February 19, 2019

Dissemination of evidence-based practices has been a long-standing challenge for healthcare providers and policy makers. Research has increasingly focused on effective knowledge translation (KT) in healthcare settings. AIMS: This study examined the effectiveness of two KT interventions, informal walkabouts and documentation information sessions, in supporting care aide adoption of new evidence-based practices in continuing care. METHODS: The Sustaining Transfers through Affordable Research Translation (START) study examined sustainability of a new practice, the sit-to-stand activity completed with residents in 23 continuing care facilities in Alberta, Canada. At each facility, two informal walkabouts and two documentation information sessions were conducted with care aides during the first 4 months. To assess their effect, uptake of the sit-to-stand activity was compared 4 days prior to and 4 days after each intervention, as well as the entire first and fourth months of the study were compared. Data were analyzed using mixed linear regression models created to estimate the changes in uptake. RESULTS: Data were collected from 227 residents. After controlling for age, sex, dementia, and mobility, a 5.3% (p = .09) increase in uptake of the mobility activity was observed during the day shift and 6.1% (p = .007) increase in uptake of the mobility activity during the evening shift. Site size had a significant effect on the outcome with medium-sized facilities showing a 12.6% (SE = .07) increase over small sites and a 18.2% (SE = .05) increase over large sites. These results suggest that repeated KT interventions and sufficient time are key variables in the successful implementation of new practices. LINKING EVIDENCE TO ACTION: Consideration of time, repetition, and facility-specific variables such as size may generate simple, cost-effective KT interventions in healthcare settings.

There is increasing recognition in Canada and globally that a substantial proportion of health care delivered is inappropriate as evidenced by (1) harmful and/or ineffective practices being overused, (2) effective clinical practices being underused, and (3) other clinical practices being misused. Inappropriate health care leads to negative patient experiences, poor health outcomes, and inefficient use of scarce health care resources. The purpose of this study is to conduct a systematic review of inappropriate health care in Canada. Our specific objectives are to (1) systematically search and critically review published and grey literature for studies on inappropriate health care in Canada; (2) estimate the nature and magnitude of inappropriate health care in Canada and its provincial and territorial jurisdictions. METHODS: We will include all quantitative study designs reporting objective or subjective measurements of inappropriate health care in Canada over the last 10 years. We will search the following online databases: MEDLINE, Cochrane Central Register of Controlled Trials, EconLit, and ISI-Web of Knowledge, which contains Web of Science Core Collection-Citation Indexes, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, and Conference Proceedings Citation Index-Social Science & Humanities. We will also search grey literature sources to identify provincial and national audits of inappropriate health care. Two authors will independently screen, assess data quality, and extract data for synthesis. Study findings will be synthesized narratively. We will organize our data into three care categorizations: preventive care, acute care, and chronic care. We will provide a compendium of inappropriate health care for each care category for Canada and each Canadian province and territory, where sufficient data exists, by calculating (1) overall medians of underuse, overuse, and misuse of clinical practices and (2) the range of medians of underuse, overuse, and misuse for each clinical practice investigated. DISCUSSION: This review will result in the first-ever evidence-based compendium of inappropriate health care in Canada. We will also develop detailed reports of inappropriate health care for each Canadian province and territory. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018093495.

Most newborns undergo newborn screening blood tests. Breastfeeding, skin-to-skin care, and sweet solutions effectively reduce pain; however, these strategies are inconsistently used. We conducted a 2-armed pilot randomized controlled trial in a mother-baby unit to examine the feasibility and acceptability of a parent-targeted and -mediated video demonstrating use of these pain-reducing strategies and to obtain preliminary effectiveness data on uptake of pain management. One hundred parent-newborn dyads were randomized to view the video or receive usual care (51 intervention and 49 control arm). Consent and attrition rates were 70% and 1%, respectively. All participants in the intervention arm received the intervention as planned and reported an intention to recommend the video and to use at least 1 pain treatment with breastfeeding or skin-to-skin care preferred over sucrose. In the intervention arm, 60% of newborns received at least 1 pain treatment compared with 67% in the control arm (absolute difference, -7%; 95% confidence interval, -26 to 12). The video was well accepted and feasible to show to parents. As there was no evidence of effect on the use of pain management, major modifications are required before launching a full-scale trial. Effective means to translate evidence-based pain knowledge is warranted.

Dietitians in countries across the world have been implementing the Nutrition Care Process (NCP) and Terminology (NCPT) during the past decade. The implementation process has been evaluated in specific countries and in smaller international studies; however, no large international study comparing implementation between countries has been completed. OBJECTIVE: The aim of this study was to describe and compare the level of NCP/NCPT implementation across 10 countries. METHODS: A previously tested web-based survey was completed in 2017 by 6,719 dietitians across 10 countries. Participants were recruited through e-mail lists, e-newsletters, and social media groups for dietitians. Nondietitians were excluded through screening questions and targeted dissemination channels. MAIN OUTCOME MEASURES AND STATISTICAL ANALYSIS: The main outcome of interest was the level of implementation of each of the four NCP steps. Differences in implementation between the NCP (process) and NCPT (terminology) were also measured. Differences between groups were assessed using Kruskal-Wallis test and Mann-Whitney U test. Multiple linear regression was used to assess relationships between the main outcomes and respondent demographic information. RESULTS: Australia, New Zealand, and the United States had higher implementation rates compared with other countries surveyed. Awareness of the NCP was high in most countries (>90%) but lower in Greece (50%). All countries had a higher implementation level of the NCP (process) compared with the NCPT (terminology). Dietitians working with inpatients reported the highest implementation levels while those working in public health reported the lowest. CONCLUSIONS: Dietitians in countries with more experience in NCP/NCPT implementation and a clear implementation strategy had higher levels of implementation. To achieve a successful NCP/NCPT implementation among dietitians, there is a need to promote the value of a standardized dietetic language together with the more easily implemented process. There is also a need to promote NCP/NCPT for all areas of practice, and develop strategic plans for implementation of the NCP and NCPT.

The Nutrition Care Process (NCP) and NCP Terminology (NCPT) is a systematic framework for critical thinking, decision making, and communication for dietetics practitioners worldwide, aiming to improve quality and patient safety in nutrition care. Although dietetics practitioners in several countries have implemented the NCP/NCPT during recent years, to date there is no globally validated instrument for the evaluation of NCP/NCPT implementation that is available in different languages and applicable across cultures and countries. OBJECTIVE: The aim of this study was to develop and test a survey instrument in several languages to capture information at different stages of NCP/NCPT implementation across countries and cultures. SETTING: In this collaboration between dietetics practitioners and researchers from 10 countries, an International NCP/NCPT Implementation Survey tool was developed and tested in a multistep process, building on the experiences from previous surveys. The tool was translated from English into six other languages. It includes four modules and describes demographic information, NCP/NCPT implementation, and related attitudes and knowledge. METHODS: The survey was reviewed by 42 experts across 10 countries to assess content validity and clarity. After this, 30 dietetics practitioners participated in cognitive interviews while completing the survey. A pilot study was performed with 210 participants, of whom 40 completed the survey twice within a 2- to 3-week interval. RESULTS: Scale content validity index average was 0.98 and question clarity index was 0.8 to 1.0. Cognitive interviews and comments from experts led to further clarifications of the survey. The repeated pilot test resulted in Krippendorff’s alpha=.75. Subsequently, refinements of the survey were made based on comments submitted by the pilot survey participants. CONCLUSIONS: The International NCP/NCPT Implementation Survey tool demonstrated excellent content validity and high test-retest reliability in seven different languages and across an international context. This tool will be valuable in future research and evaluation of implementation strategies.

Nursing home (NH) residents are increasingly in need of timely and frequent medical care, presupposing not only available but perhaps also continual medical care provision in NHs. The provision of this medical care is organized differently both within and across countries, which may in turn profoundly affect the overall quality of care provided to NH residents. Data were collected from official legislations and regulations, academic publications, and statistical databases. Based on this set of data, we describe and compare the policies and practices guiding how medical care is provided across Canada (2 provinces), Germany, Norway, and the United States. Our findings disclose that there is a considerable difference to find among jurisdictions regarding specificity and scope of regulations regarding medical care in NHs. Based on our data, we construct 2 general models of medical care: (1) more regulations-fee-for-service payment-open staffing models and (2) less regulation-salaried positions-closed staffing models. Some evidence indicates that model 1 can lead to less available medical care provision and to medical care provision being less integrated into the overall care services. As such, we argue that the service models discussed can significantly influence continuity of medical care in NH.

The aim of this review was to examine the extent and nature of published literature on nurses’ and nursing students’ preparedness to care for older adults in lower and middle-income countries. Method A scoping review with 27 articles, guided by the Arksey and O’Malley (2005) framework was conducted. The following electronic databases were searched: MEDLINE, CINAHL, ERIC and SCOPUS. Grey literature using Google Scholar and ProQuest were also searched. Key search terms and subject headings such as “nursing students”, “nurses”, “stakeholders”, “ministry of health”, “readiness”, “knowledge”, “attitudes”, “elder care”, “seniors care” and “older adults” were used to identify relevant articles. Studies that reported on gerontological nursing, nursing students’ and nurses’ knowledge and attitudes towards older adults, and stakeholders/employers’ views about nursing students’ knowledge and attitudes towards older adults were included. Results Nurses reported having moderate to insufficient knowledge in the care of older adults in the majority of the studies. Nursing students reported insufficient knowledge in the care of older adults. However, both nurses and nursing students reported positive attitudes towards the care of older adults but held misconceptions about and caring for older adults. Nursing students also reported a low preference for working with older adults. Discussion and Implications The inadequate preparation of nurses and nursing students in the care of older adults means there are opportunities to enhance knowledge about health and nursing care in lower and middle-income countries and build on the positive attitudes towards older adults.

We are grateful to Nuño-Solinís and Puchalski Ritchie and Straus for their commentaries on our article that presents the organizational readiness for knowledge translation (OR4KT), an instrument measuring healthcare organizations’ readiness to implement evidence-informed knowledge across a variety of services.3 They provide useful feedback on the tool, and share ideas that contribute to advance knowledge on how to improve the implementation of evidence-informed practices in healthcare organizations by considering organizational readiness (OR) as a precursor of successful change. Implementing evidence-informed interventions in healthcare requires organizations to be ready to initiate and support change. However, translating scientific knowledge to the ‘real-life’ care context faces several challenges. Our article describes the process for the development, transcultural adaptation, and initial content and face validation of the OR4KT instrument. The tool was initially developed based on a conceptual mapping of the dimensions and concepts proposed in previous theories and models of OR. Subsequently, a systematic review of OR measurement instruments, a Delphi exercise, and consultation with experts provided an initial pool of items. The OR4KT was then translated and tested in three contexts – Basque region of Spain, Ontario and Québec (Canada).

This study sets out to examine the experience, outcomes and motivation to study for non-medical clinicians who have completed doctorates. This research proposal arose from a Yorkshire and Humber community of practice ACORN (Addressing Capacity in Organisations to do Research Network). This community of practice is funded and facilitated by the NIHR Collaborations for Leadership in Applied Health Research and Care for Yorkshire and Humber (CLAHRC YH) as part of its core principle of research capacity development.

Translational Mobilisation Theory is a sociological theory, which provides a framework for understanding and investigating the emergent organisation of collaborative work practices in institutional contexts. Understanding collective action of this kind is both a sociological and practical concern.

We are interested in presentations that are related to patient-oriented research which provide insights for the following themes:
● Innovative methods in knowledge synthesis, knowledge translation and/or implementation science
● Innovative patient-oriented research techniques in clinical trials
● Leveraging Alberta’s provincial data resources for patient-oriented research
● Practical approaches to meaningfully engage patients in health research
● Innovative methods for conducting patient-oriented research

The EU Joint Programme – Neurodegenerative Disease Research (JPND) launched earlier this year, in collaboration with the European Commission, a call for “Multinational research projects on Personalised Medicine for Neurodegenerative Diseases”.JPND has chosen to focus on the area of Precision Medicine, which relates to the targeting of specific elements responsible for pathology in a given individual at a particular point in time. It is an emerging approach for disease prevention, diagnosis and treatment that takes into account individual variability in genes as well as biological/molecular characteristics together with environmental and lifestyle factors.

The call for multidisciplinary research proposals will focus in the following research areas:
-Diagnosis (e.g. biomarkers, imaging data, omics approaches, big data analyses);
-Prevention (e.g. biomarkers for studying novel treatments and interventions, co-morbidities, digital technologies, stratification within cohort studies and clinical trials); and
–Care (e.g. improvement of social and health care systems, molecular profiling, imaging, lifestyle data).

Improving nursing home safety is important to the quality of resident care. Increasing evidence points to the relationship between actual safety and a strong safety climate, i.e., staff agreement about safety norms. This national study focused on Veterans Health Administration nursing homes (Community Living Centers [CLCs]), assessing direct care staff and senior managers’ agreement about safety norms. METHODS: We recruited all 134 CLCs to participate in the previously validated CLC Employee Survey of Attitudes about Resident Safety. To assess whether safety climate domains (7) differed by management level and by direct care staff occupation, we estimated multilevel linear regression models with random effects clustered by CLCs, medical center, Department of Veterans Affairs 2017 integrated service network (n = 20), and region. RESULTS: Of the 5288 individuals we e-mailed, 1397 (25.7%) completed surveys, with participation from 56 CLCs or 41.8% of 134 CLCs. In our analysis of 1316 nurses, nursing assistants, clinicians/specialists, and senior managers, senior managers rated co-worker interactions around safety (P < 0.0013) and overall safety in their CLC (P < 0.0001) more positively than did direct care staff. In contrast, on these same two domains, direct care groups had similar perceptions, though differing significantly in safety priorities, safety attitudes, and senior management commitment to safety. CONCLUSIONS: In this national sample of nursing homes in one of the largest integrated U.S. healthcare systems, direct care staff generally perceived weaker safety processes than did senior managers, pointing to future targets for interventions to strengthen safety climate.

While the number of prescribing clinicians (physicians and nurse practitioners) who provide any nursing home care remained stable over the past decade, the number of clinicians who focus their practice exclusively on nursing home care has increased by over 30%. OBJECTIVES: To measure the association between regional trends in clinician specialization in nursing home care and nursing home quality. DESIGN: Retrospective cross-sectional study. SETTING AND PARTICIPANTS: Patients treated in 15,636 nursing homes in 305 US hospital referral regions between 2013 and 2016. MEASURES: Clinician specialization in nursing home care for 2012-2015 was measured using Medicare fee-for-service billings. Nursing home specialists were defined as generalist physicians (internal medicine, family medicine, geriatrics, and general practice) or advanced practitioners (nurse practitioners and physician assistants) with at least 90% of their billings for care in nursing homes. The number of clinicians was aggregated at the hospital referral region level and divided by the number of occupied Medicare-certified nursing home beds. Nursing Home Compare quality measure scores for 2013-2016 were aggregated at the HHR level, weighted by occupied beds in each nursing home in the hospital referral region. We measured the association between the number of nursing home specialists per 1000 beds and the clinical quality measure scores in the subsequent year using linear regression. RESULTS: An increase in nursing home specialists per 1000 occupied beds in a region was associated with lower use of long-stay antipsychotic medications and indwelling bladder catheters, higher prevalence of depressive symptoms, and was not associated with urinary tract infections, use of restraints, or short-stay antipsychotic use. CONCLUSIONS AND IMPLICATIONS: Higher prevalence of nursing home specialists was associated with regional improvements in 2 of 6 quality measures. Future studies should evaluate whether concentrating patient care among clinicians who specialize in nursing home practice improves outcomes for individual patients. The current findings suggest that prescribing clinicians play an important role in nursing home care quality.

This study examines the relationship between nursing home quality and financial performance to assess whether there is a business case for quality. Secondary data sources included the Online Survey Certification and Reporting (OSCAR), Certification and Survey Provider Enhanced Reporting (CASPER), Medicare Cost Reports, Minimum Data Set (MDS 2.0), Area Resource File (ARF), and LTCFocus for all free-standing, nongovernment nursing homes for 2000 to 2014. Data were analyzed using panel data linear regression with facility and year fixed effects. The dependent variable, financial performance, consisted of the operating margin. The independent variables comprised nursing home quality measures that capture the three dimensions of Donabedian’s structure-process-outcomes framework: structure Registered Nurse (RN) hours per resident day, Licensed Practical Nurse (LPN) hours per resident day, Certified Nursing Assistant (CNA) hours per resident day, RN skill mix), process (facility-acquired restraints, facility-acquired catheters, pressure ulcer prevention, and restorative ambulation), and outcomes (facility-acquired contractures, facility-acquired pressure ulcers, hospitalizations per resident, rehospitalizations, and health deficiencies). Control variables included size, average acuity index, market competition, per capita income, and Medicare Advantage penetration rate. This study found that the operating margin was lower in nursing homes that reported higher LPN hours per resident day and higher RN skill mix (structure); higher use of catheters, lower pressure ulcer prevention, and lower restorative ambulation (process); and more residents with contractures, pressure ulcers, hospitalizations and health deficiencies (outcomes). The results suggest that there is a business case for quality, whereas nursing homes that have better processes and outcomes of care perform better financially.

Nursing staff in residential settings are exposed to a large number of stressors. This study examined the relationship between geriatric nursing staff (GNS) burnout and the well-being of residents in long-term care (LTC) facilities. Data were obtained concerning 590 older residents who were served by 315 GNS in 172 LTC facilities in Taiwan, using multilevel modeling. The depersonalization (DP) dimension of burnout in GNS was consistently related to various resident well-being outcomes. Higher DP among GNS was associated with lower residential satisfaction and perceived quality-of-life, as well as more depressive symptoms among older LTC residents. The findings support the claim that DP among GNS has a greater role in determining LTC resident well-being than other dimensions of burnout. Efforts should be made to mitigate the emergence of DP among GNS. Support and education are also needed to enable GNS to foster positive interactions and relationships with LTC residents.

The need for older people nursing expertise is increasing, and every effort is required to ensure that personnel taking care of older people are capable of providing high-quality care. AIMS: To explore care home nursing professionals’ self-rated competence in older people nursing and to identify predictors of this competence. DESIGN: A cross-sectional survey design. METHOD: Data were collected in August-September 2017 via an electronic questionnaire using the newly developed Nurse Competence in Care Home Scale (NCCHS). Participants (n = 781) were recruited via nurses’ associations and social media. They were working in care homes either as licensed practical nurses (n = 680) or as registered nurse and/or in managerial position (n = 101). FINDINGS: Approximately 65% of the respondents had “adequate competence,” and 35% had “inadequate competence” in older people nursing based on self-assessed overall competence. Respondents rated their competence highest in “observation, communication, interaction” and lowest in “group guidance and activities” subscale. Age and further training were predictors of licensed practical nurses’ competence, and length of work experience predicted registered nurses’ competence. CONCLUSIONS: Self-assessments revealed the need for competence development especially in relation to holistic support of a person’s well-being. It is recommended that care home nurses, managers, educators and curriculum developers all strive to develop care home staff’s ability to support residents’ well-being holistically. IMPLICATIONS FOR PRACTICE: Nursing personnel should consider all aspects of older people’s well-being holistically. In care homes, it is essential to assess nursing staff competence and to provide possibilities for competence development for personnel.

Quality of life of people with dementia and their family carers is strongly influenced by interpersonal issues and personal resources. In this context, relationship quality (RQ) and sense of coherence (SOC) potentially protect and promote health. We aimed to identify what influences RQ in dyads of people with dementia and their carers and to examine differences in their perspectives. METHODS: Cross-sectional data from the Actifcare cohort study of 451 community-dwelling people with dementia and their primary carers in eight European countries. Comprehensive assessments included the Positive Affect Index (RQ) and the Orientation to Life Questionnaire (SOC). RESULTS: Regression analyses revealed that RQ as perceived by people with dementia was associated with carer education, stress and spouse caregiving. RQ as perceived by carers was associated with carer stress, depression, being a spouse, social support, reported neuropsychiatric symptoms of dementia and carer SOC. Neuropsychiatric symptoms and carer stress contributed to discrepancies in RQ ratings within the dyad. The only factor associated with both individual RQ ratings and with discrepancies was carer stress (negative feelings sub-score). No significant differences in the overall perception of RQ were evident between spouses and adult children carers, but RQ determinants differed between the two. CONCLUSIONS: In this European sample, carer SOC was associated with carer-reported RQ. RQ determinants differed according to the perspective considered (person with dementia or carer) and carer subgroup. A deeper understanding of RQ and its determinants will help to tailor interventions that address these distinct perspectives and potentially improve dementia outcomes.

To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills.

Although providing direct care to residents with dementia, long-term care (LTC) home staff of registered nurses’, registered practical nurses’, and personal support workers’ involvement in end-of-life decision-making is rarely acknowledged. The purpose of this study was to examine barriers and facilitators to LTC home staff involvement in end-of-life decision-making for people with advanced dementia. We report on the barriers to staff involvement in decision-making. Using an interpretive descriptive design, four major barriers to staff involvement in decision-making were identified: (a) the predominance of a biomedical model of care; (b) a varied understanding of a palliative approach; (c) challenging relationships with families; and (d) a discomfort with discussing death. Findings suggest that the predominant biomedical model in LTC homes, while important, must be imbued with a philosophy that emphasizes relationships among residents with dementia, family and staff.

Perceived self-efficacy is proposed to impact on the psychological health of dementia care staff. The current study adopted a qualitative methodology to increase understanding of the experiences of self-efficacious care assistants. Purposive sampling identified eight care assistants with high levels of self-efficacy. Data from semi-structured interviews were analysed using interpretative phenomenological analysis. Four themes captured experiences of ‘feeling torn’ between competing demands when providing care; a sense of ‘togetherness and connection’, included sub-themes of support, closeness and the value of engaging; ’emotional attunement’ to resident’s needs, including reciprocity of emotion, personal perspective-taking and empathy as guides to care. The final theme, ‘caring as a part of life’, described interest, motivation and accepting attitudes as well as caring being part of carers’ identity. The themes highlight how staff might manage the dilemmas they face and emphasize important areas for care staff training as well as further research.

The study aimed to explore the experiences of healthcare assistants working with people with dementia in UK residential care homes. Eight participants completed semi-structured interviews which were analysed by interpretative phenomenological analysis. Data analysis revealed three main themes representing healthcare assistants’ experiences: the importance of relationships, which referred to the importance of their relationships with clients, families and colleagues as well as their attachment to clients; something special about the role, which referred to their perception that their role was unique and rewarding as well as their personal commitment to the job; and the other side of caring, which referred to the more difficult aspects of their role, including managing emotions and conflicts within the caring role. The findings indicate that staff should be supported to build strong and supportive relationships within their role and have opportunities to explore their emotional reactions to reduce any adverse impact on care provision. It is possible that this could be facilitated through reflective practice groups or clinical supervision.

Dementia-friendly wards are recent developments to improve care for patients with dementia in acute hospitals. This qualitative study used focus groups to understand the impact of dementia friendly ward environments on nurses experiences of caring for acutely unwell patients with dementia. Qualified nurses and health care assistants working in an acute NHS Trust in England discussed their perceptions and experiences of working in a dementia-friendly ward environment. Four themes developed from the thematic analysis: (1) ‘It doesn’t look like a hospital’: A changed environment, (2) ‘More options to provide person-centred care’: No one size fits all, (3) ‘Before you could not see the patients’: A constant nurse presence and (4) ‘The ward remains the same’: Resistance to change. Recommendations and implementations for practice are discussed.

Long-term care (LTC), residential care requiring 24-hour nursing services, plays an important role in the health care service delivery system. The purpose of this study was to identify the needed clinical information and information flow to support LTC Registered Nurses (RNs) in care collaboration and clinical decision making. METHODS: This descriptive qualitative study combines direct observations and semistructured interviews, conducted at Alberta’s LTC facilities between May 2014 and August 2015. The constant comparative method (CCM) of joint coding was used for data analysis. RESULTS: Nine RNs from six LTC facilities participated in the study. The RN practice environment includes two essential RN information management aspects: information resources and information spaces. Ten commonly used information resources by RNs included: (1) RN-personal notes; (2) facility-specific templates/forms; (3) nursing processes/tasks; (4) paper-based resident profile; (5) daily care plans; (6) RN-notebooks; (7) medication administration records (MARs); (8) reporting software application (RAI-MDS); (9) people (care providers); and (10) references (i.e., books). Nurses used a combination of shared information spaces, such as the Nurses Station or RN-notebook, and personal information spaces, such as personal notebooks or “sticky” notes. Four essential RN information management functions were identified: collection, classification, storage, and distribution. Six sets of information were necessary to perform RN care tasks and communication, including: (1) admission, discharge, and transfer (ADT); (2) assessment; (3) care plan; (4) intervention (with two subsets: medication and care procedure); (5) report; and (6) reference. Based on the RN information management system requirements, a graphic information flow model was constructed. CONCLUSION: This baseline study identified key components of a current LTC nursing information management system. The information flow model may assist health information technology (HIT) developers to consolidate the design of HIT solutions for LTC, and serve as a communication tool between nurses and information technology (IT) staff to refine requirements and support further LTC HIT research.

To explore the education and developmental needs of care home nursing staff. BACKGROUND: With an increasing ageing population, the need for high-quality care provision is set to rise and will require nursing staff with the desired knowledge, skills and values. However, multiple concerns have been identified when considering the development of nurses working in care homes. Moreover, challenges in the care home sector have also contributed to a situation where some nurses view care home work as being of low status and choose this work to fit around other commitments, rather than viewing it as a viable career pathway. METHOD: A qualitative approach based on the principles of Appreciative Inquiry. Fifteen participants working in five care homes with nursing, based in England (UK), took part in this study. Data were collected during 2016-2017 and involved managerial, qualified and unqualified staff. RESULTS: Data analysis revealed three distinct themes: an effective learning environment; the care home as a nursing student placement; and the need for financial investment. These themes were found to have the most influence on the development and education of care home nursing staff. CONCLUSION: This research provides important insights into the care home as an educational environment, not only for nursing students but also for those employees already working in such settings. Exploration of the ways in which higher education organisations and care home teams could collaborate more closely could be mutually beneficial to the quality of care and to raising the profile of care home work. IMPLICATIONS FOR PRACTICE: Care homes can provide a rich learning environment for both staff and nursing students. Collaboration and appreciative ways of working enhance opportunities for developing practice and care.

The outlook of administrative staff and registered nurses (RNs) plays a critical role in the management of nursing homes. No previous study has compared the outcomes of nursing homes with RNs on staff with those of nursing homes without RNs on staff in Korea. PURPOSE: The aim of this study was to investigate the association between nurse-led nursing homes, staff turnover, and resident outcomes in nursing homes in Korea. METHODS: Using a cross-sectional design, 36 nursing homes with 30 or more beds participated. Primary data included 15 quality indicators. RESULTS: Nursing homes with RNs had statistically significant better resident outcomes. RN turnover related positively to the prevalence of falls ( beta = 1.68, p < .05) and tube feeding (beta = 1.71, p < .01) and negatively to incontinence (beta = -1.53, p < .01). Nursing homes with RNs with tenures greater than 1 year had statistically significant lower prevalence of falls (beta = -0.47, p < .05), incontinence (beta = -0.45, p < .05), weight loss (beta = -0.53 p < .05), and bed rest (beta = -0.54, p < .01) and increased range of motion (beta = 0.51, p < .05). Interestingly, having a nurse as a director for more than 1 year related negatively to the incidence of urinary tract infection (beta = -0.56, p < .05) in residents. The rate of RN turnover was found to impact fall prevalence (beta = 1.68, p < .05) and tube feeding (beta = 1.71, p < .01) positively and to impact incontinence (beta = -1.53, p < .01) negatively. CONCLUSIONS: Turnover of nursing home staff and length of tenure may contribute to the more effective management of nursing homes, higher-quality long-term care insurance, and RN-staffing-related laws. Assessing staff characteristics and the tenure of employees promotes the effective management of nursing homes.

The American College of Surgeons Coalition for Quality in Geriatric Surgery is a multidisciplinary stakeholder group that aims to systematically improve the surgical care of older adults by establishing a verifiable quality improvement program with standards based on best evidence. Prior work confirmed the validity of a preliminary set of 308 standards to improve the quality of geriatric surgery, but concerns exist as to whether the standards are feasible for hospitals to implement. OBJECTIVE: Our aim was to utilize data gained from a multi-institutional survey and interview to improve the scalability and generalizability of a geriatric quality improvement program. METHODS: Using a survey followed by a targeted debrief interview, 15 hospitals gathered an interdisciplinary panel to answer whether each standard was already in place at their institution, and if not, the perceived difficulty of implementation according to a five-point Likert scale (from 1 [very easy] to 5 [very difficult]). The standards were then placed into categories according to the hospital responses. Standards were designated “duplicative” if 11 or more hospitals reported baseline implementation, “prohibitively difficult” if 6 or more hospitals rated the standard as such, and “high potential” if they were neither duplicative nor difficult. A targeted debrief interview was then conducted with each participating hospital. RESULTS: Fifteen participating hospitals evaluated the feasibility of 108 standards and found 28 (26%) duplicative, 35 (32%) too difficult, and 45 (42%) high potential. Of the 108 standards, 49 (45%) were selected for the next iteration of standards, and 59 were removed. Among the standards that were removed, the majority (64%) were rated duplicative and/or difficult. CONCLUSION: A multi-institutional survey and interview successfully identified care standards that were redundant or too difficult to implement on the hospital level. These data will help improve the generalizability and scalability of the program while maintaining the overall goal of improving care.

Increasing the use of evidence in healthcare policy and practice requires greater understanding of how stakeholders use evidence to inform policy, refine systems and change practice. Drawing on implementation theory, we have used system-focused participatory research to engage diverse stakeholders in using aggregated continuous quality improvement (CQI) data from Australian Indigenous primary health care settings to identify priority evidence-practice gaps, barriers/enablers and strategies for improvement. This article reports stakeholders’ use or intended use of evidence at various levels of the system, and factors mediating use. Material and Methods: Interviews were undertaken with a purposeful sample of 30 healthcare stakeholders in different roles, organization types and settings in one Australian jurisdiction and with national participants, as part of the project’s developmental evaluation. Qualitative data were analyzed to identify themes and categories relating to use of evidence. Results: Context-specific aggregated CQI data that were relatable to the diverse professional roles and practices provided an effective starting point for sharing perspectives, generating practice-based evidence and mobilizing evidence-use. Interviewees perceived the co-produced findings as applicable at different levels and useful for planning, policy development, supporting best practice and reflection, capacity strengthening and developing new research. Factors mediating use were commitment to best practice; the credibility of the evidence and its perceived relevance to work roles, contexts and decision needs; report format and language; facilitation and communication; competing work pressures and the organizational environment for change. Conclusions: This study found that primary health care stakeholders used evidence on quality of care for a variety of purposes. This could be linked to the interactive research processes used to engage stakeholders in different roles and settings in interpreting data, sharing and generating knowledge. Findings indicate that system-based participatory research using CQI data and iterative, interactive and systematic CQI-based methods can be applied at scale to support concurrent action for healthcare improvement at different system levels. Factors known to influence implementation should be addressed within the research design to optimize evidence use. Further research is needed to explore the utility of interactive dissemination for engaging healthcare stakeholders in informing policy and system change.

Determine the accuracy of nursing home self-reported antipsychotic prescribing before and after implementation of a Medicare campaign to reduce use. METHODS: Quasi-experimental study comparing trends in self-reported antipsychotic prescribing relative to claims-based prescribing. Setting is a nationwide sample of 11,912 facilities, 2011-2013. Participants are long-stay nursing home residents (n = 586,281) with prescribing data in Medicare Minimum Data Set 3.0 and Medicare Part D claims database. Verified with a pharmacy dispensing database. Main outcomes are the discrepancies in quarterly prevalence of antipsychotic prescribing between nursing home self-reports and claims data and the characteristics of facilities and residents where discrepancies were identified. RESULTS: Nursing homes underreport their antipsychotic prescribing levels, on average, by 1 percentage point per quarter relative to Medicare Part D claims (0.013, 95% confidence interval (CI), 0.012-0.015; p<.001). After the Medicare campaign, the underreporting gap increased by another half a percentage point (0.004, 95% CI .003-.005; p = .012). Nursing home residents with dementia, Alzheimer’s disease or bipolar disorders were at the highest risk for underreported antipsychotic prescribing before the campaign (Adjusted Odds ratio (AOR) 1.385, 95% CI: 1.330-1.444; AOR 1.234, 95% CI: 1.172-1.300; AOR 1.574, 95% CI: 1.444-1.716, respectively) and afterwards. After the launch of the Medicare campaign, underreported antipsychotic prescribing occurred most in for-profit nursing homes (AOR 1.088, 95% CI: 1.005-1.178) and facilities in the US South (AOR 1.262, 95% CI: 1.145-1.391). Agreement was high between claims and dispensing data (99.7%). CONCLUSION: Nursing homes did not identify up to 6,000 residents per calendar quarter as having received antipsychotics despite these prescriptions being paid by Medicare and dispensed by a pharmacy. Nursing home rates of antipsychotic prescribing from self-reported data may be biased.

Healthcare contexts are rapidly changing, with growing demand for health services to accommodate an aging population and financial pressures. Assessment of context in healthcare settings has been the subject of increasing debate. The Context Assessment Index (CAI) examines three interconnected contextual elements derived from the Promoting Action on Research Implementation in Health Services (PARIHS) framework to provide practitioners with an understanding of the context in which they work. AIMS: (a) To describe the translation of the CAI into Danish and adapt the instrument for use in Danish hospitals and (b) to evaluate the psychometric properties of the Danish version of the CAI. METHODS: Translation and adaptation included an expert panel and a translation and back-translation process. The CAI was then sent to 4,416 nurses in the Region Zealand, Denmark. There are two alternative measurement models to explain the factor structure of the CAI, the five-factor model and the three-factor model. To provide the best explanation for the data, both measurement models were examined using confirmatory factor analysis. RESULTS: The CAI was translated and modified based on expert review and usability testing. Completing the CAI were 2,261 nurses. For both models, factor loadings and fit statistics were acceptable, appropriate, and statistically significant, and the measurement models were confirmed (five-factor model: root mean square error of approximation [RMSEA] 0.07, comparative fit index [CFI] = 0.923; three-factor model: RMSEA 0.07, CFI = 0.924). Cronbach’s alpha scores showed the models to have broadly acceptable scores (five-factor model 0.64-0.89; three-factor model 0.72-0.89). LINKING EVIDENCE TO ACTION: The three-factor model can advantageously be used when the PARIHS framework is part of the project. In a translation process, differences in cultural specificity, language, and working environment have to be considered. By understanding the context of practice, nurses may enable person-centered care and improve patient outcomes.

The proportion of women engaged in clinical research has increased over time. However, it is unclear if women and men contribute to the same extent during the conduct of research and, if so, if they are equally rewarded by a strategic first or last author position. We aim to describe the prevalence of women authors of original articles published 15 years apart and to compare the research contributions and author positions according to gender. DESIGN: Repeated cross-sectional study. SETTING: Published original articles. PARTICIPANTS: 1910 authors of 223 original articles published in the Annals of Internal Medicine in 2000 and 2015. PRIMARY AND SECONDARY OUTCOMES MEASURES: Self-reported contributions to 10 aspects of the article (primary) and author position on the byline. RESULTS: The proportion of women authors increased from 32% (n=243) to 41% (n=469) between 2000 and 2015 (p<0.0001). In 2000, women authors were less frequently involved than men in the conception and design (134 (55%) vs 323 (61%); p=0.0256), critical revision (171 (70%) vs 426 (81%); p=0.0009), final approval (196 (81%) vs 453 (86%); p=0.0381) and obtaining of funding (39 (16%) vs 114 (22%); p=0.0245). Women were more frequently involved than men in administration and logistics (85 (35%) vs 137 (26%); p=0.0188) and data collection (121 (50%) vs 242 (46%); p=0.0532), but they were similarly involved in the analysis and interpretation of data, drafting of the manuscript, provision of materials/patients and statistical expertise. Women were less often last authors than men (22 (9%) vs 82 (16%); p=0.0102). These gender differences persisted in 2015. CONCLUSIONS: The representation of women among authors of medical articles increased notably between 2000 and 2015, but still remained below 50%. Women’s roles differed from those of men with no change over time.

Registries are an important platform to which persons with dementia and other cognitive impairments can contribute to research studies. Registries also provide an opportunity for patients to stay informed about current studies. Engaging patients in registry development can increase sustainability of a registry and patient retention in clinical registries. We sought the perspective of persons with dementia and their accompanying family members about their registry participation experiences, barriers and facilitators to participation, and potential avenues for improvement of registry processes such as recruitment, data collection, and knowledge translation. Two semi-structured focus groups with persons with dementia and their family members ( n = 18) were conducted and analyzed using thematic content analysis. Participants were recruited from an existing patient registry made up of patients currently being seen in a dementia assessment clinic. The main themes identified included altruistic motives with regards to registry participation; and access to and privacy of personal health information. As electronic health records are becoming more common, understanding barriers and facilitators from the perspectives of people with dementia is essential to inform the future development of cognitive condition-related registries. The results from our focus groups identified engagement strategies and solutions to overcome perceived barriers for individuals experiencing progressive cognitive decline to participate in longitudinal registry projects.

Patient and public involvement is widely accepted as good practice in dementia research contributing substantial benefits to research quality. Reports detailing involvement of individuals with dementia as co-researchers, more specifically in analysis of findings are lacking. This paper reports an exercise involving individuals with dementia as co-researchers in a qualitative analysis. Data was from anonymised extracts of interviews with people with dementia who had participated in a multistage study on risk communication in dementia care, relating to concepts and communication of risk. Co-researchers were involved in deriving meaning from the data, identifying and connecting themes. The analysis process is described, reflections on the exercise provided and impact discussed. The session improved overall research quality by enhancing validity of the findings through application of multiple perspectives while also generating sub-themes for exploration in subsequent interviews. Development of guidance for involving individuals with dementia in analysis of research findings is needed.

Hospitalizations of long-term care (LTC) residents can result in adverse outcomes such as functional decline. The objective of our study was to investigate the association between demographic and health information and hospitalization rate for newly admitted LTC residents. We conducted a retrospective cohort study of all LTC homes in six provinces and one territory in Canada, using data from the Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 and the Discharge Abstract Database. We included newly admitted residents with an assessment between January 1 and December 31, 2013 (n = 37,998). Residents who were male, had higher health instability, and had moderate or severe functional impairment had higher rates of hospitalization, whereas residents who had moderate or severe cognitive impairment had decreased rates. The results of our study can be used to identify newly admitted residents who may be at risk for hospitalization, and appropriately target preventative interventions, including rehabilitation, advance care planning, palliative care, and geriatric specialty services.

Assessing health-related quality of life (HRQOL) in people with advanced dementia is challenging but important for informed decision-making. Proxy measurement of this construct is difficult and is often rated lower than self-report. Accurate proxy rating of quality of life in dementia is related to identification of concepts important to the person themselves, as well as the sensitivity of the measures used. The main aim of this study was to compare the performance of two instruments-QUALID and EQ-5D-5L-on measuring HRQOL in people with advanced dementia. METHODS: In a sub-study nested within a cluster-RCT we collected proxy(nurse)-completed EQ-5D-5L and QUALID measures at baseline, 3, 6, 9 and 12 months’ follow-up for people with advanced dementia, residing in 20 nursing homes across Australia. Spearman’s rank correlations, partial correlations and linear regressions were used to assess the relationship between the HRQOL instrument scores and their changes over time. RESULTS: The mean weight from 284 people for the EQ-5D-5L and QUALID at baseline were 0.004 (95% CI – 0.026, 0.033) and 24.98 (95% CI 24.13, 25.82), respectively. At 12 months’ follow-up, 115 participants remained alive. EQ-5D-5L weights and QUALID scores at baseline and at follow-up were moderately correlated (r = – 0.437; p < 0.001 at 12 months). Changes within QUALID and EQ-5D-5L across the same follow-up periods were also correlated (r = – 0.266; p = 0.005). The regression analyses support these findings. CONCLUSION: Whilst these quality of life instruments demonstrated moderate correlation, the EQ-5D-5L does not appear to capture all aspects of quality of life that are relevant to people with advanced dementia and we cannot recommend the use of this instrument for use within this population. The QUALID appears to be a more suitable instrument for measuring HRQOL in people with severe dementia, but is not preference-based, which limits its application in economic evaluations of dementia care.

There have been substantial achievements in legislative and human rights for lesbian, gay, bisexual and transgender (LGBT) older people and their visibility in health and social care has equally increased. These appear to have surpassed the ability of care services to meet their needs given documented concerns about the accessibility, inclusiveness and safety of care services particularly institutionalised care. This requires systemic change not easy to operationalise. This paper describes an action research initiative where six care homes belonging to a national care provider, collaborated to assess and develop their services with the support of local LGBT “Community Advisors” and academic partners. Framed within Rogers’ (2003) change management framework and combined with a participatory leadership approach, a programme of intervention was implemented comprising structured activities around seven key areas thought to promote LGBT inclusion. A formal evaluation was conducted involving 35 pre- and post-intervention qualitative interviews with 18 people (community advisors; care home managers and senior managers). The findings are presented across three key themes (1) starting points on the journey; (2) challenges encountered along the journey (organisational and interpersonal); and (3) making change happen; opportunities, initiatives and gains. We make recommendations on the value of a programme approach for achieving tangible outcomes that demonstrate increased inclusion for older LGBT people living in long-term care settings.

Moving from one care setting to another is common as death nears. Many concerns exist over these end-of-life (EOL) care setting transitions, including low-quality moves as mistakes and other mishaps can occur. Delayed or denied moves are also problematic, such as a move out of hospital for dying inpatients who want to spend their last hours or days at home. The aim of the study was to identify current issues or problems with care setting transitions during the last year of life as well as potential or actual solutions for these problems. A grounded theory analysis approach was used based on interviews with 38 key informants who represent a wide range of healthcare providers, healthcare managers, government representatives, lawyers, healthcare recipients and their family/friends across Ontario in 2016. Three interrelated themes were revealed: (a) communication complexities, (b) care planning and coordination gaps and (c) health system reform needs. Six solutions were highlighted, with these designed to prevent care setting transition issues and monitor care setting transitions for continued improvements.

Discrimination toward the lesbian, gay, bisexual and transgender (LGBT) population has raised concerns about the type of long-term services and supports (LTSS) that will be available to them as they age. To understand the unique needs of aging LGBT populations, we sought to synthesize and critique the evidence related to LTSS providers and LGBT individuals’ perspectives of LGBT issues in LTSS in the United States. Research Design and Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, a systematic review of the literature was conducted. The Crowe Critical Appraisal Tool was used to appraise the quality of the included studies. Results: Nineteen studies met inclusion criteria. Seven studies that examined the perspectives of LTSS providers identified two themes, including that they lack knowledge and training on LGBT health issues and generally report negative attitudes toward same-sex relations among older adults. In addition, 12 studies that examined the perspectives of LGBT individuals found that they (i) are concerned about LTSS planning, (ii) fear discrimination from providers in LTSS, and (iii) identify several strategies for improving care of LGBT older adults receiving LTSS. Discussion and Implications: This systematic review highlights the importance for LTSS providers to receive training in LGBT health and be reflective of potential biases toward the LGBT population. LGBT individuals identified concerns related to LTSS planning and fear of discrimination from LTSS providers. LGBT individuals also identified a need for increased training of providers to improve the care of LGBT older adults in LTSS.

This qualitative study explored a multisensory (including olfactory) intervention for people with dementia. Six themed boxes (e.g. Childhood) containing items chosen from the Boots archive designed to encourage conversation were used in weekly group sessions. Session participants were people with dementia and care staff from a local care home, a trained facilitator and archivists from Boots UK. Semi-structured interviews explored participants’ experiences of the sessions. Interviews were analysed using thematic analysis. The three major themes Engagement (subthemes: Inclusiveness; Emotional involvement; Factors that supported engagement), What’s in the box (subthemes: Contents stimulate memories; Mystery, variety and age of items; Value of olfactory stimuli), and A conversation starter (subtheme: Opportunity for self-expression) reveal the success of the intervention and the value of olfactory stimuli. Multisensory boxes including olfactory stimulation can be an engaging intervention with scope to refine it for people with dementia and their carers in the wider community.

Examine the effects of a 6-month exercise intervention on neuropsychiatric symptoms, pain, and medication consumption in older people with dementia (PWD) living in nursing homes (NH). METHODS: Ninety-one older PWD living in NH performed a 6-month structured exercise intervention (n = 44) or a social activity intervention (n = 47). Neuropsychiatric symptoms were measured by the neuropsychiatric inventory (NPI), pain was assessed using the Algoplus scale, and dementia-related drug prescriptions were obtained for all participants. RESULTS: Between-group analysis found a nonsignificant difference that could be of clinical relevance: a 4-point difference in the NPI and 1.3-point difference in the reduction of the number of medications favoring exercisers. No significant differences were found for pain, and a trend was found for an increase in medication consumption in the social group. CONCLUSION: Exercise effects did not differ from social intervention effects on neuropsychiatric symptoms, pain, and medication consumption in older PWD living in NH.

To examine family caregivers’ experiences with end-of-life care for nursing home residents with dementia and associations with the residents dying peacefully. DESIGN: A secondary data analysis of family caregiver data collected in the observational Dutch End of Life in Dementia (DEOLD) study between 2007 and 2010. SETTING AND PARTICIPANTS: Data were collected at 34 Dutch nursing homes (2799 beds) representing the nation. We included 252 reports from bereaved family members of nursing home residents with dementia. MEASURES: The primary outcome was dying peacefully, assessed by family members using an item from the Quality of Dying in Long-term Care instrument. Unpleasant experiences with end-of-life care were investigated using open-ended questions. Overall satisfaction with end-of-life care was assessed with the End-of-Life Satisfaction With Care (EOLD-SWC) scale, and families’ appraisal of decision making was measured with the Decision Satisfaction Inventory. Associations were investigated with multilevel linear regression analyses using generalized estimating equations. RESULTS: Families’ reports of unpleasant experiences translated into 2 themes: neglect and lack of respect. Neglect involved facing inaccessibility, disinterest, or discontinuity of relations, and negligence in tailored care and information. Lack of respect involved perceptions of being purposefully disregarded, an insensitive approach towards resident and family, noncompliance with agreements, and violations of privacy. Unpleasant experiences with end-of-life care were negatively associated with families’ perceptions of the resident dying peacefully. Families’ assessment of their relative dying peacefully was positively associated with satisfaction with end-of-life care and decision making. CONCLUSIONS/IMPLICATIONS: Families’ reports of unpleasant experiences with end-of-life care may inform practice to improve perceived quality of dying of their loved ones. Humane and compassionate care and attention from physicians and other staff for resident and family may facilitate recollections of a peaceful death.

This study aimed to investigate quality of life in nursing home residents and the relationship with personal, organizational, activity-related factors and social satisfaction. METHODS: In a cross-sectional survey study in 73 nursing homes in Flanders, Belgium, 171 cognitively healthy residents were randomly recruited (mean age 85.40 years [+/-5.88]; 27% men, 73% women). Quality of life, as the dependent/response variable, was measured using anamnestic comparative self-assessment (range -5 to +5). Multiple linear regression (forward stepwise selection) was used (1) to investigate which factors were significantly related to nursing home residents’ quality of life and (2) to model the relationship between the variables by fitting a linear equation to the observed data. RESULTS: Nursing home residents reported a quality of life score of 2.12 (+/-2.16). Mood, self-perceived health status, social satisfaction and educational level were withheld as significant predictors of the anamnestic comparative self-assessment score (p < 0.001), explaining 38.1% of the variance in quality of life. CONCLUSIONS: Results suggest that a higher quality of life in nursing homes can be pursued by strategies to prevent depression and to improve nursing home residents’ subjective perception of health (e.g. offering good care) and social network. It is recommended that nursing homes prepare for future generations, who will be more educated.

To investigate the characteristics of nursing home residents with psychosis and the association with potential underlying factors, such as pain, sleep disturbances, and antipsychotic medication. METHOD: 545 residents with and without dementia from 67 Norwegian nursing home units were included in the cross sectional analyses. Psychosis was the main outcome measure in our study; other outcome measures include quality of life (QoL), ADL function, cognitive function, pain, and antipsychotic medication. RESULTS: 112 residents had one or more symptoms of psychosis, and compared to residents without psychosis, they had lower QoL (p <0.001), ADL function (p = 0.003) and cognitive functioning (p = 0.001). Adjusted logistic regression analyses showed that psychosis was associated with the prevalence of pain (OR: 3.19, 95% CI: 1.94-5.24), sleep disturbances (OR: 4.51, 95% CI: 2.91-6.99), and total number of medication (OR: 1.10, 95% CI: 1.03-1.17). Residents with psychosis but without antipsychotic medication, had better quality of life (p = 0.005) compared with residents receiving any antipsychotics. CONCLUSION: Psychosis in NH residents is associated with pain, sleep disturbances and number of medications. Residents with psychosis have poor quality of life, though better quality of life was observed among those who did not use antipsychotic medication.

Elderly patients, particularly those in long-term care (LTC), are a growing proportion of patients who present to the emergency department (ED). This population is medically complex, with high burdens on ED resources and patient flow. This study sought to characterize how elderly LTC and community-dwelling (CD) patients use ED services. Materials and methods This was a retrospective cohort study that assessed approximately 200 senior (age>65) ED visits. These patients were either residing in LTC facilities or they were CD. All participants lived in the same, medium-sized Canadian city. Data indicating demographic information, acuity of presentation, and administrative parameters (such as disposition status or length of stay) were collected and analyzed. Results A few statistically significant differences between the populations were noted. This included mean age, which was 82.6 years in the LTC population and 77.3 for the CD group (p<0.001). There were 27 repeat visits among patients in the LTC group, compared to six from the CD patients (p<0.001). In the LTC population, 75 patients required transport from emergency medical services (EMS) compared to 41 from the control group (p<0.001). Conclusion LTC patients re-present to the ED and use EMS services more frequently than their CD counterparts. This difference indicates potential areas to target for future quality improvement work to help enhance care to this vulnerable population.

Nursing home residents with dementia show a rapid decline in their ability to perform activities of daily living. This decline is linked to a greater care dependency, which is associated with a reduced quality of life. Care dependency is influenced by multiple predictors, yet current research often focuses on the contribution of a single or a small number of predictors of care dependency. OBJECTIVES: To examine the contribution of multiple predictors in predicting care dependency. DESIGN: The present study analyzed baseline data from a 6-month double-parallel randomized controlled trial which examined the effect of three physical activity interventions on multiple outcomes. SETTING: This study was conducted in eleven nursing homes in Bergen op Zoom, the Netherlands. PARTICIPANTS: In total, 85 nursing home residents with moderate to severe dementia were included in the study, of which 75 were included for analysis. METHODS: Predictors considered were cognitive, physical, neuropsychiatric, demographic, and disease related factors. The outcome measure care dependency was assessed with the Care Dependency Scale and the Erlangen Test of Activities of Daily Living. Linear multilevel regression analyses were used to identify the most important predictors of care dependency. RESULTS: Apathy, physical endurance, number of comorbidities, and global cognition were significant predictors of care dependency. The model explained 66% of the variance in care dependency. Global cognition was a significant predictor of ability to perform activities of daily living and explained 60% percent of its variance. CONCLUSION: The present study shows that multiple predictors (i.e., apathy, cognitive and physical abilities, and disease-related factors) contribute to predicting care dependency. Future research could focus on the effectiveness of multifactorial interventions to maintain the highest possible level of independence in nursing home residents with dementia.

The current study operationalized, assessed, and evaluated the feasibility and preliminary effects of implementing a person-centered approach to incontinence care for older adults with cognitive decline in residential care facilities (RCFs) in Sweden. Twenty health care workers were purposively sampled from two intervention RCFs. Process outcome was measured as number of assessments conducted for incontinence management. Impact outcome measures were quality of life, basal assessment of incontinence, incontinence actions taken, and personally chosen incontinence aids. A usual care control group RCF was matched by resident case-mix and geographic region. Introduction of a person-centered approach showed an increase in residents’ quality of life in the intervention group compared to baseline and the control group. A positive effect was found on the number of urinary incontinence assessments conducted (p < 0.05). In addition, the number of person-centered caring actions (e.g., toilet assistance) was significantly higher during and 6 months after implementation of the person-centered approach. Implementing a person-centered approach in clinical practice focused on incontinence care, quality of care, and quality of life is supported for RCF residents.

The physical environment in long-term care facilities has an important role in the care of residents with dementia. This paper presents a literature review focusing on recent empirical research in this area and situates the research with therapeutic goals related to the physical environment. Research Design and Methods: A comprehensive literature search was conducted in Ageline, PsychINFO, CINAHL, Medline and Google Scholar databases to identify relevant articles. A narrative approach was used to review the literature. Results: A total of 103 full-text items were reviewed, including 94 empirical studies and 9 reviews. There is substantial evidence on the influence of unit size, spatial layout, homelike character, sensory stimulation, and environmental characteristics of social spaces on residents’ behaviors and well-being in care facilities. However, research in this area is primarily cross-sectional and based on relatively small and homogenous samples. Discussion and Implications: Given the increasing body of empirical evidence, greater recognition is warranted for creating physical environments appropriate and responsive to residents’ cognitive abilities and functioning. Future research needs to place greater emphasis on environmental intervention-based studies, diverse sample populations, inclusion of residents in different stages and with multiple types of dementia, and on longitudinal study design.

Questions What is the clinical effectiveness of using weighted blankets for patients with dementia in long-term care? What is the cost-effectiveness of using weighted blankets for patients with dementia in long-term care?
What are the evidence-based guidelines associated with the use of weighted blankets for patients with dementia in long-term care?
Key Message
No relevant literature was identified regarding the use of weighted blankets for dementia patients in long-term care.

Some of the report findings include:
-The Feedback and Communication About Incidents composite had the highest average percent positive scores, in which 85 percent of respondents reported that staff discuss ways to keep residents safety and incidents from happening again.
-The Staffing composite had the lowest average percent positive scores, in which 46 percent of respondents indicated that there are enough staff to handle the workload and meet residents’ needs during shift changes.
Results include data submitted from 10,499 healthcare providers and other staff in 191 U.S. nursing homes participating in the SOPS Nursing Home database. Forty-three items assessing 12 composite measures of patient safety culture are included.

Background. Social isolation and loneliness in older adults are substantial public health problems. Interventions have been examined for their effect on reducing social isolation and loneliness; however, it is unclear which are effective at improving health outcomes and avoiding unnecessary health care utilization. Purpose. To review recent literature evaluating the effectiveness of interventions that target social isolation and loneliness to improve health and/or health care utilization. Methods. We used rapid review methods to evaluate recent research. We systematically searched Ovid/Medline®, PsycInfo®, and CINAHL® from 2013 to 2018 for systematic reviews and from 2016 to 2018 for primary studies. We used predetermined criteria to select primary studies from systematic reviews published in 2018, in addition to the primary study search. We extracted study-level data, conducted quality assessments, and synthesized results. Findings. Sixteen studies were included: one good-quality randomized controlled trial [RCT], seven fair-quality studies (6 RCTs and 1 pre-post), and eight poor-quality studies (7 pre-post and 1 cross-sectional with post-test survey). Of the eight good- or fair-quality studies, five examined physical activity, two examined social interventions, and one examined an arts and recreation intervention. Two were associated with a positive effect on health outcomes: a resistance training, nutrition, and psychosocial support intervention improved functionality, depression, diet, and social capital, and a physical/leisure activity intervention improved quality of life but not social support. Two interventions (group tai chi and facilitated group discussion) improved loneliness but not health outcomes (e.g. quality of life or depression). Of the four fair- or good-quality studies reporting a positive impact on social isolation or health outcomes, three involved a health care professional in delivery, and three met more than once/week. Most poor-quality studies showed improvement in health but not social isolation; however, study design issues limited the reliability of these results. Five of 16 studies reported on harms and none were clinically significant. Three reported on health care utilization, with conflicting results.

As more emphasis is placed on the importance of supporting the use of evidence alongside systematically elicited citizen values and stakeholder insights to strengthen health and social systems globally, there are growing opportunities to learn from the innovative approaches taken in different regions around the world. Ruth Stewart and Laurenz Langer (Director and Evidence Synthesis Specialist, respectively, of the Africa Centre for Evidence) will share insights from their experience in supporting evidence-informed policymaking in Africa.

If you are seeking new, high-impact ways for organizations and communities to work together to create social change, this is a learning opportunity you won’t want to miss. Drawing on case studies from Australia and Canada, as well as techniques and activities that demonstrate alternative ways to meaningfully engage communities/citizens throughout the lifespan of your project, workshop participants will leave with the confidence to design and lead efforts to generate effective solutions to address our most challenging community issues.

The KTDRR Center and the international Campbell Collaboration are working together to offer a five-part training course that focuses on high-quality methods for synthesis of evidence, including the procedures and methods for conducting systematic reviews/research syntheses (SR/RS) as well as software, tools, and strategies for analyzing and reporting data. The training materials are developed by representatives of the Campbell Collaboration. Online resources from various national and international organizations will be provided for each session.
The first session, an Overview of Systematic Review and Research Synthesis, describes the benefits of evidence from SR, different types of reviews and differences between SR and RS, introduces organizations supporting and conducting SR/RS, and ends with the basic steps in SR/RS.

Examine how care homes are organised in Europe and how palliative care in care homes can be improved for older people. On this course, you will learn how care homes in six European countries can be improved using the research from a project called ‘PACE, Palliative Care for Older People’, funded by the European Commission. Using the PACE Steps to Success programme, you will learn how to improve palliative care in care homes for both residents and staff. This course is for staff working in care homes in either a management or caregiving role. This includes staff and volunteers that deliver services in care homes. This course is also ideal for older people and their families wanting to learn more about care homes.

The Yorkshire and Humber Clinical Network, in collaboration with NHS England’s Dementia Policy team and Intensive Support Team, has developed a tool to support commissioners of dementia services. The resource is primarily intended to support CCGs who are endeavouring to improve dementia care services and are striving to meet the national ambitions. It will also be of interest to STPs in helping to clarify work which will add value for dementia care services. The tool covers the dementia care pathway and advocates a systematic, standardised approach to investigating and enhancing the attributes and processes that positively impact effective commissioning of dementia care services.

Members of the SPOR Evidence Alliance will have access to the following benefits:
-Access to a broad network of researchers across Canada with advanced expertise in the areas of knowledge synthesis, clinical practice guidelines development, knowledge translation, and patient-oriented research across various disciplines
-Opportunity for Canada-wide collaboration on various projects, grant applications and funding opportunities
-Opportunity to participate in one of six committees and provide leadership on the governance and strategic direction of the Alliance
-Participate in various capacity-building initiatives and have exclusive access to online courses and training material
-Opportunity for knowledge users, trainees, and patient partners to gain practical research experience through involvement in research projects
-Access to mentorship and practicum opportunities offered by the Alliance partner organizations and members
-Opportunity to participate in the yearly Seed Grant competitions to support the conception of projects by trainees and junior researchers