention have been developed to proactively identify problems related to health and wellbeing in (frail) older people, with the aim of supporting them to live independently for as long as possible. Nevertheless, it remains unclear what the best way is to design such initiatives and how older people’s needs and preferences can be best addressed. This study aimed to address this gap in the literature by exploring: 1) older people’s perspectives on health and living environment in relation to living independently at home; 2) older people’s needs and preferences in relation to initiating and receiving care and support; and 3) professionals’ views on what would be necessary to enable the alignment of early detection initiatives with older people’s own needs and preferences.
BACKGROUND: An enriched environment for residents with dementia may have a positive effect on the rest-activity rhythm. A small scaled homelike special care unit might be such an enriched environment. The present study shows whether the rest-activity rhythm of residents with moderate to severe dementia responds positively to a transfer from a regular Special Care Unit (SCU) to a small scaled homelike SCU.
BACKGROUND: Many adults are discharged to skilled nursing facilities (SNFs) prior to returning home from the hospital. Patient characteristics and factors that can help to prevent postdischarge adverse outcomes are poorly understood.
OBJECTIVE: To identify whether early post-SNF discharge care reduces likelihood of 30-day hospital readmissions.
Background: While nutritional problems have been recognized as common in institutional settings for several decades, less is known about how nutritional care and nutrition has changed in these settings over time.
Objectives: To describe and compare the nutritional problems and nutritional care of residents in all nursing homes (NH) in 2003 and 2011 and residents in all assisted living facilities (ALF) in 2007 and 2011, in Helsinki, Finland.
OBJECTIVE: To evaluate the quality of meals and meal service as well as the nutritional value of the main menus (regular menu, menu for diabetics, and pureed menu) offered in three long-term care (LTC) homes located in the metropolitan area of Granada (Spain).
BACKGROUND: Patient safety culture concerns leader and staff interaction, attitudes, routines, awareness and practices that impinge on the risk of patient-adverse events. Due to their complex multiple diseases, nursing home patients are at particularly high risk of adverse events. Studies have found an association between patient safety culture and the risk of adverse events. This study aimed to investigate safety attitudes among healthcare providers in Norwegian nursing homes, using the Safety Attitudes Questionnaire – Ambulatory Version (SAQ-AV). We studied whether variations in safety attitudes were related to professional background, age, work experience and mother tongue.
Abstract: As traditional family-based care in China declines, the demand for residential care increases. Knowledge of residents’ experiences with long-term care (LTC) facilities is essential to improving quality of care. This pilot study aimed to describe residents’ experiences in LTC facilities, particularly as it related to physical function. Semi-structured open-ended interviews were conducted in two facilities with residents stratified by three functional levels (n = 5). Directed content analysis was guided by the Adaptive Leadership Framework. A two-cycle coding approach was used with a first-cycle descriptive coding and second-cycle dramaturgical coding. Interviews provided examples of challenges faced by residents in meeting their daily care needs. Five themes emerged: staff care, care from family members, physical environment, other residents in the facility, and personal strategies. Findings demonstrate the significance of organizational context for care quality and reveal foci for future research.
BACKGROUND: Literature agrees that post-diagnostic services for people living with young onset dementia (YOD) need to be age-appropriate, but there is insufficient evidence of ‘what works’ to inform service design and delivery.
The excessive use of antipsychotic drugs among long-term nursing home residents with dementia has been among the most challenging issues in the care of this vulnerable population. According to data from 2013-2014, dementia affects 50.4% of the 1.4 million persons residing in the 15 600 nursing homes in the United States.1 Despite long-standing and widely recognized concerns about safety and efficacy, antipsychotic agents, including older “typical” agents (ie, haloperidol and chlorpromazine) and newer “atypical” agents (ie, quetiapine, risperidone, and olanzapine), have been commonly used to treat behavioral and psychological symptoms of dementia.
This Viewpoint describes a national initiative of the Centers for Medicare & Medicaid Services (CMS) focused on the use of antipsychotics in nursing homes. These efforts have led to a 33% relative reduction (from 23.9% to 16.0%) in the prevalence of antipsychotic use among long-term nursing home residents over the past 5 years.
OBJECTIVE: Describe the cognitive status on admission to a skilled nursing facility (SNF) according to a hospital discharge diagnosis of dementia in a national sample of Medicare beneficiaries.
INTRODUCTION: An ageing population has become an urgent concern for Asia in recent times. In nursing homes, polypharmacy has also become a compounding issue. Deprescribing practice is an evidence-based strategy to provide a better outcome in this group of patients; however, its implementation in nursing homes is often challenging, and prospective outcome data on deprescribing practice in the elderly is lacking. Our study assesses the implementation of team-care deprescribing to understand the benefits of this practice in geriatric setting and to explore the factors affecting deprescribing practice.
This prospective, direct-observation study examined medication administration accuracy of medications dispensed by nurses and caregivers in long-term care facilities. Investigators compared medication administration from original medication packaging to administration from multicompartment medication devices. The team observed nearly 2500 doses. When medications were dispensed from original packaging, the medication administration error rate was 9%. When multicompartment devices were used, the medication administration error rate was 3%. This difference persisted in settings where both original packaging and multicompartment medication devices were used. This study adds to the evidence about how literacy-friendly health systems can enhance medication safety.
AIM: “Don’t put me in a home” is a common preference of older people, but so too is “I don’t want to be a burden on my family.” These and other goals often conflict with each other when people have worsening dementia and the issue of possible nursing home admission arises.
BACKGROUND: The use of antipsychotic medications (APMs) in nursing home residents in the U.S. is an increasingly prominent issue and has been associated with increased risk of hospitalization, cardiovascular events, hip fractures, and mortality, among other adverse health events. The Food and Drug Administration has placed a black box warning on these drugs, specifying that they are not meant for residents with dementia, and has asked providers to review their treatment plans. The purpose of this systematic PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses)-based review was to summarize original research studies on facility level characteristics contributing to the use of antipsychotics in nursing homes across the United States, in order to investigate the variation of use.
Abstract: Specialized Care Units (SCUs) in nursing home facilities offer care for individuals with late-stage dementia primarily when care in the home no longer supports physical and sociobehavioral needs. Prior research has primarily examined new facilities; however, due to market demand and financial constraints, many SCUs are retrofits of existing nursing homes. The purpose was to determine the capacity of the physical environment to enhance person-centered care (PCC) and identify potential design opportunities to help patients adapt to and cope with dementia progression to maintain quality of life (QoL). Grounded in empirical knowledge and best practices for SCU design, an instrumental case study of a retrofit SCU in the Rocky Mountain region of the United States examined relationships between the physical environment and the behavior of residents and staff. Qualitative and quantitative data were collected through a spatial inventory, staff e-survey, and behavioral observations in the unit’s public spaces. Data indicate that even (less than ideal) retrofit SCU designs have the potential to support PCC goals significantly, and some physical conditions found to undermine PCC goals could be remedied by simple (low-cost) design interventions, suggesting staff may lack awareness of the capacity for the SCU physical environment to improve residents’ QoL. By linking design features from empirical studies and best practices with observed behaviors in a retrofit SCU, the primary contribution of our exploratory study is a framework of roles design features play in adaptation–coping and maladjustment–stress for people managing progressive dementia conditions. This framework suggests directions for future research and evolving methods to better understand the impacts of environmental designs on users’ QoL over the course of progressive illnesses, like dementia.
OBJECTIVE: This paper aims to investigate the nature and extent of physical restraint deaths reported to Coroners in Australia over a 13-year period.
OBJECTIVE: To measure the health and functioning of people moving into care homes and how they have changed between 2002 and 2015.
BACKGROUND: Frontotemporal dementia (FTD) constitutes on average 10-15% of dementia in younger persons (≤65 years old), but can also affect older people. These patients demonstrate a decline in social conduct, and/or language aphasias, apathy, and loss of insight that is gradual and progressive. Preservation of dignity seems to be highly relevant both before and after admission to different types of institutionalized care, but the research is scant. From the perspective of close relatives, this study aims to develop knowledge related to dignified or undignified care of patients with FTD and similar conditions.
OBJECTIVES: To examine whether there was a bidirectional association between cognition and depressive symptoms in Alzheimer’s disease (AD), and to explore the role of socio-demographic factors and daily performance in this association.
BACKGROUND: Social engagement is known to be an important factor that affects the quality of life and the psychological well-being of residents in long-term care settings. Few studies have examined social engagement in long-term care facilities in non-Western countries.
PURPOSE: This study aimed to evaluate the validity and reliability of the revised index for social engagement (RISE), which was derived from the Korean version of the interRAI Long Term Care Facilities instrument.
BACKGROUND: Depression has a high prevalence among patients with Alzheimer’s disease, and it has a significant negative impact on their functioning. However, despite its significant impact and challenge, few treatment outcomes data are available to guide clinical care of depression among this population. We developed a cognitive-behavioral intervention to persons with AD. In this paper, we describe the intervention and results of an open trial evaluating its feasibility and utility.
PURPOSE OF THE STUDY: This study aimed to explore the experience of living with and caring for a person with dementia who wanders and transgresses boundaries into out-of-bounds and potentially hazardous areas (wandering-related boundary transgression [BT]), from the perspective of family members and care staff.
PURPOSE OF THE STUDY: Ambivalence has been described as simultaneous positive and negative emotional experiences. Although ambivalent feelings are often reported by dementia family caregivers, the effect of these feelings on caregivers’ mental health has not been studied. Furthermore, the measurement of ambivalence specific to caregiving situations has not been studied. The aims of this study are to analyze the psychometric properties of the Caregiving Ambivalence Scale (CAS) and, drawing upon the stress and coping model, to test whether ambivalent feelings significantly contribute to caregivers’ distress.
Background: Pressure ulcers increase the risk of costly hospitalization and mortality of nursing home residents, so timely healing is important. Disparities in healthcare have been identified in the nursing home population but little is known about disparities in the healing of pressure ulcers.
Purpose: To assess racial and ethnic disparities in the healing of pressure ulcers present at nursing home admission. Multi-levels predictors, at the individual resident, nursing home, and community/Census tract level, were examined in three large data sets.
A facilitated approach to family case conferencing for people with advanced dementia living in nursing homes: perceptions of palliative care planning coordinators and other health professionals in the IDEAL study
Non UofA Access
BACKGROUND: Palliative care for nursing home residents with advanced dementia is often sub-optimal due to poor communication and limited care planning. In a cluster randomized controlled trial, registered nurses (RNs) from 10 nursing homes were trained and funded to work as Palliative Care Planning Coordinators (PCPCs) to organize family case conferences and mentor staff. This qualitative sub-study aimed to explore PCPC and health professional perceptions of the benefits of facilitated case conferencing and identify factors influencing implementation.
Objective To forecast dementia prevalence with a dynamic modelling approach that integrates calendar trends in dementia incidence with those for mortality and cardiovascular disease.
Abstract: The Centers for Medicare and Medicaid Services initiated three strategies (in March and July 2012 and in May 2013) to reduce the use of unnecessary antipsychotic medications in nursing homes, especially their widespread use to control behavioral symptoms of dementia. We examined 86,163 state recertification surveys conducted at 15,055 facilities in the period January 1, 2009-March 31, 2015. We found that these strategies were associated with increases in citations for only one of two targeted deficiencies (unnecessary drug use) and only after the third strategy (revisions to the federal guidelines for the citations) was implemented. Each strategy was associated with a modest but significant reduction in antipsychotic prevalence in the general nursing home population. Initial reductions were greater in the ten states with the highest prevalence of antipsychotic use in nursing homes, compared to the ten states with the lowest prevalence. Use of other psychoactive medications, some of which are potential substitutes for antipsychotics, varied with each strategy and by state. Continuous monitoring and consistent enforcement are needed to ensure the continued decline in unnecessary use of antipsychotics and psychoactive medications in nursing homes.
BACKGROUND: Many studies have examined the mental health of carers of people with dementia. Few have examined their experiences in the advanced stages of disease and into bereavement. We aimed to understand the experiences of carers during advanced dementia exploring the links between mental health and experiences of end of life care.
BACKGROUND: In 2009, the Dutch Health Care Inspectorate (IGZ) observed several serious risks to safety involving medication within elderly care facilities. However, by 2011, high risks had been reduced in almost all the organisations we visited. And yet the IGZ analysed too the alarming increase in the number of incidents arising in the self-reported national indicator of medication safety between 2009 and 2010. The aim of this study was to understand the factors that can explain this contradiction between the increase in self-reported medication incidents and the observation of the IGZ in reducing the risks to medication safety through supervision.
CIHR is holding a series of Question and Answer webinars on the Project Grant: Fall 2017 application starting on Thursday, July 20, 2017. They will provide participants with a brief overview of recent changes and an opportunity to ask questions. Register early if you would like to ensure your place.
The KT Program’s KT Basics is a 2-day workshop on the fundamentals of implementing change using best practices in KT.
In KT Basics, participants learn how to do the following:
– Identify key KT definitions
– Assess and prioritize implementation needs
– Use appropriate methods to assess the quality of available evidence
– Define the scope of change and ideal practices to be implemented
– Identify key processes that inform the selection of implementation strategies
Course 2 – The creation of productive contexts for knowledge mobilization requires acting on the factors enhancing or limiting individual, organizational and societal capacity for using and sharing evidence. This course focuses on processes and products to support target audiences in engaging with new evidence. You will learn skills and techniques to help build capacity for users to identify, make sense of, and apply relevant evidence in their individual, organizational and societal contexts. You will explore the role of knowledge brokers in enhancing user literacy and motivation, facilitating engagement, and increasing understanding and uptake of evidence.
Course 3 – The ultimate objective of knowledge mobilization is to support the transformation of knowledge into action, enabling individual or social innovation and change. This course focuses on the final stage in the KMb continuum, where evidence is transformed into decisions and practices at the system, organization, community and individual level. You will learn about KMb tools and techniques that facilitate the implementation of evidence into practice and support target audiences in sustainable change. Finally, you will be introduced to more complex approaches to knowledge production and use, including co-creation, which can enhance the uptake of evidence and favour evidence-informed decisions and practices.
This webinar will discuss the development of innovative technologies for improving communication and care planning for aging adults. Presenters will discuss technologies designed to provide health information, resources, and tools to connect aging adults with families, providers, and peers to aid in healthy aging and to integrate home context with clinical data for improving care planning for aging adults.
This hallmark series from the NCCMT features knowledge translation resources from our Registry of Methods and Tools; an online database that supports the planning, implementation and evaluation of public health policies and practices. Held monthly, each webinar features a presentation by the developer of the resource as well as a user account of a real-world application of the resource.
Population aging has led to a greater number of seniors, many of whom suffer from multiple ongoing health problems. Unfortunately, the health care system is currently designed to deal with single, sudden and usually curable problems. Providing care to older adults living with frailty is challenging due to comorbidities, multiple providers, multiple care settings, long wait times, inefficient referral processes and insufficient transitional care across settings. As a result, many of these seniors living with frailty have no other choice than to visit crowded hospital emergency departments. One way to respond to these pressures is to improve the ability of Canada’s primary health care providers to deliver care to older people living with frailty.
Very brief tools were used to screen all seniors in the primary care practice, and identify those who were at greater risk of developing problems. Those at higher risk could then be evaluated in greater depth, and connected with appropriate health care services as soon as possible. Our highly qualified team worked with these care practices to develop and evaluate a model of care to accomplish these tasks.
Beginning July 2017, BMJ Quality Improvements Reports will be rebranded as BMJ Open Quality.
It’s time to question the model of dementia research and funding that’s being energetically pursued around the world. Elevated expectations, promoted by a variety of players, have led to widespread public misunderstanding about the true state of evidence on risk reduction, early detection and diagnosis, and effectiveness of drugs.
It’s no secret that our emergency departments are busy. Many patients come in every day. It’s taking longer to move patients from our hospitals to more appropriate places for their care. That means it takes longer to find beds for new patients who need to be admitted.
This happens for a variety of reasons and many people are working to address these challenges. One of the most successful ways to reduce pressure on our emergency departments is also one of the simplest: keep patients who don’t need to be in the hospital out of the hospital.
Canadians are deluding themselves about the quality and true costs of home care, even as governments shift more of seniors’ care away from institutions, said experts at the recent Canadian Association for Health Services and Policy conference.
Eight years after Greg O’Brien was diagnosed with early-onset Alzheimer’s disease, the 67-year-old’s memory is failing slowly and irreversibly. But, increasingly, it is his other symptoms that interrupt his day-to-day life as a writer, father, husband and now grandfather.
Windsor’s Bonnie Campeau says she’s fearful a local nursing home’s goal to put all residents on regular diets — including those with diabetes and kidney problems — will lead to worsening health for some.
Alzheimer’s Australia is thrilled to welcome Brisbane Airport on board as it becomes Australia’s first dementia-friendly airport with the launch of an airport guide for travellers with dementia.
In the now 30-year history of bringing modern quality methods into the control, improvement, and planning of health care, skeptics sometimes comment on the “religious” tone of that movement. Leaders and others in the workforce who get the quality “bug,” seem to buzz with their enthusiasm. They adopt phrases like “joy in work,” “pursuing perfection,” and a “never-ending journey,” and sprinkle their vocabulary with unfamiliar technical expressions, like “PDSA cycles,” “high reliability organizations,” and “statistical process control.” And, they seem to think they are right, lamenting together that too many others so not see what they, at last, see. So it does, indeed, seem to newcomers as if a religion, or at least a cult, has arrived in town.
Ontario’s personal support workers need their own governing body to offer more accountability to residents in long-term care and their families, says the head of a group that represents 25,000 of these workers.
It could make for awkward conversation. Teenagers mingling over tea and cookies with seniors who have dementia. But at Calgary’s Rundle College, teenaged students are being equipped with questions both generations have in common. The students recently met with seniors from Wentworth Manor, pairing up for tea at the school. This gave the teens a chance to practise what they’ve learned about chatting with folks who have dementia.
Rabbits, guinea pigs, hens and ferrets are being used as an unlikely therapy in the battle against dementia and loneliness.
While working as a nurse, Elizabeth Wettlaufer killed at least eight nursing-home residents and attempted to kill at least six others. … But now the important work must begin – to determine how frail, elderly, vulnerable patients such as those in her care can be better protected and cared for.
In 2012, Parkview Healthcare Center’s history of safety violations led California regulators to issue an ultimatum reserved for the most dangerous nursing homes. The state’s public health department designated Parkview, a Bakersfield, Calif., nursing home, a “special focus facility,” requiring it to either fix lapses in care while under increased inspections or be stripped of federal funding by Medicare and Medicaid — a financial deprivation few homes can survive. After 15 months of scrutiny, the regulators deemed Parkview improved and released it from extra oversight. But a few months later, Elaine Fisher, a 74-year-old who had lost the use of her legs after a stroke, slid out of her wheelchair at Parkview.
New York City may be a cradle of gay rights, but for many in the gay community it is still not an easy place to grow old. …
The operator of the senior center, SAGE, a nonprofit advocacy and service organization, is working with private developers to build New York City’s first subsidized housing for older people who need a place to live, may face discrimination from their neighbors, or simply want to spend their later years among those they feel most comfortable with.
Depression is very common among people with Alzheimer’s, especially during the early and middle stages. Treatment is available and can make a significant difference in quality of life.
Experts are predicting that there will be 1.2 million people in England and Wales living with dementia by 2040 – a rise of 57% from 2016 – due to increased life expectancy.
With thousands of people on waiting lists for long-term care beds in this region, you might expect a new long-term care home in Ottawa to bring some relief. But the Ontario government’s move to approve a new facility in the city’s west end without adding a single new bed to the mix is drawing criticism and frustration from doctors. It offers a glimpse, they say, into how the province is failing the elderly and not dealing with a growing health-care crisis.
Plans to provide faster access to long-term care and supportive living flopped last year, according to new provincial statistics that show many patients actually found themselves waiting longer for a bed. Numbers included in the latest Alberta Health annual report show the goal of providing a continuing care bed within 30 days of assessment was achieved for 56 per cent of patients last year — the worst rate since the province began tracking the standard in 2011.
More than 20 per cent of Canadian seniors who go into residential care might have been able to stay at home with supports, according to a new report.
Summer 2017 newsletter
Individuals, families, and societies around the world are concerned about dementia and the other forms of cognitive impairment that affect many older adults. It is now known that brain changes typically begin years—if not decades—before people show symptoms, which suggests that a window of opportunity exists to prevent, slow, or delay the onset of these conditions. Further, emerging evidence that the incidence and prevalence of dementia are declining in some high-income countries offers hope that public health interventions can be effective in preventing cognitive decline and dementia. Although the evidence base on how to prevent, slow, or delay these conditions has been limited at best—despite the many claims of success made in popular media and advertising—a growing body of prevention research is emerging. A systematic review published in 2010 by the Agency for Healthcare Research and Quality (AHRQ) and an associated “state of the science” conference at the National Institutes of Health (NIH) concluded that there was insufficient evidence to make recommendations about interventions to prevent cognitive decline and dementia. Since then, understanding of the pathological processes that result in dementia and cognitive impairment has significantly advanced, and a number of clinical trials of potential preventive interventions have been completed and published, with more under way or being planned. Within that context, the National Institute on Aging (NIA) initiated this study with the National Academies of Sciences, Engineering, and Medicine to take stock of the current state of knowledge on interventions for preventing cognitive decline and dementia, to help shape the messages NIA conveys to the broader public about these conditions, and to inform future actions and research in this area. The expert committee was tasked to help inform the design of a new AHRQ systemic review whose results then would be used by the committee as the primary evidence base for recommendations on the appropriate content for communicating with the public about steps that can be taken to prevent, slow, or delay the onset of mild cognitive impairment (MCI) and clinical Alzheimer’s-type dementia (CATD) and delay or slow age-related cognitive decline (ARCD), as well as recommendations for future prevention research.
Factsheet and infographic about dementia statistics in Canada
The Kit provides guidance for starting conversations about end-of-life care in the early stages of decline, and for using this resource to speak on your loved one’s behalf when advanced illness occurs.
Dementia is our focus on Evidently Cochrane over the next four weeks. Why? Well, a few facts alone provide pretty good justification, with around 850,000 people with dementia in the UK, a number expected to rise to over one million by 2025. One person in every six, over the age of 80, has dementia, but let’s not forget the 40,000 people younger than 65 who have dementia. In care homes, 70% of residents have dementia, or severe memory problems. We hope there will be something to interest everyone in this blog series. We’ll also be hearing about the latest Cochrane evidence and some views from clinical practice on drug treatments and arts therapies for people with dementia, as well as interventions for carers, and about some of the new living and social care models prevalent in other parts of Europe, and what we can learn from them here in the UK.
To develop, lead and sustain a social science informed research and evaluation programme that uses qualitative methods within the Institute of Health and Wellbeing’s HEHTA research group. The postholder will also be expected to actively contribute to the development of research and evaluation across the Institute and to contribute to existing taught courses and development of new courses.
This position plays a pivotal leadership role in maintaining Prostate Cancer Canada as a critical organization in the generation of new prostate cancer knowledge through research and the rapid translation of new research findings to benefit those affected by prostate cancer. Reporting to the VP Research, Health Promotion & Survivorship, the Manager, Research and Knowledge Translation contributes to the definition of the strategic research direction of PCC, has responsibility for maintaining the high quality peer review process for all PCC research programs and develops policies and position statements based on the emerging evidence.