October 22, 2018


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New TREC Article
Who Is (Still) Looking After Mom and Dad? Few Improvements in Care Aides’ Quality-of-Work Life
Non UofA Access

S. A. Chamberlain, M. Hoben, J. E. Squires, G. G. Cummings, P. Norton and C. A. Estabrooks.
Can J Aging 2018 Oct 9:1-16
Unregulated care aides provide most of the direct care to nursing home residents. We previously reported the first demographic profile of care aides in Western Canada through the Translating Research in Elder Care (TREC) longitudinal research program (2007-2022) in applied health services. Here we describe demographic, health, and work life characteristics of aides from 91 nursing homes in Western Canada. Demographics and work life varied significantly across health regions and facility owner-operator models. Our longitudinal cohort of aides from Alberta and Winnipeg had higher emotional exhaustion (a negative attribute), professional efficacy (a positive attribute), and experience of dementia-related responsive behaviours from residents. Overall, results indicate little improvement or worsening of care aide health and quality of work life. Coupled with limited provincial or national initiatives for workforce planning and training of these workers, this signals a long-term care system ill-prepared to care effectively for Canada’s aging population.

New article by Dr. Adrian Wagg
Development of quality outcome indicators to improve the quality of urinary and faecal continence care
Non UofA Access

A. Wagg, D. Gove, K. Leichsenring and J. Ostaszkiewicz.
Int Urogynecol J 2018 Oct 16
Despite the range of treatment options available, relatively few people with incontinence find a total cure. The importance of daily management with toileting and containment cannot be underestimated. To our knowledge, there are no outcome measures to benchmark good care. The aim of this study was to create a set of key performance indicators (KPIs) to measure outcomes for toileting and containment. METHODS: An expert panel (EP) defined a set of KPIs using evidence from a scoping review, stakeholder engagement, and expert consensus. Peer reviewed articles, high-quality grey literature and international and national standards were reviewed to identify existing measures for management. These findings were augmented by an exercise involving patients, caregivers, nurses, clinicians, payers, policy makers and care providers to prioritise the findings and identify additional areas of interest. RESULTS: The final set of 14 KPIs includes quality indicators of process and outcome for those managed with a toileting and containment strategy and is relevant for both care-independent and -dependent persons. Rates of assessment, days waiting for specialist assessment, rates of return to work and those rating their quality of life as good or acceptable are captured. An indicator of well-being for caregivers and the economic costs of poor care are also defined. CONCLUSIONS: The set of KPIs to measure outcomes from toileting and containment strategies describes the components of each to encourage integration into existing quality frameworks. Each KPI has been refined and detailed to encourage this. If implemented, resulting benchmarking data will facilitate care quality improvement and inform value-based care procurement and provision of toileting and containment strategies.

New article by Dr. Kim Fraser
Case Manager Work and Workload: Uncovering a Wicked Problem—A Secondary Analysis Using Interpretive Description
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K. D. Fraser, L. Garland Baird, S. Labonte, H. O’Rourke and N. S. Punjani.
Home Health Care Management & Practice 2018 10/01; 2018/10:1084822318803099
Canada’s population is aging, and by 2027, it is expected that 22 million people will be older than 65 years. Home care services were used by 2.2 million individuals, or 8% of Canadians 15 years of age and older in 2012. Home care programs are continually expanding to meet the needs of the growing number of clients, and goals include keeping people in their homes for as long as possible, delaying the need for institutional care, and maintaining quality of life. Case managers are the gatekeepers to home care in Canada. They collaborate with families to plan care, coordinate home care services and community supports, as well as monitor client progress and evaluate outcomes. The aim of our study was to conduct a qualitative secondary analysis to understand the factors that influence case manager work and workload in home care. We completed a secondary analysis of four data sets from four primary studies of related concepts that occurred between 2006 and 2013. Our study design was inductively driven using the tenets of interpretive description. Case managers? work and workloads are messy and affected by interrelated complex structures of home care programs within health care systems. The concept of a wicked problem, which describes a problem that is complex and intractable, is a useful construct we use to gain some clarity around the work and workload problems that case managers face. Case managers aim to make a positive difference in their client?s lives, but are constantly dealing with change, and can experience feelings of being their client?s last resort with the resulting pressure ultimately impacting their workload. In addition, case managers reported health system failures, including a lack of capacity and structural integration within home care programs that increase their work and workload. Case manager work and workload requires further research including the development and refinement of accurate workload measurement tools that consider the multiple aspects of professional responsibilities and case management activities. Workload and workload measurement tools are needed to account for the unplanned and unpredictable nature of case management work and assist with the distribution of more equitable caseloads among case managers and home care teams.

 

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Grants & Awards

CIHR Team Grant: Transitions in Care

DEADLINE 24 January 2019
This funding opportunity is one of several planned as part of the Transition in Care (TiC) Initiative. The focus is to support inter-disciplinary teams that are poised and ready to optimize transition in care outcomes. The grants will provide funds to implement, evaluate, spread, and scale pragmatic solutions to problems associated with transitions in care from a clinical, health care or health system perspective.

CFN Interdisciplinary Fellowships

DEADLINE Pre-Application 13 November
For graduate and PhD students, post-docs and working professionals, the one-year CFN Interdisciplinary Fellowships are an interdisciplinary, experiential program offered in partnership with member institutions and partners across the country.

CFN 2019 Summer Student Awards

DEADLINE Pre-Application 13 November
CFN Summer Student Awards go to undergraduate students enrolled full-time in a degree program at a Canadian university. During the summer they work under supervisors on research related to improving care for older Canadians living with frailty, and also complete modules of the CFN Interdisciplinary Training Program.

 

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Publications

KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Practice and Methodology
Aging

KT

Translating an Evidence-based Multicomponent Intervention for Older Adults With Dementia and Caregivers
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L. Teri, R. G. Logsdon, S. M. McCurry, K. C. Pike and E. L. McGough.
Gerontologist 2018 Oct 9
Effective community-based programs to maintain health and well-being of adults with dementia are needed. This article describes the translation, implementation, and effectiveness of a multicomponent exercise plus behavioral/psychosocial intervention (Reducing Disability in Alzheimer’s Disease-NorthWest [RDAD-NW]) conducted by staff in regional Area Agencies on Aging (AAAs). Research Design and Methods : Staggered multiple baseline design was used; 10 AAAs, 20 case managers, and 255 community-residing persons with dementia (PWDs), and family caregivers were enrolled. RDAD-NW was conducted in-home over 6 weeks with aerobic/endurance, strength, and balance/flexibility exercises, dementia education, training to increase pleasant events, and activator-behavior-consequence problem-solving approach. Outcomes included case manager treatment fidelity, and caregiver/PWD physical activity, restricted activity days, physical functioning, quality of life, and affect. Results: RDAD-NW was successfully translated and implemented by AAA agency staff through their usual service provision mechanisms. Staff responded positively and delivered the program with a high degree of fidelity. Caregiver/PWD dyads also responded favorably engaging in both exercise and behavioral/psychosocial portions of the program. A total of 207 dyads (81%) completed the intervention and 140 (55%) completed the 13-month follow-up. PWD physical activity increased significantly pre- to posttreatment (p < .001, ES = .54), and 13 months (p < .01, ES = .21). Quality of life of PWD increased significantly pre- to posttreatment (p < .001, ES = .29); caregiver depression improved pre- to posttreatment (p = .01, ES = -.18). Discussion and Implications: RDAD-NW was successfully translated and implemented by AAA case managers and resulted in increased physical activity and improved behavioral and emotional outcomes of caregiver/PWDs. Results support continued dissemination and implementation of RDAD-NW. Clinical Trials Registration: NCT01708304.

What is a research derived actionable tool, and what factors should be considered in their development? A Delphi study.
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S. Hampshaw, J. Cooke and L. Mott.
BMC Health Serv Res 2018 Sep 27;18(1):740-018-3551-6
Research findings should be disseminated appropriately to generate maximum impact. The development of research derived ‘actionable’ tools (RDAT) as research outputs may contribute to impact in health services and health systems research. However there is little agreement on what is meant by actionable tool or what can make them useful. We set out to develop a consensus definition of what is meant by a RDAT and to identify characteristics of a RDAT that would support its use across the research-practice boundary. METHODS: A modified Delphi method was used with a panel of 33 experts comprising of researchers, research funders, policy makers and practitioners. Three rounds were administered including an initial workshop, followed by two online surveys comprising of Likert scales supplemented with open-ended questions. Consensus was defined at 75% agreement. RESULTS: Consensus was reached for the definition and characteristics of RDATs, and on considerations that might maximize their use. The panel also agreed how RDATs could become integral to primary research methods, conduct and reporting. A typology of RDATs did not reach consensus. CONCLUSIONS: A group of experts agreed a definition and characteristics of RDATs that are complementary to peer reviewed publications. The importance of end users shaping such tools was seen as of paramount importance. The findings have implications for research funders to resource such outputs in funding calls. The research community might consider developing and applying skills to coproduce RDATs with end users as part of the research process. Further research is needed on tracking the impact of RDATs, and defining a typology with a range of end-users.

EPC Pilot Project: A Dual Approach To Facilitate Health Systems Uptake of Evidence Synthesis Reports. Anxiety in Children

AHRQ October 2018
Selected Key Messages:
-Findings: A health system decision aid and an encounter decision aid were shown to be feasible and effective tools that can provide health systems with contextual and implementation information on the treatment of anxiety in children.
-Lessons learned for EPC Program: Comparative effectiveness evidence syntheses often do not have sufficient information that allows decision-making and implementation of evidence. This includes information on costs, resources, patients’ values, acceptability and feasibility of interventions. Additional synthesis of study characteristics and intervention components is often needed.
-Utility for health systems: A dual approach that caters to the needs of both health system decision-makers and the clinician-patient dyad may facilitate uptake of evidence synthesis reports by health systems.

 

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Health Care Administration and Organization

The associations between staffing hours and quality of care indicators in long-term care
Non UofA Access

V. M. Boscart, S. Sidani, J. Poss, et al.
BMC Health Serv Res 2018 Oct 3;18(1):750-018-3552-5
Long-term care (LTC) staffing practices are poorly understood as is their influence on quality of care. We examined the relationship between staffing characteristics and residents’ quality of care indicators at the unit level in LTC homes. METHODS: This cross-sectional study collected data from administrative records and resident assessments from July 2014 to June 2015 at 11 LTC homes in Ontario, Canada comprising of 55 units and 32 residents in each unit. The sample included 69 registered nurses, 183 licensed/registered practical nurses, 858 nursing assistants, and 2173 residents. Practice sensitive, risk-adjusted quality indicators were described individually, then combined to create a quality of care composite ranking per unit. A multilevel regression model was used to estimate the association between staffing characteristics and quality of care composite ranking scores. RESULTS: Nursing assistants provided the majority of direct care hours in LTC homes (76.5%). The delivery of nursing assistant care hours per resident per day was significantly associated with higher quality of resident care (p = < 0.01). There were small but significant associations with quality of care for nursing assistants with seven or more years of experience (p = 0.02), nursing assistants late to shift (p = < 0.01) and licensed/registered practical nurses late to shift (p = 0.02). CONCLUSIONS: The number of care hours per resident per day delivered by NAs is an important contributor to residents’ quality of care in LTC homes. These findings can inform hiring and retention strategies for NAs in LTC, as well as examine opportunities to optimize the NA role in these settings.

Exploring the sensory screening experiences of nurses working in long-term care homes with residents who have dementia: a qualitative study
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F. Hobler, X. Argueta-Warden, M. Rodriguez-Monforte, A. Escrig-Pinol, W. Wittich and K. S. McGilton.
BMC Geriatr 2018 Oct 4;18(1):235-018-0917-x
The prevalence of vision and hearing loss is higher amongst older individuals with dementia, as well as higher in long-term care settings than in the wider community. However, the incidence of sensory impairment is underreported and often goes untreated. In this study, we aimed to understand nurses’ current experiences of screening and caring for long-term care residents who have dementia and sensory impairment. METHODS: As part of a larger study on the sensory screening of long-term care residents with dementia, an environmental scan was conducted with front-line healthcare providers. We report here on the findings from the content analysis of individual, semi-structured interviews with nurses working in two long-term care homes in Southern Ontario, Canada. Twenty regulated nurses, including designated resident assessment coordinators, working full- or part-time with individuals who have dementia, participated across the two sites. All interviews were transcribed, and their contents reviewed and coded for themes by means of inductive thematic analysis. RESULTS: Following a systematic and recursive approach, three analysts identified several themes relating to: 1) the sensory screening process, 2) communication strategies, and 3) quality of life, sensory loss, and dementia. Participants reported on the strengths and limitations of screening procedures, what improvements should be made, which informal strategies are effective, and the continued professional development that is needed. CONCLUSIONS: Nurses demonstrated insight into the facilitators and barriers to effective screening and care of residents with dementia and sensory impairments, and expressed the need for further education, more suitable screening tools, and formalised accountability within the screening process for vision and hearing loss in these long-term care residents.

Care coordinator assistants: Job satisfaction and the importance of teamwork in delivering person-centered dementia care
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D. Nowaskie, C. A. Carvell, C. A. Alder, et al.
Dementia (London) 2018 Oct 2:1471301218802739
As the prevalence of persons with dementia increases, a larger, trained, and skilled healthcare workforce is needed. Attention has been given to models of person-centered care as a standard for dementia care. One promising role to deliver person-centered care is the care coordinator assistant. An inquiry about care coordinator assistant’s job satisfaction is reasonable to consider for retention and quality improvement purposes. We evaluated care coordinator assistants’ job satisfaction quantitatively and qualitatively. This study was part of a Centers for Medicare & Medicaid Services Health Care Innovation Award to the Indiana University School of Medicine. Sixteen care coordinator assistants, predominately female, African American or Caucasian, college graduates with a mean age of 43.1 years participated. Care coordinator assistants wrote quarterly case reports to share stories, lessons learned, and/or the impact of their job and completed the revised Job Satisfaction Inventory and Job in General scales during the second year of the Centers for Medicare & Medicaid Services award. For the Job Descriptive Index subscales promotion, supervision, and coworkers and Job in General, care coordinator assistants scored similar to normative means. Care coordinator assistants reported significantly higher satisfaction on the work subscale and significantly lower satisfaction on the pay subscale compared to normative data. Care coordinator assistants completed 119 quarterly case reports. Job satisfaction and teamwork were recurring themes in case reports, referenced in 47.1% and 60.5% of case reports, respectively. To address the demands of increasing dementia diagnoses, care coordinator assistants can constitute a compassionate, competent, and satisfied workforce. Training care coordinator assistants to work together in a team to address the needs of persons with dementia and caregivers provides a viable model of workforce development necessary to meet the growing demands of this population.

Supportive Supervision and Staff Intent to Turn Over in Long-Term Care Homes
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J. Bethell, C. H. Chu, W. P. Wodchis, K. Walker, S. C. Stewart and K. S. McGilton.
Gerontologist 2018 Sep 14;58(5):953-959
To examine the association between supervisory support and intent to turn over among personal support workers (PSWs) employed in long-term care (LTC) homes in Ontario, Canada, by assessing whether the association is mediated by job satisfaction and the potential confounding effect of happiness. Research Design and Methods: Cross-sectional survey data of 5,645 PSWs working within 398 LTC homes in Ontario, Canada, were obtained and analysed through a series of multilevel regression models. Results: Overall, analyses support the assertion that the effect of supervisory support on intent to turn over is partially mediated by job satisfaction. However, happiness may act as an effect modifier rather than as a confounder. Discussion and Implications: These results reinforce the importance of supportive supervision for PSWs working in LTC homes and highlight the multifaceted role of nurses in LTC, who traditionally provide the majority of PSW supervision. Nurses must be equipped with competencies and skills that reflect the complex organisational environments in which they work. However, these results must also be interpreted in context with the limitations of cross-sectional data; future research should incorporate prospective data collection and clarify the potential role of happiness.

The impact of Nursing Homes staff education on end-of-life care in residents with advanced dementia: a quality improvement study.
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P. Di Giulio, S. Finetti, F. Giunco, et al.
J Pain Symptom Manage 2018 Oct 10
End-of-life care in nursing homes (NH) needs improvement. We carried out a study in 29 NHs in the Lombardy Region (Italy). OBJECTIVES: To compare End-of-Life care in NH residents with advanced dementia before and after an educational intervention aimed to improving palliative care. METHODS: The intervention consisted of a 7-hour lecture, followed by two 3-hour meetings consisting of case discussions. The intervention was held in each NH and well attended by NH staff. This multicenter, comparative, observational study included up to 20 residents with advanced dementia from each NH: the last 10 who died before the intervention (pre-intervention group, 245 residents) and the first 10 who died at least 3 months after the intervention, (post-intervention group, 237 residents). Data for these residents were collected from records for 60 days and 7 days death. RESULTS: The use of “comfort hydration” (<1000 ml/day subcutaneously) tended to increase from 16.9 to 26.8% in the post-intervention group. The number of residents receiving a palliative approach for nutrition and hydration increased, though not significantly, from 24% pre- to 31.5% post-intervention. On the other hand, the proportion of tube-fed residents and residents receiving intravenous hydration decreased from 15.5% to 10.5%, and from 52% to 42% respectively. Cardiopulmonary resuscitations decreased also from 52/245 (21%) to 18/237 (7.6%) cases (p=0.002). CONCLUSION: The short educational intervention modified some practices relevant to the quality of End-of-Life care of advanced dementia patients in NHs, possibly raising and reinforcing beliefs and attitudes already largely present.

Nurses and nurse assistants’ experiences with using a design thinking approach to innovation in a nursing home.
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T. F. Eines and S. Vatne.
J Nurs Manag 2018 May;26(4):425-431
The aim of this study was to evaluate nurses’ and nurse assistants’ experiences with a design thinking approach to innovation used in a nursing home in Norway. BACKGROUND: A design thinking approach to innovation that focuses on users’ needs can be employed to address many of the challenges facing health care providers in a field facing a growing ageing population, complex diseases and financial shortfalls. EVALUATION: This study is based on a thematic analysis of four focus group interviews with nurses and nurse assistants (n = 23). KEY ISSUES: In the initial phase of developing the new service model, which included defining staff roles and responsibilities, participating nurses and nurse assistants felt engaged and motivated by the designers’ inclusive and creative methods. However, during the new model’s testing phase, they were critical of management’s lack of involvement in the model`s implementation and therefore became less motivated about the project. CONCLUSION: The findings of the study highlight the importance of the designers cooperating with management and staff for the duration of the innovation process. IMPLICATIONS FOR NURSING MANAGEMENT: Challenging innovation processes require strong managers who engage with designers, patients, staff and volunteers throughout all phases of an innovation process using a design thinking approach.

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Health Care Innovation and Quality Assurance

The effects of nutritional guideline implementation on nursing home staff performance: a controlled trial
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J. Torma, U. Winblad, A. Saletti and T. Cederholm.
Scand J Caring Sci 2017 Aug 29
Suboptimal nutritional practices in elderly care settings may be resolved by an efficient introduction of nutritional guidelines. 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. METHODOLOGICAL DESIGN: A quasi-experimental study with baseline and follow-up measurements. OUTCOME MEASURES: The primary outcome was staff performance as a function of mealtime ambience and food service routines. INTERVENTIONS/RESEARCH METHODS: The EF strategy was a 1-year, multifaceted intervention that included support, guidance, practice audit and feedback in two NH units. The EOV strategy comprised one-three-hour lecture about nutritional guidelines in two other NH units. Both strategies were targeted to selected NH teams, which consisted of a unit manager, a nurse and 5-10 care staff. Mealtime ambience was evaluated by 47 observations using a structured mealtime instrument. Food service routines were evaluated by 109 food records performed by the staff. RESULTS: Mealtime ambience was more strongly improved in the EF group than in the EOV group after the implementation. Factors improved were laying a table (p = 0.03), offering a choice of beverage (p = 0.02), the serving of the meal (p = 0.02), interactions between staff and residents (p = 0.02) and less noise from the kitchen (p = 0.01). Food service routines remained unchanged in both groups. CONCLUSIONS: An EF strategy that included guidance, audit and feedback improved mealtime ambience when nutritional guidelines were introduced in a nursing home setting, whereas food service routines were unchanged by the EF strategy.

A National-Level Analysis of the Relationship Between Nursing Home Satisfaction and Quality.
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P. Nadash, J. G. Hefele, E. A. Miller, A. Barooah and X. J. Wang.
Res Aging 2018 Oct 16:164027518805001
Little research has explored the relationship between consumer satisfaction and quality in nursing homes (NHs) beyond the few states mandating satisfaction surveys. We examine this relationship through data from 1,765 NHs in the 50 states and District of Columbia using My InnerView resident or family satisfaction instruments in 2013 and 2014, merged with Certification and Survey Provider Enhanced Reporting, LTCfocus, and NH Compare (NHC) data. Family and resident satisfaction correlated modestly; both correlated weakly and negatively with any quality-of-care (QoC) and any quality-of-life deficiencies and positively with NHC five-star ratings; this latter positive association persisted after covariate adjustment; the negative relationship between QoC deficiencies and family satisfaction also remained. Overall, models explained relatively small proportions of satisfaction variance; correlates of satisfaction varied between residents and families. Findings suggest that satisfaction is a unique dimension of quality and that resident and family satisfaction represent different constructs.

 

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Research Practice and Methodology

Appraising Qualitative Research for Evidence Syntheses: A Compendium of Quality Appraisal Tools
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U. Majid and M. Vanstone.
Qual Health Res 2018 Nov;28(13):2115-2131
As the movement toward evidence-based health policy continues to emphasize the importance of including patient and public perspectives, syntheses of qualitative health research are becoming more common. In response to the focus on independent assessments of rigor in these knowledge products, over 100 appraisal tools for assessing the quality of qualitative research have been developed. The variety of appraisal tools exhibit diverse methods and purposes, reflecting the lack of consensus as to what constitutes appropriate quality criteria for qualitative research. It is a daunting task for those without deep familiarity of the field to choose the best appraisal tool for their purpose. This article provides a description of the structure, content, and objectives of existing appraisal tools for those wanting to evaluate primary qualitative research for a qualitative evidence synthesis. We then discuss common features of appraisal tools and examine their implications for evidence synthesis.

Challenges of conducting research in long-term care facilities: a systematic review
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H. R. Lam, S. Chow, K. Taylor, et al.
BMC Geriatr 2018 Oct 12;18(1):242-018-0934-9
The aim of this review is to describe the challenges and barriers to conducting research in long-term care facilities. METHODS: A literature search was conducted in Ovid MEDLINE, Embase, Cochrane Central, PsycINFO and CINAHL. Keywords used included “long term care”, “nursing home”, “research”, “trial”, “challenge” and “barrier”, etc. Resulting references were screened in order to identify relevant studies that reported on challenges derived from first-hand experience of empirical research studies. Challenges were summarized and synthesized. RESULTS: Of 1723 references, 39 articles were selected for inclusion. To facilitate understanding we proposed a classification framework of 8 main themes to categorize the research challenges presented in the 39 studies, relating to the characteristics of facility/owner/administrator, resident, staff caregiver, family caregiver, investigator, ethical or legal concerns, methodology, and budgetary considerations. CONCLUSIONS: Conducting research in long-term care facilities is full of challenges which can be categorized into 8 main themes. Investigators should be aware of all these challenges and specifically address them when planning their studies. Stakeholders should be involved from an early stage and flexibility should be built into both the methodology and research budget.

Social Network Analysis: An Example of Fusion Between Quantitative and Qualitative Methods
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Reza Yousefi Nooraie, Joanna Sale E.M., Alexandra Marin and Lori E. Ross.
Journal of Mixed Methods Research 2018 10/08; 2018/10:1558689818804060
A quantitative approach to social network analysis involves the application of mathematical and statistical techniques and graphical presentation of results. Nonetheless?as with all sciences?subjectivity is an integral aspect of network analysis, manifested in the selection of measures to describe connection patterns and actors? positions (e.g., choosing a centrality indicator), in the visualization of social structure in graphs, and in translating numbers into words (telling the story). Here, we use network research as an example to illustrate how quantitative and qualitative approaches, techniques, and data are mixed along a continuum of fusion between quantitative and qualitative realms.

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Aging

The Effectiveness of the Positive Mood and Active Life Program on Reducing Depressive Symptoms in Long-term Care Facilities
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H. Luo, V. W. Q. Lou, C. Chen and I. Chi.
Gerontologist 2018 Oct 5
Depression is prevalent among long-term care facility (LTCF) residents. However, interventions are not normally part of the management of these residents due to a shortage of mental health professionals. On the basis of Lewinsohn’s behavioral model of depression, we developed a 12-week pleasant activity scheduling intervention, the Positive Mood and Active Life (PMAL) program. This study evaluated the effectiveness of the PMAL program on reducing depressive symptoms and improving quality of life among at-risk LTCF residents. Research Design and Methods: We adopted a cluster randomized controlled trial design. Four LTCFs were randomly assigned as treatment sites and three provided care as usual. At-risk LTCF residents (N = 68) were identified using the Mood Resident Assessment Protocol from the Minimum Data Set 2.0. The PMAL program was delivered to 34 residents. The primary and secondary outcomes were depressive symptoms and quality of life, as measured by the Geriatric Depression Scale-15 (GDS-15) and the World Health Organization Quality of Life scale-BREF (WHOQoL-BREF), respectively. Results: After 12 weeks, the GDS-15 score in the intervention group showed a reduction from 7.59 to 5.67, with a significant treatment by time effect (p = .006), based on the mixed model analysis; the WHOQoL-BREF score also substantially increased from 69.83 to 86.61 (p = .000). Discussion and Implications: The PMAL program is effective in reducing depressive symptoms of at-risk LTCF residents. It is a feasible intervention that requires minimum resources and can be integrated with standardized assessment systems.

Living at home with cognitive impairments: Risks during daily living and support from home care service (Thesis)

Linda Sandberg
The overall study’s aim was to increase knowledge of conditions for older, home-residing persons with cognitive impairments – with focus on risks during daily living and support from home care service.

The Change in Nursing Home Residents’ Preferences Over Time
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K. M. Abbott, A. R. Heid, M. Kleban, M. J. Rovine and K. Van Haitsma.
J Am Med Dir Assoc 2018 Oct 1
Nursing home (NH) residents’ preferences for everyday living are the foundation for delivering individualized person-centered care. Yet, work has not examined what the most and least important preferences of nursing home residents are and if those preferences change over time. DESIGN: This study examined the change in nursing home residents’ (n = 255) preferences for everyday living over a 3-month period. Participants were recruited from 28 NHs in the suburbs of a major metropolitan East Coast area of the United States. MEASURES: Residents were interviewed face-to-face using the Preferences for Everyday Living Inventory-Nursing Home version at baseline (T1) and 3 months later (T2). Change was analyzed in 2 ways: (1) percentage exact agreement (eg, respondent stated “very important” at both time points) and (2) percentage of preferences that remained either important or not important between T1 and T2. RESULTS: Sixteen preferences were rated as very or somewhat important by 90% or more of NH residents. With regard to the stability of preference ratings, findings demonstrate an average exact agreement of 59%, and an average important versus not important agreement of 82%. In addition, 68 of the 72 preferences had 70% or higher stability over time. In other words, the preference either remained “important” or “not important” to the NH resident 3 months later. Preferences in the domain of enlisting others in care had the least amount of change. CONCLUSION/IMPLICATIONS: This study highlights the most important everyday living preferences of NH residents and provides assurance to care providers that the majority of preferences assessed via the PELI are both important to NH residents and stable over time. Preference-based care plans can be designed and used over a 3-month period with confidence by providers.

Skin and Wound Map From 23,453 Nursing Home Resident Records: Relative Prevalence Study

Yunghan Au, Marcon Laforet, Kirsten Talbot and Sheila C. Wang.
JMIR Dermatol 2018 10/09;1(2):e11875
The overall distribution of all skin and wound problems experienced by residents in skilled nursing facilities, with respect to the location on the body, is poorly understood. Previous studies focused largely on one disease type, rather than all possible skin lesions. Hence, the relative distribution of skin and wound problems as mapped on the body has not previously been reported. In addition, existing data come mainly from clinical studies and voluntarily reported statistics; unbiased real-world evidence is lacking. Objective: The aim of this study was to understand the type and location of skin and wound lesions found in skilled nursing facilities and to map these on the body. Methods: Data from 23,453 wounds were used to generate heat maps to identify the most common areas of skin and wound lesions, as well as the most common wound types at different body locations. Results: The most common wound types were abrasion (8792/23,453, 37.49%), pressure ulcers (4089/23,453, 17.43%), surgical wounds (3107/23,453, 13.25%), skin tears (2206/23,453, 9.41%), and moisture-associated skin damage (959/23,453, 4.09%). The most common skin and wound locations were the coccyx (962/23,453, 4.10%), right (853/23,453, 3.64%) and left (841/23,453, 3.59%) forearms, and sacrum (818/23,453, 3.49%). Conclusions: Here, we present the body location hot spots of skin and wound lesions experienced by residents of skilled nursing facilities. In addition, the relative prevalence of these conditions is presented. We believe that identifying areas on the body prone to preventable wounds can help direct actions by care workers and improve the quality of care for skilled nursing residents. This study represents an example of how analysis of specialized electronic medical records can be used to generate insights to educate and inform facility managers where to focus their efforts to prevent these injuries from occurring, not only from retrospective database analysis but also in near real time.

Efficacy of interventions led by staff with geriatrics expertise in reducing hospitalisation in nursing home residents: A systematic review.
Non UofA Access

E. Santosaputri, K. Laver and T. To.
Australas J Ageing 2018 Oct 7
To determine the efficacy of interventions, delivered by geriatrics-trained staff for nursing home residents, in reducing hospitalisation. METHODS: Multiple databases and clinical trial registers were searched. Studies that provided comparative data and involved residents aged >/=65 years evaluating patient-level interventions delivered by geriatrics-trained staff were included. The systematic review protocol was made available on PROSPERO (registration number CRD42017079928; www.crd.york.ac.uk/PROSPERO). RESULTS: Sixteen studies were included; six were randomised controlled trials. Studies were categorised according to intervention approaches into the following: (i) hospital prevention program; (ii) emergency department-based hospital avoidance program; and (iii) post-hospital supported discharge program. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) quality of evidence was low to moderate. Most studies demonstrated a favourable trend; however, only a few reported statistically significant reductions in hospitalisations. Results from the randomised studies were non-significant. CONCLUSIONS: Despite the heterogeneity of studies, there is limited evidence that interventions delivered by geriatrics-trained staff reduce hospitalisations in nursing home residents. Further work examining decision-making around hospital transfer may help inform future intervention design.

A Feasibility Study of a Multifaceted Walking Intervention to Maintain the Functional Mobility, Activities of Daily Living, and Quality of Life of Nursing Home Residents With Dementia.
Non UofA Access

C. H. Chu, M. Puts, D. Brooks, M. Parry and K. S. McGilton.
Rehabil Nurs 2018 Oct 12
The aim of the study was to evaluate the feasibility, acceptability, and efficacy of a multifaceted walking intervention (MWI) aimed to maintain the functional mobility, activities of daily living function, and quality of life of long-term care home residents with dementia. DESIGN/METHODS: A quasiexperimental time-series design was used. The 4-month intervention provided one-on-one walking 2-4 days a week, guided by an individualized communication care plan and interviews with collaterals and staff. RESULTS: The MWI was feasible based on high recruitment and adherence rates (86% and 94%, respectively) and highly acceptable to stakeholders. Residents (n = 25) showed significant improvements after the intervention: Timed Up-and-Go (-8.85 seconds, p = .00), Two-Minute Walk Test (27.47 m, p = .00), Functional Independence Measure (0.72, p = .00), and Alzheimer’s Disease-Related Quality of Life (2.44, p = .05). CONCLUSION: The MWI was feasible and improved functional mobility compared to usual care. CLINICAL RELEVANCE: Physical activity delivered with a person-centered care was feasible and may be beneficial to mitigate decline in long-term care home residents with dementia.

Sensory and memory stimulation as a means to care for individuals with dementia in long-term care facilities.
Non UofA Access

M. Mileski, J. Baar Topinka, M. Brooks, C. Lonidier, K. Linker and K. Vander Veen.
Clin Interv Aging 2018 May 17;13:967-974
The primary objective of this study was to identify and further examine the facilitators and barriers of utilizing sensory and memory stimulation as a means to care for individuals with dementia who live in long-term care settings. Materials and methods: The authors conducted a literature review of 30 academic articles found using the databases such as CINAHL, PubMed, and Academic Search Ultimate from the past 15 years. Facilitator and barrier themes were found within each article and analyzed for their relevance to sensory and memory stimulation therapies and their effects on individuals with dementia. Results: The most common facilitator was improved communication. The top three barriers were access, staff training, and mixed results. Discussion: Reminiscence therapy appears to provide a person-centered method of care for those who otherwise have problems communicating. These implementations will be more effective if they have the support of staff and management. Conclusion: The authors conclude that sensory and memory stimulation therapies have the potential to help improve many dementia-specific issues for individuals living in long-term care settings.

Adaptation and Initial Validation of Minimum Data Set (MDS) Mortality Risk Index to MDS Version 3.0
Non UofA Access

J. D. Niznik, S. Zhang, M. K. Mor, et al.
J Am Geriatr Soc 2018 Oct 18
To evaluate the predictive validity of an adapted version of the Minimum Data Set (MDS) Mortality Risk Index-Revised (MMRI-R) based on MDS version 3.0 assessment items (MMRI-v3) and to compare the predictive validity of the MMRI-v3 with that of a single MDS item indicating limited life expectancy (LLE). DESIGN: Retrospective, cross-sectional study of MDS assessments. Other data sources included the Veterans Affairs (VA) Residential History File and Vital Status File. SETTING: VA nursing homes (NHs). PARTICIPANTS: Veterans aged 65 and older newly admitted to VA NHs between July 1, 2012, and September 30, 2015. MEASUREMENTS: The dependent variable was death within 6 months of admission date. Independent variables included MDS items used to calculate MMRI-v3 scores (renal failure, chronic heart failure, sex, age, dehydration, cancer, unintentional weight loss, shortness of breath, activity of daily living scale, poor appetite, acute change in mental status) and the MDS item indicating LLE. RESULTS: The predictive ability of the MMRI-v3 for 6-month mortality (c-statistic 0.81) is as good as that of the original MMRI-R (c-statistic 0.76). Scores generated using the MMRI-v3 had greater predictive ability than that of the single MDS indicator for LLE (c-statistic 0.76); using the 2 together resulted in greater predictive ability (c-statistic 0.86). CONCLUSION: The MMRI-v3 is a useful tool in research and clinical practice that accurately predicts 6-month mortality in veterans residing in Veterans Affairs NHs. Identification of residents with LLE has great utility for studying palliative care interventions and may be helpful in guiding allocation of these services in clinical practice.

Quality of care to nursing home residents with incontinence.
Non UofA Access

T. Harrison, S. Blozis, A. Manning, M. Dionne-Vahalik and S. Mead.
Geriatr Nurs 2018 Oct 13
Quality of care for residents with urinary incontinence (UI) living in nursing facilities was analyzed using data collected from 815 facilities for the Nursing Facility Quality Review in Texas. Overall, of the 1,560 residents, 48.4% (n = 755) experienced UI. The risk of developing UI over a ten-year-period in a nursing facility was 6%. Only 54% of residents with UI had a care plan for their incontinence. For those with a UI plan in their chart, 143 (35%) had a person entered UI plan developed based on that resident’s voiding pattern and needs. Further, the creation of a UI plan of care by a RN for a person with UI was associated with a higher perceived level of health after controlling for gender, and age. Finally, the more satisfied the resident was with the response to their calls for help with voiding the more satisfied with the nursing facility.

 

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Events

KTDRR’s 2018 Online KT Conference “Engaging Ways to Engage Stakeholders”

11:00-15:00 each day on November 5, 7 and 9, 2018
Sponsored by the Center on Knowledge Translation for Disability and Rehabilitation Research (KTDRR) the conference is designed for grantees and other stakeholders of the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The conference also provides opportunities to network with other KT specialists and researchers. Global experts will present on impactful topics, including:
– How to engage stakeholders early: Project planning strategies and integrated KT
– How to engage stakeholders often: Implementation and evaluation strategies
– How to know you’ve had an impact on stakeholders: Measurement and sustainability

Patient Engagement for Beginners

Friday October 26 13:00-14:00 MT
Presenters: Maria Hudspith & Linda Wilhelm
Research funders are increasingly supporting patient-oriented research that includes patients as partners. Health authorities and other service organizations are seeking input on decisions, from program design to policy. Patient outcomes improve when people are engaged in their care, but what does it mean to engage with patients across the health system and research? How do you evaluate this engagement and know that it had an impact?

Save the date CIHR Summer Program in Aging

26-31 May 2019
Program will be launched in December on CIHR ResearchNet.

Dissemination Strategies for Health Services Researchers

Available on demand
Presenter: Dr. Rani Elwy
Dissemination Strategies for Health Services Researchers. Many effective programs emerging from research fail to have a significant impact on population health because no plans are made to disseminate these programs to agencies and organizations that can use them. In this cyberseminar, the presenter discussed the science of dissemination, described evidence-based dissemination strategies, covered important dissemination lessons learned by researchers in this area, discussed current dissemination practices and available tools, and provided examples of how to measure dissemination impact.

 

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Courses

META: A pragmatic workshop series on Moving Evidence To Action to improve patient outcomes

26-28 November, University of Alberta
Various workshops will be offered:
Choosing the best knowledge synthesis method for your research question
How to Use Endnote and project management for knowledge synthesis research: Best practices
How to use human-centred design in knowledge translation
Integrated knowledge translation
Scaling implementation for tobacco addiction treatment in primary and community care settings: A case study
How to read and interpret a meta-analysis
A tool in your toolkit: Using Practice Profiles to move evidence to practice
System dynamics and translating “big data” into policy
Advances in implementation adherence research: Measuring what matters and developing effective adherence strategies
How to use the GRADE system for assessing evidence and developing health recommendations and clinical guidelines
Arts-based knowledge translation
Principles of effective knowledge translation in collaborative research with stakeholders: special focus on Indigenous partnerships
Developing an end-of-grant knowledge translation plan

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Resources

Reminiscence Radio Show Music For Memories

The Reminiscence Radio Show aims to give reassurance, comfort and a sense of security. Its programmes use well-known music specially curated for people with short-term memory loss to rekindle old memories.

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News

The ‘Butterfly model’ transforms this dementia care facility into a real home

25-10-3 An understanding of the research on how and why groups of people change can lead to better ways of organizing as a society or an organization.

When ICU Delirium Leads To Symptoms Of Dementia After Discharge

SickKids team launches expanded and updated CALIPER app and website

Costly Rehab for the Dying Is on the Rise at Nursing Homes, a Study Says (US)

Your reader is a little bit drunk

Do we need chief science advisers in Canada?

Time for action on neglected Naylor report advice

Every Older Patient Has a Story. Medical Students Need to Hear It

Pro-bono work by UK university staff ‘worth £3.2 billion a year’

When scientists want their data fudged and why you should care

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Opportunities

Open Rank Tenure/Tenure Track Faculty at the Center for Dissemination and Implementation Science, University of Illinois at Chicago

The newly established Center for Dissemination and Implementation Science in the Department of Medicine at the University of Illinois at Chicago (UIC) invites applications and nominations for a tenure-eligible, open-rank faculty position. The successful candidate will demonstrate a record of extramural funding, strong publications, collaborative research, mentoring, and experience in implementation science.

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