March 5, 2019

 

The burden of pain in nursing homes is substantial; however, pain assessment for both acute and chronic conditions remain inadequate resulting in inappropriate or inadequate treatment. Complexities in assessing resident pain have been attributed to factors (barriers and facilitators) arising at the resident, health care provider and health care system levels. OBJECTIVES: In this systematic review protocol, we identify our research approach that will be used to critically appraise and synthesize data in order to assess barriers and facilitators to pain assessment in nursing home residents aged >/= 65 years. METHODS: This is a Cochrane style systematic review protocol adhering to the PRISMA-P reporting standards. This review will include primary (original) qualitative literature concerning either barriers or facilitators to pain assessment in older adult nursing home residents. A thematic analysis approach will be employed in collating and summarizing included data, and will be categorized into resident, health care provider, and system levels factors. Database searches will include Abstracts in Social Gerontology, CINAHL, Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and Web of Science. DISCUSSION: The identification of barriers and facilitators to pain assessment in older adult nursing home residents may assist health care providers across all platforms and levels of education to improve pain assessment among nursing home residents. Improving the assessment of pain has the potential to improve quality of care and ultimately quality of life for older adult nursing home residents.

To explore adolescents’ and health care providers’ (HCPs) perspectives on adolescents’ involvement in decision-making within multidisciplinary clinical care for pediatric weight management. METHODS: In this multi-centre, qualitative description study, we purposefully recruited 13-17-year-olds with overweight or obesity and HCPs from two pediatric weight management clinics in Edmonton and Ottawa, Canada. Participants completed one-on-one, in-person, semi-structured interviews (adolescents) or focus groups (HCPs), which were audio-recorded, transcribed verbatim, and managed using NVivo 11. Data were analyzed by two independent researchers using inductive thematic analysis and the congruent methodological approach for group interactions. RESULTS: A total of 19 adolescents and 16 HCPs participated. Three themes were identified in relation to adolescents’ decision-making for weight management, including (i) conditions for adolescent involvement, (ii) preferences for adolescent involvement, and (iii) extent of parental involvement. CONCLUSIONS: Although adolescents and HCPs positively valued adolescents’ involvement in making decisions regarding their weight and health, the extent to which adolescents wished to be involved in the decision-making process varied between individuals and families. PRACTICE IMPLICATIONS: HCPs are encouraged to include adolescents and families in their health services delivery, including consulting individually with adolescents and tailoring care to their expectations regarding decision-making.

Building on the broader themes explored in our Implementation Science Masterclass, the conference is an opportunity for applied-health researchers, health professionals, policymakers and service user researchers from the UK and around the world to come together and share how best to implement evidence-based practice and clinical research within services and systems.

The conference will feature presentations from leading international researchers working in the field, oral and poster presentations, and parallel sessions.

We are delighted to announce the third call for abstracts for the 2019 Oxford Health Congress, which will take place in St Hugh’s College, Oxford (26-28 June 2019). As in previous years, we welcome excellent research papers from across the spectrum of health and medical research of particular relevance to the understanding of, and need for, health services in all settings.

The aim of the call is to support innovative, transnational and multi-disciplinary collaborative projects. Call 2019 is characterised by the following approach:

The AAL Call 2019 is open to developing ICT-based solutions targeting any application area(s) within the AAL domain. The solutions need to be embedded in the strategies of the participating end-user organisations, service providers and business partners.
The AAL Call 2019 allows for more flexibility regarding the scope, size and duration of the proposed projects (including small collaborative projects).

The AAL domains include solutions for Active Living, such as in work & training, for vitality & abilities, in leisure & culture, for information & communication, as well as for Assisted Living, such as in health & care, living & building, mobility & transport, safety & security.

Although there is growing recognition that the implementation of evidence-based practices is a social process, the conceptualization of social capital in implementation frameworks often conflates bonding and bridging social capital. This conflation makes it difficult to concretely operationalize social capital and limits the concept’s utility for explaining implementation outcomes. DISCUSSION: We propose a new framework of implementation capital that merges an existing conceptual framework of implementation outcomes with an existing operational framework of social capital. First, we review a conceptual framework of implementation outcomes, which includes the acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, and sustainability of evidence-based practices. Second, we describe an operational framework of social capital that grounds bonding and bridging social capital in the structure of implementers’ social networks. Third, we bring these two frameworks together to create a merged framework of implementation capital that shows how specific aspects of social capital can support specific implementation outcomes. Implementation outcomes of acceptability, appropriateness, and adoption are linked to bonding social capital through mechanisms of trust and norm enforcement, while outcomes of feasibility and fidelity are linked to bridging social capital through mechanisms of increased access to information and resources. Additionally, setting-level implementation outcomes of cost, penetration, and sustainability are associated with small worldliness at the setting level, which simultaneously optimizes both bonding and bridging social capital in a setting. CONCLUSION: The implementation capital framework is helpful because it separates two distinct forms of social capital-bonding and bridging-that are often conflated in the implementation literature, and offers concrete ways to operationalize them by examining the structure of implementers’ social networks and the networks of their settings. This framework offers specific guidance about how individual and setting networks might be shifted to support implementation outcomes.

Many academics have strong incentives to influence policymaking, but may not know where to start. We searched systematically for, and synthesised, the ‘how to’ advice in the academic peer-reviewed and grey literatures. We condense this advice into eight main recommendations: (1) Do high quality research; (2) make your research relevant and readable; (3) understand policy processes; (4) be accessible to policymakers: engage routinely, flexible, and humbly; (5) decide if you want to be an issue advocate or honest broker; (6) build relationships (and ground rules) with policymakers; (7) be “entrepreneurial” or find someone who is; and (8) reflect continuously: should you engage, do you want to, and is it working? This advice seems like common sense. However, it masks major inconsistencies, regarding different beliefs about the nature of the problem to be solved when using this advice. Furthermore, if not accompanied by critical analysis and insights from the peer-reviewed literature, it could provide misleading guidance for people new to this field.

The current study investigated the buffering effect of positive social exchanges at work on the way workplace aggression and violence, both verbal and physical, affect individual well-being and commitment to the organization. Method: We collected survey responses from staff working in long-term care facilities (N = 723) about their experiences with residents and their outlook on their health and commitment to their workplaces. Results: Using multilevel modeling, we found a significant interaction effect of positive social exchanges with residents on resident-instigated aggression and violence in explaining the levels of employee well-being and commitment. Simple slopes analyses suggested that in staff who experience more positive social exchanges the negative effects of aggression and violence on individual well-being and commitment were dampened compared with staff who experienced less positive social exchanges. Conclusions: Because mistreatment behaviors operate in a wider context of concurrent social behaviors, examining experiences of aggression and violence without considering positive social exchanges can result in a truncated and misleading body of research findings. Furthermore, based on our findings, we recommend that employers should focus not only on eliminating aggressive and violent incidents at work but also on providing opportunities for care workers to develop high-quality relationships with their residents.

Dementia care staff working in long-term care settings are often exposed to a variety of complex situations that can be emotionally challenging, and a lack of adequate support and limited training opportunities may contribute to high levels of staff turnover in this area. Good-quality training may be beneficial for improving the quality of care provided, and in improving staff confidence and morale. This systematic review aimed to establish how dementia care home staff perceived their own competence and confidence in relation to the care they deliver, whether there are any specific interventions that improve these feelings, and whether feeling more competent and confident impacts on care delivery. METHOD: A search of the literature focusing on staff perceptions of competence and confidence identified 14 873 studies. Following the removal of duplicates and papers that did not meet the inclusion criteria, 19 studies were included in the review and subject to quality assessment. RESULTS: Studies varied in terms of quality and design, and were categorised as either intervention or non-intervention studies. Four studies found a significant increase in feelings of competence and confidence following intervention, although many studies did not statistically analyze their data. The most successful interventions seemed to be those that involved practical support alongside education, and non-intervention studies highlighted the importance of specific dementia and palliative care training with regard to feelings of competence and confidence. CONCLUSION: Teaching alone may not be an adequate method of training dementia care staff, and the most successful interventions were those where practical support was also provided. Most studies suggested that improvements in competence and confidence also had benefits for care delivery and staff wellbeing. More research needs to be done using validated outcome measures and with competence and confidence as the primary aim.

Advance care planning (ACP) is a process where patients express their wishes regarding their future healthcare. Its importance has been increasingly recognised in the past decade. As increasing numbers of elderly people are living in care homes, the aim of this review was to identify the most effective ACP interventions to train/educate all levels of healthcare professionals working in care homes. DESIGN: A systematic review. Two independent reviewers undertook screening, data extraction and quality assessment. DATA SOURCES: Searched from inception to June 2018: Ovid Medline, Ovid Medline in process, Ovid Embase, Cochrane Central Register of Controlled Trials, EBSCO Cinahl and Ovid PsycINFO. RESULTS: Six studies were included: three before and after studies, one cluster randomised controlled trial (RCT), one non-blinded RCT and one qualitative study. Five studies reported on ACP documentation, three on impact on ACP practice and three studies on healthcare-related outcomes. All quantitative studies reported an improvement in outcomes. In the three studies reporting on health-related outcomes, one showed significant reductions in hospitalisation rate, days and healthcare costs; one reported significant reductions in hospital deaths; and the third showed reductions in hospital days and deaths. A meta-analysis could not be performed due to the heterogeneity of the outcome measures. The included qualitative study highlighted perceived challenges to implementing an educational programme in the care home setting. CONCLUSION: There is limited evidence for the effectiveness of ACP training for care home workers. More well-designed studies are needed. TRIAL REGISTRATION NUMBER: CRD42016042385.

In this study, we examined the influence of professional network characteristics, available professional support, and perceived support quality on intent to stay among for-profit nursing home (NH) directors of nursing (DON). We hypothesized that the receipt of high quality professional support would be associated with DON intent to stay. DONs have a critical mandate to provide leadership that influences their facilities’ work climate and care quality. Yet, they often struggle to manage overwhelming responsibilities and are left feeling alienated, frustrated, and intent on leaving their jobs. Professional support, accessed via professional networks, may help DONs combat frustration and mitigate turnover that threatens NH care quality. Using a descriptive survey design, we electronically surveyed all DONs employed by a single for-profit NH corporation to collect data pertaining to their professional networks, receipt of professional support, perceptions regarding support quality, and intentions to stay in their positions. One-hundred-ninety-five DONs (65%) responded, with 133 (44%) completing every survey component. We employed social network analysis methods to construct datasets linking descriptors of DON respondents with attribute information about 1,164 network members. Statistical analyses (ANOVAs, point biserial correlations, and binomial logistic regression) yielded several findings supporting our hypothesis: (i) DONs’ professional networks closely resembled the teams in which they worked daily; (ii) DONs relied on this core network of individuals to provide task support primarily; (iii) DON-nursing home administrator relationships were most important; and (iv) perceptions of support quality and support from nursing home administrators were the strongest predictors of DON intent to stay.

Infection prevention and control (IPC) is a measure to prevent healthcare-associated infections in healthcare settings. There is limited evidence of the effectiveness of IPC programmes in long-term care facilities (LTCFs). AIM: The purpose of this systematic review was to review and analyse the effectiveness and the components of IPC programmes in LTCFs for older adults. METHODS: We systematically searched the English-language articles assessing IPC interventions in LTCFs, published over the last decade (2007-2016) in electronic databases (PubMed, EMBASE, CINAHL, and Cochrane CENTRAL). We analysed the components of IPC programmes based on the World Health Organization (WHO) manuals for improving IPC activities. Two reviewers independently assessed the quality of studies using the Cochrane risk-of-bias tool and the risk-of-bias assessment tool for non-randomized studies. FINDINGS: Seventeen studies met the eligible criteria; 10 studies were randomised trials (58.8%) and the others were non-randomised trials for examining the impact of IPC programmes on infection and/or performance outcomes of healthcare workers. None of the included studies implemented all of the WHO core components. Behavioural change strategies using education, monitoring, and feedback were reported to be successful interventions for reducing threats of healthcare-associated infections. Generally, studies using the WHO multimodal strategy with four or more elements reported significant reductions in infection rates. CONCLUSIONS: There is some evidence for the effectiveness of IPC interventions using education, monitoring, feedback, and the WHO multimodal strategy with four or more elements to control healthcare-associated infections in LTCFs.

The aim of the systematic review was to determine the effectiveness of organizational-level person-centered care for people living with dementia in relation to their quality of life, mood, neuropsychiatric symptoms and function. ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialised Register databases, were searched up to June 2018 using the terms dementia OR cognitive impairment OR Alzheimer AND non-pharmacological AND personhood OR person-centered care. Reviewed studies included randomized controlled trials (RCTs), cluster-randomized trials (CRTs) and quasi-experimental studies that compared outcomes of person-centered care and usual (non-person-centered) care, for people with a diagnosis of dementia. The search yielded 12 eligible studies with a total of 2599 people living with dementia in long-term care homes, 600 receiving hospital care and 293 living in extra-care community housing. Random-effects models were used to pool adjusted risk ratios and standard mean differences from all studies; the findings were assessed followed the PRISMA guidelines and GRADE criteria. Statistical heterogeneity was assessed using the I2 method and Chi2 P value; studies with low statistical heterogeneity were analyzed using a random-effects model with restricted maximum likelihood estimation in R. Analyses of pre/post data within 12 months identified: a significant effect for quality of life (standardized mean difference (SMD) 0.16 and 95% CI 0.03 to 0.28; studies = 6; I2 = 22%); non-significant effects for neuropsychiatric symptoms (SMD 0.06, 95% CI -0.08 to 0.19; studies = 4; I2 = 0%) and well-being (SMD 0.15, 95% CI -0.15 to 0.45; studies = 4; I2 = 77%); and no effects for agitation (SMD -0.05 (95% CI -0.17 to -0.07; studies 5; I2 = 0%) and depression (SMD -0.06 and 95% CI -0.27 to 0.15, studies = 5; I2 = 53%). The evidence from this review recommends implementation of person-centered care at the organizational-level to support the quality of life of people with living with dementia.

With the ageing of the population also comes increasing comorbidities and the use of multiple medications and administration methods, along with greater susceptibility to adverse drug reactions. Dosage form modification to facilitate drug administration in older adults can be potentially problematic as altering the original licensed formulation can affect medication safety and efficacy. The reporting of adverse drug reactions and medication incidents is a key strategy in avoiding preventable adverse drug events for aged care residents. This study evaluated the effect of an on-site clinical pharmacist on reducing inappropriate dosage form modification and staff time spent on medication administration, and optimizing the documentation of drug allergies, adverse drug reactions and medication incidents. METHODS: A pilot-controlled trial was performed in a purposive sample of two residential aged care homes. Both homes belonged to the same organization; the study site had 104 beds and the control site had 100 beds. All permanent residents were eligible for inclusion in the study if written consent was provided. A residential care pharmacist position was implemented at the study site for six months, with a focus on performing medication reviews and quality improvement activities. Observational audits of medication rounds were performed, and documentation relating to allergies, adverse drug reactions, and medication incidents was obtained from both sites before and after the pharmacist trial period. RESULTS: At the study site, there was a significant reduction over the trial in the proportion of inappropriate dosage form modification (from 24% to 0% of all dosage form modifications; P < 0.01). Mean time spent on medication rounds per resident reduced from 4.8 minutes per resident (SD 1.1) to 3.2 minutes per resident (SD 1.7) per round (P < 0.05). The incidence of previous allergy and adverse drug reaction documentation significantly improved from 77% of residents pre-study to 100% of residents post-study (P < 0.01). Mean monthly medication incident reports significantly improved from 13.3 (SD 7.4) pre-study to 25.7 (SD 10.8) post-study (P < 0.05). There was no change in these outcomes at the control site. WHAT IS NEW AND CONCLUSION: Including a pharmacist in a residential aged care home can improve medication administration practices by reducing inappropriate dosage form modification and staff time spent on medication administration rounds, and increasing the documentation of resident allergies, adverse drug reactions and medication incidents. These findings warrant further exploration in a large randomized controlled trial.

Social relations are part of the complex set of factors affecting health and well-being in old age. This systematic review seeks to uncover whether social interventions have an effect on social and health-related measures among nursing home residents. The authors screened PubMed, Scopus, and PsycINFO for relevant peer-reviewed literature. Interventions were included if (1) they focused primarily on social relations or related terms such as loneliness, social support, social isolation, social network, or being involuntarily alone either as the base theory of the intervention or as an outcome measure of the intervention; (2) they were implemented at nursing homes (or similar setting); (3) they had a narrative activity as its core (as opposed to dancing, gardening or other physical activity); (4) their participants met either physically or nonphysically, ie, via video-conference or the like; and if (5) they targeted residents at a nursing home. The authors systematically appraised the quality of the final selection of studies using the Mixed Methods Assessments Tool (MMAT) version 2011 and did a qualitative synthesis of the final study selection. A total of 10 studies were included. Reminiscence therapy was the most common intervention. Studies also included video-conference, cognitive, and support group interventions. All studies found the social interventions brought about positive trends on either/or the social and health-related measures included. Despite limited and very diverse evidence, our systematic review indicated a positive social and health-related potential of social interventions for older people living in nursing homes or similar institutions.

This article reports findings on the usability and staff use of 5 condition- specific pamphlets of high prevalence in long-term care (LTC): dementia, heart failure, chronic obstructive pulmonary disease, renal failure, and frailty. The pamphlets were created in response to residents’, families’, and staff’s recommendations for activating early reflections and communication about end-of-life care. DESIGN: A mixed-method (qualitative and quantitative) survey design was used. Step 1 collected survey data on the usability of the pamphlets. Step 2 collected survey data on pamphlet use. SETTINGS AND PARTICIPANTS: Two nurses with specialized palliative care training, 2 resident/family representatives, 10 condition-specific specialists, and 33 LTC palliative leads reviewed the pamphlets for usability prior to distribution. A total of 178 LTC home staff in 4 participating LTC homes reported on pamphlet use. MEASURES: Specialists and resident/family representatives were asked to provide open comments and LTC home palliative leads were asked to complete a survey on the accuracy, readability, and relevance of the pamphlets. After 6 months of distribution, all staff in participating LTC homes were asked to complete a survey on pamphlet use, usefulness, and comfort with distribution. RESULTS: The pamphlets were reportedly accurate, relevant, and easy to understand. Following 6 months of availability, most staff in LTC had read the pamphlets, found the information useful, and planned to share them. However, half of the staff questioned their role in pamphlet distribution and most had not distributed them. Regulated staff (ie, staff affiliated with a regulated profession) expressed more comfort sharing the pamphlets than care aides and support staff. CONCLUSIONS/IMPLICATIONS: Condition-specific pamphlets appear to hold promise in providing residents and families with relevant information that may activate early reflections and conversations about end-of-life care. However, structured implementation strategies, training, and discussions are required to improve staff comfort with distribution and explore roles in distribution and follow-up.

The aims of this paper are to explore the role of cross-disciplinary knowledge exchange and integration in advancing the science of unfinished nursing care and to offer preliminary guidance for theory development activities for this growing international community of scholars. BACKGROUND: Unfinished nursing care, also known as missed care or rationed care is a highly prevalent problem with negative consequences for patients, nurses and healthcare organizations around the world. It presents as a ‘wicked’ sustainability problem resulting from structural obstacles to effective resource allocation that have been resistant to conventional solutions. Research activity related to this problem is on the rise internationally but is hindered by inconsistencies in conceptualizations of the problem and lack of robust theory development around the phenomenon. A unified conceptual framework is needed to focus scholarly activities and facilitate advancement of a robust science of unfinished nursing care. DESIGN: Discussion paper. DATA SOURCES: This discussion paper is based on our own experiences in international and interdisciplinary research partnerships related to unfinished nursing care. These experiences are placed in the context of both classic and current literature related to the evolution of scientific knowledge. IMPLICATIONS FOR NURSING: The problem of unfinished nursing care crosses multiple scientific disciplines. It is imperative that the community of scholars interested in solving this wicked problem engage in meaningful cross-disciplinary knowledge integration and move towards transdisciplinarity. CONCLUSION: Metatheorizing guided by structuration theory should be considered as a strategy to promote transdiciplinarity around the problem of unfinished nursing care.

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.

Antipsychotic drugs are regularly prescribed as first-line treatment for neuropsychiatric symptoms in persons with dementia although guidelines clearly prioritise non-pharmacological interventions. OBJECTIVE: we investigated a person-centred care approach, which has been successfully evaluated in nursing homes in the UK, and adapted it to German conditions. DESIGN: a 2-armed 12-month cluster-randomised controlled trial. SETTING: nursing homes in East, North and West Germany. METHODS: all prescribing physicians from both study arms received medication reviews for individual patients and were offered access to 2 h of continuing medical education. Nursing homes in the intervention group received educational interventions on person-centred care and a continuous supervision programme. Primary outcome: proportion of residents receiving at least one antipsychotic prescription after 12 months of follow-up. Secondary outcomes: quality of life, agitated behaviour, falls and fall-related medical attention, a health economics evaluation and a process evaluation. RESULTS: the study was conducted in 37 nursing homes with n = 1,153 residents (intervention group: n = 493; control group: n = 660). The proportion of residents with at least one antipsychotic medication changed after 12 months from 44.6% to 44.8% in the intervention group and from 39.8 to 33.3% in the control group. After 12 months, the difference in the prevalence was 11.4% between the intervention and control groups (95% confidence interval: 0.9-21.9; P = 0.033); odds ratio: 1.621 (95% confidence interval: 1.038-2.532). CONCLUSIONS: the implementation of a proven person-centred care approach adapted to national conditions did not reduce antipsychotic prescriptions in German nursing homes. TRIAL REGISTRATION: ClinicalTrials.gov NCT02295462.

Quality improvement interventions demonstrate variable degrees of effectiveness. The aim of this work was to (1) qualitatively explore whether, how, and why an academic detailing intervention could improve evidence uptake and (2) identify perceived changes that occurred to inform outcomes appropriate for quantitative evaluation. METHODS: A qualitative process evaluation was conducted involving semistructured interviews with nursing home staff. Interviews were analyzed inductively using the framework method. RESULTS: A total of 29 interviews were conducted across 13 nursing homes. Standard processes to reduce falls are well-known but not fully implemented due to a range of mostly postintentional factors that influence staff behavior. Conflicting expectations around professional roles impeded evidence uptake; physicians report a disconnection between the information they would like to receive and the information communicated; and a high proportion of casual and part-time staff creates challenges for those looking to effect change. These factors are amenable to change in the context of an active, tailored intervention such as academic detailing. This seems especially true when the entire care team is actively engaged and when the intervention can be tailored to the varied determinants of behaviors across different team members. DISCUSSION: Interventions aiming to increase evidence-based practice in the nursing home sector need to move beyond education to explicitly address team functioning and communication. Variability in team functioning requires a flexible intervention with the ability to tailor to individual- and home-level needs. Evaluations in this setting may benefit from measuring changes in team functioning as an early indicator of success.

Healthcare worker (HCW) hand hygiene compliance is key to patient safety; however, compliance is suboptimal. Nevertheless hand hygiene compliance is not well studied in the long-term care setting. AIM: To apply a behaviour change framework, the Theoretical Domains Framework (TDF), to identify modifiable facilitators and barriers for HCW hand hygiene compliance in long-term care settings. METHODS: HCW hand hygiene compliance facilitators and barriers were examined using a questionnaire for HCWs from long-term care homes in Ontario, Canada. The questionnaire was informed by the TDF, which is based on a synthesis of constructs from a number of relevant psychological theories of behaviour change. FINDINGS: Barriers identified from the questionnaire aligned with the TDF domain environmental context and resources (time pressure, workload, and environmental controls). Facilitators identified from questionnaire results aligned with the TDF domains social/professional role and identity (it is what is expected of HCWs), and beliefs about consequences (risk of transmission of micro-organisms to self or others). CONCLUSION: There are several barriers to hand hygiene compliance that persist in long-term care. A behaviour change theory-informed framework such as the TDF can be helpful to identify those barriers. This study identified several key behavioural constructs aligned with the TDF that can be targeted when developing novel hand hygiene interventions.

Several models have been proposed to connect academia and practice in order to improve long-term care. In this paper we propose and describe the “Mini-Research Group” as an alternative model of such collaboration. The formation of mini-research groups was the unplanned by-product of a longitudinal action research project headed by the late Prof. Rebecca Bergman, a prominent nursing leader from the Department of Nursing at Tel-Aviv University. It involved a two-stage project aimed at developing, and later implementing, a specific tool to evaluate the quality of care provided in geropsychiatric units and to design a nursing intervention which entailed an improved model for care in specialized geropsychiatric units for persons with dementia. Initially, this article describes the projects that led to the development of mini-research groups, and then continues to describe several mini-research projects, focusing on the research questions which emerged from practice as well as the variety of methodologies used. Finally, we discuss the ways in which mini- research groups contributed to the quality of care for persons with dementia, benefited their families, professional staff, faculty participants, and advanced policy development. We argue that in light of the present array of ethical and legal restrictions which inhibit the recruitment of participants, using mini-research groups combined of practitioners and researchers, can provide a pragmatic solution, not only to overcome these barriers, but to improve the quality of care, stimulate clinical dementia research, and promote new insights into the lives of persons with dementia.

Physician Orders for Life-Sustaining Treatment (POLST) can help ensure continuity of do-not-resuscitate (DNR) decisions and other care preferences after discharge from the hospital. OBJECTIVE: We aimed to improve POLST completion rates for patients with DNR orders who were being discharged to a nursing home (NH) after an acute hospitalization at our institution. DESIGN: We implemented an interprofessional quality improvement intervention involving education, communication skills, and nursing and case manager cues regarding POLST use. The intervention was later augmented with performance feedback and financial incentives for resident physicians who completed a POLST at NH transfer. MEASURE: Whether patients with DNR orders at hospital discharge have a POLST at NH transfer. RESULTS: The intervention resulted in increased POLST use for patients with DNR orders discharged to NH: baseline 25/65 (38%), intervention 36/71 (51%), and augmented intervention 44/63 (70%) (p < 0.01). CONCLUSIONS: An interdisciplinary intervention can increase POLST use for patients with DNR orders transitioning to NH. Multiple components, including financial incentives and performance feedback, may be needed to effect statistically significant change.

The quality of life of people receiving health and social care is an important indicator of service quality, but the relationship between patient experience and outcomes and regulator quality ratings in England is unknown. In 2013, the health and social care regulator in England, the Care Quality Commission (CQC), introduced a new ratings system and by February 2017, all social care services were inspected and awarded new quality ratings (outstanding, good, requires improvement and inadequate). This study aimed to explore whether quality ratings were associated with residents’ quality of life, controlling for confounding variables. METHODS: We conducted a nested, cross-sectional study, collecting social care-related quality of life (SCRQoL) data for 293 older care home residents in 34 care homes (20 nursing and 14 residential) in the South East of England. CQC ratings and other resident and home-level variables were also collected for the analysis. Multilevel modelling explored whether residents’ social care-related quality of life (SCRQoL) was associated with regulator ratings, controlling for confounding variables. RESULTS: Outstanding and good homes were collapsed into one category and compared with homes requiring improvement. Nationally, only 2 % of care homes for older people are rated as inadequate and it was not possible to capture sufficient numbers for the analysis. We recruited one but it was re-inspected during the fieldwork period and its rating changed to requires improvement. The random intercept multilevel model, which accounted for 16.93% of the differences in SCRQoL within homes and 69.80% between, indicated that better SCRQoL was significantly associated with being female, better functioning, no dementia diagnosis, fewer communication difficulties, and living in a care home rated as outstanding/good by CQC. Size of home and registration category were not significant predictors. CONCLUSIONS: This study found evidence that quality ratings are associated with residents’ SCRQoL. As well as aiming to improve quality and ensure minimum standards, quality ratings have the potential to inform user choice and help the public compare care homes based on quality. Future research to establish the generalisability and replicability of the results is required.

Studies on the adoption of innovations in organizations are abundant and have introduced many different factors that are likely to influence adoption decisions yet, somehow, without an integrated view among them and with somehow contradictory empirical results. This study introduces a conceptual framework in which the attributes of innovation–adoption decision linkages in organizations are mediated by both the behavioral preferences of managers and organizations’ resources and moderated by the innovation life cycle. It further meta-analytically tests the framework’s predictions on 185 primary empirical studies. The findings are expected to contribute to the literature on the adoption of innovations by deepening the theoretical conditions and empirical factors that are likely to influence adoption decisions in organizations. The study also has implications for practice, since it sheds light on the factors that practitioners can leverage to manage the diffusion of innovations.

This commentary for the special issue on research that went wrong describes a study that explored factors that contribute to variability within Certified Nursing Assistants (CNAs) on organizational safety culture. We know from previous research that CNAs provide most direct care in nursing homes and that direct care workers often experience agency culture differently from agency management (Wolf et al., 2014). We were looking for factors that nursing homes could alter to improve the culture for CNAs, and thus, residents. We conducted a secondary analysis of data collected via a multi-component paper survey of CNAs employed in long term care. We used results from the Nursing Home Survey on Patient Safety Culture and primary shift, type of unit, and years as a CNA to identify modifiable characteristics that would explain variability in the perceptions of patient safety culture. The final sample included n = 106 from three nursing homes. Dimension scores were compared using bivariate tests appropriate to the scale and ordinal logistic regression. Despite support in the literature for the hypothesis, we found few significant differences on the total scale within groups. Differences in perceptions have implications for quality of care and the experiences of residents within nursing homes.

This study examines the impact of personal resilience on the well-being of care workers and how perceptions of the quality of care provided and the social climate in the organization influences this relationship. We examine quality of patient care as both a mediating and outcome variable to better understand if ‘doing good’ (quality of care) leads to ‘feeling good’ (personal well-being). BACKGROUND: As an ageing population and the care for the older people has become an increasing challenge to many societies, developing and retaining a professional care workforce through effective management is vital in providing care services. DESIGN: A cross-sectional regression design was used in the study. METHODS: In 2017 we surveyed care workers in 20 Australian aged care facilities. The sample consist of 194 usable questionnaires. Using regression techniques, we constructed an interaction term (resilience x social climate) and investigated its impact on well-being (the outcome variable) and quality of care (the mediator variable). RESULTS: Our results reveal that quality of care is important as an outcome variable particularly in a supportive climate where high personal resilience positively influences quality of care. Quality of care is also important as a mediating variable as it provides a conduit through which high personal resilience fosters well-being, especially in a supportive climate. Our results support the argument that ‘doing good’ leads to ‘feeling good’. CONCLUSION: These findings contribute to our appreciation of the important outcomes of resilience in the aged care context and its influence on perceived performance and carer well-being.

Implementation researchers have typically studied organizational culture and climate by testing whether individual dimensions are linked to the implementation of evidence-based practices (EBPs) rather than examining how the overarching social context influences implementation. This approach may limit implementation theory and strategy development to the extent that individual dimensions of culture and climate interact, mutually reinforce or counteract one another, or exhibit non-linear relationships. This study tests whether empirically identifiable culture and climate profiles emerge in a sample of organizations and examines how these profiles relate to EBP fidelity and work attitudes that support EBP sustainment, focusing on three EBPs for youth with autism delivered in schools as an example. METHODS: The study included 65 elementary schools in the U.S. that implemented three EBPs-discrete trial training, pivotal response training, and visual schedules-for youth with autism. Organizational culture and climate and work attitudes were assessed using the Organizational Social Context measure at the beginning of the school year. Observations of EBP fidelity occurred mid school-year. We used bias-adjusted stepwise latent profile modeling to (1) identify subpopulations of schools that share similar culture and climate profiles, and (2) test for mean differences across profiles in observed EBP fidelity and teacher and staff work attitudes. RESULTS: Controlling for region, four profiles best characterized the organizational cultures and climates of schools. Teachers and staff in schools with a comprehensive profile (high proficiency culture, positive climate) exhibited higher fidelity to two of three EBPs (d’s = .95 to 1.64) and reported superior work attitudes (d’s = .71 to 1.93) than teachers and staff in all other schools. Teachers and staff in supportive schools (low rigidity culture, positive climate) had better work attitudes, but not better fidelity, than those in schools with indifferent (low culture/climate, elevated stress) and constrained (high rigidity and resistance, high stress) profiles. CONCLUSIONS: Organizational culture and climate profiles are a strong predictor of EBP fidelity and work attitudes that support EBP sustainment, highlighting the importance of an organization’s overarching social context when developing implementation theory and strategies. Strategies that foster a comprehensive profile may improve EBP implementation.

Randomized controlled trials (RCTs) can provide high quality evidence about the comparative effectiveness of health care interventions, but many RCTs struggle with or fail to complete recruitment. RCTs are built on the principles of the experimental method, but their planning, conduct, and interpretation can depend on complex social, behavioral, and cultural factors that may be best understood through qualitative research. Most qualitative studies undertaken alongside RCTs involve interviews that produce data that are used in a supportive or supplicatory role, but there is potential for qualitative research to be more influential. In this article, we describe the research methods underpinning the “QuinteT” (Qualitative Research Integrated Within Trials) approach to understand and address RCT recruitment difficulties. The QuinteT Recruitment Intervention (QRI) brings together multiple qualitative strategies and quantitative data and uses triangulation to understand recruitment issues rapidly. These nuanced understandings are used to inform the implementation of collaborative actions to improve recruitment.

The present study is a follow-up to an analysis of research citations of nursing academics in Canada that was conducted in 2009 (Hack et al., 2010). The goal of this earlier research was to describe the research publication productivity of these individuals using citation analysis, and in so doing, both honour these individuals and promote nursing research scholarship. Over the past decade, there have been additional efforts to describe and analyze the research citation rates of nurses in academia.

Across countries and disciplines, studies show male researchers receive more research funding than their female peers. Because most studies have been observational, it is unclear whether imbalances stem from evaluations of female research investigators or of their proposed research. In 2014, the Canadian Institutes of Health Research created a natural experiment by dividing investigator-initiated funding applications into two new grant programmes: one with and one without an explicit review focus on the calibre of the principal investigator. METHODS: We analysed application success among 23 918 grant applications from 7093 principal investigators in all investigator-initiated Canadian Institutes of Health Research grant programmes between 2011 and 2016. We used generalised estimating equations to account for multiple applications by the same applicant and compared differences in application success between male and female principal investigators under different review criteria. FINDINGS: Overall application success across competitions was 15.8%. After adjusting for age and research domain, the predicted probability of success in traditional programmes was 0.9 percentage points lower for female applicants than male applicants (95% CI 2.0 lower-0.2 higher; odds ratio 0.934, 95% CI 0.854-1.022). In the new programme, in which review focused on the proposed science, the gap remained 0.9 percentage points (3.2 lower-1.4 higher; 0.998, 0.794-1.229). In the new programme with an explicit review focus on the calibre of the principal investigator, the gap was 4.0 percentage points (6.7 lower-1.3 lower; 0.705, 0.519-0.960). INTERPRETATION: Gender gaps in grant funding are attributable to less favourable assessments of women as principal investigators, not of the quality of their proposed research. We discuss reasons less favourable assessments might occur and strategies to foster fair and rigorous peer review

In late-stage dementia, families often prioritize quality of life (QoL) and comfort, yet little research examines factors impacting QoL. We sought to (1) describe temporal trends in QoL in late-stage dementia, and (2) explore associations between patient characteristics, care interventions, and QoL. DESIGN: Secondary analysis of data from the Goals of Care clinical trial. SETTING: Twenty-two nursing homes (NHs) in North Carolina. PARTICIPANTS: Family decision makers for residents with late-stage dementia. MEASUREMENTS: Family-reported QoL at baseline and at 9 months using the Alzheimer’s Disease-Related Quality of Life Instrument (ADRQL) with five subscales scored 0 to 100 (higher scores indicate better quality). Families reported demographics, primary goal of care, and described their perceptions of residents’ QoL. Chart reviews provided data on hospital transfers, treatment plans, and hospice enrollment. We ran mixed effects models of hypothesized variables and change in ADRQL over time. RESULTS: The study sample was 241 dyads of residents with late-stage dementia and family decision makers. Family-reported ADRQL scores reflected moderately good QoL at baseline and at 9 months (69.1 vs 66.9; p = .106). Subscales for Awareness of Self (62.8; Global Deterioration Scale [GDS] = 5; 30.5; GDS = 7; p > .01) and Enjoyment of Activities (53.4; GDS = 5; 39.4; GDS = 7; p > .01) were lower in later stage disease. Qualitatively, family members associated better QoL for dementia with (1) activities, (2) opportunities to leave NH, (3) NH-structured activities, (4) attentiveness in NH, and (5) passive interaction. ADRQL at 9 months was associated with later dementia stage and referral to hospice (p < .01). Age (p = .004) and hospice enrollment were significantly associated with a larger decrease in ADRQL over 9 months (p = .019). A primary goal of comfort was associated with a larger increase in ADRQL (p = .022). CONCLUSION: Families judge QoL to be moderately good in late-stage dementia. They perceive activities, opportunities to leave the NH, and quality of interpersonal care as ways to improve dementia-specific QoL.

A real-time locating system (RTLS) can be used to track the walking activity of institutionalized older adults in long-term care who are at risk for wandering behaviors. The benefits of a RTLS are objective and continuous measurements of activity. Self-report methods of activity, especially wandering, by health care staff are vulnerable to floor effects and recall bias, and continuous clinical or research observation over the long-term can be time-consuming and expensive. Health care staff also fail to recognize the onset and/or duration of wandering behaviors, which are associated with a variety of adverse health outcomes in this population but amenable to intervention. RTLS technologies can measure the walking activity of institutionalized residents with cognitive impairment over time with a high degree of accuracy. This is particularly useful for the study of wandering, defined as walking for at least 60 seconds with few (if any) breaks in activity. Wandering is associated with disease progression, hospitalizations, falls and death. Previous work suggests older adults with poor balance ability and high sustained walking activity may be particularly susceptible to poor health outcomes. RTLS’s are used to assess cognitive impairment and factors associated with gait and balance; however, supplemental paper and pencil gait/balance tools may be used to further refine risk profiles. This project discusses the use of a RTLS to measure walking activity and also gait quality and balance ability measures on this population.

The aim of this study was to investigate the effect of spiritual care on the perceived stress and mental health of the elderlies living in nursing home in Isfahan. This is a semi-experimental study with pretest and posttest design with control group. Ninety eligible elderlies living in the nursing home were divided into intervention and control groups through census and random allocation. The interventional spiritual care was conducted for the intervention group for 90 days. After conducting the spiritual care, the majority of the elderlies (62.22%) in the intervention group had a low perceived stress level and the majority of the subjects (64.44%) in the control group had a high perceived stress level. Therefore, after performing spiritual care, a significant difference was observed at the perceived stress level of the two groups (X(2) = 3.22 and P = 0.001). The results of mental health level indicated that the mean score of the general health questionnaire was ranged between 10.95 and 27.2. After performing care, a significant difference was observed in mental health level of both groups, and 31.11% and 53.33% of the participants were suspected to general disorder in the intervention and control groups, respectively. Based on the results, there was a significant difference in the mental health level of both groups after the implementation of spiritual care (X(2) = 6.56 and P = 0.001). Further, a significant negative correlation was found between the perceived stress and mental health (r = – 0.241 and P = 0.01). Considering the spiritual health as one of the health dimensions influencing the psychosocial variables of elderlies seems necessary. Policymakers and planners of health area contribute to the improvement of mental health level by using comprehensive care approach with an emphasis on the spiritual dimension of care for the elderly people.

Sleep disturbance is one of the most prevalent symptoms among elderly adults, especially those living in nursing homes. Sleep disturbance adversely affects the healthcare system as well as elderly adults’ quality of life. Nonpharmacological interventions have shown promising results regarding improvements in sleep. This systematic review intended to identify the effects of nonpharmacological interventions on sleep quality and nighttime sleep among nursing home residents. We searched both English and Chinese databases through December 2018 and found 28 eligible studies describing five types of interventions: physical activity (n=6), light therapy (n=5), mind-body practices (n=2), complementary and alternative therapy (n=8), and multicomponent interventions (n=7). Although the wide variety of interventions in each category limited the generalizability of the results, physical activity, mind-body practices, acupressure and chamomile extract intake demonstrated positive and promising impacts on sleep quality and nighttime sleep. Due to the small number of included trials, the results should be interpreted cautiously. Further higher-quality studies concerning nonpharmacological treatments are needed.

A number of studies have explored factors associated with resident length of stay in care homes; however the findings of these studies have not been synthesized. The aim of this paper is to provide a systematic review of factors associated with length of stay until death and the strength of evidence supporting each of these factors. METHODOLOGY: This is a systematic review; databases included MEDLINE, EMBASE, PsycINFO, CINAHL, Proquest, the Cochrane Library and Web of Science were searched. Observational studies, either prospective or retrospective, that explored multiple factors associated with length of stay until death in care homes were included. Studies that met the inclusion criteria were sourced, data extracted and assessed for quality. Data synthesis combined the direction and significance of association with the quality of the study, resulting in strong, moderate, weak or inconclusive evidence for each factor identified. RESULTS: Forty-seven studies were identified as meeting the inclusion criteria. After quality assessment, 14 studies were judged to be of a high quality, 31 of a moderate quality and 2 of a low quality. Three factors had strong evidence to support their association with shorter lengths of stay: shortness of breath, receipt of oxygen therapy and admission to a facility providing nursing care. CONCLUSIONS: This review summarized the factors associated with length of stay. It found stronger evidence for physical functioning being associated with shorter lengths of stay than for cognitive functioning. An understanding of expected length of stay for older adults admitted to a care home is important for estimating lifetime costs and the implications of reforming funding arrangements for social care. Further research is needed to explore heterogeneity in this area.

The main purpose of the study was to explore the associations of sleep duration and sleep quality with physical activity (PA). In this cross-sectional study, participants were 894 elderly individuals (mean age 80 +/- 3 years; 56.0% women) living in nursing homes. PA, sleep duration, and sleep quality (based on the Pittsburgh Sleep Quality Index (PSQI)) were self-reported. The associations of sleep duration and sleep quality with PA at the nursing home level were analyzed using generalized estimating equations with clustering. Participants reporting short sleep duration (9 h; OR = 2.61; 95% CI 1.35(-)5.02) and good sleep quality (<5 points; OR = 1.59; 95% CI 1.19(-)2.12) were more likely to report sufficient PA. When sleep duration and sleep quality were entered into the same model, the same associations remained. This study shows that elderly individuals who report short sleep duration are less likely to meet PA guidelines, while those who report long sleep duration and good sleep quality are more likely to meet PA guidelines. Strategies aiming to improve sleep duration and sleep quality are warranted.

This study aimed to identify possible groups of people with dementia (PWD) in nursing homes with different trajectories of proxy-rated quality of life (QoL), and to explore how anxiety (along with other characteristics) was associated with these trajectories of QoL of PWD in nursing homes at a 12-month follow-up. METHODS: We included 298 PWD aged 65 years and older from 17 Norwegian nursing homes. The Norwegian version of the Rating Anxiety in Dementia scale (RAID-N) was used to assess anxiety, defined as RAID-N score >/=12; proxy-rated QoL was assessed by Quality of Life in Late-Stage Dementia (QUALID). The assessments were made at baseline and after a mean follow-up period of 350 days (SD 12.3). A growth mixture model identified two distinct trajectories of QUALID scores. Association between the QUALID score trajectories and demographic and clinical characteristics were analyzed with logistic regression models. RESULTS: Trajectory group 1 (206 participants) had a lower proportion of participants with anxiety, and a more stable and better QoL, compared to trajectory group 2 (92 participants) at a 12-month follow-up. In a multivariate logistic regression analysis, more severe impairment in activities of daily living, along with presence of anxiety, depression, agitation, and use of antipsychotics at baseline, were associated with belonging to the trajectory group with proxy-rated poor QoL. SIGNIFICANCES: This study reveals that anxiety is associated with proxy-rated poor QoL of PWD at a 12-month follow-up. Efforts should be made to identify anxiety among nursing home residents with dementia to initiate treatment.

Many of the elderly in nursing homes are very ill and have a reduced quality of life. Life expectancy is often hard to predict. Decisions about life-prolonging treatment should be based on a professional assessment of the patient’s best interest, assessment of capacity to consent, and on the patient’s own wishes. The purpose of this study was to investigate and compare how these types of decisions were made in nursing homes and in hospital wards. METHODS: Using a questionnaire, we studied the decision-making process for 299 nursing home patients who were treated for dehydration using intravenous fluids, or for bacterial infections using intravenous antibiotics. We compared the 215 (72%) patients treated in nursing homes to the 84 (28%) nursing home patients treated in the hospital. RESULTS: The patients’ capacity to consent was considered prior to treatment in 197 (92%) of the patients treated in nursing homes and 56 (67%) of the patients treated in hospitals (p < 0.001). The answers indicate that capacity to consent can be difficult to assess. Patients that were considered capable to consent, were more often involved in the decision-making in nursing homes than in hospital (90% vs. 52%). Next of kin and other health personnel were also more rarely involved when the nursing home patient was treated in hospital. Whether advance care planning had been carried out, was more often unknown in the hospital (69% vs. 17% in nursing homes). Hospital doctors expressed more doubt about the decision to admit the patient to the hospital than about the treatment itself. CONCLUSIONS: This study indicates a potential for improvement in decision-making processes in general, and in particular when nursing home patients are treated in a hospital ward. The findings corroborate that nursing home patients should be treated locally if adequate health care and treatment is available. The communication between the different levels of health care when hospitalization is necessary, must be better. TRIAL REGISTRATION: ClinicalTrials.gov NCT01023763

The aim of this study was to assess the impact of a multifaceted hand hygiene (HH) program on the infectious risk in nursing homes (NHs). METHODS: This was a 2-arm cluster randomized trial; French NHs were allocated randomly to the intervention (13 NHs) or control (13 NHs) groups. The intervention consisted of implementing a bundle of HH-related measures over 1 year, including increased availability of alcohol-based handrub, HH promotion, staff education, and local work groups. The primary end point was the incidence rate of acute respiratory infections and gastroenteritis reported in the context of clustered cases episodes. Secondary end points were mortality, hospitalization, and antibiotic prescription rates. RESULTS: Baseline characteristics did not differ between groups. The overall handrub consumption was higher in the intervention group over the 1-year intervention period. Because of underreporting, data on the primary end points were of insufficient quality for analysis. Hospitalizations did not differ between the 2 groups. However, the intervention group showed significantly lower mortality (2.10 vs 2.65 per 100 residents per month, respectively; P = .003) and antibiotic prescriptions (5.0 vs 5.8 defined daily doses per 100 resident days, respectively; P < .001). These results were confirmed by the longitudinal multivariate analysis adjusted for NH and resident characteristics and for seasonality (mortality rate ratio, 0.76). CONCLUSIONS: A multifaceted HH intervention may have a short-term impact on mortality in NHs. Nevertheless, other strategies may remain necessary to reduce morbidity.

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.

Drug consumption increases with age, but there are few comparisons of drug use between old people living at home or in a nursing home. To identify areas of concern as well as in need for quality improvement in the two settings, we compared drug use among people aged >/=70 years living at home or in a nursing home. METHODS: Cross-sectional observational study from Oslo, Norway. Information about drug use by people living at home in 2012 was retrieved from the Norwegian Prescription Database. Drug use in nursing homes was recorded within a comprehensive medication review during November 2011-February 2014. Prevalence rates and relative risk (RR) with 95% confidence intervals were compared between uses of therapeutic groups with prevalence rates of >/=5%. Drug use was compared for the total population and by gender and age group. RESULTS: Older people (both genders) in nursing homes (n = 2313) were more likely than people living at home (n = 48,944) to use antidementia drugs (RR = 5.7), antipsychotics (RR = 4.0), paracetamol (RR = 4.0), anxiolytics (RR = 3.0), antidepressants (RR = 2.8), dopaminergic drugs (RR = 2.7), antiepileptic drugs (RR = 2.4), loop diuretics (RR = 2.3), cardiac nitrates (RR = 2.1) or opioids (RR = 2.0). By contrast, people living in a nursing home were less commonly prescribed statins (RR = 0.2), nonsteroidal antiinflammatory drugs (NSAIDs) (RR = 0.3), osteoporosis drugs (RR = 0.3), thiazide diuretics (RR = 0.4), calcium channel blockers (RR = 0.5) or renin-angiotensin inhibitors (RR = 0.5). Each of the populations had only minor differences in drug use by gender and a trend towards less drug use with increasing age (p < 0.01). CONCLUSIONS: Drug use by older people differs according to care level, and so do areas probably in need for quality improvement and further research. In nursing home residents, this relates to a probable overuse of psychotropic drugs and opioids. Among older people living at home, the probable overuse of NSAIDs and a possible underuse of cholinesterase inhibitors and osteoporosis drugs should be addressed.

Approaches to sexual expression in nursing homes are often devoid of person-centered components, such as resident choice. Little is known about residents’ preferences for sexual and intimate expression across different situations. To evaluate future resident preferences, a convenience sample of 389 midlife and older adults in the United States were assessed for their perceptions of appropriateness of sexual and intimate activity among couples in nursing homes, given certain situational factors (e.g., cognitive impairment, relationship status, assent behaviors). RESEARCH DESIGN AND METHODS: A randomized experimental vignette design was implemented to determine situational factors that influence future resident preferences for sexual expression in nursing homes. Data were analyzed via multilevel modeling, allowing for multiple vignette ratings to be nested among respondents. RESULTS: Behavioral indications of assent, level of intimacy between the couple, and age of respondent affected respondents’ ratings of appropriateness of sexual and intimate activities. Also, cognition and relationship levels interacted for more nuanced effects on activity appropriateness. DISCUSSION AND IMPLICATIONS: Future resident preferences are often incongruent with attitudes and common practices for approaching sexual expression in nursing home settings. This marks a unique opportunity for person-centered policy development and implementation in the realm of sexual expression.

This project examined the laws governing health care consent for people living with dementia in British Columbia. It also went a step further to explore policy and practice, particularly in long-term care facilities, where some of the most vulnerable members of our communities reside. This report includes 34 recommendations. They address law reform, access to justice and legal aid, health care professional legal education, and systemic barriers to informed consent. The recommendations were developed by an inter-disciplinary advisory committee, and informed by both legal research and consultation. As part this project we spoke with a broad range of stakeholders, including people living with dementia, family caregivers, and professionals who deal with health care consent as part of their work. The recommendations invite the Government of BC, health professional regulators, and other key stakeholders in BC to consider how to develop the most robust legal framework and support best practice.

During 2018, stakeholders from the health and social care system, and the charitable sector, were asked to comment on the progress of the actions set out in the Challenge on dementia 2020 implementation plan and what else needed to be done to complete them. This report summarises the responses and sets out revised actions for 2018 to 2020.

The Building Trust project aimed to understand the process of gaining access to dementia-related information, diagnosis, care and psychosocial supports by Punjabi- and Korean-speaking older adults with Alzheimer’s Disease and related dementias and their informal caregivers living in the Fraser Health region of British Columbia, Canada.

To understand interactions between care recipients and care providers, we conducted semi-structured interviews with 20 staff members (11 dementia service staff from ASBC and the health authority, and 9 immigrant-serving staff working with Punjabi or Korean communities), and with 15 dyads of persons with dementia (PWD) and their informal care partners (10 Punjabi; 5 Korean), as well as 6 focus groups, one each with older men, older women, and working age men and women in each of the Punjabi and Korean communities.
The regional health authority and Alzheimer Society chapter in British Columbia have valuable resources on dementia and other health and social supports, but they do not know how to adapt their policy and practice tools to address the complex problems of access for immigrant older adults and their families. Staff in immigrant-serving agencies typically understand the multiple barriers and facilitators to access for these populations and are better positioned to gain the trust of immigrant older adults.

How will you evaluate efforts to create systems change? Through our work at Tamarack, it has become clear that there is no one answer. The right approach depends on your situation, the type of change, and many other constraints that are unique. As demand for systems change initiatives has increased, so has the need to evaluate this type of work, though this type of evaluation is still emerging. To respond to this need, over the past year we have been developing a planning tool for evaluating Systems Change efforts — a Systems Change Evaluation Canvas.

In this webinar, Mark Cabaj and Galen MacLusky will introduce the canvas, walk through important things to consider when planning systems change, and show how the canvas can be applied to a real-world scenario. We’re excited to be releasing this tool and hope you will join us not only to learn what we have uncovered, but also to help us shape this tool and make it work for you.

Learning objectives:
1. Understand the importance of engaging frail and/or seriously ill patients in research
2. Describe the practical and ethical considerations of engaging frail and/or seriously ill patients in research
3. Appreciate the significance of patient engagement in research from a patient’s perspective

Many of you have probably heard the term “culture change,” but what does it mean, exactly? And how can you make it a reality? This webinar will explore the topic of culture change, and how to move from being task-focused to people-focused. Resources will be shared to support long-term care homes interested in putting living first and creating a culture where everyone – residents, family members, and team members – thrive.

This webinar is being offered in collaboration with the Schlegel-UW Research Institute for Aging.

Learning Objectives
-Understand what culture change is and why it’s vital to resident, family and team member quality of life.
-Learn about the Working Together to Put Living First guidebook and other resources that are available to support culture change in your long-term care home.
-Leave with practical strategies and resources to start making change.

Choosing Wisely Alberta and the Physician Learning Program invite you to attend this free symposium to engage in a discussion with clinicians, patients and system leaders about how to prioritize and implement Choosing Wisely recommendations.

Helping a person with dementia to maintain a healthy diet can be difficult for the people caring for them. This newly updated leaflet from Dementia UK aims to provide some positive tips on ways to help.

The Change Foundation has worked with family caregivers since 2015 to understand what it is like to be a caregiver. During that time, we have undertaken a variety of initiatives to improve the caregiver experience with Ontario’s healthcare system, including the Changing CARE projects and our work with young carers.

In this toolkit, we’ve packaged together all the tools, resources, reports and learnings we’ve put out along the way, in an effort to help others learn from our experience with co-design and caregivers. We will keep this page updated as our work, and learnings, progress.

Regardless of where your organization is in terms of caregiver involvement – building the case, starting the conversation, ready to implement or evaluating the impact – we’re confident there’s something in this toolkit to help you out.

Researchers at the Research School of Population Health (RSPH) conduct innovative and multidisciplinary research across a range of pressing national and international health problems. The Population Health Exchange (PHX) is a new initiative that aims to create high-impact, highly-collaborative co-productions with healthcare consumers, clinicians, policy makers, health advocates and other researchers, in order to expand the reach of our work. The ultimate aim is to tackle entrenched health inequities and emerging health threats.

The Research Fellow/Senior Fellow (Implementation Lead) will engage with staff and students in RSPH to build capacity within the School, develop a flourishing PHX and undertake research on population health implementation and translation.

Members of the SPOR Evidence Alliance (hereafter, the 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

The ideal candidate has expertise in community-engaged or patient-oriented research across any of the research challenge areas in the Faculty of Health Sciences. These include Mental Health and Addictions; Infectious Diseases; Health Systems and Health Policy; Developmental Trajectories; Big Data and Social and Technological Innovation; and Planetary Change. Programs of research that attend to our core cross-cutting themes of global health, gender and social inequities, Indigenous health, and underserved communities will be prioritized.

Reporting to the Director, Practice Services, Professional Practice, the Manager is a member of the Professional Practice Leadership Team responsible for providing organization leadership in professional standards and strategic planning, development, implementation and evaluation of practice-related initiatives and programs for health care professionals, support workers and students that aligns with the vision, mission, values, goals and strategic priorities of the Vancouver Island Health Authority (VIHA).