Older adults who have reduced decision-making capacity and no family or friends to compensate for these deficiencies are known as unbefriended and require a public guardian. The purpose of this study was to review the peer-reviewed and grey literature to determine the scope of available research on unbefriended older adults in Canada and the United States. We found limited research examining unbefriended older adults. No Canadian studies or reports were located. Unbefriended older adults were childless or had fewer children, were more cognitively impaired, and were older than older adults who were not unbefriended. These findings demonstrate a stark scarcity of studies on unbefriended older adults. Research is urgently needed using standardized data collection of guardianship status in order to enable studies of the prevalence of public guardianship in Canada.
New Article by Dr. Amanda Grenier
Social Isolation in Later Life: Extending the Conversation
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As Canada’s population continues to age, social isolation among older people is a growing concern and national-level priority. Although much is known about individual-level risks and negative health outcomes associated with social isolation in later life, the impact of life course trajectories and the more collective experiences are seldom considered. Current definitions and program responses tend to rely on individualized approaches to social isolation. Here, we argue that the conversation be extended to consider the social and cultural aspects of social isolation among older people. Specifically, we suggest that definitions and approaches consider three particular dimensions: temporal factors, spatial factors, and the relationship between social isolation and exclusion. Doing so, we argue, would result in a more inclusive approach to social isolation in late life, and the development of capacity to address social isolation among a wide range of older people, particularly the needs of vulnerable or marginalized groups.
New Article by Dr. Susan Slaughter
Inadequate fluid intake in long term care residents: Prevalence and determinants
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Dehydration is estimated to be present in half of long term care residents, as many do not consume the recommended levels of fluid intake. This study aims to describe fluid intake in long term care residents and identify the factors associated with fluid intake. Data were collected from 622 long term care residents, with a mean age of 86.8 +/- 7.8. Total fluid intake was estimated over three non-consecutive days. Potential resident and unit-level variables risk factors for low fluid intake were collected, such as dementia status, activities of daily living, and eating challenges. Average daily fluid intake ranged from 311-2390 mL (1104.1 +/- 379.3). Hierarchical regression analysis revealed that fluid intake was negatively associated with increased age, cognitive impairment, eating challenges and increased dining room staffing. Being male and requiring more physical assistance were positively associated with intake. Variables identified to predict intake could help inform strategies and targeted interventions to improve fluid intake.
New Articles by Dr Shannon Scott
Two Approaches to Focus Group Data Collection for Qualitative Health Research: Maximizing Resources and Data Quality
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This article discusses four challenges to conducting qualitative focus groups: (1) maximizing research budgets through innovative methodological approaches, (2) recruiting health-care professionals for qualitative health research, (3) conducting focus groups with health-care professionals across geographically dispersed areas, and (4) taking into consideration data richness when using different focus group data collection methods. In light of these challenges, we propose two alternative approaches for collecting focus group data: (a) extended period of quantitative data collection that facilitated relationship building in the sites prior to qualitative focus groups and (b) focus groups by videoconference. We share our experiences on employing both of these approaches in two national research programs.; This article discusses four challenges to conducting qualitative focus groups: (1) maximizing research budgets through innovative methodological approaches, (2) recruiting health-care professionals for qualitative health research, (3) conducting focus groups with health-care professionals across geographically dispersed areas, and (4) taking into consideration data richness when using different focus group data collection methods. In light of these challenges, we propose two alternative approaches for collecting focus group data: (a) extended period of quantitative data collection that facilitated relationship building in the sites prior to qualitative focus groups and (b) focus groups by videoconference. We share our experiences on employing both of these approaches in two national research programs.
Twitter is one of the most popular social media platforms. The growing use of Twitter by health-care consumers creates a novel venue to understand patient experiences. To understand the potential for this platform to be utilized in patient- and family-oriented health research, this study reviewed published literature on the use of Twitter in health research.Methods:In collaboration with the research team, a research librarian designed and implemented a search strategy in eight databases. Primary and secondary screenings were conducted using predetermined criteria by one reviewer. A second reviewer verified screening decisions in 10% of the studies. Evidence tables were created to synthesize across the following study elements: research design, data collection techniques, analytic approaches, and author?s insights on Twitter as a data collection method. Descriptive narrative analysis was used to synthesize data.Results:The search strategy captured 618 articles; 233 were eliminated in primary screening and 366 articles were eliminated during secondary screening. Verification by the second reviewer resulted in very good agreement (? = .980). Seventeen articles were included in the final data set. Synthesis across the studies demonstrated that Twitter is currently used to search and mine research data, while active recruitment strategies on Twitter are just beginning to emerge.Conclusion:The novelty of Twitter for study recruitment and data collection with health-care consumers presents advantages and challenges that differ from traditional methods of data collection.; Background:Twitter is one of the most popular social media platforms. The growing use of Twitter by health-care consumers creates a novel venue to understand patient experiences. To understand the potential for this platform to be utilized in patient- and family-oriented health research, this study reviewed published literature on the use of Twitter in health research.Methods:In collaboration with the research team, a research librarian designed and implemented a search strategy in eight databases. Primary and secondary screenings were conducted using predetermined criteria by one reviewer. A second reviewer verified screening decisions in 10% of the studies. Evidence tables were created to synthesize across the following study elements: research design, data collection techniques, analytic approaches, and author?s insights on Twitter as a data collection method. Descriptive narrative analysis was used to synthesize data.Results:The search strategy captured 618 articles; 233 were eliminated in primary screening and 366 articles were eliminated during secondary screening. Verification by the second reviewer resulted in very good agreement (? = .980). Seventeen articles were included in the final data set. Synthesis across the studies demonstrated that Twitter is currently used to search and mine research data, while active recruitment strategies on Twitter are just beginning to emerge.Conclusion:The novelty of Twitter for study recruitment and data collection with health-care consumers presents advantages and challenges that differ from traditional methods of data collection.
Grants and Awards
The KT Innovation Incubator grant competition will award $20,000 to a winning knowledge translation project that aims to improve life outcomes for children with brain-based developmental disabilities and their families.
The CIHR Institute of Aging will provide funding for applications that are determined to be relevant to the following research priority areas described below:
-The life trajectory as a determinant of active, and satisfying aging;
Adding life to the late years;
-Interventions appropriate to the complexity of older people’s state of health;
-Health care and services that combine and integrate continuity, innovation and efficiency;
-Ensuring the conditions for a positive impact on older people’s health and wellness.
CIHR is pleased to continue to offer an Observer program for early career investigators (ECIs) to participate as an observer in the peer review process of the Project Grant: Spring 2018 competition.
For national and local leaders to achieve universal health coverage, a new approach or technique to gathering evidence and understanding the contexts that influence the outcome of a study and goes beyond the quantitative results of clinical trials and pilot projects is important. The Doris Duke Charitable Foundation’s African Health Initiative (AHI) was designed to produce this type of knowledge through embedding implementation research into Population Health Implementation and Training (PHIT) partnership projects in five countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) with the goal of improving primary health care and population health. In Ghana, this integration of research into implementation has contributed to the successful testing, adaptation and implementation of the Community-based Health Planning and Services (CHPS) model (The Navrongo Pilot Project), with results from the AHI-funded work informing national scale-up of effective practices. Further application of implementation science methods and frameworks to study cross-project lessons also produced the evidence needed by national and local decision makers on how and why different intervention components were successful and where and how local context drove implementation and adaptation. Cross-project research also identified effective approaches across diverse settings for building capacity for data-driven improvement, coaching and mentoring clinicians and researchers, developing locally appropriate interventions to reduce neonatal mortality, and integrating implementation research to inform local implementers and researchers in more effective strategies to strengthen health systems and improve health services and population health. Evidence has already shown the potential for this type of work to accelerate regional learning and spread of successful interventions to achieve targeted health goals more efficiently, better enabling countries to achieve the ambitious, but important, U.N. Sustainable Development Goals.
Sweden has a policy of supporting older people to live a normal life at home for as long as possible. Therefore, it is often the oldest, most frail people who move into nursing homes. Nursing home staff are expected to meet the existential needs of the residents, yet conversations about death and dying tend to cause emotional strain. This study explores organizational readiness to implement palliative care based on evidence-based guidelines in nursing homes in Sweden. The aim was to identify barriers and facilitators to implementing evidence-based palliative care in nursing homes. METHODS: Interviews were carried out with 20 managers from 20 nursing homes in two municipalities who had participated along with staff members in seminars aimed at conveying knowledge and skills of relevance for providing evidence-based palliative care. Two managers responsible for all elderly care in each municipality were also interviewed. The questions were informed by the theory of Organizational Readiness for Change (ORC). ORC was also used as a framework to analyze the data by means of categorizing barriers and facilitators for implementing evidence-based palliative care. RESULTS: Analysis of the data yielded ten factors (i.e., sub-categories) acting as facilitators and/or barriers. Four factors constituted barriers: the staff’s beliefs in their capabilities to face dying residents, their attitudes to changes at work as well as the resources and time required. Five factors functioned as either facilitators or barriers because there was considerable variation with regard to the staff’s competence and confidence, motivation, and attitudes to work in general, as well as the managers’ plans and decisional latitude concerning efforts to develop evidence-based palliative care. Leadership was a facilitator to implementing evidence-based palliative care. CONCLUSIONS: There is a limited organizational readiness to develop evidence-based palliative care as a result of variation in the nursing home staff’s change efficacy and change commitment as well as restrictions in many contextual conditions. There are considerable individual- and organizational-level challenges to achieving evidence-based palliative care in this setting. The educational intervention represents one of many steps towards developing a culture conducive to evidence-based nursing home palliative care.
Catheter-associated urinary tract infection is the most common health care-associated infection, is considered avoidable, and has cost implications for health services. Prevalence is high in nursing homes, but little research has been undertaken to establish whether implementing clinical guidelines can reduce infection rates in long-term care or improve quality of urinary catheter care. METHODS: Systematic search and critical appraisal of the literature. RESULTS: Three studies evaluated the impact of implementing a complete clinical guideline. Five additional studies evaluated the impact of implementing individual elements of a clinical guideline. CONCLUSIONS: Prevention of catheter-associated urinary tract infection in nursing homes has received little clinical or research attention. Studies concerned with whole guideline implementation emerged as methodologically poor using recognized criteria for critically appraising epidemiologic studies concerned with infection prevention. Research evaluating the impact of single elements of clinical guidelines is more robust, and their findings could be implemented to prevent urinary infections in nursing homes.
Health Care Administration and Organization
The intent of Paid Family Leave (PFL) is to make it financially easier for individuals to take time off from paid work to care for children and seriously ill family members. Given the linkages between care provided by family members and the usage of paid services, we examine whether California’s PFL program influenced nursing home utilization in California during the 1999 to 2008 period. This is the first empirical study to examine the effects of PFL on long-term care patterns. Multivariate difference-indifference estimates across alternative comparison groups provide consistent evidence that the implementation of PFL reduced the proportion of the elderly population in nursing homes by 0.5 to 0.7 percentage points. Our preferred estimate, employing an empirically-matched group of control states, finds that PFL reduced nursing home usage by about 0.65 percentage points. For California, this represents an 11 percent relative decline in elderly nursing home utilization.
Implementing person-centered care requires shared attitudes, beliefs, and values among all care employees. Existing research has failed to examine the attitudes of non-nursing employees. AIM: This study examined attitudes toward aggression among nursing and non-nursing employees to address gaps in existing research and assess readiness for wider adoption of person-centered frameworks. METHOD: The Management of Aggression in People with Dementia Attitude Questionnaire was used to survey attitudes of employees in Michigan-based nursing homes. RESULTS: Overall, employees preferred person-centered over standard approaches. Job title was a significant predictor of paradigm support. Frontline employees were found to support person-centered attitudes the least. Wide-ranging responses were noted within employee groups. DISCUSSION: Job title may influence the degree to which an employee supports and utilizes person-centered approaches. Employees with the most contact with persons with dementia may be the least likely to implement person-centered approaches. In contrast to prior studies, years of experience was not a significant predictor of attitude toward aggressive behavior. Wide-ranging responses indicate that employee attitudes are varied and complex. IMPLICATIONS: Person-centered approaches should be trained within care areas rather than individual employee groups. Programs should be interdisciplinary and seek to establish a shared understanding of person-centered beliefs and values.
The United States Department of Veterans Affairs (VA) is facing pressures to rebalance its long-term care system. Using VA administrative data from 2004-2011, we describe changes in the VA’s nursing homes (called Community Living Centers [CLCs]) following enactment of directives intended to shift CLCs’ focus from providing long-term custodial care to short-term rehabilitative and post-acute care, with safe and timely discharge to the community. However, a concurrent VA hospice and palliative care expansion resulted in an increase in hospice stays, the most notable change in type of stay during this time period. Nevertheless, outcomes for Veterans with non-hospice short and long stays, such as successful discharge to the community, improved. We discuss the implications of our results for simultaneous implementation of two initiatives in VA CLCs.
BACKGROUND: Residential care homes (RCHs) are a common place of death. Previous studies have reported a high prevalence of symptoms such as pain and shortness of breath among residents in the last week of life. AIM: To explore the presence of symptoms and symptom relief, and identify factors associated with symptom relief of pain, nausea, anxiety, and shortness of breath among RCH residents in end-of-life care. METHOD: The data consisted of all expected deaths at RCHs registered in the Swedish Register of Palliative Care (n=22 855). Univariate and multiple logistic regression analyses were conducted. RESULTS: Pain was reported as the most frequent of the four symptoms (68.8%) and the one that most often had been totally relieved (84.7%) by care professionals. Factors associated with relief from at least one symptom were sex, age, time in the RCH, use of a validated pain or symptom assessment scale, documented end-of-life discussions with physicians for both the residents and family members, consultations with other units, diseases other than cancer as cause of death, presence of ulcers, assessment of oral health, and prescribed pro re nata injections for pain, nausea, and anxiety. CONCLUSION: Our results indicate that use of a validated pain assessment scale, assessment of oral health, and prescribed pro re nata injections for pain, nausea, and anxiety might offer a way to improve symptom relief. These clinical tools and medications should be implemented in the care of the dying in RCHs, and controlled trials should be undertaken to prove the effect.
The many negative effects of burnout have prompted researchers to better understand the factors contributing to it. The purpose of this paper is to add to this body of knowledge through the study of burnout among direct care workers (DCWs) in nursing homes (NH). Background Perhaps the factor most often associated with employee burnout is the level of staffingâ€”insufficient staffing results in work overload and eventually employee burnout. A closer look at research findings suggest that there are many other factors also contributing to burnout. These range from those at the organizational level, such as availability of training and resources to individual characteristics such as self-esteem and length of employment. Methods A self-administered survey instrument was completed by 410 DCWs working within 11 NHs in the north Texas region. Regression analyses were performed, adjusting for clustering by NH. Beta coefficients and structure coefficients are reported. Burnout was measured through three dimensions: emotional exhaustion, depersonalization, and personal accomplishment. Results Organizational, work design, interpersonal, and individual characteristics were found to be associated with one or more dimensions of burnout. Conclusions The analyses largely support previous research. Organizational variables of significance included the availability of resources to do the work, available training, and fair pay. Work design variables of significance included adequate staffing. The individual characteristic, self-esteem, appeared to have the strongest impact on burnout. Commitment to the organization also had a large impact. Relevance to Clinical Practice While the data do not allow for the testing of causal relationships, the data do suggest that providing adequate staffing, perceived fair pay, sufficient work resources (e.g., towels, gowns), management support, and adequate training may result in less DCW burnout on the job.
Interprofessional collaboration in nursing homes (interprof): development and piloting of measures to improve interprofessional collaboration and communication: a qualitative multicentre study.
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Given both the increase of nursing home residents forecast and challenges of current interprofessional interactions, we developed and tested measures to improve collaboration and communication between nurses and general practitioners (GPs) in this setting. Our multicentre study has been funded by the German Federal Ministry of Education and Research (FK 01GY1124). METHODS: The measures were developed iteratively in a continuous process, which is the focus of this article. In part 1 “exploration of the situation”, interviews were conducted with GPs, nurses, nursing home residents and their relatives focusing on interprofessional interactions and medical care. They were analysed qualitatively. Based on these results, in part 2 “development of measures to improve collaboration”, ideas for improvement were developed in nine focus groups with GPs and nurses. These ideas were revisited in a final expert workshop. We analysed the focus groups and expert workshop using mind mapping methods, and finally drew up the compilation of measures. In an exploratory pilot study “study part 3” four nursing homes chose the measures they wanted to adopt. These were tested for three months. Feasibility and acceptance of the measures were evaluated via guideline interviews with the stakeholders which were analysed by content analyses. RESULTS: Six measures were generated: meetings to establish common goals, main contact person, standardised pro re nata medication, introduction of name badges, improved availability of nurse/GP and standardised scheduling/ procedure for nursing home visits. In the pilot study, the measures were implemented in four nursing homes. GPs and nurses reviewed five measures as feasible and acceptable, only the designation of a “main contact person” was not considered as an improvement. CONCLUSIONS: Six measures to improve collaboration and communication could be compiled in a multistep qualitative process respecting the perspectives of involved stakeholders. Five of the six measures were positively assessed in an exploratory pilot study. They could easily be transferred into the daily routine of other nursing homes, as no special models have to exist in advance. Impact of the measures on patient oriented outcomes should be examined in further research.
To examine the within-trial costs and cost-effectiveness of using PARO, compared with a plush toy and usual care, for reducing agitation and medication use in people with dementia in long-term care. DESIGN: An economic evaluation, nested within a cluster-randomized controlled trial. SETTING: Twenty-eight facilities in South-East Queensland, Australia. PARTICIPANTS: A total of 415 residents, all aged 60 years or older, with documented diagnoses of dementia. INTERVENTION: Facilities were randomized to 1 of 3 groups: PARO (individual, nonfacilitated 15-minute sessions, 3 afternoons per week for 10 weeks); plush toy (as per PARO but with artificial intelligence disabled); and usual care. MEASUREMENTS: The incremental cost per Cohen-Mansfield Agitation Inventory-Short Form (CMAI-SF) point averted from a provider’s perspective. Australian New Zealand Clinical Trials Registry (BLINDED FOR REVIEW). RESULTS: For the within-trial costs, the PARO group was $50.47 more expensive per resident compared with usual care, whereas the plush toy group was $37.26 more expensive than usual care. There were no statistically significant between-group differences in agitation levels after the 10-week intervention. The point estimates of the incremental cost-effectiveness ratios were $13.01 for PARO and $12.85 for plush toy per CMAI-SF point averted relative to usual care. CONCLUSION: The plush toy used in this study offered marginally greater value for money than PARO in improving agitation. However, these costs are much lower than values estimated for psychosocial group activities and sensory interventions, suggesting that both a plush toy and the PARO are cost-effective psychosocial treatment options for agitation.
Health Care Innovation and Quality Assurance
Montessori-based activities use a person-centred approach to benefit persons living with dementia by increasing their participation in, and enjoyment of, daily life. This study investigated recreation staff and multidisciplinary consultants’ perceptions of factors that affected implementing Montessori Methods for Dementia in long-term care homes in Ontario, Canada. Qualitative data were obtained during semi-structured telephone interviews with 17 participants who worked in these homes. A political economy of aging perspective guided thematic data analysis. Barriers such as insufficient funding and negative attitudes towards activities reinforced a task-oriented biomedical model of care. Various forms of support and understanding helped put Montessori Methods for Dementia into practice as a person-centred care program, thus reportedly improving the quality of life of residents living with dementia, staff and family members. These results demonstrate that when Montessori Methods for Dementia approaches are learned and understood by staff they can be used as practical interventions for long-term care residents living with dementia.
There is a lack of research on implementation of person-centered care in nursing home care. The purpose of this study was to assess the implementation of the Veder contact method (VCM), a new person-centered method using theatrical, poetic and musical communication for application in 24-hr care. Research Design and Methods: Caregivers (n = 136) and residents (n = 141) participated in a 1-year quasi-experimental study. Foundation Theater Veder implemented VCM on six experimental wards and rated implementation quality. Six control wards delivered care-as-usual. Before and after implementation, caregiver behavior was assessed during observations using the Veder-observation list and Quality of Caregivers’ Behavior-list. Caregiver attitude was rated with the Approaches to Dementia Questionnaire. Quality of life, behavior, and mood of the residents were measured with QUALIDEM, INTERACT and FACE. Residents’ care plans were examined for person-centered background information. Results: Significant improvements in caregivers’ communicative behavior (i.e., the ability to apply VCM, establishing positive interactions) and some aspects of residents’ behavior and quality of life (i.e., positive affect, social relations) were found on the experimental wards with a high implementation score, as compared to the experimental wards with a low implementation score, and the control wards. No significant differences were found between the groups in caregivers’ attitudes, residents’ care plans, or mood. Discussion and Implications: The positive changes in caregivers’ behavior and residents’ well-being on the high implementation score wards confirm the partly successful VCM implementation. Distinguishing between wards with a high and low implementation score provided insight into factors which are crucial for successful implementation.
Studies have shown that residents in nursing homes may be exposed to inappropriate medication, especially with psychoactive drugs. This increases the risk of adverse effects. Mission We identified, evaluated and compiled research on the effect of interventions to reduce inappropriate use of medicines in nursing homes. The report was commissioned by the Norwegian Directorate of Health in connection with the work of Care Plan 2015. Main findings Educational outreach or educational interventions given alone or as part of a complex package aimed at health professionals may in some contexts reduce inappropriate drug use. The quality of evidence for these results in a nursing home setting varies from very low to low. Medical review by pharmacists in an interdisciplinary collaboration with the nursing home physician and other relevant health professionals may in some contexts reduce inappropriate drug use. The quality of evidence for these results varies from very low to low. A geriatric assessment team responsible for all medical treatment of the elderly demonstrated a statistical significant effect on prescribing of drugs in one study. The study had few participants and a high risk of bias in the results. The evidence is therefore of too low quality to be able to judge whether the intervention affects inappropriate use of medicines. Early psychiatric intervening had no statistically significant effect on the use of psychoactive drugs. Since the quality of the evidence for this result is very low, we cannot determine whether the intervention affects inappropriate use of drugs or not. Activating residents combined with educational meetings for health personnel had no statistically significant effect on the use of antipsychotics or the number of drugs used in total. Since the quality of the evidence for this result is very low, we cannot determine whether the intervention affects the use of drugs or not. The quality of the evidence is too low to assess whether interventions to reduce inappropriate medication affects health outcomes.
Nursing home residents are often characterized by longevity, multiple chronic illnesses and a low level of physical and mental function. These characteristics contribute to nursing home residents’ vulnerability for acute and deteriorating illness. When occurring, the decision of whether to hospitalize makes an important and complex part of the clinical decision making. The aim of this report was to give a systematic review of the effect of interventions to reduce hospitalizations from nursing homes. We emphasize that hospital admissions from nursing homes can be both appropriate and essential for the elderly to receive the best possible health care. The focus of this report is on reducing unnecessary admissions, i.e. where there are medically sound alternatives to hospitalization in the nursing home. We included four systematic reviews and five primary studies in this review. In total there were eleven unique interventions that were evaluated, gathered in three main categories. Interventions to standardize treatment and care: Four out of seven interventions for structuring and standardizing treatment and care yielded fewer hospital admissions for the intervention groups. The results for mortality, however, were unclear. The quality of the evidence was assessed as being low or very low. Geriatric specialist services: Geriatric specialist teams compared with usual care demonstrated fewer hospital admissions in the intervention groups. The quality of the evidence was judged as being very low. Influenza vaccination: Promoting influenza vaccination of health personnel in nursing homes demonstrated unclear results for hospital admissions, but yielded fewer deaths for the intervention group. The quality of the evidence was judged as low. Influenza vaccination of nursing home residents showed fewer hospital admissions and fewer cases of influenza-like illness and deaths for the intervention group, but for laboratory confirmed influenza the result was unclear. The quality of the evidence was judged as very low. Overall there were relatively few studies evaluating the effects of interventions to reduce hospital admissions from nursing homes. Although the results of the evaluation of several of the interventions showed a reduction in admissions, the evidence for these results was graded as of low or very low quality. Our confidence in the results corresponds to this, which means that we cannot draw any definitive conclusions for the effect of any of the interventions.
People with dementia at green care farms (GCFs) are physically more active, have more social interactions, are involved in a larger variety of activities, and come outdoors more often than those in other long-term dementia care settings. These aspects may positively affect health and well-being. This study explored which and how characteristics of GCFs could be implemented in other long-term dementia care settings, taking into account possible facilitators and barriers. METHODS: Semi-structured interviews were conducted with 23 professionals from GCFs, independent small-scale long-term care facilities, and larger scale long-term care facilities in the Netherlands. The framework method was used to analyze the data. RESULTS: Several characteristics of GCFs (e.g. homelike aspects, domestic activities, and access to outdoor environments) have already been applied in other types of long-term dementia care settings. However, how and the extent to which these characteristics are being applied differ between GCFs and other types of long-term dementia care settings. Facilitators and barriers for the implementation of characteristics of GCFs were related to the physical environment in which the care facility is situated (e.g. the degree of urbanization), characteristics and competences of staff members (e.g. flexibility, creativity), characteristics and competences of managers (e.g. leadership, vision), and the political context (e.g. application of risk and safety protocols). CONCLUSION: Several characteristics can be implemented in other dementia care settings. However, to realize innovation in dementia care it is important that not only the physical environment but also the social and organizational environments are supporting the process of change.
The objective of this study was to explore home and community-based service (HCBS) providers’ perspectives of organizational readiness for quality improvement (QI). Data were obtained from a survey of participants (N = 56) in a state-sponsored HCBS QI initiative. Quality improvement challenges included lack of time and resources, staff apprehension or resistance, resistance from consumers and families, and project sustainability. Support from leadership was viewed as an important factor in participating organizations’ decision to engage in QI. Internal resources available to support QI varied widely between participating organizations, with differences observed between smaller and larger agencies, as well as between provider types and populations served.
The first large-scale clinical trials of statins were held in the mid-1980s and statins became available on prescription from the NHS in the 1990s. By the early 2000s, the English NHS was prescribing around 8 billion daily doses of statins each year, contributing to dramatic reductions in rates of mortality from cardiovascular disease. Meanwhile, despite considerable progress, the NHS, like other health systems, is still struggling to implement basic hygiene protocols such as handwashing in hospitals, 150 years after Joseph Lister published his observations in the Lancet on antiseptic methods. Some innovations are incendiary, spreading with a spark from funders, regulators, professionals or the public. Others seem stubbornly immobile, no matter how easy they appear to implement or how persuasive the evidence.
The Social Care Institute for Excellence (SCIE)’s Future of Care Briefing Number 6, which tackles Innovative models of health, care and support for adults covers the spread of innovation from small-scale models of health, social care and support for adults. It discusses the potential benefits of scaling-up new models of care / relationship-based care which may exist locally, but which tend to be implemented inconsistently more widely.
Research Practice and Methodology
Program theory, that is, the specific idea about how a program causes the intended or observed outcomes, should be the central aspect of any realist evaluation or synthesis. The methods used for explicating or building initial rough program theories (IRPTs) in realist research are varied and arguably often underreported. In addition, preexisting psychological and sociological theories, at a higher level of abstraction, could be used to a greater extent to inform their development. This article illustrates a method for building IRPTs for use in realist research evaluation and synthesis. This illustration involves showing how the IRPTs were developed in a realist evaluation concerning sexual health services for young people. In this evaluation, a broad framework of abstract theories was constructed early in the process to support IRPT building and frame more specific program theories as they were developed. These abstract theories were selected to support theorizing at macro-, meso-, and microlevels of social structure. This article discusses the benefits of using this method to build initial theories for particular types of interventions that are large, complex, and messy. It also addresses challenges relating to the selection of suitable theories.; Program theory, that is, the specific idea about how a program causes the intended or observed outcomes, should be the central aspect of any realist evaluation or synthesis. The methods used for explicating or building initial rough program theories (IRPTs) in realist research are varied and arguably often underreported. In addition, preexisting psychological and sociological theories, at a higher level of abstraction, could be used to a greater extent to inform their development. This article illustrates a method for building IRPTs for use in realist research evaluation and synthesis. This illustration involves showing how the IRPTs were developed in a realist evaluation concerning sexual health services for young people. In this evaluation, a broad framework of abstract theories was constructed early in the process to support IRPT building and frame more specific program theories as they were developed. These abstract theories were selected to support theorizing at macro-, meso-, and microlevels of social structure. This article discusses the benefits of using this method to build initial theories for particular types of interventions that are large, complex, and messy. It also addresses challenges relating to the selection of suitable theories.
Routinely collected health data (RCD) are increasingly used for randomized controlled trials (RCTs). This can provide three major benefits: increasing value through better feasibility (reducing costs, time, and resources), expanding the research agenda (performing trials for research questions otherwise not amenable to trials), and offering novel design and data collection options (e.g., point-of-care trials and other designs directly embedded in routine care). However, numerous hurdles and barriers must be considered pertaining to regulatory, ethical, and data aspects, as well as the costs of setting up the RCD infrastructure. Methodological considerations may be different from those in traditional RCTs: RCD are often collected by individuals not involved in the study and who are therefore blinded to the allocation of trial participants. Another consideration is that RCD trials may lead to greater misclassification biases or dilution effects, although these may be offset by randomization and larger sample sizes. Finally, valuable insights into external validity may be provided when using RCD because it allows pragmatic trials to be performed.
Low participation in research is one of the key challenges to advancing understanding of dementia, and improving the care and treatment of those who live with this condition. Nurses and nurse researchers play a vital role in recruiting people with dementia to studies, as several countries including the United States and the United Kingdom set national targets and develop initiatives to encourage more people with dementia to take part in research. Aim To highlight the challenges to recruiting people with dementia to studies, and to identify strategies that nurses, and in particular, nurse researchers can use for overcoming them. Our focus is primarily on the role of nurses in recruiting people with dementia to dementia studies, but much of the discussion will apply to other health professionals involved in the recruitment of people with dementia to research more generally. Discussion Challenges discussed include a lack of awareness about research participation opportunities and a suitable study partner. We discuss how the nurses’ role is to ensure that recruitment practices are personalised and responsive to participants’ needs and situation, rather than target driven. The notion of responsible research is used to anchor the discussion. Conclusion Increasing the participation of people with dementia in research is a global priority. Nurses and nurse researchers play an important role in ensuring that people who take part in research have an optimal research experience. IMPLICATIONS FOR PRACTICE: Recruiting people with dementia to research studies is a national priority in many countries. With a greater understanding of the challenges involved and strategies that can be used to overcome them, nurses can have an effective role in the recruitment process and research experience.
The purpose of this qualitative multiple case study is to describe and compare how researchers in the education, nursing, psychology, and sociology disciplines operationalize and conceptualize the quality of mixed methods research (MMR). An international sample of 44 MMR researchers representing these four disciplines were interviewed. The study findings point to (a) two perspectives from which the quality of MMR is understood, one contingent and flexible and the other universal and fixed; (b) a relationship between these two perspectives and the participants? discipline; and (c) a similar occurrence, both in terms of nature and frequency, of the MMR quality criteria most mentioned by the participants across disciplines. Implications of the findings for the field of MMR are discussed.; The purpose of this qualitative multiple case study is to describe and compare how researchers in the education, nursing, psychology, and sociology disciplines operationalize and conceptualize the quality of mixed methods research (MMR). An international sample of 44 MMR researchers representing these four disciplines were interviewed. The study findings point to (a) two perspectives from which the quality of MMR is understood, one contingent and flexible and the other universal and fixed; (b) a relationship between these two perspectives and the participants? discipline; and (c) a similar occurrence, both in terms of nature and frequency, of the MMR quality criteria most mentioned by the participants across disciplines. Implications of the findings for the field of MMR are discussed.
End-of-life (EoL) communication in long-term care (LTC) homes is often inadequate and delayed, leaving residents dying with unknown preferences or goals of care. Poor communication with staff contributes to families feeling unprepared, distressed, and dissatisfied with care. Family care conferences (FCCs) aim to increase structured systematic communication around goals and plans for the end of life. As part of the Strengthening a Palliative Approach to Care (SPA-LTC) project, FCCs were implemented in four LTC sites in Ontario, Canada. The purpose of this substudy was to examine FCC content and such guiding processes as documentation and multidisciplinary staff participation. METHOD: A total of 24 FCCs were held for residents with a Palliative Performance Scale score of 40% (nearing death). Data were collected from conference forms (i.e., Family Questionnaires, Care Plan Conference Summaries), site-specific electronic chart documents, and fieldnotes. Directed content analysis of data was informed by the Canadian Hospice Palliative Care Association’s Square of Care Model, which describes eight domains of care: disease management, physical, psychological, social, practical, spiritual, EoL, and loss/bereavement. RESULTS: The FCCs addressed an average of 71% of the content domains, with physical and EoL care addressed most frequently and loss/bereavement addressed the least. Two goals and five interventions were documented and planned on average per FCC. Examination of the processes supporting EoL communication found: (1) advantages to using FCC forms versus electronic charts; and (2) high levels of multidisciplinary participation overall but limited participation of personal support workers (PSWs) and physicians. SIGNIFICANCE OF RESULTS: Communication around the end of life in LTC can be supported through the use of FCCs. Description of content and FCC processes provides guidance to persons implementing FCCs. Recommendations for tailoring conferences to optimize communication include use of specific conference forms, increased bereavement discussion, and further engagement of PSWs and physicians.
A phenomenon of interest for nursing is the facilitation of humanistic health care experiences and quality of life. Inquiry into the concept of thriving as it manifests in the older adult residing in long-term care aligns with this interest. Thriving has been described by scholars in various disciplines but no context-specific definition for the LTC resident currently exists. Contrary to the generally held negative view of LTC, there is emerging evidence that older adult LTC residents “do well” or thrive in this environment.
Over the last 10 years there has been a multitude of studies of psychosocial interventions for people with dementia. However, clinical services face a dilemma about which intervention should be introduced into clinical practice because of the inconsistency in some of the findings between different studies and the differences in the study qualities and trustworthiness of evidence. There was a need to provide a comprehensive summary of the best evidence to illustrate what works. METHODS: A review of the systematic reviews of psychosocial interventions in dementia published between January 2010 and February 2016 was conducted. RESULTS: Twenty-two reviews (8 physical, 7 cognitive, 1 physical/cognitive and 6 other psychosocial interventions) with a total of 197 unique studies met the inclusion criteria. Both medium to longer-term multi-component exercise of moderate to high intensity, and, group cognitive stimulation consistently show benefits. There is not sufficient evidence to determine whether psychological or social interventions might improve either mood or behaviour due to the heterogeneity of the studies and interventions included in the reviews. CONCLUSION: There is good evidence that multi-component exercise with sufficient intensity improves global physical and cognitive functions and activities of daily living skills. There is also good evidence that group-based cognitive stimulation improves cognitive functions, social interaction and quality of life. This synthesis also highlights the potential importance of group activities to improve social integration for people with dementia. Future research should investigate longer-term specific outcomes, consider the severity and types of dementia, and investigate mechanisms of change.
The John Dossetor Health Ethics Centre invites you to an upcoming Issues in Health Ethics presentation
CIHR: Understanding dementia: An exchange with experts on prevention, treatment, and care
This bilingual event is hosted by the CIHR Institute of Aging in partnership with the Public Health Agency of Canada, the Alzheimer Society of Canada and the Canadian Consortium on Neurodegeneration in Aging. please RSVP at firstname.lastname@example.org
Join Samantha Yammine to discuss the positive impact talking about science on social media can have, both within scientific communities and beyond. We will also go into specifics about how to create engaging content that will resonate with your target audience, including best practices for Instagram and Twitter.
This webinar is an introduction to creative media and knowledge translation meant for use as research-to-practice or educational purposes. Specifically, it will focus on the medium of blogging and how to make scholarly work accessible to the general population and/or a target population using this creative outlet. Key topics of discussion will include dismantling the knowledge translation process, building a narrative, understanding language and purpose, logistics, and ethics. The webinar is tailored for researchers and health professionals, and will focus on mental health and mental illness for examples.
Personal support workers (PSWs) in Ontario’s long-term care homes who have approximately six minutes, on average, to ready each resident in their facility for the day ahead.
Too many papers cite retracted research — even after it’s been retracted. It’s a problem. It can be especially a problem in clinical fields, where patient care is at stake. Recently, Richard Gray at La Trobe University in Australia and his colleagues examined the scope of the problem in the nursing field, noting how many systematic reviews included findings from retracted clinical trials.
IHI recently conducted a survey of 90 US quality leaders to find out more about the challenges they’re facing.
Singer-songwriter Beatie Wolfe was inspired to explore the power of music on people with dementia after reading Oliver Sacks’ Musicophilia: Tales of Music and the Brain.”
January marks Alzheimer Awareness Month, and this year, Alzheimer Society of Canada’s campaign is focused on tackling stigma.
In what has become an increasingly common business arrangement, owners of nursing homes outsource a wide variety of goods and services to companies in which they have a financial interest or that they control. Owners then siphon off higher profits, which are not recorded on the nursing home’s accounts.
Researchers trying to use the knowledge they’ve produced to inform public policy are often warned of the importance of context to policy decisions. But what exactly does “context” mean?
Biggest titles’ opening of sister periodicals is taking submissions away from specialist titles, researchers warn.
Nation-wide campaign for Alzheimer’s Awareness Month aimed at ending stigma and increasing multi-dimensional research.
Research impact is often talked about, but how clear is it what this term really means?
Peter Severinson reports on work published by the Federation for the Humanities and Social Sciences in Canada that it is hoped will provide guidance to university administrators, public servants, and other members of the research community undertaking the demanding work of impact assessment.
With one in five elderly Japanese predicted to have dementia by 2025, entire communities are working to improve the lives of older citizens.
How should researchers, with or without experience in the arts, actually go about planning and implementing arts-based knowledge translation?
Secrecy around abuse investigations in Nova Scotia’s nursing homes puts residents at further risk, according to an advocate for the elderly.
Once a week, a music therapist helps Mrs. Herzog transform her thoughts into lyrics, then sings them back to her mellifluously over the strums of her guitar. The result can be transformative.
The Alzheimer Society has created a social awareness campaign—I live with dementia to spark conversations and encourage Canadians to see dementia differently. Use the hashtag #ilivewithdementia to help spread the word.
Springer Publishing Company is accepting nominations, including self‐nominations, for the position of Editor-in-Chief of the International Journal of Childbirth. Ideally they are seeking 2 Co-Editors, with one based in the United States and another in Europe. This is a young, respected journal which is steadily growing. We are looking for candidates with the passion, vision, and drive to shape the journal and deliver it to the next level.
Our Implementation Support and Knowledge Mobilization Team members are looking to expand the pool of our contracted experts to perform some or all of the following functions on an as-needed basis:
-Undertake short writing assignments (in consultation with CADTH Knowledge Mobilization Officers) for implementation support/considerations, chapter development in alignment with standardized framework.
-Participate in teleconference or webinar-based meetings with research team leads on matters pertaining to clinical projects.
-Mock-up or draft plain language tools from research project work including from CADTH expert committee recommendations.
-Prepare in-briefs summaries or other concise evidence products based on results from larger CADTH projects.
-Prepare clinician-focused tools from Rapid Response reports as needed or as identified by customer request.
-Create infographic tools on particular clinical topics in alignment with CADTH evidence.
-Write newsletters and/or conference abstracts for use by Implementation Support team members.
The editor and editorial board of Written Communication invite article submissions for a special issue on writing and science. Submissions from established and new scholars of writing studies are welcome. The special issue will tentatively be published as Volume 35, Issue 1, of the journal, in January 2019.