New TREC article
RATIONALE, AIMS, AND OBJECTIVES: Process evaluation can be used to understand the factors influencing the impact of knowledge translation (KT) interventions. The aim of this mixed methods process evaluation was to evaluate the processes and perceived outcomes of eight KT interventions that were used with healthcare aides (HCAs) to introduce a mobility innovation into their daily care practices. The study examined the perceived effectiveness of various KT interventions in sustaining daily performance of the sit-to-stand mobility innovation by HCAs with residents in long-term care.
Article from TREC researchers
Abstract: This article is based on a study that investigated factors associated with long-term care wait list placement in Ontario, Canada. We based the study’s analysis on Resident Assessment Instrument for Home Care (RAI-HC) data for 2014 in the North West Local Health Integration Network (LHIN). Our analysis quantified the contribution of three factors on the likelihood of wait list placement: (1) care recipient, (2) informal caregiver, and (3) formal system. We find that all three factors are significantly related to wait list placement. The results of this analysis could have implications for policies aimed at reducing the number of wait-listed individuals in the community.
Grants & Awards
Knowledge Mobilisation Research Fellowships (KMRF) are designed to support a balance of innovative knowledge mobilisation and research into the processes and impacts of such innovation. Through innovative practice and systematic study of that practice KMR Fellows should advance knowledge and understanding about research use, influence and impact.
OBJECTIVE: The objective of this work was to provide easy access to reliable health information based on good quality research that will help health care professionals to learn what works best for seniors to stay as healthy as possible, manage health conditions and build supportive health systems. This will help meet the demands of our aging population that clinicians provide high quality care for older adults, that public health professionals deliver disease prevention and health promotion strategies across the life span, and that policymakers address the economic and social need to create a robust health system and a healthy society for all ages.
BACKGROUND: Clinicians are important stakeholders in the translation of well-designed research evidence into clinical practice for optimal patient care. However, the application of knowledge translation (KT) theories and processes may present conceptual and practical challenges for clinicians. Online learning platforms are an effective means of delivering KT education, providing an interactive, time-efficient, and affordable alternative to face-to-face education programs.
Health Care Administration and Organization
Although gerontological nurses are well positioned to care for older adults with dementia, barriers to implementing quality client care remain, including: limited knowledge (Brown, Wielandt, Wilson, Jones, & Crick, 2014; Wang, Xiao, Ullah, He, & De Bellis, 2017), poor morale among care staff (Kupeli et al., 2016), lack of professional development opportunities (Fossey et al., 2014), and unsuitability of acute care hospitals for this client group (Dewing & Dijk, 2016).
BACKGROUND: Evidence-informed care to support seniors is based on strong knowledge and skills of nursing assistants (NAs). Currently, there are insufficient NAs in the workforce, and new graduates are not always attracted to nursing home (NH) sectors because of limited exposure and lack of confidence. Innovative collaborative approaches are required to prepare NAs to care for seniors.
BACKGROUND: Swedish nursing home care has undergone a transformation, where the previous virtual public monopoly on providing such services has been replaced by a system of mixed provision. This has led to a rapidly growing share of private actors, the majority of which are large, for-profit firms. In the wake of this development, concerns have been voiced regarding the implications for care quality. In this article, we investigate the relationship between ownership and care quality in nursing homes for the elderly by comparing quality levels between public, for-profit, and non-profit nursing home care providers. We also look at a special category of for-profit providers; private equity companies.
AIMS: To understand how nursing homes employ baccalaureate-educated registered nurses (BRNs) and how they view the unique contributions of BRNs to staff and residents in their organizations.
OBJECTIVE: There are few studies on how professional caregivers apply the Liverpool Care Pathway (LCP) in nursing home care for people with dementia. Further, despite critiques in the United Kingdom, the LCP continues to be used in the Netherlands, while, to the best of our knowledge, no studies have been conducted since its implementation. The purpose of the present study was to analyze professional caregivers’ experiences with the LCP in this context.
Abstract: The emerging care personnel shortage in Swiss nursing homes is aggravated by high turnover rates. As intention to leave is a predictor of turnover, awareness of its associated factors is essential. This study applied a secondary data analysis to evaluate the prevalence and variability of 3,984 nursing home care workers’ intention to leave. Work environment factors and care worker outcomes were tested via multiple regression analysis. Although 56% of care workers reported intention to leave, prevalences varied widely between facilities. Overall, intention to leave showed strong inverse relationships with supportive leadership and affective organizational commitment and weaker positive relationships with stress due to workload, emotional exhaustion, and care worker health problems. The strong direct relationship of nursing home care workers’ intention to leave with affective organizational commitment and perceptions of leadership quality suggest that multilevel interventions to improve these factors might reduce intention to leave.
BACKGROUND:The Knowledge about Older Patients-Quiz (KOP-Q) is designed as a unidimensional scale measuring knowledge of hospital nurses about older patients. Furthermore, the KOP-Q measures a second unidimensional construct, certainty of hospital nurses about their knowledge. The KOP-Q is developed and validated in the Netherlands. Whether the KOP-Q can be used in other countries is unknown given the cultural and language differences.
Purpose The purpose of this paper is to examine the effectiveness of an emotional intelligence (EI) and leadership development education program involving 20 nurse leaders at nursing homes. Also, it investigates the relationship between EI and transformational leadership. Design/methodology/approach Three research questions are posed. Correlation analysis and t-tests were conducted to answer the questions posed. Findings The findings of this paper indicate that the EI educational development was effective, while the personal leadership development was not. The data also showed a positive significant relationship between EI and transformational leadership. Research limitations/implications This paper is limited by the small sample size; thus, a causal relationship between EI and leadership could not be investigated. Additionally, the sample was not randomly selected because of the commitment needed from the participants. Furthermore, the paper was focused on nurse leaders in nursing homes, so it may not be generalizable to other populations. Practical implications With the increasing need for nursing home facilities and the limited training generally provided to nurses who move into managerial roles in these facilities, it is critical for organizations to understand the effectiveness of educational programs that exist. Moreover, the findings of this paper may provide information that would be useful to others who wish to develop EI and/or leadership education for nurses. Originality/value While much research exists on EI and transformational leadership, little of this research focuses on nurses in nursing home facilities. Thus, this paper fills a gap in the literature.
Health Care Innovation and Quality Assurance
Background: Quality of life in persons with dementia is, in large part, dependent on the quality of care they receive. Investigating both subjective and objective aspects of quality of care may reveal areas for improvement regarding their care, which information may ultimately enable persons with dementia to remain living in their own homes while maintaining quality of life. The aim of this study was to 1) describe self-reported quality of life in persons with dementia at risk of nursing home admission. 2) describe subjective and objective aspects of quality of care, 3) investigate the significance of quality of care for quality of life.
BACKGROUND: Audit and feedback (AF) interventions that leverage routine administrative data offer a scalable and relatively low-cost method to improve processes of care. AF interventions are usually designed to highlight discrepancies between desired and actual performance and to encourage recipients to act to address such discrepancies. Comparing to a regional average is a common approach, but more recipients would have a discrepancy if compared to a higher-than-average level of performance. In addition, how recipients perceive and respond to discrepancies may depend on how the feedback itself is framed. We aim to evaluate the effectiveness of different comparators and framing in feedback on high-risk prescribing in nursing homes.
Strategies used in improving and assessing the level of reporting of implementation fidelity in randomised controlled trials of palliative care complex interventions: A systematic review
Non UofA Access
BACKGROUND: Implementation fidelity is critical in evaluating effectiveness of interventions.
AIM: Identifying and summarising strategies to improve and assess the level of reporting of implementation fidelity in randomised controlled trials of palliative care complex interventions.
BACKGROUND: Many people with dementia die in nursing homes, but quality of care may be suboptimal. We developed the theory-driven ‘Compassion Intervention’ to enhance end-of-life care in advanced dementia.
BACKGROUND: Many countries are introducing smaller, more home-like care facilities that represent a radically new approach to nursing home care for people with dementia. The green care farm is a new type of nursing home developed in the Netherlands. The goal of this study was to compare quality of care, quality of life and related outcomes in green care farms, regular small-scale living facilities and traditional nursing homes for people with dementia.
RATIONALE: Improving end-of-life care (EOLC) in long-term care (LTC) homes requires quality measurement tools that assess families’ satisfaction with care. This research adapted and pilot-tested an EOLC satisfaction measure (Canadian Health Care Evaluation Project (CANHELP) Lite Questionnaire) for use in LTC to measure families’ perceptions of the EOLC experience and to be self-administered.
Higher acuity of care at the time of admission to long-term care (LTC) is resulting in a shorter period to time of death, yet most LTC homes in Canada do not have formalized approaches to palliative care. Namaste Care is a palliative care approach specifically tailored to persons with advanced cognitive impairment who are living in LTC. The purpose of this study was to employ the ecological framework to identify barriers and enablers to an implementation of Namaste Care.
Abstract: The paper seeks to identify aspects of care that may be easily modified to yield a desired level of improvement in residents’ overall satisfaction with nursing homes, comparing data across Canada and Italy. Using a structured questionnaire, 681 and 1116 nursing home residents were surveyed in Ontario in 2009 and in Tuscany in 2012, respectively. Fourteen items were common to the surveys, including willingness to recommend (WTR), which was used as the dependent variable and measure of global satisfaction. The other analogous items were entered as covariates in ordinal logistic regression models predicting residents’ WTR in each jurisdiction separately. Regression coefficients were then incorporated into a constrained nonlinear optimization problem selecting the most efficient combination of predictors necessary to increase WTR by as much as 15%. Staff-related aspects of care were selected first in the optimization models of each jurisdiction. In Ontario, to improve WTR the primary focus should be on staff relationships with residents, while in Tuscany it was the technical skill and knowledge of staff that was selected first by the optimization model. Different optimization solutions might mean that the strategies required to improve global satisfaction in one jurisdiction could be different than those for the other jurisdictions. The optimization model employed provides a novel solution for prioritizing areas of focus for quality improvement for nursing homes.
Research Practice and Methodology
<Abstract: The field of dissemination and implementation (D&I) research in health has grown considerably in the past decade. Despite the potential for advancing the science, limited research has focused on mapping the field. We administered an online survey to individuals in the D&I field to assess participants’ demographics and expertise, as well as engagement with journals and conferences, publications, and grants. A combined roster-nomination method was used to collect data on participants’ advice networks and collaboration networks; participants’ motivations for choosing collaborators was also assessed. Frequency and descriptive statistics were used to characterize the overall sample; network metrics were used to characterize both networks. Among a sub-sample of respondents who were researchers, regression analyses identified predictors of two metrics of academic performance (i.e., publications and funded grants). A total of 421 individuals completed the survey, representing a 30.75% response rate of eligible individuals. Most participants were White (n = 343), female (n = 284, 67.4%), and identified as a researcher (n = 340, 81%). Both the advice and the collaboration networks displayed characteristics of a small world network. The most important motivations for selecting collaborators were aligned with advancing the science (i.e., prior collaborators, strong reputation, and good collaborators) rather than relying on human proclivities for homophily, proximity, and friendship. Among a sub-sample of 295 researchers, expertise (individual predictor), status (advice network), and connectedness (collaboration network) were significant predictors of both metrics of academic performance. Network-based interventions can enhance collaboration and productivity; future research is needed to leverage these data to advance the field.
BACKGROUND: The need to better understand implementing evidence-informed dementia care has been recognised in multiple priority-setting partnerships. The aim of this scoping review was to give an overview of the state of the evidence on implementation and dissemination of dementia care, and create a systematic evidence map.
Purpose: The literature is reviewed to examine how ‘improvement capability’ is conceptualized and assessed and to identify future areas for research.
BACKGROUND: The methodological quality and completeness of reporting of the systematic reviews (SRs) is fundamental to optimal implementation of evidence-based health care and the reduction of research waste. Methods exist to appraise SRs yet little is known about how they are used in SRs or where there are potential gaps in research best-practice guidance materials. The aims of this study are to identify reports assessing the methodological quality (MQ) and/or reporting quality (RQ) of a cohort of SRs and to assess their number, general characteristics, and approaches to ‘quality’ assessment over time.
INTRODUCTION: The unjustified exclusion of older participants from clinical trials creates research populations that are non-representative, in turn creating difficulties applying research to the target populations. The aim of this study was to assess the proportion of randomised control trials (RCTs) that have unexplained upper age limits and review whether this proportion is reducing over time.
Article themes include caregiving, neighbourhood, dementia, brain donation, physical activity, elder abuse, driving, policy studies, and intervention research.
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
Purpose of Study: This study focuses on the relationship between family involvement and family perceptions of nursing home residents’ quality of life (QOL).
INTRODUCTION: According to the World Health Organization (WHO) and FDI World Dental Federation (FDI), malnutrition and bad oral health are of great concern to global health, especially among the older population. This study aimed to assess the associations between oral health problems ([artificial] teeth problems, chewing problems, and xerostomia) and malnutrition in residents of somatic and psychogeriatric wards in Dutch nursing homes.
BACKGROUND: Polypharmacy is considered the most important etiologic factor of hyposalivation, which in turn can initiate oral health problems.
OBJECTIVES: To describe the medication use of nursing home residents, to identify the medications related to hyposalivation and to find possible associations between the different classes of medication, the number of medications, and the oral health status of the residents.
OBJECTIVES: To explore associations between carer burden and characteristics of (1) the informal carer, (2) the person with dementia, and (3) the care support network in 8 European countries.
Many nursing homes provide continuing care and support for older people with dementia. Care home residents may have three or more health conditions, with an estimated 80% in the United Kingdom having dementia without a confirmed or documented diagnosis, up to a third of whom may be at an advanced stage. In this editorial the term care home is used and includes registered homes providing nursing, social, and/or continuing aged care. Advanced dementia is variably defined but usually includes complete loss of memory and recognition, severe dependency for activities of daily living (such as bathing, dressing, toileting, and feeding), poor or absent communication, incontinence, poor mobility, difficulty swallowing, and weight loss.
Objective: To assess efficacy and safety of citalopram compared to quetiapine and olanzapine for the treatment of agitation in patients with Alzheimer disease (AD).
OBJECTIVE: Poor food intake is known to lead to malnutrition in long-term care homes (LTCH), yet multilevel determinants of food intake are not fully understood, hampering development of interventions that can maintain the nutritional status of residents. This study measures energy and protein intake of LTCH residents, describes prevalence of diverse covariates, and the association of covariates with food intake.
BACKGROUND: Many interventions aim to alleviate well-documented problems of malnutrition in residential care homes and improve residents’ health and wellbeing. Despite some positive findings, little is known about how and why mealtime interventions might be effective, and in particular, what effects residents’ experiences of mealtimes have on health outcomes. The aim of this study was to gain an insight into these experiences and explore some of the issues that may impact on residents’ enjoyment of meals, and resulting health and wellbeing.
OBJECTIVES: Measure the clinical effectiveness and cost effectiveness of using sensor data from an environmentally embedded sensor system for early illness recognition. This sensor system has demonstrated in pilot studies to detect changes in function and in chronic diseases or acute illnesses on average 10 days to 2 weeks before usual assessment methods or self-reports of illness.
BACKGROUND: Common foot problems are independent risk factors for falls in older people. There is evidence that podiatry can prevent falls in community-dwelling populations. The feasibility of implementing a podiatry intervention and trial in the care home population is unknown. To inform a potential future definitive trial, we performed a pilot randomised controlled trial to assess: (i) the feasibility of a trial of a podiatry intervention to reduce care home falls, and (ii) the potential direction and magnitude of the effect of the intervention in terms of number of falls in care home residents.
Objectives The primary aim of this study is to describe depression and physical function in nursing home residents with dementia, as well as to examine the associations between depression and balance function, lower limb muscle strength, mobility and activities of daily living. The secondary aim is to examine the differences in physical function between the groups classified as depressed and not depressed.
Abstract: Readmissions to hospitals from post-acute care (PAC) units within long-term care settings have been rapidly increasing over the past decade, and are drivers of increased healthcare costs. With an average of $11,000 per admission, there is a need for strategies to reduce 30-day preventable hospital readmission rates. In 2018, incentives and penalties will be instituted for long-term care facilities failing to meet all-cause, all-condition hospital readmission rate performance measures. An interprofessional team (IPT) developed and implemented a Transfer Triage Protocol used in conjunction with the INTERACT programme to enhance clinical decision-making and assess the potential to reduce the facility’s 30-day preventable hospital readmission rates by 10% within 6 weeks of implementation. Results from quantitative analysis demonstrated an overall 35.2% reduction in the 30-day preventable hospital readmission rate. Qualitative analysis revealed the need for additional staff education, improved screening and communication upon admission and prior to hospital transfer, and the need for more IPT on-site availability. This pilot study demonstrates the benefits and implications for practice of an IPT to improve the quality of care within PAC and decrease 30-day preventable hospital readmissions.
OBJECTIVES: The primary objective of this study was to identify information included in long-term care (LTC) transfer documentation and to compare it to the information required by local emergency department (ED) physicians to provide optimal care and make decisions for LTC patients.
Abstract: Advance directives allow individuals and their families or legal guardians to communicate preferences for interventions and treatments in the event that these individuals are no longer able to make decisions for themselves. This study examines how often do-not-hospitalize (DNH) and do-not-resuscitate (DNR) directives were recorded for residents in 982 reporting Canadian long-term care facilities between 2009-2010 and 2011-2012 and, to the extent possible, whether these directives were followed in acute care settings. It found that three-quarters of long-term care residents had a directive not to resuscitate and that these directives appeared to be well followed across the continuum; only 1 in 2,500 residents with a DNR received resuscitation in hospital. Fewer residents – 1 in 5 – had a directive not to hospitalize, and about 1 in 14 (7%) of these residents was admitted to hospital. The data are unable to determine whether patients or their families provided consent for these hospitalizations at the time of a decision to transfer. Close to half of hospitalizations among residents with a DNH directive were from potentially preventable causes, such as injuries or infections. Although hospital transfers from long-term care decreased over the study period, hospitalizations could be further reduced with the enhancement of palliative care services in long-term care settings.
BACKGROUND: Despite sexual expression being recognised as a fundamental human need, sexuality in old age is often ignored and frequently misunderstood, with residents with dementia in a nursing home often viewed as asexual or incapable of being sexually active.
OBJECTIVES: The current study aims to understand the views held by nursing care home staff towards dementia and sexuality and explore the roles they may adopt whilst responding and managing sexual needs and expression for residents with dementia.
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
This virtual online conference is designed to address major strategies in the planning and implementation of effective and efficient KT measurement approaches.
The event will occur over 3 days on Oct. 30, Nov. 1, and Nov. 3, 2017, between 1 and 5 PM (Eastern) each day.
Oct. 30: Overcoming Barriers to Outreach
Nov. 1: Tools for Tracking Implementation
Nov. 3: Strategies for Measuring Impact
Registration will be limited to 250 participants. There is no fee to participate but all must register by close of business Friday, October 26, 2017.
Join Dr. Travis Sztainert for a discussion on how small, simple changes to “choice architecture” can result in lasting behavioural change.
A new study has found that a community-based service learning experience involving greater interaction with older adults had a positive impact on career development for medical residents (physicians who have graduated from medical school and are starting work at a healthcare facility under supervision).
New research shows that Admiral nurses not only improve the lives of those with dementia and their families, they also save cash-strapped NHS and local authorities money because they reduce the numbers going into care homes and inappropriate acute hospital admissions, as well as cutting referrals to GPs and psychological therapies.
One woman was escorted from the long-term care home’s dining room by a security guard while her elderly mother, who suffers from dementia, watched in shock. Another was handed a notice under the Trespass To Property Act and told she could no longer stay in her severely disabled mother’s room while she was being cared for by staff.
When he was 51, Jeff Borghoff, a software developer, began experiencing odd neurological symptoms, as well as difficulty concentrating and multitasking. Because Jeff was so young, neither he, his wife, nor even his doctor, suspected Alzheimer’s could be the cause. It was.
Increasingly, people are dying at home, which sounds like a good thing. For years, Americans have told researchers and anyone else who would listen that this is how they want to go: surrounded by loved ones in the familiarity of their own house. But is dying at home really best for everyone?
Involving front-line staff has helped residential home find lasting and low-cost solutions to injury hazards.
Arborists, hairdressers, even swine herders are governed by a regulatory body in Ontario, which holds them to professional standards. But personal support workers — who make up the backbone of the increasingly overtaxed long-term health care system — are not.
One in three cases of dementia could be prevented if more people looked after their brain health throughout life, according to an international study in the Lancet.
In the past year a new movement focused on redesigning the display of research data has been gaining ground on Twitter. The drive primarily deals with combining research abstracts and infographics to create a “visual abstract.” These easily digestible abstracts can be shared in the community for quick dissemination of research results.
19 July 2017
26 July 2017
In 2016, the HQCA surveyed residents and family members at designated supportive living facilities from across Alberta about their experiences with care and services. This work was done in collaboration with Alberta Health and Alberta Health Services (AHS) and is a follow-up to the HQCA’s supportive living surveys in 2013-14.
The state of adult social care services 2014 to 2017 presents findings from our comprehensive programme of adult social care inspections. The report looks at what we’ve found about the quality of care across the full range of adult social care services that we regulate.
In October 2014, we formally rolled out our new inspection framework for adult social care. It includes overall ratings for each service as well as ratings in each of five key questions – whether they’re safe, effective, caring, responsive and well-led. Between then and February 2017, we’ve completed over 33,000 inspections of around 24,000 adult social care locations.
Know a young academic with an idea that could breakdown walls or improve society? Then encourage them to apply for Falling Walls Lab UAlberta. All disciplines are welcome. The top three ideas presented win a trip to Berlin to compete in the international finale on November 8, 2017.
Applications are confidential and presentations should be high-level containing no confidential details. Presentations should explain problem being addressed and the vision or potential solution in general terms.