November 5, 2019

Grants & Awards
Events & Training Opportunities


New article by Stephanie Chamberlain and Carole Estabrooks
Incapacitated and Alone: Prevalence of Unbefriended Residents in Alberta Long-Term Care Homes

Stephanie A. Chamberlain, Wendy Duggleby, Janet Fast, Pamela B. Teaster and Carole A. Estabrooks.
SAGE Open 2019 07/01; 2019/11;9(4):2158244019885127
The objective of this study was to assess the prevalence of residents who are incapacitated and have no surrogate decision maker, known as the ?unbefriended? in Alberta long-term care (LTC) homes. Using cross-sectional online survey methods, data were collected from 123 staff (i.e., directors of care/nursing, administrators) from Alberta LTC homes. Information was collected on survey respondents? demographic characteristics, number of unbefriended residents, and on organizational characteristics. The overall prevalence of unbefriended residents in LTC homes was 4.14% in Alberta (SD = 6.28%, range: 0%-34.6%). Homes with the highest prevalence (nearly 15%) of unbefriended residents had >135 beds and were public not-for-profit and located in large urban centers. Fifty-three percent of unbefriended residents were male. The highest prevalence of unbefriended residents lived in homes located in large urban centers and public not-for-profit operators. Population level and LTC home level prevalence data are needed to assess the scope of unmet needs.

New article by Gillian Harvey & Alison Kitson
Leadership for evidence-based practice—Enforcing or enabling implementation?
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Gill Harvey, Janet Kelly, Alison Kitson, Karleen Thornton and Vanessa Owen.
Collegian 2019/11
The implementation of research evidence into nursing and midwifery practice and care is inconsistent. Leadership is identified as one of the variables that influences the implementation of evidence-based practice. However, less is known about which type of nursing and midwifery leadership roles are key to enhance implementation, nor the specific strategies that should be used.; BackgroundThe implementation of research evidence into nursing and midwifery practice and care is inconsistent. Leadership is identified as one of the variables that influences the implementation of evidence-based practice. However, less is known about which type of nursing and midwifery leadership roles are key to enhance implementation, nor the specific strategies that should be used.

Canadian Frailty Network – FOCUS: The Frailty Outcomes Consensus Project
Participate in Delphi survey on standardizing common outcome measures in frailty studies

DEADLINE: Friday 8 November
FOCUS aims to standardize research and translation studies so that common outcome measures are captured in all frailty studies. A set of common outcome measures will enable study findings to be collectively analyzed to better inform patient care. A Delphi process will be used to arrive at consensus on a set of common outcome measures.

New article by Anne-Marie Boström
Enabling At-Homeness for Older People With Life-Limiting Conditions: A Participant Observation Study From Nursing Homes.
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L. Saarnio, A. M. Bostrom, R. Hedman, P. Gustavsson and J. Ohlen.
Glob Qual Nurs Res 2019 Oct 22;6:2333393619881636-Dec
At-homeness, as an aspect of well-being, can be experienced despite living with life-limiting conditions and needs for a palliative approach to care. In nursing homes, older residents with life-limiting conditions face losses and changes which could influence their experience of at-homeness. The aim of this study was to explore how nursing staff enable at-homeness for residents with life-limiting conditions. Interpretive description was employed as the design using data from participant observations and formal and informal interviews related to nursing care situations. The strategies found to be used to enable at-homeness comprising nursing staff presenting themselves as reliable, respecting the resident’s integrity, being responsive to the resident’s needs, collaborating with the resident in decision-making, and through nurturing comforting relationships. The result on how to enable at-homeness could be used as strategies for a person-centered palliative approach in the care for residents in nursing homes.

New article by Shannon Scott
Parents’ experiences and information needs related to childhood fever: A systematic review.
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A. P. Thompson, M. Nesari, L. Hartling and S. D. Scott.
Patient Educ Couns 2019 Oct 9
To synthesize current evidence about experiences and information needs of parents/caregivers managing pediatric fever. METHODS: We used systematic review methodology with an a priori protocol. We searched Medline, Embase, PsycINFO, CINAHL and ProQuest Dissertations and Theses Global, from 2000 to May 2018. RESULTS: We included thirty-six studies (n=29 quantitative, n=7 qualitative; 15,727 participants). Quantitative data contained four themes; 1) caregivers seek information about pediatric fever, 2) low knowledge is coupled with misconceptions and anxiety, 3) fever assessment and management practices vary, 4) demographic factors (e.g., ethnicity, age, socioeconomic status, education) influence information needs and health practices. Qualitative data contained three themes; 1) tension between logic and emotion, 2) responsibility contrasted with sense of vulnerability, 3) seeking support and information to build confidence. CONCLUSION: Parents often overestimate the risks associated with pediatric fever and struggle to make decisions during a child’s febrile illness – leading to caregiving actions that may not reflect current clinical recommendations. Parents seek knowledge about how to care for a febrile child at home and what indicators should prompt them to seek medical attention. PRACTICE IMPLICATIONS: In addition to providing clear, reliable information, interventions that address educational, pragmatic, and emotional domains may be effective in supporting parents.

Grants & Awards

CFHI How and why do healthcare innovations spread and scale across the country? Help us learn more and nominate a healthcare innovation that has spread and scaled in Canada.

DEADLINE 8 November
Understanding What Leads to Spread and Scale of Healthcare Innovations
How and why do healthcare innovations spread and scale across the country? Help us learn more and nominate a healthcare innovation that has spread and scaled in Canada.Our initiative will gather evidence about the key factors behind innovations that have spread and scaled. We will be studying five to six innovations from among those nominated and innovations we’ve already identified. Other innovations submitted will be considered for future research.We are using broad definitions of “innovation” and “healthcare” to help ensure wider learning and application:

In this project, we consider an innovation to be any practice, policy or program that enhances or outperforms the way healthcare was previously delivered, funded, or governed. This healthcare delivery, funding, or governing improvement can occur in any single dimension or in multiple dimensions of the quadruple aim (improved population health, enhanced patient experience, reduced healthcare costs and enhanced provider experience).
In this project, healthcare can include any area of the health system, for example public health, primary care, secondary care, tertiary care, or home and community care. Innovations that solely target or primarily address the social determinants of health are not contained under this definition.
As we want to understand the spread and scale process on a pan-Canadian level, any healthcare innovation should be operating across at least two provinces/territories. We will also consider innovations that are no longer operating as extensively due to a recent change.

We are open to all types of healthcare innovations that demonstrate spread and scale. Examples of varieties of healthcare innovations we would consider including in our case study research on spread and scale include:

Specific tools which direct healthcare practice (e.g. the Rourke Baby Record, an evidence-based infant/child health maintenance guide);
Broad, diffuse practices resulting from a combination of efforts (e.g. current smoking cessation rates);
Specific policy changes that may lead to changes in healthcare practice (e.g. legislated universal Hepatitis C treatment coverage).

Request for Funding – Knowledge Mobilization & Skills in Relevant Research (UAlberta only)

DEADLINE 18 November
Through University of Alberta’s membership in Research Impact Canada, the Office of the VP Research & Innovation and the University of Alberta Library, in partnership with the Kule Institute for Advanced Study (KIAS), are pleased to announce a one-time opportunity to request funding for knowledge mobilization of University of Alberta research. The funding will enable researchers to mobilize the results of recent research of relevance to skills, skills development, skills infrastructure, training and/or future skills, and/or to provide students with opportunities to learn skills related to knowledge mobilization.


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


Elucidating the influence of supervisors’ roles on implementation climate.
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A. C. Bunger, S. A. Birken, J. A. Hoffman, H. MacDowell, M. Choy-Brown and E. Magier.
Implement Sci 2019 Oct 25;14(1):93-019-0939-6
Supervisors play an essential role in implementation by diffusing and synthesizing information, selling implementation, and translating top management’s project plans to frontline workers. Theory and emerging evidence suggest that through these roles, supervisors shape implementation climate-i.e., the degree to which innovations are expected, supported, and rewarded. However, it is unclear exactly how supervisors carry out each of these roles in ways that contribute to implementation climate-this represents a gap in the understanding of the causal mechanisms that link supervisors’ behavior with implementation climate. This study examined how supervisors’ performance of each of these roles influences three core implementation climate domains (expectations, supports, and rewards). MATERIALS AND METHODS: A sequenced behavioral health screening, assessment, and referral intervention was implemented within a county-based child welfare agency. We conducted 6 focus groups with supervisors and frontline workers from implementing work units 6 months post-implementation (n = 51) and 1 year later (n = 40) (12 groups total). Participants were asked about implementation determinants, including supervision and implementation context. We audio-recorded, transcribed, and analyzed focus groups using an open coding process during which the importance of the supervisors’ roles emerged as a major theme. We further analyzed this code using concepts and definitions related to middle managers’ roles and implementation climate. RESULTS: In this work setting, supervisors (1) diffused information about the intervention proactively, and in response to workers’ questions, (2) synthesized information by tailoring it to workers’ individual needs, (3) translated top managements’ project plans into day-to-day tasks through close monitoring and reminders, and (4) justified implementation. All four of these roles appeared to shape the implementation climate by conveying strong expectations for implementation. Three roles (diffusing, synthesizing, and mediating) influenced climate by supporting workers during implementation. Only one role (diffusing) influenced climate by conveying rewards. CONCLUSIONS: Supervisors shaped implementation climate by carrying out four roles (diffusing, synthesizing, mediating, and selling). Findings suggest that the interaction of these roles convey expectations and support for implementation (two implementation climate domains). Our study advances the causal theory explaining how supervisors’ behavior shapes the implementation climate, which can inform implementation practice.

Scaling-up implementation in community hospitals: a multisite interrupted time series design of the Mobilization of Vulnerable Elders (MOVE) program in Alberta.
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J. Holroyd-Leduc, C. Harris, J. S. Hamid, et al.
BMC Geriatr 2019 Oct 25;19(1):288-019-1311-z
As the population ages, older hospitalized patients are at increased risk for hospital-acquired morbidity. The Mobilization of Vulnerable Elders (MOVE) program is an evidence-informed early mobilization intervention that was previously evaluated in Ontario, Canada. The program was effective at improving mobilization rates and decreasing length of stay in academic hospitals. The aim of this study was to scale-up the program and conduct a replication study evaluating the impact of the evidence-informed mobilization intervention on various units in community hospitals within a different Canadian province. METHODS: The MOVE program was tailored to the local context at four community hospitals in Alberta, Canada. The study population was patients aged 65 years and older who were admitted to medicine, surgery, rehabilitation and intensive care units between July 2015 and July 2016. The primary outcome was patient mobilization measured by conducting visual audits twice a week, three times a day. The secondary outcomes included hospital length of stay obtained from hospital administrative data, and perceptions of the intervention assessed through a qualitative assessment. Using an interrupted time series design, the intervention was evaluated over three time periods (pre-intervention, during, and post-intervention). RESULTS: A total of 3601 patients [mean age 80.1 years (SD = 8.4 years)] were included in the overall analysis. There was a significant increase in mobilization at the end of the intervention period compared to pre-intervention, with 6% more patients out of bed (95% confidence interval (CI) 1, 11; p-value = 0.0173). A decreasing trend in median length of stay was observed, where patients on average stayed an estimated 3.59 fewer days (95%CI -15.06, 7.88) during the intervention compared to pre-intervention period. CONCLUSIONS: MOVE is a low-cost, effective and adaptable intervention that improves mobilization in older hospitalized patients. This intervention has been replicated and scaled up across various units and hospital settings.

Implementation of a national policy for improving health and social care: a comparative case study using the Consolidated Framework for Implementation Research.
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H. Strehlenert, J. Hansson, M. E. Nystrom and H. Hasson.
BMC Health Serv Res 2019 Oct 22;19(1):730-019-4591-2
Comprehensive policies are becoming common for addressing wicked problems in health and social care. Success of these policies often varies between target organizations. This variation can often be attributed to contextual factors. However, there is a lack of knowledge about the conditions for successful policy implementation and how context influences this process. The aim of this study was to investigate county-level actors’ perspectives on the implementation of a comprehensive national policy in three Swedish counties. The policy focused on developing quality of care for elderly based on the use of national quality registries (NQRs) and to improve coordination of care. METHODS: A comparative case study approach was used. Data was collected longitudinally through documents and interviews. The Consolidated Framework for Implementation Research (CFIR) guided the analysis. RESULTS: All three counties shared the view that the policy addressed important issues. Still, there was variation regarding how it was perceived and managed. Adaptable features-i.e., NQRs and improvement coaches-were perceived as relevant and useful. However, the counties differed in their perceptions of another policy component-i.e., senior management program-as an opportunity or a disturbance. This program, while tackling complex issues of collaboration, fell short in recognizing the counties’ pre-existing conditions and needs and also offered few opportunities for adaptations. Performance bonuses and peer pressure were strong incentives for all counties to implement the policy, despite the poor fit of policy content and local context. CONCLUSIONS: Comprehensive health policies aiming to address wicked problems have better chances of succeeding if the implementation includes assessments of the target organizations’ implementation capacity as well as the implicit quid pro quos involved in policy development. Special attention is warranted regarding the use of financial incentives when dealing with wicked problems since the complexity makes it difficult to align incentives with the goals and to assess potential consequences. Other important aspects in the implementation of such policies are the use of collaborative approaches to engage stakeholders with differing perspectives, and the tailoring of policy communication to facilitate shared understanding and commitment.


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Health Care Administration and Organization

Development of an ICT-Based Dementia Care Mapping Support System and Its Usefulness Assessment
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Hirotoshi Yamamoto and Yasuyoshi Yokokohji.
Am J Alzheimers Dis Other Demen 2019 10/15; 2019/11:1533317519880422
Dementia Care Mapping (DCM) is an established practice method to implement Person-centred Care in dementia care settings. However, it is not easy to carry out DCM because of its high complexity. The aim of this study is to solve DCM complexity by adopting technology.Methods:Authors developed (1) a new information-communication technology (ICT) based DCM support system based on the investigation of difficulties and/or burden encountered during mapping (n = 33) and (2) a new evaluation test method, using role-play videos, for assessing the usefulness and reliability of the system. Mapping data, collected using the support system or the conventional paper-based DCM (n = 22), were compared.Results:We obtained users? positive ratings of the system for burden reduction and its usability. Moreover, the developed prototype system indicated to have already reached the level of conventional paper-based DCM in terms of mapping accuracy.Conclusion:Usefulness of the ICT-based support system was confirmed to help overcome DCM complexity.

A systematic review of the impact of Person-Centred Care interventions on the behaviour of staff working in dementia care.
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D. Blake, K. Berry and L. J. E. Brown.
J Adv Nurs 2019 Oct 27
To examine the content, focus and effectiveness of person-centred care (PCC) interventions aimed at increasing staff PCC behaviour in health and social care settings for people with dementia. DESIGN: Systematic search and narrative synthesis of quantitative data. DATA SOURCES: PsychINFO, Medline, EMBASE, Web of knowledge, CINAHL, ASSIA and BNI were searched from inception to 5 November 2016. REVIEW METHODS: All records retrieved were screened using predetermined eligibility criteria. Quality assessment was performed with the Effective Public Health Practice Project tool (EPHPP). RESULTS: A total of 4,367 records were screened and 33 studies examining the impact of PCC interventions were included. Eight different categories of PCC intervention were identified, with seven of these having at least some evidence to support their effectiveness in increasing staff PCC behaviour. CONCLUSION: The range of interventions and outcome measures identified in this review highlight different ways PCC behaviour can be demonstrated by staff and the range of interventions that can be used to enhance PCC staff behaviour. Future, more rigorously controlled research comparing the relative effectiveness of these interventions, will support nursing facilities and staff to choose appropriate interventions to support them in enhancing PCC. IMPACT: This study addressed the health priority of increasing PCC for people with dementia. It found preliminary evidence that seven of the eight intervention types identified are effective at increasing staff PCC behaviour in health and social care settings for people with dementia.

A Multicenter Study to Identify Clinician Barriers to Participating in Goals of Care Discussions in Long-term Care.
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H. Y. H. Siu, D. Elston, N. Arora, et al.
J Am Med Dir Assoc 2019 Oct 28
Long-term care (LTC) is an important setting for goals of care (GoC) discussions. Understanding clinician barriers to GoC discussions could identify opportunities for LTC-specific interventions to improve quantity and quality of GoC discussions in the context of serious illness. DESIGN: A multicenter, cross-sectional survey study. SETTING AND PARTICIPANTS: 1184 LTC clinicians from 34 Ontario LTC homes were invited to participate. MEASURES: The questionnaire assessed (1) clinician barriers related to the LTC resident power of attorney (POA), the health care provider, and the health care system; (2) willingness to engage in GoC discussions; and (3) suggestions to address identified barriers. Responses were rated on a 7-point scale (1 = extremely unimportant/unwilling, 7 = extremely important/willing). A linear mixed-effects model determined significance between mean importance ratings for each barrier and the willingness to engage in GoC discussion between physicians and nurses. A simple content analysis was performed on written suggestions to address GoC discussion barriers. RESULTS: The overall response rate was 49% (581/1184). The top 3 rated barriers were (1) POA’s difficulty accepting their loved one’s poor prognosis, (2) POA’s difficulty understanding the limitations and complications of life-sustaining therapies, and (3) lack of adequate documentation of prior discussions with LTC resident or POA. Barriers related to the health care provider, and the health care system, were deemed statistically more important by nurses. LTC physicians were more willing to exchange information, be a decision coach, and participate in the final decision than nurses. Suggestions to improve GoC discussions include a dedicated team to have these conversations in LTC, and updating policies to mandate and standardize these conversations at all family meetings. CONCLUSIONS AND IMPLICATIONS: This study has identified key LTC clinician-identified barriers to GoC discussions. Developing targeted interventions to these barriers could be the foundation for developing new interventions that support high-quality GoC discussions.

Development and usability of a decision support App for nurses to facilitate aging in place of people with dementia.
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T. Thoma-Lurken, M. A. S. Lexis, M. H. C. Bleijlevens and J. P. H. Hamers.
Appl Nurs Res 2018 Aug;42:35-44
The aim of this study was to develop a decision support tool for nurses to facilitate aging in place of people with dementia and to test its usability. BACKGROUND: Nurses play an important role in detecting practical problems preventing persons with dementia (PwD) from aging in place and advising them on possible solutions. These are complex and challenging tasks for nurses. METHODS: A mixed methods study was conducted. The content development of the App comprised a literature and internet search, and individual and group interviews with professionals (n=8) and researchers (n=5). The technical development was an iterative process in which usability was tested by the project team (n=4), experts (n=6), and end-users (n=9), using heuristic evaluation, a think-aloud approach, and a questionnaire (PSSUQ). RESULTS: The App contains a structured problem assessment for three problem domains-self-reliance, safety, and informal care-based on validated questionnaires and self-formulated questions. The problem assessment is linked to an overview of possible solutions for the problems detected. Three prototypes have been developed. The users of the third prototype were overall satisfied with the App as they scored on average 1.7 on the PSSUQ (range 1-7 and lower scores indicating higher satisfaction). CONCLUSIONS: A user-friendly prototype of the decision support App is now available. Users indicated to be very willing to use to App in daily practice. However, besides further technical development, implementation of the App into practice requires evidence supporting its efficacy, feasibility and effectiveness.

Psychosocial Predictors of Anxiety in Nursing Home Staff.
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L. Gallego-Alberto, A. Losada, C. Vara, J. Olazaran, R. Muniz and K. Pillemer.
Clin Gerontol 2018 Jul-Sep;41(4):282-292
Although research shows that nursing home staff experience significant levels of stress and burnout, studies analyzing the relationship of psychosocial variables on their feelings of anxiety are scarce. This study aims to analyze the relationship between psychosocial variables and levels of anxiety among staff. METHOD: Participants were 101 nursing home professionals. In addition to anxiety, socio-demographic variables, depersonalization, burden, relationship with families of the residents, and guilt about the care offered to the residents were assessed. A hierarchical regression analysis was carried out to analyze the contribution of the assessed variables to staff anxiety levels. RESULTS: The obtained model explained 57% of the variance in anxious symptomatology. Guilt about the care offered and poor quality of the relationship with residents’ family were associated with anxiety. Further, working at nursing homes where the staff report higher levels of anxiety symptoms, the presence of depersonalization and burden were also associated with anxiety. CONCLUSION: The findings suggest that in addition to work-related variables (burden and burnout), problems with family members and guilt about the care offered are relevant variables for understanding staff’s anxious symptomatology. CLINICAL IMPLICATIONS: Interventions that address issues of guilt about the quality of care, and problematic relationships with family members of residents, may have potential to reduce staff anxiety and promote their well-being.

Long-term care nurses´ attitudes and the incidence of voluntary stopping of eating and drinking: A cross-sectional study.
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S. Stangle, W. Schnepp, D. Buche and A. Fringer.
J Adv Nurs 2019 Oct 29
To assess the incidence of voluntary stopping of eating and drinking in long-term care and to gain insights into the attitudes of long-term care nurses about the voluntary stopping of eating and drinking. DESIGN: A cross-sectional study. METHODS: Heads of Swiss nursing homes (535; 34%) answered the Online-Survey between June and October 2017, which was evaluated using descriptive data analysis. RESULTS: The incidence of patients who died in Swiss nursing homes by voluntarily stopping eating and drinking is 1.7% and 67.5% of participants consider this phenomenon highly relevant in their daily work. Most participants (64.2%) rate voluntary stopping of eating and drinking as a natural death accompanied by health professionals and patients are also granted the right to care (91.9%). This phenomenon is expected by the participants less at a young age and more in old age. CONCLUSION: Participants’ overall views on the voluntary stopping of eating and drinking are very positive, whereas it is assumed that voluntary stopping of eating and drinking is a phenomenon of old age. Professionals still lack sufficient knowledge about this phenomenon, which could be clarified through training. International Registered Report Identifier (IRRID): DERR1-10.2196/10358. IMPACT: Voluntary stopping of eating and drinking is much discussed interprofessional, but there is a lack of knowledge on how this is perceived in the context of long-term care and about the incidence of the phenomenon. Voluntary stopping of eating and drinking is rare but noticeable end-of-life practises that is considered by professionals to be mainly dignified and peaceful, although moral concerns make it difficult to accompany. These findings call on long-term care institutions to discuss voluntary stopping of eating and drinking as an end-of-life practice. Positioning on the issue provides clarity for staff and patients and promotes to develop standardized care.

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Health Care Innovation and Quality Assurance

Quality Indicators as Predictors of Future Inspection Performance in Ontario Nursing Homes
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Pouria Mashouri, Babak Taati, Hannah Quirt and Andrea Iaboni.
Journal of the American Medical Directors Association 2019/11
There are several mechanisms for monitoring the quality of care in long-term care (LTC), including the use of quality indicators derived from resident assessments and formal inspections. The LTC inspection process is time and resource-intensive, and there may be opportunities to better target inspections. In this study, we aimed to examine whether quality indicators could predict future inspection performance in LTC homes across Ontario, Canada.; ObjectivesThere are several mechanisms for monitoring the quality of care in long-term care (LTC), including the use of quality indicators derived from resident assessments and formal inspections. The LTC inspection process is time and resource-intensive, and there may be opportunities to better target inspections. In this study, we aimed to examine whether quality indicators could predict future inspection performance in LTC homes across Ontario, Canada.

Measuring implementation: development of the implementation process assessment tool (IPAT).
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M. Hartveit, E. Hovlid, M. H. A. Nordin, et al.
BMC Health Serv Res 2019 Oct 21;19(1):721-019-4496-0
Implementation science comprises a large set of theories suggesting interacting factors at different organisational levels. Development of literature syntheses and frameworks for implementation have contributed to comprehensive descriptions of implementation. However, corresponding instruments for measuring these comprehensive descriptions are currently lacking. The present study aimed to develop an instrument measuring care providers’ perceptions of an implementation effort, and to explore the instrument’s psychometric properties. METHODS: Based on existing implementation literature, a questionnaire was designed with items on individual and team factors and on stages of change in an implementation process. The instrument was tested in a Norwegian study on implementation of evidence based practices for psychosis. Item analysis, factor structure, and internal consistency at baseline were examined. RESULTS: The 27-item Implementation Process Assessment Tool (IPAT) revealed large variation between mean score of the items. The total scale scores were widely dispersed across respondents. Internal consistency for the total scale was high (Cronbach’s alpha: .962), and all but one item contributed positively to the construct. The results indicated four underlying constructs: individual stages for behavioural change, individual activities and perceived support, collective readiness and support, and individual perceptions of the intervention. CONCLUSIONS: The IPAT appears to be a feasible instrument for investigating the implementation process from the perspective of those making the change. It can enable examination of the relative importance of factors thought to be essential for implementation outcomes. It may also provide ongoing feedback for leaders tailoring support for teams to improve implementation. However, further research is needed to detect the instrument’s properties later in the implementation process and in different contexts. TRIAL REGISTRATION: code NCT03271242 (retrospective registered September 5, 2017).

Optimizing Practices, Use, Care and Services-Antipsychotics (OPUS-AP) in Long-term Care Centers in Québec, Canada: A Strategy for Best Practices.
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B. Cossette, M. A. Bruneau, Y. Couturier, et al.
J Am Med Dir Assoc 2019 Oct 25
Antipsychotic medications are often used for the first-line management of behavioral and psychological symptoms of dementia (BPSD) contrary to guideline recommendations. The Optimizing Practices, Use, Care and Services-Antipsychotics (OPUS-AP) strategy aims to improve the well-being of long-term care (LTC) residents with major neurocognitive disorder (MNCD) by implementing a resident-centered approach, nonpharmacologic interventions, and antipsychotic deprescribing in inappropriate indications. DESIGN: Prospective, closed cohort supplemented by a developmental evaluation. SETTING AND PARTICIPANTS: Residents of designated wards in 24 LTC centers in Quebec, Canada. METHODS: Provincial guidelines were disseminated, followed by the implementation of an integrated knowledge translation and mobilization strategy, including training, coaching, clinical tools, evaluation of clinical practices, and a change management strategy. Antipsychotic, benzodiazepine, and antidepressant prescriptions; BPSD; and falls were evaluated every 3 months, for 9 months, from January to October 2018. Semistructured interviews (n = 20) were conducted with LTC teams to evaluate the implementation of OPUS-AP. RESULTS: Of 1054 residents, 78.3% had an MNCD diagnosis and 51.7% an antipsychotic prescription. The cohort included 464 residents with both MNCD and antipsychotic prescription. Antipsychotic deprescribing (cessation or dose decrease) was attempted in 220 of the 344 residents still admitted at 9 months. Complete cessation was observed in 116 of these residents (52.7%) and dose reduction in 72 (32.7%), for a total of 188 residents (85.5%; 95% confidence interval: 80.1%, 89.8%). A decrease in benzodiazepine prescriptions and improvements in Cohen-Mansfield Agitation Inventory scores were observed among residents who had their antipsychotics deprescribed. Caregivers and clinicians expressed satisfaction as a result of observing an improved quality of life among residents. CONCLUSIONS AND IMPLICATIONS: Antipsychotic deprescribing was successful in a vast majority of LTC residents with MNCD without worsening of BPSD. Based on this success, phase 2 of OPUS-AP is now under way in 129 LTC centers in Quebec.

A framework for cross-cultural development and implementation of complex interventions to improve palliative care in nursing homes: the PACE steps to success programme.
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J. Hockley, K. Froggatt, L. Van den Block, et al.
BMC Health Serv Res 2019 Oct 24;19(1):745-019-4587-y
The PACE Steps to Success programme is a complex educational and development intervention to improve palliative care in nursing homes. Little research has investigated processes in the cross-cultural adaptation and implementation of interventions in palliative care across countries, taking account of differences in health and social care systems, legal and regulatory policies, and cultural norms. This paper describes a framework for the cross-cultural development and support necessary to implement such an intervention, taking the PACE Steps to Success programme as an exemplar. METHODS: The PACE Steps to Success programme was implemented as part of the PACE cluster randomised control trial in seven European countries. A three stage approach was used, a) preparation of resources; b) training in the intervention using a train-the-trainers model; and c) cascading support throughout the implementation. All stages were underpinned by cross-cultural adaptation, including recognising legal and cultural norms, sensitivities and languages. This paper draws upon collated evidence from minutes of international meetings, evaluations of training delivered, interviews with those delivering the intervention in nursing homes and providing and/or receiving support. RESULTS: Seventy eight nursing homes participated in the trial, with half randomized to receive the intervention, 3638 nurses/care assistants were identified at baseline. In each country, 1-3 trainers were selected (total n = 16) to deliver the intervention. A framework was used to guide the cross-cultural adaptation and implementation. Adaptation of three English training resources for different groups of staff consisted of simplification of content, identification of validated implementation tools, a review in 2 nursing homes in each country, and translation into local languages. The same training was provided to all country trainers who cascaded it into intervention nursing homes in local languages, and facilitated it via in-house PACE coordinators. Support was cascaded from country trainers to staff implementing the intervention. CONCLUSIONS: There is little guidance on how to adapt complex interventions developed in one country and language to international contexts. This framework for cross-cultural adaptation and implementation of a complex educational and development intervention may be useful to others seeking to transfer quality improvement initiatives in other contexts.

A four-stage process for intervention description and guide development of a practice-based intervention: refining the Namaste Care intervention implementation specification for people with advanced dementia prior to a feasibility cluster randomised trial.
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C. Walshe, J. Kinley, S. Patel, et al.
BMC Geriatr 2019 Oct 21;19(1):275-019-1275-z
Some interventions are developed from practice, and implemented before evidence of effect is determined, or the intervention is fully specified. An example is Namaste Care, a multi-component intervention for people with advanced dementia, delivered in care home, community, hospital and hospice settings. This paper describes the development of an intervention description, guide and training package to support implementation of Namaste Care within the context of a feasibility trial. This allows fidelity to be determined within the trial, and for intervention users to understand how similar their implementation is to that which was studied. METHODS: A four-stage approach: a) Collating existing intervention materials and drawing from programme theory developed from a realist review to draft an intervention description. b) Exploring readability, comprehensibility and utility with staff who had not experienced Namaste Care. c) Using modified nominal group techniques with those with Namaste Care experience to refine and prioritise the intervention implementation materials. d) Final refinement with a patient and public involvement panel. RESULTS: Eighteen nursing care home staff, one carer, one volunteer and five members of our public involvement panel were involved across the study steps. A 16-page A4 booklet was designed, with flow charts, graphics and colour coded information to ease navigation through the document. This was supplemented by infographics, and a training package. The guide describes the boundaries of the intervention and how to implement it, whilst retaining the flexible spirit of the Namaste Care intervention. CONCLUSIONS: There is little attention paid to how best to specify complex interventions that have already been organically implemented in practice. This four-stage process may have utility for context specific adaptation or description of existing, but untested, interventions. A robust, agreed, intervention and implementation description should enable a high-quality future trial. If an effect is determined, flexible practice implementation should be enabled through having a clear, evidence-based guide.

Impact of the Liverpool Care Pathway on quality end-of- care in residential care homes and home care-Nurses’ perceptions.
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C. Olsson, E. Kling, K. Grundel Persson and M. Larsson.
Nurs Open 2019 Sep 9;6(4):1589-1599
Aim was to describe how Registered Nurses (RNs) and assistant nurses (ANs) working in residential care homes and home care perceived quality end-of-life care after implementation of the Liverpool Care Pathway (LCP) in terms of subjective importance of care aspects and actual care given. Design: Descriptive cross-sectional. Methods: Registered Nurses (N = 22; 100% response rate) and ANs (N = 120; 59% response rate) working in a Swedish municipality. Data collection with a study-specific questionnaire (50 items) about perceived reality (PR) and subjective importance (SI). Non-parametric statistics. Results: Implementation of the LCP ensured systematic assessment and alleviation of patients’ symptoms and needs. The ANs, more than the RNs, perceived that the patients received the best possible nursing and medical care (p = .01). Both groups considered that communication with patients and families as well as the information exchange between the team members was facilitated. Areas for improvement were identified about psychological and existential support and patients and families’ participation in care.

What does it take to scale-up a complex intervention? Lessons learned from the Connect-Home transitional care intervention.
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J. Leeman and M. Toles.
J Adv Nurs 2019 Oct 23
Discuss the multiple phases of research done to plan for wide-scale implementation (i.e., scale-up) of Connect-Home, a complex nurse-develop intervention. Barker et al.’s (2016) framework for intervention scale-up is applied to address the methods used to answer four questions: “Who” needs to be involved in scale-up? “What” intervention and implementation strategies need to be taken to scale? “How” will scale-up be achieved? And what contextual factors influence “when” scale-up is or is not successful? DESIGN: Discussion paper. DATA SOURCES: Data sources include the experience of our research team, supported by literature and theory. The Connect-Home team conducted multiple research studies to plan for Connect-Home scale-up. Early studies (2008-2015) focused on formative work to design the Connect-Home intervention. Recent studies involved successive pilot tests of Connect-Home’s effectiveness, implementation and scale-up (2015-2019). IMPLICATIONS FOR NURSING: This paper describes a systematic approach that nurse researchers can apply to plan for taking their interventions to scale. CONCLUSIONS: Planning for scale-up early in the process of intervention development is essential to speeding the translation of effective interventions into wide-scale practice. IMPACT: This paper details methods that nursing researchers applied to develop and test the strategies needed to plan for taking a complex intervention to scale across multiple settings. The methods described are applicable to nursing and other health researchers’ development and scale-up of any complex intervention.

The “CHROME criteria”: Tool to optimize and audit prescription quality of psychotropic medications in institutionalized people with dementia.
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R. Muniz, A. I. Perez-Wehbe, F. Couto, et al.
Int Psychogeriatr 2019 Oct 22:1-10
Describe and validate the CHROME (CHemical Restraints avOidance MEthodology) criteria. DESIGN: Observational prospective longitudinal study. SETTING: Single nursing home in Las Palmas de Gran Canaria, Spain. PARTICIPANTS: 288 residents; mean age: 81.6 (SD 10.6). 77.4% had dementia. INTERVENTION: Multicomponent training and consultancy program to eliminate physical and chemical restraints and promote overall quality care. Clinicians were trained in stringent diagnostic criteria of neuropsychiatric syndromes and adequate psychotropic prescription. MEASUREMENTS: Psychotropic prescription (primary study target), neuropsychiatric syndromes, physical restraints, falls, and emergency room visits were semi-annually collected from December 2015 to December 2017. Results are presented for all residents and for those who had dementia and participated in the five study waves (completer analysis, n=107). RESULTS: For the study completers, atypical neuroleptic prescription dropped from 42.7% to 18.7%, long half-life benzodiazepines dropped from 25.2% to 6.5%, and hypnotic medications from 47.7% to 12.1% (p<0.0005). Any kind of fall evolved from 67.3 to 32.7 (number of falls by 100 residents per year). Physicians’ diagnostic confidence increased, while the frequency of diagnoses of neuropsychiatric syndromes decreased (p<0.0005). CONCLUSIONS: Implementing the CHROME criteria reduced the prescription of the most dangerous medications in institutionalized people with dementia. Two independent audits found no physical or chemical restraint and confirmed prescription quality of psychotropic drugs. Adequate diagnosis and independent audits appear to be the keys to help and motivate professionals to optimize and reduce the use of psychotropic medication. The CHROME criteria unify, in a single compendium, neuropsychiatric diagnostic criteria, prescription guidelines, independent audit methodology, and minimum legal standards. These criteria can be easily adapted to other countries.

Implementing advance care planning in routine nursing home care: The development of the theory-based ACP+ program.
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J. Gilissen, L. Pivodic, A. Wendrich-van Dael, et al.
PLoS One 2019 Oct 17;14(10):e0223586
While various initiatives have been taken to improve advance care planning in nursing homes, it is difficult to find enough details about interventions to allow comparison, replication and translation into practice. OBJECTIVES: We report on the development and description of the ACP+ program, a multi-component theory-based program that aims to implement advance care planning into routine nursing home care. We aimed to 1) specify how intervention components can be delivered; 2) evaluate the feasibility and acceptability of the program; 3) describe the final program in a standardized manner. DESIGN: To develop and model the intervention, we applied multiple study methods including a literature review, expert discussions and individual and group interviews with nursing home staff and management. We recruited participants through convenience sampling. SETTING AND PARTICIPANTS: Management and staff (n = 17) from five nursing homes in Flanders (Belgium), a multidisciplinary expert group and a palliative care nurse-trainer. METHODS: The work was carried out by means of 1) operationalization of key intervention components-identified as part of a previously developed theory on how advance care planning is expected to lead to its desired outcomes in nursing homes-into specific activities and materials, through expert discussions and review of existing advance care planning programs; 2) evaluation of feasibility and acceptability of the program through interviews with nursing home management and staff and expert revisions; and 3) standardized description of the final program according to the TIDieR checklist. During step 2, we used thematic analysis. RESULTS: The original program with nine key components was expanded to include ten intervention components, 22 activities and 17 materials to support delivery into routine nursing home care. The final ACP+ program includes ongoing training and coaching, management engagement, different roles and responsibilities in organizing advance care planning, conversations, documentation and information transfer, integration of advance care planning into multidisciplinary meetings, auditing, and tailoring to the specific setting. These components are to be implemented stepwise throughout an intervention period. The program involves the entire nursing home workforce. The support of an external trainer decreases as nursing home staff become more autonomous in organizing advance care planning. CONCLUSIONS: The multicomponent ACP+ program involves residents, family, and the different groups of people working in the nursing home. It is deemed feasible and acceptable by nursing home staff and management. The findings presented in this paper, alongside results of the subsequent randomized controlled cluster trial, can facilitate comparison, replicability and translation of the intervention into practice.

Medication-related quality of care in residential aged care: an Australian experience.
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J. B. Hillen, A. Vitry and G. E. Caughey.
Int J Qual Health Care 2019 May 1;31(4):298-306
To describe medication-related quality of care (MRQOC) for Australian aged care residents. DESIGN: Retrospective cohort using an administrative healthcare claims database. SETTING: Australian residential aged care. PARTICIPANTS: A total of 17 672 aged care residents who were alive at 1 January 2013 and had been a permanent resident for at least 3 months. MAIN OUTCOME MEASURES: Overall, 23 evidence-based MRQOC indicators which assessed the use of appropriate medications in chronic disease, exposure to high-risk medications and access to collaborative health services. RESULTS: Key findings included underuse of recommended cardiovascular medications, such as the use of statins in cardiovascular disease (56.1%). Overuse of high-risk medications was detected for medications associated with falls (73.5%), medications with moderate to strong anticholinergic properties (46.1%), benzodiazepines (41.4%) and antipsychotics (33.2%). Collaborative health services such as medication reviews were underutilised (42.6%). CONCLUSION: MRQOC activities in this population should be targeted at monitoring and reducing exposure to antipsychotics and benzodiazepines, improving the use of preventative medications for cardiovascular disease and improving access to collaborative health services. Similarity of suboptimal MRQOC between Australia and other countries (UK, USA, Canada and Belgium) presents an opportunity for an internationally collaborative approach to improving care for aged care residents.

Ratings game: an analysis of Nursing Home Compare and Yelp ratings.
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K. Johari, C. Kellogg, K. Vazquez, K. Irvine, A. Rahman and S. Enguidanos.
BMJ Qual Saf 2018 Aug;27(8):619-624
Two strategies for rating the quality of nursing homes (NHs) in the USA are exemplified by the Nursing Home Compare (NHC) website, launched by the federal Centers for Medicare and Medicaid Services in 1998, and, an online consumer review site that has grown in popularity since its founding in 2004. Both sites feature a 5-star rating system. While much is known about NHC ratings, little is known about NH Yelp ratings. This study examines Yelp ratings for NHs in California and compares these ratings with NHC ratings. Understanding how these ratings relate can inform efforts to empower consumers and enhance NH decision-making. METHODS: We collected NHC and Yelp ratings for all California NHs between September and November 2016. For each NH with a Yelp review, we recorded the star rating and the total number of reviews. We also recorded the NHC 5-star rating and NHC ratings for inspections, staffing and quality measures (QMs). We conducted descriptive statistics and frequencies for these variables. We conducted correlations and tested means to compare the ratings. RESULTS: A total of 675 NHs (68.1% of the total sample of 991 NHs) had both Yelp ratings and NHC ratings. Correlations between the Yelp and NHC ratings were relatively weak. The Yelp rating was significantly lower than the 5-star NHC rating and the NHC ratings for staffing and QMs. It was significantly higher than the NHC inspection rating. CONCLUSIONS: This study found that when consumers rate NHs on Yelp, their ratings differ considerably from NHC ratings, a finding in keeping with similar studies of NH quality measurement. Further research is needed to analyse the content of Yelp reviews and compare the themes and topics consumers identify with those reported on NHC.

Barriers and facilitators to development and implementation of a rural primary health care intervention for dementia: a process evaluation.
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D. Morgan, J. Kosteniuk, M. E. O’Connell, et al.
BMC Health Serv Res 2019 Oct 17;19(1):709-019-4548-5
With rural population aging there are growing numbers of people with dementia in rural and remote settings. The role of primary health care (PHC) is critical in rural locations, yet there is a lack of rural-specific PHC models for dementia, and little is known about factors influencing the development, implementation, and sustainability of rural PHC interventions. Using a community-based participatory research approach, researchers collaborated with a rural PHC team to co-design and implement an evidence-based interdisciplinary rural PHC memory clinic in the Canadian province of Saskatchewan. This paper reports barriers and facilitators to developing, implementing, and sustaining the intervention. METHODS: A qualitative longitudinal process evaluation was conducted over two and half years, from pre- to post-implementation. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) which consists of 38 constructs within five domains: innovation characteristics, outer setting, inner setting, individual characteristics, and process. Data were collected via focus groups with the PHC team and stakeholders, smaller team workgroup meetings, and team member interviews. Analysis was conducted using a deductive approach to apply CFIR codes to the data and an inductive analysis to identify barriers and facilitators. RESULTS: Across all domains, 14 constructs influenced development and implementation. Three domains (innovation characteristics, inner setting, process) were most important. Facilitators were the relative advantage of the intervention, ability to trial on a small scale, tension for change, leadership engagement, availability of resources, education and support from researchers, increased self-efficacy, and engagement of champions. Barriers included the complexity of multiple intervention components, required practice changes, lack of formal incentive programs, time intensiveness of modifying the EMR during iterative development, lack of EMR access by all team members, lack of co-location of team members, workload and busy clinical schedules, inability to justify a designated dementia care manager role, and turnover of PHC team members. CONCLUSIONS: The study identified key factors that supported and hindered the development and implementation of a rural-specific strategy for dementia assessment and management in PHC. Despite challenges related to the rural context, the researcher-academic partnership was successful in developing and implementing the intervention.


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Research Practice and Methodology

‘There’s more to life than money and health’: Family caregivers’ views on the role of Power of Attorney in proxy decisions about research participation for people living with dementia
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V. Shepherd, R. Griffith, K. Hood, M. Sheehan and F. Wood.
Dementia (London) 2019 Oct 25:1471301219884426.
People living with dementia may experience difficulties when making decisions for themselves in the later stages of the condition. While there are mechanisms in England and Wales for appointing an attorney to make decisions about welfare and finances on their behalf, there are no provisions for appointing an attorney to make future decisions about research participation. This is despite a growing focus on Advanced Care Planning and other processes that provide opportunities to discuss future preferences and ensure that decisions are made in line with those preferences. This qualitative study with 15 family caregivers who had acted as research proxies explored the role of Power of Attorney in their decisions about research, and their views about extending current legal arrangements to include research. Five themes were identified: the holistic nature of decision-making; the ‘power’ of attorney; making decisions by putting yourself in their shoes; support for bringing research under the umbrella of attorney arrangements and a unifying theme of trusting relationships. Legal provisions for prospectively appointing a research proxy may encourage discussion about future wishes and so enable decisions about research to be made that are in accordance with the person’s preferences and wishes. However, further consultation with the public including people living with dementia and their families, and a range of stakeholders is needed. Providing guidance to families, people living with dementia and the wider research community may provide greater clarity and improve decision-making in the meantime.

Rewarding Success: Changing the Paradigm of How Research Is Rewarded.
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J. Nadigel and R. Tamblyn.
Healthc Pap 2019 Oct;18(3):41-49
International health system comparisons reveal that Canada ranks poorly in several measures when assessed against comparable countries, despite the fact that billions of dollars are spent on the Canadian healthcare system every year. Canada is among one of the highest spenders on health care, yet value for our investment is not always clear. To sustain Canadian health care, it is essential that innovations and process transformations that improve health outcomes and value for our investment are implemented in the health system. Following the movement of other organizations that are experimenting with innovative models of funding, the Canadian Institutes of Health Research partnered with four Canadian provinces to pilot the Rewarding Success Initiative. This initiative rewards and incentivizes research teams to develop effective partnerships with health system payers and, together, implement innovative solutions in the health system that will enhance value-based care, health system sustainability and health outcomes.

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The Minimum Data Set Agitated and Reactive Behavior Scale: Measuring Behaviors in Nursing Home Residents With Dementia
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Ellen McCreedy, Jessica A. Ogarek, Kali S. Thomas and Vincent Mor.
Journal of the American Medical Directors Association 2019 10/31
Interventions aimed at managing agitated and aggressive behaviors in dementia without the use of antipsychotics are currently being tested in nursing homes (NHs). Researchers and clinicians require a measure that can capture the severity of residents’ behaviors. We test the internal consistency and construct validity of the Agitated and Reactive Behavior Scale (ARBS), a measure created using data from mandatory NH assessments. Design Cross-sectional. Setting and Participants The 2016 national sample of 15,326 Centers for Medicare and Medicaid Services-certified NHs. The analytic sample included 489,854 new admissions and 765,367 long-stay residents (at least 90 days in NH). All participants have a dementia diagnosis. Methods Minimum Data Set (MDS), version 3.0. The ARBS is a composite measure of (1) physical behavioral symptoms directed at other people; (2) verbal behavioral symptoms directed at other people; (3) other behavioral symptoms not directed at other people; and (4) rejection of care. Variables used to establish construct validity included degree of cognitive impairment, use of medications for managing agitation and aggression, and co-occurring conditions associated with agitated and aggressive behaviors (eg, schizophrenia, depression, or delirium). Results This report has 3 important findings: (1) the ARBS score has borderline-adequate internal consistency (α = .64-.71) in the national population NH residents with dementia; (2) only 18% of new admissions and 21% of long-stay residents with dementia evidence any agitated or aggressive behaviors in the last week, as rated in the MDS assessment; and (3) the ARBS demonstrates good construct validity; it increases with cognitive impairment, treatment with relevant medications, and co-occurring psychiatric conditions and symptoms. Discussion Nationally available MDS data may significantly underestimate the prevalence of agitated and aggressive behaviors among NH residents with dementia. Conclusions and Implications Researchers conducting pragmatic trials of non-pharmaceutical interventions to manage behaviors in NH residents with dementia should consider the likely underdetection of these behaviors in the available MDS data.

Transitioning of older Australian women into and through the long-term care system: a cohort study using linked data.
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M. M. Rahman, J. T. Efird and J. E. Byles.
BMC Geriatr 2019 Oct 24;19(1):286-019-1291-z
Over two-thirds of older Australians use different types/levels of aged care at some point in later life. Our aims were to estimate transitional probabilities and to identify risk factors influencing the movement between different levels of long-term care. METHODS: The sample consisted of 9007 women from the 1921-26 birth cohort of the Australian Longitudinal Study on Women’s Health. Transitional probabilities between different levels of long-term care were estimated using a continuous-time Markov model. RESULTS: An 11-fold transition rates ratio was observed for the movement from non-user to home and community care (HACC) versus non-user to residential aged care (RAC). The predicted probabilities of remaining in the non-user state, HACC, and RAC after 10 years from the baseline were .28, .24, and .11, respectively. While the corresponding probabilities of dying from these states were .36, .65, and .90. The risk of transitioning from the non-user state to either HACC or RAC was greater for participants who were older at baseline, widowed, living outside of major cities, having difficulties in managing income, or having chronic condition, poor/fair self-rated health, or lower SF-36 scores (p < .05). CONCLUSION: Women spend a substantial period of their later life using long-term care. Typically, this will be in the community setting with a low level of care. The transition to either HACC or RAC was associated with several demographic and health-related factors. Our findings are important for the planning and improvement of long-term care among future generations of older people. TRIAL REGISTRATION: Not applicable.

Texture modified diet in German nursing homes: availability, best practices and association with nursing home characteristics.
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C. Burger, E. Kiesswetter, R. Alber, U. Pfannes, U. Arens-Azevedo and D. Volkert.
BMC Geriatr 2019 Oct 23;19(1):284-019-1286-9
For nursing home (NH) residents with swallowing or chewing problems, appealing texture-modified-diets (TMD) need to be available in order to support adequate nutrition. The aim of this study was to describe the availability of TMD and best practices for TMD in German NHs and to identify related NH characteristics. METHODS: Information on NH characteristics, available texture-modified (TM)-levels (soft, “minced & moist”, pureed) and implemented best practices for TMD (derived from menu plan, separately visible components, re-shaped components, considering individual capabilities of the resident) was collected in a survey in German NHs. The number of TM-levels as well as the number of best practices for TMD were tested for their association with 4 structural, 16 operational and 3 resident-related NH characteristics. RESULTS: The response rate was 7.2% (n = 590) and 563 NHs were included. The vast majority of NHs (95.2%) reported offering “minced & moist” texture and 84.2% preparing separately visible meal components. Several operational characteristics were more frequently (p < 0.05) reported from NHs offering three TM-levels (27.7%) or four best practices for TMD (13.0%) compared to NHs offering one TM-level (28.4%) or one best practice for TMD (20.1%): special diets and delivery forms (e.g. fingerfood 71.2% vs 38.8%; 80.8% vs. 44.3%), written recipes (69.9% vs. 53.1%; 68.5% vs. 53.9%), a dietetic counseling service (85.9% vs. 66.3%; 89.0% vs. 65.2%), a quality circle for nutritional care (66.7% vs. 43.8%; 71.2% vs. 50.4%), regular staff training (89.7% vs. 73.1%; 95.9% vs. 74.8%) and process instructions (73.7% vs. 53.1%; 75.3% vs. 47.8%). No associations were found regarding structural and resident-related NH characteristics, except a higher percentage of residents receiving TMD in NHs with three compared to one TM-level (median 16.3% vs. 13.2%, p = 0.037). CONCLUSION: All participating NHs offer some form of TMD, but only a small number offers a selection of TMD and pays adequate attention to its preparation. Operational NH characteristics – which might reflect a general nutritional awareness of the NH – seem to be pivotal for provision of TMD, whereas neither structural nor resident-related characteristics seem to play a role in this regard.

Psychometric properties of the geriatric quality of life-dementia in older adults with dementia or mild cognitive impairment living in nursing homes.
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E. Y. Park, S. M. Park and J. H. Kim.
BMC Geriatr 2019 Oct 22;19(1):281-019-1307-8
Given the theoretical and methodological limitations, there is insufficient knowledge about the psychometric properties and internal structure of quality of life (QOL) measurements for patients with dementia living in nursing homes. The present study aimed to confirm the validity and reliability of the Geriatric Quality of Life-Dementia scale (GQOL-D) to measure the QOL of patients with dementia in nursing homes and analyze their QOL based on the validated GQOL-D factor structure. METHODS: The GQOL-D was used to assess QOL. A convenience sampling method was used to recruit patients with dementia or mild cognitive impairment from six nursing homes in two cities. In order to confirm the validity and factor structure of the scale, both exploratory factor analysis and confirmatory factor analysis were employed. An independent t-test and a one-way analysis of variance were performed to examine the difference in the QOL across general characteristics. RESULTS: The original factor model was not appropriate to assess the QOL of dementia patients living in nursing homes because the models did not show adequate fit indices. The results support a two-factor structure: environmental and personal factors. Our findings suggest that the internal consistency and construct validity of the proposed two-factor model are adequate, and the GQOL-D is a useful tool for assessing the QOL of dementia patients living in nursing homes. CONCLUSIONS: This factor structure model of environmental and personal aspects is a useful theoretical framework for designing and evaluating interventions for people with dementia and providing integrated person-centered care for people with dementia in nursing homes.

Associations of dry skin, skin care habits, well-being, sleep quality and itch in nursing home residents: Results of a multicentre, observational, cross-sectional study.
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E. Hahnel, U. Blume-Peytavi and J. Kottner.
Nurs Open 2019 Jul 25;6(4):1501-1509
Dry skin is one of the most frequent cutaneous problems in aged long-term care residents. Although it is clinically relevant, the impact on quality of life is unclear. The objective was to measure well-being, sleep quality and itch in nursing home residents being 65 years and older and to explore possible associations with demographics, dry skin and skincare habits. Design: Multicentre, observational, cross-sectional. Methods: Sleep quality was assessed with the Richards-Campbell Sleep Quality Questionnaire, well-being with the WHO-Five Well-being Index and itch with the 5-D Itch scale. Skin dryness was measured using the Overall Dry Skin score. Results: A total of 51 residents were included. The item scores of the sleep quality and itch questionnaires were strongly associated with each other. Demographics, dry skin and skincare habits were not associated with the questionnaires. It is unclear whether basic skincare activities can improve the quality of life in this population.

Being an institutionalized elderly person: meaning of experiences based on Heidegger’s phenomenology.
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C. C. A. Reis, T. M. O. Menezes, A. V. D. S. Freitas, L. C. Pedreira, R. A. Freitas and I. B. Pires.
Rev Bras Enferm 2019 Oct 21;72(6):1632-1638
Analyze the meaning of being an elderly person living in a long-term institution. METHOD: Qualitative study based on Martin Heidegger’s thought. Twelve phenomenological interviews were conducted with people aged over 60 years living in a long-term institution for the elderly in the city of Itabuna, Bahia, Brazil. RESULTS: The units of meaning identified were: experience of progressive loss of autonomy and independence, perception of living in an institution as an inevitable circumstance; and being-with becoming being-alone/being-lonely. After the identification of ontic aspects and hermeneutical understanding, the unit of meaning was constructed: meaning of being an elderly person living in a long-term institution. FINAL CONSIDERATIONS: The ontological needs referring to being an elderly person remain forgotten. As we are ontic and ontological, limited care to the ontic instance indicates deficiencies in institutionalization. Improvements are required to ensure the right to age with quality of life to this population.

Effects of Whole-Body Vibration on Functional Mobility, Balance, Gait Strength, and Quality of Life in Institutionalized Older People: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.
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F. Alvarez-Barbosa, J. Del Pozo-Cruz, B. Del Pozo-Cruz, A. Garcia-Hermoso and R. M. Alfonso-Rosa.
J Aging Phys Act 2019 Oct 17:1-12
The aim of this study was to quantify the effect of whole-body vibration on balance, functional mobility, gait, functional performance, and quality of life in institutionalized older people. Eight databases were systematically reviewed, as recommended by the Cochrane Collaboration. This systematic review was designed to answer the acronym set by the participants, interventions, comparators, and outcomes (PICO)-model. Ten randomized controlled trials were included in the meta-analysis. The analysis of the mean differences (MDs) of the functional mobility assessed with Time Up and Go test was MD = -2.49 s (95% confidence interval, CI, [-4.37, -0.61]; I2 = 68%). In 279 participants from five studies, the overall MD = 0.49 (95% CI [-0.13, 1.11]; I2 = 23%) for gait, and MD = 0.96 (95% CI [-0.45, 2.37]; I2 = 85%) for balance, which represents the total Tinetti score, MD = 1.59 (95% CI [-0.52, 3.70]; I2 = 82%). In summary, whole-body vibration could have benefits on functional mobility in institutionalized older people.

Measuring health-related quality of life of care home residents, comparison of self-report with staff proxy responses for EQ-5D-5L and HowRu: protocol for assessing proxy reliability in care home outcome testing.
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A. Usman, S. Lewis, K. Hinsliff-Smith, et al.
BMJ Open 2018 Aug 17;8(8):e022127-2018-022127
Research into interventions to improve health and well-being for older people living in care homes is increasingly common. Health-related quality of life (HRQoL) is frequently used as an outcome measure, but collecting both self-reported and proxy HRQoL measures is challenging in this setting. This study will investigate the reliability of UK care home staff as proxy respondents for the EQ-5D-5L and HowRu measures. METHODS AND ANALYSIS: This is a prospective cohort study of a subpopulation of care home residents recruited to the larger Proactive Healthcare for Older People in Care Homes (PEACH) study. It will recruit residents >/=60 years across 24 care homes and not receiving short stay or respite care. The sample size is 160 participants. Resident and care home staff proxy EQ-5D-5L and HowRu responses will be collected monthly for 3 months. Weighted kappa statistics and intraclass correlation adjusted for clustering at the care home level will be used to measure agreement between resident and proxy responses. The extent to which staff variables (gender, age group, length of time caring, role, how well they know the resident, length of time working in care homes and in specialist gerontological practice) influence the level of agreement between self-reported and proxy responses will be considered using a multilevel mixed-effect regression model. ETHICS AND DISSEMINATION: The PEACH study protocol was reviewed by the UK Health Research Authority and University of Nottingham Research Ethics Committee and was determined to be a service development project. We will publish this study in a peer-reviewed journal with international readership and disseminate it through relevant national stakeholder networks and specialist societies.

Meeting the social and emotional support needs of older people using aged care services (Australia)

The Health Services Union (HSU) and United Voice
October 2019
Aged care services touch the lives of substantial – and increasing – numbers of people. Yet the capacity of service systems to meet older people’s needs, and to do so at standards acceptable to the Australian community, remains under question, subject to several major inquiries in recent years including the current Royal Commission into Aged Care Quality and Safety.
Recognising that the community expects aged care services to deliver supports which go beyond basic physical care, this project explored: the ways current aged care arrangements and processes of care work attend to older people’s social and emotional needs; and the policy, regulatory and organisational arrangements which would more effectively ensure provision of quality, whole-of-person care.


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Events & Training Opportunities

Webinar: To Sell or Scale-Up: Canada’s Patent Strategy in a Knowledge Economy

Tuesday 12 November 11:00-12:00 MT
Presenters: IRPP, Nancy Gallini, Aiden Hollis
Canadian innovators tend to transfer or sell their intellectual property to foreign entities rather than continue to develop their patented technologies and commercialize them. But in doing so, they lose the opportunity to scale up and profit from the innovations they pioneered. In this webinar, Nancy Gallini and Aiden Hollis, authors of a recent study on the topic for the IRPP, share their analysis of this growing trend, looking at 20 years of patent invention and ownership by Canadians. Why is this happening? The authors discuss economic and institutional factors behind the patterns they have uncovered and examine the implications for Canada’s innovation policy.

CIHR Summer Program in Aging Longitudinal Studies on Aging: Understanding Health Span and Longevity

7-12 June 2020 at the Hockley Valley Resort, approximately one hour north of Toronto, ON
Graduate students and postdoctoral fellows either working with or interested in learning more about research related to the area of longitudinal studies in aging are encouraged to apply. Trainees will have the opportunity to participate in advanced training that crosses disciplines and brings together trainees, researchers, and members of the public and private sector from Canada and abroad. The program will feature internationally renowned guest speakers, and networking opportunities will be offered throughout the week. The program is expected to be launched in January 2020 on CIHR’s ResearchNet. More information will be available in the coming weeks.

Webinar: Policy Interventions to Improve Hospital Nurse Staffing

Wednesday 6 November 10L00-11:00 MT
Presenter: Linda H. Aiken
A strong evidence base shows that better nurse staffing is associated with better patient outcomes. The International Council of Nurses (ICN) recently concluded that the evidence is sufficient for action to be taken to implement evidence-based staffing in hospitals globally. In this webinar, Dr. Linda Aiken, an international expert on the outcomes of safe nurse staffing, shares new research results from Penn Nursing’s Center for Health Outcomes and Policy Research evaluating the impact and outcomes of interventions to improve nurse staffing in the U.S. and abroad, and discusses how future interventions should be organized to enable rigorous research on their impact.

Webinar: Creation of a data analyst team (MyCHILD ALBERTA) to facilitate the evaluation of KT and Quality Projects

Thursday 14 November 10:00-11:00 MT
Presenter: David Johnson
Learning objectives:
1. Understand that extraction of data from electronic medical records is complex and not straight forward,
2. Learn about ‘late binding’ approach to creating data repositories,
3. Learn about potential for patient-level costing data to improve value-for-money.

Online Course: Intro to systematic reviews and meta-analysis

6 January-3 April 2020
Instructors: Andrea Tricco & Sharon Straus
DEADLINE to apply: 13 December
The overall course objective is to teach about systematic reviews in general, as well as how to go about doing a systematic review.It is recommended that students conduct a systematic review while taking this course, as the information provided will help guide the systematic review process.Topics include:
How to formulate a review question
How to develop a review protocol
How to abstract data
How to appraise the quality of studies
How to perform a meta-analysis

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How to Engage Patients & Public in Health Research Tool

This interactive online engagement methods tool is designed to help research teams plan appropriate activities for their patient and public engagement strategy. The tool is and always will be completely free and publicly available to health researchers, patients, caregivers, families, communities, health consumer organizations, policy-makers, and anyone interested in learning more about participatory approaches.

The Policy Brief: A Tool for Knowledge Transfer

The policy brief is a knowledge transfer tool that has increasingly been used in recent years as a way to inform or influence public policy decisions.
Because policy briefs are designated by a variety of terms (e.g.: policy note, research snapshot, etc.) and prepared in various formats, it can be difficult to determine how to go about writing one. What exactly is it? What criteria should be met to produce a high quality document? Which writing guides are of interest?
This document is intended to assist knowledge producers in writing a policy brief based on research evidence.
The first two sections describe the characteristics of a policy brief, its components and the elements that should be considered to maximize its potential. The final section presents a selection of resources to guide readers who wish to pursue further knowledge.
The information presented is based on the recommendations included in the guides reviewed (2008-2018), as well as on studies of experimentation with different models of policy briefs and research on factors that support or limit the extent to which policy makers take evidence into account.

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