September 12, 2017

Calls for Abstracts


New TREC newsletter

Global Online Consultation on Research Priority Setting for Healthy Ageing


The World Health Organization (WHO) adopted the Global strategy and action plan on ageing and health in May 2016 during the World Health Assembly. A key objective of the Strategy is to improve measurement, monitoring, and research on Healthy Ageing. This survey is expected to be completed in 15 minutes and contains two short sections. It is part of an open public consultation that will help to identify research priorities to support the implementation of the new Strategy. WHO welcomes and encourages response from all institutions, groups and individuals with an interest in ageing and health. All responses are anonymous.
Results from this survey will be synthesized by WHO and may be used by WHO in discussions with governments, research funding institutions, those who could design and conduct research, and those who could benefit from research findings.

Articles by TREC researchers

Understanding middle managers’ influence in implementing patient safety culture
Non UofA Access

Gutberg J, Berta W.
BMC Health Serv Res. 2017 Aug 22;17(1):4

BACKGROUND: The past fifteen years have been marked by large-scale change efforts undertaken by healthcare organizations to improve patient safety and patient-centered care. Despite substantial investment of effort and resources, many of these large-scale or “radical change” initiatives, like those in other industries, have enjoyed limited success – with practice and behavioural changes neither fully adopted nor ultimately sustained – which has in large part been ascribed to inadequate implementation efforts. Culture change to “patient safety culture” (PSC) is among these radical change initiatives, where results to date have been mixed at best.

Online tools for individuals with depression and neurologic conditions: A scoping review
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Lukmanji S, Pham T, Blaikie L, Clark C, Jett N, Wiebe S, Bulloch A, Holroyd-Leduc J, MacRodimitris S, MacKie A, Patten SB.
Neurology: Clinical Practice. 2017;7(4):344-53

Background: Patients with neurologic conditions commonly have depression. Online tools have the potential to improve outcomes in these patients in an efficient and accessible manner. We aimed to identify evidence-informed online tools for patients with comorbid neurologic conditions and depression. Methods: A scoping review of online tools (free, publicly available, and not requiring a facilitator) for patients with depression and epilepsy, Parkinson disease (PD), multiple sclerosis (MS), traumatic brain injury (TBI), or migraine was conducted. MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, and Cochrane CENTRAL Register of Controlled Trials were searched from database inception to January 2017 for all 5 neurologic conditions. Gray literature using Google and Google Scholar as well as app stores for both Android and Apple devices were searched. Self-management or self-efficacy online tools were not included unless they were specifically targeted at depression and one of the neurologic conditions and met the other eligibility criteria. Results: Only 4 online tools were identified. Of these 4 tools, 2 were web-based self-management programs for patients with migraine or MS and depression. The other 2 were mobile apps for patients with PD or TBI and depression. No online tools were found for epilepsy. Conclusions: There are limited depression tools for people with neurologic conditions that are evidence-informed, publicly available, and free. Future research should focus on the development of high-quality, evidence-based online tools targeted at neurologic patients.

Calls for Abstracts

Evidence Live 2018 Symposium

Centre for Evidence Based Medicine at the University of Oxford and The Bristish Medical Jourmal
Blavatnik School of Government, University of Oxford
19-20 June 2018

Evidence Live 2018 will focus on the dissemination of research discussing ways to ensure good sound evidence is disseminated in the right way to the relevant end users to improve the delivery of healthcare.
Call for abstracts is open under the the following themes:
· Educating patients, the public and healthcare providers in making informed choices.
· Improving the dissemination of evidence
· Making research evidence relevant, replicable and accessible
· Better, usable and more accessible clinical guidelines.
· Better use of real world data.
· Building Capability and Leadership
· Increase the systematic use of existing evidence
· Improve the use of information in the media
· Translation of evidence into better care
· Tools and concepts that are basic and central to the teaching and practising of evidence-based medicine

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Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Change


Exploring an Unknown Territory:“Sleeping Beauties” in the Nursing Research Literature
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Kokol P, Blazun Vosner H, Vermeulen J.
Nurs Res. 2017;66(5):359-67

BACKGROUND: Sleeping Beauties (SBs) are publications that are scarcely cited in the years immediately following publication but then suddenly become highly cited later. Such publications have unique citation patterns and can reveal important developments in the field in which they appear.
OBJECTIVES: No holistic analysis of nursing SBs has been done yet. The aim of this study was to identify and analyze the SB phenomenon in the nursing research literature.

Improving the production of applied health research findings: insights from a qualitative study of operational research
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Crowe S, Turner S, Utley M, Fulop NJ.
Implement Sci. 2017 Sep 8;12(1):3

BACKGROUND: Knowledge produced through applied health research is often of a form not readily accessible to or actionable by policymakers and practitioners, which hinders its implementation. Our aim was to identify research activities that can support the production of knowledge tailored to inform policy and practice. To do this, we studied an operational research approach to improving the production of applied health research findings.

“Scaling-out” evidence-based interventions to new populations or new health care delivery systems
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Aarons GA, Sklar M, Mustanski B, Benbow N, Brown CH.
Implement Sci. 2017 Sep 6;12(1):6

BACKGROUND: Implementing treatments and interventions with demonstrated effectiveness is critical for improving patient health outcomes at a reduced cost. When an evidence-based intervention (EBI) is implemented with fidelity in a setting that is very similar to the setting wherein it was previously found to be effective, it is reasonable to anticipate similar benefits of that EBI. However, one goal of implementation science is to expand the use of EBIs as broadly as is feasible and appropriate in order to foster the greatest public health impact. When implementing an EBI in a novel setting, or targeting novel populations, one must consider whether there is sufficient justification that the EBI would have similar benefits to those found in earlier trials.

A descriptive qualitative examination of knowledge translation practice among health researchers in Manitoba, Canada Canada-flat-icon
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Sibley KM, Roche PL, Bell CP, Temple B, Wittmeier KDM.
BMC Health Serv Res. 2017 Sep 6;17(1):9

BACKGROUND: The importance of effective translation of health research findings into action has been well recognized, but there is evidence to suggest that the practice of knowledge translation (KT) among health researchers is still evolving. Compared to research user stakeholders, researchers (knowledge producers) have been under-studied in this context. The goals of this study were to understand the experiences of health researchers in practicing KT in Manitoba, Canada, and identify their support needs to sustain and increase their participation in KT.

Nursing assistants matters-An ethnographic study of knowledge sharing in interprofessional practice
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Lindh Falk A, Hult H, Hammar M, Hopwood N, Abrandt Dahlgren M.
Nurs Inq. 2017 Aug 3

Abstract: Interprofessional collaboration involves some kind of knowledge sharing, which is essential and will be important in the future in regard to the opportunities and challenges in practices for delivering safe and effective health care. Nursing assistants are seldom mentioned as a group of health care workers that contribute to interprofessional collaboration in health care practice. The aim of this ethnographic study was to explore how the nursing assistants’ knowledge can be shared in a team on a spinal cord injury rehabilitation ward. Using a sociomaterial perspective on practice, we captured different aspects of interprofessional collaboration in health care. The findings reveal how knowledge was shared between professionals, depending on different kinds of practice architecture. These specific cultural-discursive, material-economic, and social-political arrangements enabled possibilities through which nursing assistants’ knowledge informed other practices, and others’ knowledge informed the practice of nursing assistants. By studying what health care professionals actually do and say in practice, we found that the nursing assistants could make a valuable contribution of knowledge to the team.

Basis for Sarcopenia Screening With the SARC-CalF in Nursing Homes
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Urzi F, Simunic B, Buzan E.
J Am Med Dir Assoc. 2017 Aug 30

BACKGROUND: Sarcopenia is a major health problem of the older population. The European Working Group on Sarcopenia in Older People (EWGSOP) developed diagnostic criteria for diagnosis of sarcopenia that require assessing muscle mass and strength or physical performance. Recently, however, a rapid screening method SARC-CalF was developed.

Handoffs: what’s good for residents is good for nurses…so what’s next? (editorial)
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Kitzmiller RR, Sitkin SB, Vidyarthi AR.
BMJ Qual Saf

Shift changes generally, and the nursing handoff specifically, create gaps in care where errors may occur. In this issue of BMJ Quality and Safety, Starmer and colleagues describe a framework, IPASS, to bridge this gap. IPASS stands for Illness severity; Patient summary, Action list; Situation awareness and contingency planning; and Synthesis by receiver. IPASS is a handoff improvement bundle that provides a standardised structure to the information exchanged at shift change. This work joins a growing literature that demonstrates the positive effects gained from standardising communication content and delivery methods.

Is late-life dependency increasing or not? A comparison of the Cognitive Function and Ageing Studies (CFAS)
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Kingston A, Wohland P, Wittenberg R, Robinson L, Brayne C, Matthews FE, Jagger C, Cognitive Function and Ageing Studies collaboration
Lancet. 2017 Aug 14

BACKGROUND: Little is known about how the proportions of dependency states have changed between generational cohorts of older people. We aimed to estimate years lived in different dependency states at age 65 years in 1991 and 2011, and new projections of future demand for care.

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Health Care Administration and Organization

Exploring the concurrent validity of the nationwide assessment of permanent nursing home residence in Denmark – A cross-sectional data analysis using two administrative registries
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BACKGROUND: Many register studies make use of information about permanent nursing home residents. Statistics Denmark (StatD) identifies nursing home residents by two different indirect methods, one based on reports from the municipalities regarding home care in taken place in a nursing home, and the other based on an algorithm created by StatD. The aim of the present study was to validate StatD’s nursing home register using dedicated administrative municipality records on individual nursing home residents as gold standard.

Temporal Trends in the Numbers of Skilled Nursing Facility Specialists From 2007 Through 2014
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Teno JM, Gozalo PL, Trivedi AN, Mitchell SL, Bunker JN, Mor V.
JAMA Intern Med. 2017 Sep 1;177(9):1376-8

Abstract: Residents of nursing homes (NHs) comprise a medically complex and vulnerable population with many persons experiencing multiple comorbid conditions, frailty, and advanced dementia. Health care professionals such as physicians, nurse practitioners (NPs), and physician assistants (PAs) play an important role in managing their care. An Office of Inspector General Report1 noted that specialization of health care professionals in NH care could potentially improve care through increased presence of health care professionals in NHs, enhanced knowledge in the care of patients with medically complex conditions, and better understanding of the regulatory environment. On the contrary, specialization in 1 setting of care could result in increased fragmentation of care, giving rise to concerns about medical errors and lack of care coordination. Little empirical research is available about the number of clinicians who primarily practice in NHs or the proportion of NH care delivered by these clinicians.2 Using national Medicare Part B claims from 2007, 2010, and 2014, we characterized temporal trends in the number of physicians, NPs, and PAs concentrating their practice in the NH or skilled nursing facility (SNF) setting (ie, SNFists), the fraction of all NH and SNF claims generated by SNFists, and state variation in this phenomenon in 2014.

The use of care robots in aged care: a systematic review of argument-based ethics literature
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Vandemeulebroucke T, de Casterlé BD, Gastmans C.
Arch Gerontol Geriatr

Background: As care robots become more commonplace in aged-care settings, the ethical debate on their use becomes increasingly important. Our objective was to examine the ethical arguments and underlying concepts used in the ethical debate on care robot use in aged care.

Nursing home staff perspectives on adoption of an innovation in goals of care communication
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Chisholm L, Zimmerman S, Rosemond C, McConnell E, Weiner BJ, Lin FC, Hanson L.
Geriatr Nurs. 2017 Aug 30

Abstract: Nursing homes (NH) are important settings for end-of-life care, but limited implementation may impede goals of care discussions. The purpose of this study was to understand NH staff perceptions of adoption and sustainability of the Goals of Care video decision aid for families of residents with advanced dementia. Study design was a cross-sectional survey of staff at 11 NHs in North Carolina who participated in the Goals of Care (GOC) cluster randomized clinical trial. Staff perceived the GOC decision aid intervention as a positive innovation; it was perceived as more compatible with current practices by male staff, nurses, and more experienced NH staff. Perceptions were correlated with experience, implying that experience with an innovative approach may help to promote improved GOC communication in nursing homes. Nurses and social work staff could be effective champions for implementing a communication technique, like the GOC intervention.

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Health Care Innovation and Quality Assurance

Staff awareness of food and fluid care needs for older people with dementia in residential care: a qualitative study
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Lea EJ, Goldberg LR, Price AD, Tierney LT, McInerney F.
J Clin Nurs. 2017 Sep 7

AIMS AND OBJECTIVES: To examine awareness of aged care home staff regarding daily food and fluid care needs of older people with dementia.
BACKGROUND: Older people in residential care frequently are malnourished and many have dementia. Staff knowledge of the food and fluid needs of people with dementia is limited. Qualitative research on this topic is scarce but can provide insight into how nutrition and hydration care may be improved.

Individual and institutional factors associated with functional disability in nursing home residents: An observational study with multilevel analysis
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Serrano-Urrea R, Gomez-Rubio V, Palacios-Cena D, Fernandez-de-Las-Penas C, Garcia-Meseguer MJ.
PLoS One. 2017 Aug 28;12(8):e0183945

BACKGROUND: High prevalence of functional limitations has been previously observed in nursing homes. Disability may depend not only on the characteristics of the residents but also on the facility characteristics. The aims of this study were: 1, to describe the prevalence of functional disability in older people living in Spanish nursing homes; and 2, to analyze the relationships between individual and nursing home characteristics and residents’ functional disability.

CMS MDS 3.0 Section M Skin Conditions in Long-term Care: Pressure Ulcers, Skin Tears, and Moisture-Associated Skin Damage Data Update
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Ayello EA.
Adv Skin Wound Care. 2017 Sep;30(9):415-29

GENERAL PURPOSE: The purpose of this learning activity is to provide information about the updates to the Centers for Medicare & Medicaid Services (CMS) MDS 3.0 Section M, Skin Conditions documentation in long-term care.

Important Care and Activity Preferences in a Nationally Representative Sample of Nursing Home Residents
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Roberts TJ, Gilmore-Bykovskyi A, Lor M, Liebzeit D, Crnich CJ, Saliba D.
J Am Med Dir Assoc. 2017 Aug 23

OBJECTIVES: Person-centered care (PCC), which considers nursing home resident preferences in care delivery, has been linked to important outcomes such as improved quality of life, resident satisfaction with care, and mood and reduced behavioral symptoms for residents with dementia. Delivery of PCC fundamentally relies on knowledge of resident preferences. The Minimum Data Set (MDS) 3.0 Preference Assessment Tool (PAT) is a standardized, abbreviated assessment that facilitates systematic examination of preferences from a population of nursing home residents. However, it is unknown how well the PAT discriminates preferences across residents or items. The purpose of this study was to use MDS 3.0 PAT data to describe (1) overall resident preferences, (2) variation in preferences across items, and (3) variation in preferences across residents.

Development and validation of the Fracture Risk Scale (FRS) that predicts fracture over a 1-year time period in institutionalised frail older people living in Canada: an electronic record-linked longitudinal cohort study Canada-flat-icon
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Ioannidis G, Jantzi M, Bucek J, Adachi JD, Giangregorio L, Hirdes J, Pickard L, Papaioannou A.
BMJ Open. 2017 Sep 1;7(9):016477

OBJECTIVES: To develop and validate our Fracture Risk Scale (FRS) over a 1-year time period, using the long-term care (LTC) Resident Assessment Instrument Minimum Data Set Version 2.0 (RAI-MDS 2.0).

Stepping out of the shadows of Alzheimer’s disease: a phenomenological hermeneutic study of older people with Alzheimer’s disease caring for a therapy dog
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Swall A, Ebbeskog B, Lundh Hagelin C, Fagerberg I.
Int J Qual Stud Health Well-being. 2017 Dec;12(1):1347013

PURPOSE: Living with Alzheimer’s disease (AD) can involve a person being unable to recall and convey information in daily life. There are several ways to provide person-centred care to older people with AD, e.g. by empowering them in a situation. The use of animal-assisted therapy (AAT) with a therapy dog in the care of people with dementia is increasing, with the presence of a therapy dog being described as improving, among other things, the well-being and socialization of the person. The aim of this study was to illuminate meanings of care for people with AD in their encounters with a therapy dog.

Patient reported outcome measures for measuring dignity in palliative and end of life care: a scoping review
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Johnston B, Flemming K, Narayanasamy MJ, Coole C, Hardy B.
BMC Health Serv Res. 2017 Aug 22;17(1):6

BACKGROUND: Patient reported outcome measures are frequently used standard questionnaires or tools designed to collect information from patients regarding their health status and care. Their use enables accurate and relevant insight into changes in health, quality of life, and symptom severity to be acquired. The purpose of this scoping review was to identify PROMs that had been subject to rigorous development and were suitable for use in palliative and end of life care for clinical practice and/or research purposes. The review had a specific focus on measures which could be used to assess perceptions of dignity in these contexts.

Effect of Micronutrient Powder Addition on Sensory Properties of Foods for Older Adults
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Field KM, Duncan AM, Keller HH, Stark KD, Duizer LM.
J Food Sci. 2017 Aug 29

Abstract: Micronutrient fortification can improve nutrient intake of older adults in long-term care. However, previous studies indicate that micronutrient fortification can alter food sensory attributes and, potentially, consumer liking. Others have found no effect of fortification on liking. This research investigates the effect of micronutrient powder addition on the sensory properties of selected foods commonly served in long-term care. A micronutrient powder containing 9 vitamins and 3 minerals was added to tomato soup and oatmeal at different levels. Using projective mapping, changes in sensory properties were observed with powder addition. Descriptive analysis, used to quantify these changes, showed that both the tomato soup and oatmeal had reduced flavor as the amount of added micronutrient powder increased. Oatmeal also showed changes in texture with fortification. Consumer liking scores for tomato soup showed that micronutrient addition affected liking when 100% of a daily dose was added into the soup. Addition of 50% of the daily dose did not affect liking. Oatmeal liking did not differ between fortified and unfortified samples.

Comparative safety and efficacy of pharmacological and non-pharmacological interventions for the behavioral and psychological symptoms of dementia: protocol for a systematic review and network meta-analysis
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Watt J, Goodarzi Z, Tricco AC, Veroniki AA, Straus SE.
Syst Rev. 2017 Sep 7;6(1)

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent in patients with dementia. Both pharmacological and non-pharmacological strategies are commonly used to treat these symptoms, but their comparative safety and efficacy is unknown.

Active residents in care homes: A holistic approach to promoting and encouraging meaningful activity for residents living in care homes (innovative practice)
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Raymond Smith, Julia Wood, Fiona Jones

Abstract: The active residents in care homes intervention aim to promote meaningful activity among care home residents. Residents, family members and staff from three residential care homes in South London are participating. It is a whole systems approach which involves formal and ‘on the floor’ training to empower care home staff to facilitate activity. Training is delivered by two occupational therapists, a physiotherapist and a rehabilitation assistant. This paper describes the active residents in care homes intervention, the evaluation methods and discusses some preliminary findings.

Reflective team in caring for people living with dementia: a base for care improvement
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Jonasson L-, Nystrm M, Rydstrm I.
Reflective Practice. 2017;18(3):397-409

Abstract: A reflective team (RT) is a team of professional carers who reflect on a specific caring issue under the direction of an RT leader. The goal for the reflective process is to accomplish care improvement based on research and proven experience, and the first step is to reflect upon the competence that already exists in the context in which RT takes place. This study aims to bring previous unarticulated competence in caring for people living with dementia to the surface after it has been reflected during RT sessions. Ten assistant nurses who work closely with patients who have dementia and attend RT sessions on a regular basis were interviewed about their competence for caring for people living with dementia. Using a phenomenographic analysis, two qualitatively separate categories emerged: general caring skills and dementia-specific caring skills. It was concluded that specific skills in caring for people living with dementia build in caring skills and that tacit knowledge can be explicit and be expressed when it has been reflected in RT.

Effects of an Intervention to Reduce Hospitalizations From Nursing Homes
A Randomized Implementation Trial of the INTERACT Program

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Kane RL, Huckfeldt P, Tappen R, Engstrom G, Rojido C, Newman D, Yang Z, Ouslander JG.
JAMA Intern Med. 2017 Sep 1;177(9):1257-64

Importance: Medicare payment initiatives are spurring efforts to reduce potentially avoidable hospitalizations.
Objective: To determine whether training and support for implementation of a nursing home (NH) quality improvement program (Interventions to Reduce Acute Care Transfers [INTERACT]) reduced hospital admissions and emergency department (ED) visits.

Preventive oral health intervention among old home care clients
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Nihtila A, Tuuliainen E, Komulainen K, Autonen-Honkonen K, Nykanen I, Hartikainen S, Ahonen R, Tiihonen M, Suominen AL.
Age Ageing. 2017 Sep 1;46(5):846-51

BACKGROUND: Poor oral health is common among older people dependent on supportive care and it affects their quality of life. Cognitive impairment and functional dependency may increase the risk of compromised daily oral hygiene.
AIM: To investigate the effectiveness of a tailored preventive oral health intervention among home care clients aged 75 years or over.

Use of the Spanish Version of the Rapid Geriatric Assessment in Mexican Patients in Long-Term Care
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Mena-Madrazo JA, Mariscal-Martinez BE, Leon-Quintero M, Lupercio Macias SM.
J Am Med Dir Assoc. 2017 Aug 30

Abstract: We report our experience with the use of a Spanish version of the rapid geriatric assessment of 30 patients in 2 long-term care institutions in Mexico City by a group of healthcare students without prior experience in geriatric medicine. The Spanish version of the rapid geriatric assessment is a very easy tool to administer that can provide overall good results for identifying frailty, sarcopenia, anorexia, weight loss, and cognitive impairment.

What impact does nursing care left undone have on patient outcomes? Review of the literature
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Recio-Saucedo A, Dall’Ora C, Maruotti A, Ball J, Briggs J, Meredith P, Redfern OC, Kovacs C, Prytherch D, Smith GB, Griffiths P.
J Clin Nurs. 2017 Aug 31

AIMS AND OBJECTIVES: Systematic review of the impact of missed nursing care on outcomes in adults, on acute hospital wards and in nursing homes.
BACKGROUND: A considerable body of evidence support the hypothesis that lower levels of registered nurses on duty increases the likelihood of patients dying on hospital wards, and the risk of many aspects of care being either delayed or left undone (missed). However, the direct consequence of missed care remains unclear.

The effects of quality of life on behavioral and psychological symptoms in elderly people with dementia residing at long-term care facilities
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Suzuki M, Hattori H, Fukuda K, Ooshiro H, Saruhara T, Furuta Y, Abe K, Kanamori M.
Nihon Ronen Igakkai Zasshi. 2017;54(3):392-402

PURPOSE: The purpose of the present study was to clarify how quality of life (QOL) affects the behavioral and psychological symptoms of dementia (BPSDs) among elderly individuals with dementia within long-term care facilities (e.g., long-term healthcare facilities, sanatorium-type medical facilities, and special nursing homes for the elderly).

Important Care and Activity Preferences in a Nationally Representative Sample of Nursing Home Residents
Non UofA Access

OBJECTIVES: Person-centered care (PCC), which considers nursing home resident preferences in care delivery, has been linked to important outcomes such as improved quality of life, resident satisfaction with care, and mood and reduced behavioral symptoms for residents with dementia. Delivery of PCC fundamentally relies on knowledge of resident preferences. The Minimum Data Set (MDS) 3.0 Preference Assessment Tool (PAT) is a standardized, abbreviated assessment that facilitates systematic examination of preferences from a population of nursing home residents. However, it is unknown how well the PAT discriminates preferences across residents or items. The purpose of this study was to use MDS 3.0 PAT data to describe (1) overall resident preferences, (2) variation in preferences across items, and (3) variation in preferences across residents.

Implementation of an interprofessional communication and collaboration intervention to improve care capacity for heart failure management in long-term care
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Boscart VM, Heckman GA, Huson K, Brohman L, Harkness KI, Hirdes J, McKelvie RS, Stolee P.
J Interprof Care. 2017 Sep 06:1-10

Abstract: Heart failure affects up to 20% of nursing home residents and is associated with high morbidity, mortality, and transfers to acute care. A major barrier to heart failure management in nursing home settings is limited interprofessional communication. Guideline-based heart failure management programs in nursing homes can reduce hospitalisation rates, though sustainability is limited when interprofessional communication is not addressed. A pilot intervention, ‘Enhancing Knowledge and Interprofessional Care for Heart Failure’, was implemented on two units in two conveniently selected nursing homes to optimise interprofessional care processes amongst the care team. A core heart team was established, and participants received tailored education focused on heart failure management principles and communication processes, as well as weekly mentoring. Our previous work provided evidence for this intervention’s acceptability and implementation fidelity. This paper focuses on the preliminary impact of the intervention on staff heart failure knowledge, communication, and interprofessional collaboration. To determine the initial impact of the intervention on selected staff outcomes, we employed a qualitative design, using a social constructivist interpretive framework. Findings indicated a perceived increase in team engagement, interprofessional collaboration, communication, knowledge about heart failure, and improved clinical outcomes. Individual interviews with staff revealed innovative ways to enhance communication, supporting one another with knowledge and engagement in collaborative practices with residents and families. Engaging teams, through the establishment of core heart teams, was successful to develop interprofessional communication processes for heart failure management. Further steps to be undertaken include assessing the sustainability and effectiveness of this approach with a larger sample.

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Organizational Change

Evaluation of the effects of the French pay-for-performance program—IFAQ pilot study
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Lalloué B, Jiang S, Girault A, Ferrua M, Loirat P, Minvielle E.
Int J Qual Health Care [Internet]

Objective: Most studies showed no or little effect of pay-for-performance (P4P) programs on different outcomes. In France, the P4P program IFAQ was generalized to all acute care hospitals in 2016. A pilot study was launched in 2012 to design, implement and assess this program. This article aims to assess the immediate impact of the 2012–14 pilot study.

Do Safety Culture Scores in Nursing Homes Depend on Job Role and Ownership? Results from a National Survey
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Banaszak-Holl J, Reichert H, Todd Greene M, Mody L, Wald HL, Crnich C, McNamara SE, Meddings J.
J Am Geriatr Soc. 2017 Aug 28

OBJECTIVES: To identify facility- and individual-level predictors of nursing home safety culture.

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Factors Associated With the Trend of Physical and Chemical Restraint Use Among Long-Term Care Facility Residents in Hong Kong: Data From an 11-Year Observational Study
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BACKGROUND: Negative effects of restraint use have been well-documented. However, the prevalence of restraints use has been high in long-term care facilities in Hong Kong compared with other countries and this goes against the basic principles of ethical and compassionate care for older people. The present study aimed to review the change in the prevalence of physical and chemical restraint use in long-term care facilities (LTCFs) over a period of 11 years in Hong Kong and to identify the major factors associated with their use.

Fall Risk, Supports and Services, and Falls Following a Nursing Home Discharge
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Noureldin M, Hass Z, Abrahamson K, Arling G.

Background and Objectives: Falls are a major source of morbidity and mortality among older adults; however, little is known regarding fall occurrence during a nursing home (NH) to community transition. This study sought to examine whether the presence of supports and services impacts the relationship between fall-related risk factors and fall occurrence post NH discharge.

New horizons in multimorbidity in older adults
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Yarnall AJ, Sayer AA, Clegg A, Rockwood K, Parker S, Hindle JV.
Age Ageing

Abstract: The concept of multimorbidity has attracted growing interest over recent years, and more latterly with the publication of specific guidelines on multimorbidity by the National Institute for Health and Care Excellence (NICE). Increasingly it is recognised that this is of particular relevance to practitioners caring for older adults, where multimorbidity may be more complex due to the overlap of physical and mental health disorders, frailty and polypharmacy. The overlap of frailty and multimorbidity in particular is likely to be due to the widespread health deficit accumulation, leading in some cases to functional impairment. The NICE guidelines identify ‘target groups’ who may benefit from a tailored approach to care that takes their multimorbidity into account, and make a number of research recommendations. Management includes a proactive individualised assessment and care plan, which improves quality of life by reducing treatment burden, adverse events, and unplanned or uncoordinated care.

Exploring physical rehabilitation in long-term care Canada-flat-icon

Caitlin McArthur
PhD diss., University of Waterloo, 2017

Determinants of first-time utilization of long-term care services in the Netherlands: an observational record linkage study
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Slobbe LCJ, Wong A, Verheij RA, van Oers, H A M, Polder JJ.
BMC Health Serv Res. 2017 Sep 5;17(1)

BACKGROUND: Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services.

Dysphoric symptoms in relation to other behavioral and psychological symptoms of dementia, among elderly in nursing homes
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Lindbo A, Gustafsson M, Isaksson U, Sandman PO, Lovheim H.
BMC Geriatr. 2017 Sep 7;17(1):4

BACKGROUND: Behavioral and psychological symptoms of dementia (BPSD) are common and varied in the elderly. The aim of the current study was to explore associations between BPSD and dysphoric symptoms at different levels of cognitive impairment.

Public knowledge and understanding of dementia-evidence from a national survey in Ireland
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Glynn RW, Shelley E, Lawlor BA.
Age Ageing. 2017 Sep 1;46(5):865-9

BACKGROUND: There is growing consensus around the importance of population level approaches which seek to improve public knowledge and awareness of dementia.
AIM: To assess knowledge of the relationship between dementia and ageing, and of the risk and protective factors associated with it, among the general public in Ireland.

Prevalence of Preventive Cardiovascular Medication Use In Nursing Home Residents. Room for Deprescribing? The SHELTER Study
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Malek Makan A, van Hout H, Onder G, Finne-Soveri H, van der Roest H, van Marum R.
J Am Med Dir Assoc. 2017 Sep 1

INTRODUCTION: In nursing home (NH) residents with a very short life expectancy, the benefits of preventive cardiovascular medication maintenance are questionable.
OBJECTIVE: To assess the prevalence of 4 classes of preventive cardiovascular medication (PCM) in NH residents, and to explore differences of prevalence across length of stay, mortality risk, cognitive impairment, functional disability, and across countries.

Nutritional supplementation for activities of daily living and functional ability of older people in residential facilities: A systematic review
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Tsuboi M, Momosaki R, Vakili M, Abo M.
Geriatr Gerontol Int. 2017 Aug 31

AIM: To review the best available evidence on nutritional supplementation for activities of daily living and functional ability of older people in residential facilities.

Dementia care mapping in nursing homes: effects on caregiver attitudes, job satisfaction, and burnout. A quasi-experimental trial
Non UofA Access

Dichter MN, Trutschel D, Schwab CGG, Haastert B, Quasdorf T, Halek M.
Int Psychogeriatr. 2017 Aug 30:1-14

BACKGROUND: The Dementia Care Mapping (DCM) method is an internationally recognized complex intervention in dementia research and care for implementing person-centered care. The Leben-QD II trial aimed to evaluate the effectiveness of DCM with regard to caregivers.

The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial
Non UofA Access

Torma J, Winblad U, Saletti A, Cederholm T.
Scand J Caring Sci. 2017 Aug 29

AIMS: To compare two different implementation strategies, external facilitation (EF) and educational outreach visits (EOVs), when introducing nutritional guidelines in nursing homes (NHs), and study the impact on staff performance.

Feasibility of Providing Safe Mouth Care and Collecting Oral and Fecal Microbiome Samples from Nursing Home Residents with Dysphagia: Proof of Concept Study
Non UofA Access

Jablonski RA, Winstead V, Azuero A, Ptacek T, Jones-Townsend C, Byrd E, Geisinger ML, Morrow C.
J Gerontol Nurs. 2017 Sep 1;43(9):9-15

Abstract: Individuals with dysphagia who reside in nursing homes often receive inadequate mouth care and experience poor oral health. From a policy perspective, the combination of absent evidence-based mouth care protocols coupled with insufficient dental coverage create a pool of individuals at great risk for preventable infectious illnesses that contribute to high health care costs. The purpose of the current study was to determine (a) the safety of a mouth care protocol tailored for individuals with dysphagia residing in nursing homes without access to suction equipment, and (b) the feasibility of collecting oral and fecal samples for microbiota analyses. The mouth care protocol resulted in improved oral hygiene without aspiration, and oral and fecal samples were safely collected from participants. Policies supporting ongoing testing of evidence-based mouth care protocols for individuals with dysphagia are important to improve quality, demonstrate efficacy, and save health care costs.

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Knowledge Translation Outcome Measurement

AIR’s Center on Knowledge Translation
for Disability and Rehabilitation Research

This virtual online conference is designed to address major strategies in the planning and implementation of effective and efficient KT measurement approaches. Participants will be able to register, view, and ask questions through the event’s virtual conference platform, Adobe Connect. Participants will listen using their computer speakers and will interact by way of a chat box (CART and accessible options will be available). Each day will include live polls as well as interactive discussions.
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.

Incorporating a frailty dimension into LOCUS for seniors in a medical-psychiatry population

Richard Shulman, MDCM, FRCPC – Trillium Health Partners
13 September 2017

Seniors with mental health disorders commonly have significant medical comorbidities that increase impairment, disability and health service utilization. Although high healthcare utilization rates by older adults have been well documented, no validated tools exist to accurately identify which patients within this population will require more healthcare resources than others.
Both Trillium Health Partners (THP) and the Centre for Addiction and Mental Health (CAMH) have successfully used a utilization management tool, the Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS) in their adult clinical mental health populations. Both hospitals now plan to implement the LOCUS in the seniors’ populations as a quality improvement project by adding a frailty dimension to the LOCUS tool, as the LOCUS has not been validated for use with seniors.
This study is the first of its kind to evaluate the variance between the LOCUS predicted level of required healthcare resources, and the actual level of care provided to seniors with mental health disorders and medical comorbidity. Ordinal logistical and categorical regressions were used to determine the extent to which independent frailty variables were able to predict the actual level of care.

The Canadian Longitudinal Study on Aging: A National Platform and Infrastructure for Researchers and Trainees Canada-flat-icon

CIHR Institute of Aging
26 September 2017

Inside Evidence-Based Health Care

Oxford University

Book a place on one of our four virtual events, giving you the chance to discover what it’s like to study on Oxford University’s part-time postgraduate programme in Evidence-Based Health Care. This diverse, internationally recognised programme aims to teach health professionals to base their clinical and health management decisions on valid, reliable and relevant evidence, determined by sound scientific research and evaluation.

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Feeling at home: Staff trainers help LGBT seniors overcome fears in long-term care Canada-flat-icon

Better training aims to quell distrust from decades of prejudice

Average American’s Risk of Needing Nursing Home Care Is Higher Than Previously Estimated

The average American’s lifetime risk of using a nursing home is substantially greater than previous research has suggested, according to a new RAND Corporation study.

Dutch nursing home offers rent-free housing to students

A nursing home in the Netherlands allows university students to live rent-free alongside the elderly residents, as part of a project aimed at warding off the negative effects of aging.

Home Health Care: Shouldn’t It Be Work Worth Doing?

How to provide long-term care for a fast-aging population poses one of the more convoluted challenges of the American labor market. Care providers — home health aides, personal care attendants and certified nursing assistants, in the government’s classification — are expected to be among the nation’s fastest-growing occupations. And yet despite their critical importance to the well-being of tens of millions of aging Americans, one-fourth of these aides live in poverty.

Measuring the cost of quality measurement

Less than 2 decades after publication of the National Academy of Medicine’s (formerly the Institute of Medicine) Crossing the Quality Chasm: A New Health System for the 21st Century, quality measurement has become routine and widespread throughout the US health care system.

‘Why’ culture improves patient outcomes

More and more health care organizations are discovering the value of working to develop a healthy organizational culture. This culture isn’t based on trends, like open-office environments and potluck lunches, but rather employee engagement, relentless focus and natural accountability at all levels. These traits are what we call a high-performance culture. This type of healthy culture makes everything work better at a fundamental level because every person takes responsibility and ownership of their work. Health care organizations can work to develop a high-performance culture by focusing more on the “why” of what they do rather than the “what.”

Training program designed to help service providers aid customers with dementia Canada-flat-icon

A new project is aimed at helping businesses deal with customers who suffer from dementia.

Extra 71000 care home places needed by 2025, Lancet study suggests – Alzheimer’s Society comments

As life expectancy increases, so too have the number of years that older adults spend with substantial care needs, suggests a study published today in The Lancet.

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Caregivers in Distress: A Growing Problem Canada-flat-icon

Office of the Seniors Advocate BC

Seniors Advocate Isobel Mackenzie released an update report today confirming that caregiver distress is rising in B.C. while supports and services are not keeping pace with growing need. The report is an update to a 2015 report that indicated 29% of unpaid caregivers are experiencing symptoms of distress such as anger, depression or feelings of not being able to continue with their caregiving duties. Data highlighted in the current report indicate rates of distress have increased by 7% to 31%.

Distribution of Lifetime Nursing Home Use and of Out-of-Pocket Spending

Michael D. Hurd, Pierre-Carl Michaud, Susann Rohwedder

Although it is important to know the annual costs and use of nursing homes, for individuals and households, it is also important to know expected lifetime costs and use of nursing homes; that is, how much they will use nursing homes and how much might spend over their lifetimes. They need this information in deciding how much to save and whether to purchase insurance that will pay for nursing home use. By following individuals over many years as they progress to advanced old age, we estimated how many days individuals will spend in nursing homes and how much they will spend out-of-pocket.

Canada Health Infoway Data Collection

Includes 2014 National Survey of Canadian Nurses, 2014 National Survey of Canadian Community Pharmacists: Use of Digital Health Technologies in Practice, 2014 National Survey of Caregivers, 2017 National Survey of Canadian Nurses: Use of Digital Health Technology in Practice, 2016 National Survey of Community-Based Pharmacists: Use of Digital Health Technology in Practice

Improving Older People’s Oral Health

Royal College of Surgeons, Faculty of Dental Surgery

Rapid Review Guidebook

National Collaborating Center for Methods and Tools

As public health organizations across Canada adopt and implement evidence-informed approaches to public health decision-making, there is a need for up to date evidence that can be applied to local contexts. An effective way to synthesize current evidence on a topic is to conduct a rapid review of the literature. The NCCMT has developed a Rapid Review Guidebook that details each step in the rapid review process, with notes on how to tailor the process given resource limitations. The Guidebook also includes a guide to writing the final report, with details on how to structure the report and what to include in each section.

Generations Together

Older People’s Commissioner for Wales

Older people and younger people have a huge amount to offer each other through sharing their knowledge and experiences, learning from one another and providing each other with support. Intergenerational projects bring a wide range of benefits, both to individuals and to our communities, and it is vital that even more older and younger people have opportunities to spend time together doing intergenerational activities. That’s why we’ve worked in partnership with the Children’s Commissioner to bring together the resources below to highlight the benefits of intergenerational activities and support those who may be looking to set up an intergenerational project in their school or community.

The Juggling Act: Balancing Work and Eldercare in Canada

Conference Board of Canada

This briefing examines eldercare trends and issues in Canada, highlights the ways in which eldercare obligations affect employees and employers, and presents a range of accommodation solutions and best practices for implementation. UofA access only.

New Global Aging Index Gauges Health and Wellbeing of Aging Populations

esearchers from Columbia University’s Mailman School of Public Health and University of Southern California Schaeffer Center for Health Policy & Economics, with the support of The John A. Hartford Foundation, have developed a new barometer that estimates how countries are adapting to the dramatic increases in the number and proportion of older persons. The Index is composed of specific measures across five social and economic indicators that reflect the status and wellbeing of older persons in a country and which can be followed over time and used to compare across nations.


KT Canada

30 August 2017


Canadian Institute for Health Information

September 2017 newsletter

KT Canada

6 September 2017

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