December 3, 2019

Calls for Abstracts
Events & Training Opportunities


TREC Research in the headlines
Caring for caregivers should be top priority

Laura Aloisio and Carole Estabrooks
More than 220,000 Canadians currently reside in a nursing home or long-term care facility, with the number projected to increase steadily as the Canadian population ages. This may include our parents, other relatives or friends, and it could include us too.

Unfortunately, staffing shortages have become a perpetual concern for long-term care facilities across the country. Projections indicate this staffing crisis will only increase as more Canadians enter long-term care facilities without enough trained professionals to care for them.

New TREC article
If we cannot measure it, we cannot improve it: Understanding measurement problems in routine oral/dental assessments in Canadian nursing homes-Part I.
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M. Hoben, M. N. Yoon, L. Lu and C. A. Estabrooks.
Gerodontology 2019 Nov 27
To compare Resident Assessment Instrument-Minimum Data Set 2.0 (RAI) oral/dental items collected by nursing home (NH) care staff to (a) assessments collected by trained research assistants (RAs) and (b) “gold standard” clinical assessments by dental hygienists (DHs). BACKGROUND: Routine collection of RAI oral/dental items is mandatory in most Canadian NHs. However, the performance of these items is less than optimal and oral/dental problems are severely under-reported. Accurate assessment is a prerequisite for preventing, detecting and treating oral health problems. Not knowing the reasons for performance problems is a barrier to improving performance of the RAI oral/dental items. MATERIALS AND METHODS: We included 103 NH residents from 4 NHs in Edmonton, Alberta, Canada. Using Kappa statistics, we compared the agreement of residents’ last (no older than 90 days) RAI assessment with RAI assessments completed by trained RAs and “gold standard” clinical assessments by DHs. We also assessed the inter-rater reliability (IRR) of RA and DH assessments. RESULTS: Care staff assessments had poor agreement with RA and DH assessments (Kappa 0.7) for most items. CONCLUSIONS: The quality of RAI oral/dental assessments can be improved by better training care staff and ensuring appropriate time to do the assessments. However, remaining problems-even with trained RAs-suggest that rewording some of the items or supplementing them by more robust tools may be required.

New article by Greta Cummings
Factors Associated With Mortality Among Long-term Care Residents Transitioning To And From Emergency Departments

Kaitlyn C. Tate, Colin Reid, Patrick McLane, Garnet E. Cummings, Brian H. Rowe and Greta G. Cummings.
Innovation in Aging 2019 11/08;3:S821-S821
Studies examining risk of death during acute care transitions have highlighted potential predictors of death during transition. However, they have not closely examined the relationships and directional effects of organizational context, care processes, resident demographics and health conditions on death during transition. By employing structural equation modeling, we aimed to 1) identify predictive factors for residents who died during transitions from long term care (LTC) to emergency departments (EDs) and back; 2) examine relationships between identified organizational, process and resident factors with resident death during these transitions; and 3) identify areas for further investigation and improvement in practice. We tracked every resident transfer from 38 participating LTC facilities to two included EDs in two Western Canadian provinces from July 2011 to July 2012. Overall, 524 residents were involved in 637 transfers of whom 63 residents (12%) died during the transition. Sustained dyspnea (in both LTC and the ED), sustained change in level of consciousness (LOC) and severity measured by triage score were direct and significant predictors of resident death during transition. The model fit the data, (x2 = 83.77, df = 64, p = 0.049) and explained 15% variance in resident death. Dyspnea and change in LOC in both LTC and ED needs to be recognized regardless of primary reason for transfer. More research is needed to determine the specific influences of LTC ownership models, family involvement in decision-making, LTC staff decision-making on resident death during transition, and interventions to prevent pre-death transfers.

Calls for Abstracts

2020 KT Canada Scientific Meeting

7-8 May, Ottawa ON
DEADLINE 5 January 2020
The theme is ‘Advancing the science of ethics, intersectionality, and knowledge translation’.

Call for Content: 2020 Canadian Knowledge Mobilization Forum

8-9 June, Halifax NS
The Canadian Knowledge Mobilization Forum was created in 2012 as a professional development forum for practitioners and professionals working in knowledge mobilization across fields and sectors.


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Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Organizational Culture and Change
Research Practice and Methodology


The pitfalls of scaling up evidence-based interventions in health.
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H. T. V. Zomahoun, A. Ben Charif, A. Freitas, et al.
Glob Health Action 2019;12(1):1670449
Policy-makers worldwide are increasingly interested in scaling up evidence-based interventions (EBIs) to larger populations, and implementation scientists are developing frameworks and methodologies for achieving this. But scaling-up does not always produce the desired results. Why not? We aimed to enhance awareness of the various pitfalls to be anticipated when planning scale-up. In lower- and middle-income countries (LMICs), the scale-up of health programs to prevent or respond to outbreaks of communicable diseases has been occurring for many decades. In high-income countries, there is new interest in the scaling up of interventions that address communicable and non-communicable diseases alike. We scanned the literature worldwide on problems encountered when implementing scale-up plans revealed a number of potential pitfalls that we discuss in this paper. We identified and discussed the following six major pitfalls of scaling-up EBIs: 1) the cost-effectiveness estimation pitfall, i.e. accurate cost-effectiveness estimates about real-world implementation are almost impossible, making predictions of economies of scale unreliable; 2) the health inequities pitfall, i.e. some people will necessarily be left out and therefore not benefit from the scaled-up EBIs; 3) the scaled-up harm pitfall, i.e. the harms as well as the benefits may be amplified by the scaling-up; 4) the ethical pitfall, i.e. informed consent may be a challenge on a grander scale; 5) the top-down pitfall, i.e. the needs, preferences and culture of end-users may be forgotten when scale-up is directed from above; and 6) the contextual pitfall, i.e. it may not be possible to adapt the EBIs to every context. If its pitfalls are addressed head on, scaling-up may be a powerful process for translating research data into practical improvements in healthcare in both LMICs and high-income countries, ensuring that more people benefit from EBIs.

Improving Evidence-Based Oral Health of Nursing Home Residents Through Coaching by Dental Hygienists.
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L. Volk, M. Spock, P. D. Sloane and S. Zimmerman.
J Am Med Dir Assoc 2019 Nov 25
Good oral hygiene has an impact on the overall health of residents in long-term care; however, significant improvement is needed in nursing homes. A “boots on the ground” project was developed that incorporates Mouth Care without a Battle, an evidence-based approach to person-centered daily mouth care, into 22 New York State nursing homes using a coaching model with part-time dental hygienists. This report discusses implementation of the quality improvement project, which improved the quality of daily mouth care provided to nursing home residents, as well as changed the knowledge and attitudes of the staff providing their care, all supported by regional dental hygienist coaches.

‘Buddy Pairs’: A novel pilot scheme crafting knowledge exchange between biomedical dementia researchers and people affected by dementia – Innovative practice.
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L. Kennedy, H. Wilkinson and C. Henstridge.
Dementia (London) 2019 Nov 12:1471301219885543.
The ‘Buddy Pairs’ pilot project, launched at the University of Edinburgh, created opportunities for people affected by dementia (people living with a diagnosis and care partners) and dementia lab researchers to participate in knowledge exchange conversations through experiential lab tours. The primary aims were to raise awareness and understanding of current dementia research and its practices, as well as allow biomedical researchers to learn about the lived experiences and research concerns of those affected by dementia. This scheme found success by flipping normative ‘speaker-audience’ communication set-ups and foregrounding the expertise held by, and communication needs of, people affected by dementia.

Exploring the frontiers of research co-production: the Integrated Knowledge Translation Research Network concept papers.
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I. D. Graham, C. McCutcheon and A. Kothari.
Health Res Policy Syst 2019 Nov 25;17(1):88-019-0501-7
Research co-production is about doing research with those who use it. This approach to research has been receiving increasing attention from research funders, academic institutions, researchers and even the public as a means of optimising the relevance, usefulness, usability and use of research findings, which together, the argument goes, produces greater and more timely impact. The papers in this cross BMC journal collection raise issues about research co-production that, to date, have not been fully considered and suggest areas for future research for advancing the science and practice of research co-production. These papers address some gaps in the literature, make connections between subfields and provide varied perspectives from researchers and knowledge users.


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Health Care Administration and Organization

Unfinished Care in Residential Aged Care Facilities: An Integrative Review.
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K. Ludlow, K. Churruca, V. Mumford, et al.
Gerontologist 2019 Nov 27
When workload demands are greater than available time and resources, staff members must prioritize care by degree of importance and urgency. Care tasks assigned a lower priority may be missed, rationed, or delayed; collectively referred to as “unfinished care.” Residential aged care facilities (RACFs) are susceptible to unfinished care due to consumers’ complex needs, workforce composition, and constraints placed on resource availability. The objectives of this integrative review were to investigate the current state of knowledge of unfinished care in RACFs and to identify knowledge gaps. RESEARCH DESIGN AND METHODS: We conducted a search of academic databases and included English-language, peer-reviewed, empirical journal articles that discussed unfinished care in RACFs. Data were synthesized using mind mapping techniques and frequency counts, resulting in two categorization frameworks. RESULTS: We identified 17 core studies and 27 informing studies (n = 44). Across core studies, 32 types of unfinished care were organized under five categories: personal care, mobility, person-centeredness, medical and health care, and general care processes. We classified 50 factors associated with unfinished care under seven categories: staff member characteristics, staff member well-being, resident characteristics, interactions, resources, the work environment, and delivery of care activities. DISCUSSION AND IMPLICATIONS: This review signifies that unfinished care in RACFs is a diverse concept in terms of types of unfinished care, associated factors, and terminology. Our findings suggest that policymakers and providers could reduce unfinished care by focusing on modifiable factors such as staffing levels. Four key knowledge gaps were identified to direct future research.

What constitutes patient-centred care for women:
a theoretical rapid review.

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J. U. Ramlakhan, A. M. Foster, S. L. Grace, C. R. Green, D. E. Stewart and A. R. Gagliardi.
Int J Equity Health 2019 Nov 26;18(1):182-019-1048-5
Women experience disparities in health care delivery and outcomes. Patient-centred care for women (PCCW) is needed. This study examined how PCC has been conceptualized and operationalized in women’s health research. METHODS: We conducted a theoretical rapid review of PCCW in MEDLINE, EMBASE, CINAHL and SCOPUS from 2008 to 2018 for studies involving women aged 18 years or greater with any condition, and analyzed data using an established 6-domain framework of patient-centred communication. RESULTS: We included 39 studies, which covered the following clinical areas: maternal care, cancer, diabetes, HIV, endometriosis, dementia, distal radius fracture, overactive bladder, and lupus erythematosus. The 34 (87.2%) studies that defined or described PCC varied in the PCC elements they addressed, and none addressed all 6 PCC domains. Common domains were exchanging information (25, 73.5%) and fostering the patient-clinician relationship (22, 64.7%). Fewer studies addressed making decisions (16, 47.1%), enabling patient self-management (15, 44.1%), responding to emotions (12, 35.3%), or managing uncertainty (1, 2.9%). Compared with mixed-gender studies, those comprised largely of women more frequently prioritized exchanging information above other domains. Few studies tested strategies to support PCCW or evaluated the impact of PCCW; those that did demonstrated beneficial impact on patient knowledge, satisfaction, well-being, self-care and clinical outcomes. CONCLUSIONS: Studies varied in how they conceptualized PCCW, and in many it was defined narrowly. Few studies examined how to implement or measure PCCW; thus, we lack insight on how to operationlize PCCW. Thus, further research is needed to confirm this, and whether PCCW differs across conditions, knowledge needed to inform policies, guidelines and measures aimed at improving health care and associated outcomes for women.

Perspectives of residents and staff regarding food choice in residential aged care: A qualitative study.
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D. Wang, B. Everett, S. Brunero, T. Northall, A. R. Villarosa and Y. Salamonson.
J Clin Nurs 2019 Nov 26
To explore the experiences of food choice and meal service in residential aged care facilities and its impact on autonomy, self-determination and quality of life from the perspectives of both residents and staff. BACKGROUND: Globally, residential aged care (RAC) is a principal provider of care for older people who can no longer live independently at home. Within this setting, lack of food choice has been identified as a significant factor impacting on residents’ self-determination, sense of autonomy and quality of life (QoL). DESIGN: This study used an exploratory descriptive qualitative approach guided by Self-Determination Theory. METHOD: A total of 14 participants (seven residents and seven staff members) from two Australian RAC facilities were recruited through purposive and snowball sampling with assistance from one independent contact nurse at each facility. In depth, semi-structured interviews were conducted, digitally recorded and transcribed. The COREQ checklist was used in this qualitative study. RESULTS: Three main themes were identified from the interview data provided by residents and staff, which were: 1) Catering for the masses; 2) Organisational barriers to providing choice; 3) Food impacts wellbeing. CONCLUSIONS: This study explored the experiences of food choice and service in RAC facilities, from the perspectives of both residents and staff. Results of interviews highlighted the importance of providing adequate food choice which has become an enduring issue that requires more attention and commitment to make a positive change for residents living in RAC facilities. RELEVANCE TO CLINICAL PRACTICE: Nurses and other staff working in RAC facilities need to be aware of the importance of providing adequate food choice, including for residents who require modified diets. As advocates for residents, nursing staff must address the persistent lack of food choice. However, this will require a radical change in organisational culture and strong leadership.

Palliative care nurse specialists’ reflections on a palliative care educational intervention in long-term care: an inductive content analysis.
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R. Frey, D. Balmer, M. Boyd, J. Robinson and M. Gott.
BMC Palliat Care 2019 Nov 19;18(1):103-019-0488-4
Older people in long-term care facilities are at a greater risk of receiving care at the end of life that does not adequately meet their needs, yet staff in long-term care are often unprepared to provide palliative care. The objective of the study was to explore palliative care nurse specialists’ experiences regarding the benefits of and barriers to the implementation of a palliative care educational intervention, Supportive Hospice Aged Residential Exchange (SHARE) in 20 long-term care facilities. METHODS: Reflective logs (465), recorded over the course of the yearlong SHARE intervention by the three palliative care nurse specialists from two local hospices, who were the on-site mentors, were qualitatively analyzed by two researchers utilizing inductive content analysis. RESULTS: Categories emerging from the logs include the importance of relationships, knowledge exchange, communication, and the challenges of providing palliative care in a long-term care setting. CONCLUSION: Evidence from the logs indicated that sustained relationships between the palliative care nurse specialists and staff (registered nurses, healthcare assistants) as well as reciprocal learning were key factors supporting the implementation of this palliative care educational intervention. Challenges remain however in relation to staffing levels, which further emphasizes the importance of palliative care nurse specialist presence as a point of stability.

Slow Nursing and Its Holistic Place in Dementia Care: A Secondary Analysis of Qualitative Data From Nurses Working in Nursing Homes.
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D. Lillekroken.
Holist Nurs Pract 2020 Jan/Feb;34(1):40-48
Despite a growing body of research literature within dementia care, research concerning how to provide holistic quality care and its benefit for people with dementia is still scarce. In this study, a secondary analysis of original qualitative data from a former study was employed. Findings demonstrated that slow nursing embodies a holistic caring approach, which may improve the care quality provided to people with dementia. The current findings also provide key knowledge that may contribute to nursing research and education.

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Health Care Innovation and Quality Assurance

Review of 128 quality of care mechanisms: A framework and mapping for health system steward
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Juan E. Tello, Erica Barbazza and Kerry Waddell.
Health Policy 2019 11/23
Health system stewards have the critical task to identify quality of care deficiencies and resolve underlying system limitations. Despite a growing evidence-base on the effectiveness of certain mechanisms for improving quality of care, frameworks to facilitate the oversight function of stewards and the use of mechanisms to improve outcomes remain underdeveloped. This review set out to catalogue a wide range of quality of care mechanisms and evidence on their effectiveness, and to map these in a framework along two dimensions: (i) governance subfunctions; and (ii) targets of quality of care mechanisms. To identify quality of care mechanisms, a series of searches were run in Health Systems Evidence and PubMed. Additional grey literature was reviewed. A total of 128 quality of care mechanisms were identified. For each mechanism, searches were carried out for systematic reviews on their effectiveness. These findings were mapped in the framework defined. The mapping illustrates the range and evidence for mechanisms varies and is more developed for some target areas such as the health workforce. Across the governance sub-functions, more mechanisms and with evidence of effectiveness are found for setting priorities and standards and organizing and monitoring for action. This framework can support system stewards to map the quality of care mechanisms used in their systems and to uncover opportunities for optimization backed by systems thinking.

Small is beautiful? Explaining resident satisfaction in Swedish nursing home care.
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D. Spangler, P. Blomqvist, Y. Lindberg and U. Winblad.
BMC Health Serv Res 2019 Nov 25;19(1):886-019-4694-9
Resident satisfaction is an important aspect of nursing home quality. Despite this, few studies have systematically investigated what aspects of nursing home care are most strongly associated with satisfaction. In Sweden, a large number of processual and structural measures are collected to describe the quality of nursing home care, though the impact of these measures on outcomes including resident satisfaction is poorly understood. METHODS: A cross-sectional analysis of data collected in two nationally representative surveys of Swedish eldercare quality using multi-level models to account for geographic differences. RESULTS: Of the factors examined, nursing home size was found to be the most important predictor of resident satisfaction, followed by the amount of exercise and activities offered by the nursing home. Measures of individualized care processes, ownership status, staffing ratios, and staff education levels were also weakly associated with resident satisfaction. Contrary to previous research, we found no clear differences between processual and structural variables in terms of their association with resident satisfaction. CONCLUSIONS: The results suggest that of the investigated aspects of nursing home care, the size of the nursing home and the amount activities offered to residents were the strongest predictors of satisfaction. Investigation of the mechanisms behind the higher levels of satisfaction found at smaller nursing homes may be a fruitful avenue for further research.

Reducing Psychotropic Drug Use in Nursing Homes in Belgium: An Implementation Study for the Roll-Out of a Practice Improvement Initiative.
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M. Wauters, M. Elseviers, L. Peeters, D. De Meester, T. Christiaens and M. Petrovic.
Drugs Aging 2019 Aug;36(8):769-780
Psychotropic drug use is high in nursing homes in Belgium. A practice improvement initiative (including education, professional support and the transition towards person-centred care) achieved significant reductions in psychotropic drug use. The initiative outline was transcribed into a general intervention template, and consequently implemented in five nursing homes (in mixed locations and with a mixed character) in preparation for a future broader roll-out in Belgium. The impact of the intervention on the use of psychotropic drugs in these five nursing homes is reported in this paper. METHODS: The general intervention template was fitted into the individual nursing home setting. Education for the nursing home personnel on psychotropic drugs and non-pharmacological alternatives, as well as details for a transition to person-centred care was provided. Psychotropic drug use was recorded using a dynamic cohort study design with cross-sectional observations (November 2016-November 2017). RESULTS: At baseline, participants’ (n = 677) mean age was 85.6 years (range 54-109 years), with 72.6% female. Mean medication intake was 8.5 (range 1-22), predominantly central nervous system drugs (Anatomic Therapeutic Chemical classification N, 88.8%). Long-term (> 3 months) psychotropic drug use (62.0%) and concomitant psychotropic drug use (31.5% taking two or more medications) were high. After 12 months, the prevalence of long-term psychotropic drug use decreased significantly (from 62.0 to 52.9%, p < 0.001), likewise the combined use of psychotropic drugs (from 31.5 to 24.0%, p = 0.001). The decrease in the prevalence of antidepressant and hypnosedative use was significant (respectively, from 32.2 to 23.4%, p < 0.001, and from 35.3 to 28.7%, p = 0.006) in contrast to antipsychotic use (from 17.1 to 15.9%, p = 0.522). CONCLUSIONS: The stand-alone adaptation of the previously reported initiative using a general template was possible. This intervention resulted in a significant decrease in psychotropic drug use (predominantly hypnosedatives and antidepressants) among nursing home residents after 12 months.

Make it complicated: a qualitative study utilizing a complexity framework to explain improvement in health care.
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M. H. Storkholm, P. Mazzocato and C. Savage.
BMC Health Serv Res 2019 Nov 14;19(1):842-019-4705-x
Successful application of Quality Improvement (QI) methods is challenging, and awareness of the role context plays has increased. Complexity science has been advocated as a way to inform change efforts. However, empirical support is scarce, and it is still difficult to grasp the practical implications for QI interventions. The aim of this study was to use a complexity-based leadership framework to explain how managers in a clinical department addressed external requirements to cut costs without compromising patient outcomes and experience. METHODS: Explanatory case study design of a Danish OB/GYN department tasked to improve efficiency. Data came from documents, 30 interviews, and 250 h of observations over 3 years. A Complexity Analysis Framework that combined two complexity-based leadership frameworks was developed to analyze all changes implemented to reduce cost, while maintaining clinical quality. RESULTS: Managers reframed the efficiency requirement as an opportunity for quality improvement. Multiple simple, complicated, and complex situations were addressed with an adaptive approach to quality improvement. Changes were made to clinical pathways for individual conditions (n = 37), multiple conditions (n = 7), and at the organizational level (n = 9). At the organizational level, changes addressed referral practice, physical space in the department, flow and capacity, discharge speed, and managerial support. Managers shared responsibility with staff; together they took a “professional path” and systematically analyzed each clinical pathway through process mapping, attentive to patterns that emerged, before deciding on the next steps, such as a engaging in a complex process of probing – the iterative development and testing of new responses. CONCLUSIONS: Quality improvement efforts could benefit from an understanding of the importance of learning and sharing responsibility to deal with the co-existing degrees of contextual complexity in modern health care. By “making things complicated” through a systematic analysis that engages staff in an open and reflective dialog, clinical praxis and established organizational structures can be questioned and improved. The Complexity Analysis Framework could then help managers to identify improvement opportunities, know when to implement technical solutions, and when to keep abreast of emerging patterns and allow appropriate responses to complex challenges to evolve.


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Organizational Culture and Change

Organisational factors that facilitate research use in public health policy-making: a scoping review.
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M. W. Jakobsen, L. Eklund Karlsson, T. Skovgaard and A. R. Aro.
Health Res Policy Syst 2019 Nov 21;17(1):90-019-0490-6
Although important syntheses and theoretical works exist in relation to understanding the organisational factors that facilitate research use, these contributions differ in their scope and object of study as well as their theoretical underpinnings. Therefore, from an exploratory angle, it may be useful to map out the current literature on organisational factors of research use in public health policy-making when revisiting existing theories and frameworks to gain further theoretical insights. METHODS: Herein, a scoping review technique and thematic content analysis were used to bring together findings from both synthesised and empirical studies of different types to map out the organisational factors that facilitate research use in public health policy-making. RESULTS: A total of 14 reviews and 40 empirical studies were included in the analysis. These were thematically coded and the intra-organisational factors reported as enabling research use were examined. Five main categories of organisational factors that advance research use in policy organisations – (1) individual factors, (2) the management of research integration, (3) organisational systems and infrastructures of research use, (4) institutional structures and rules for policy-making, and (5) organisational characteristics – were derived as well as 18 subcategories and a total of 64 specific factors, where 27 factors were well supported by research. CONCLUSIONS: Using a scoping review methodology, the intra-organisational factors influencing research use in policy-making (including individual factors) were systematically mapped and the theories applied in this area of research were assessed. The review findings confirm the importance of an intra-organisational perspective when exploring research use, showing that many organisational factors are critical facilitators of research use but also that many factors and mechanisms are understudied. The synthesis shows a lack of studies on politicians and the need for more theoretically founded research. Despite increased efforts to update the existing evidential and theoretical basis of research use, we still need frameworks that combine different approaches and theories to help us grasp the complex organisational mechanisms that facilitate research use in policy settings.

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Research Practice and Methodology

Experience of Health Leadership in Partnering With University-Based Researchers in Canada – A Call to “Re-imagine” Research.
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S. Bowen, I. Botting, I. D. Graham, et al.
Int J Health Policy Manag 2019 Dec 1;8(12):684-699
Emerging evidence that meaningful relationships with knowledge users are a key predictor of research use has led to promotion of partnership approaches to health research. However, little is known about health system experiences of collaborations with university-based researchers, particularly with research partnerships in the area of health system design and health service organization. The purpose of the study was to explore the experience and perspectives of senior health managers in health service organizations, with health organization-university research partnerships. METHODS: In-depth, semi-structured interviews (n = 25) were conducted with senior health personnel across Canada to explore their perspectives on health system research; experiences with health organization-university research partnerships; challenges to partnership research; and suggested actions for improving engagement with knowledge users and promoting research utilization. Participants, recruited from organizations with regional responsibilities, were responsible for system-wide planning and support functions. RESULTS: Research is often experienced as unhelpful or irrelevant to decision-making by many within the system. Research, quality improvement (QI) and evaluation are often viewed as separate activities and coordinated by different responsibility areas. Perspectives of senior managers on barriers to partnership differed from those identified in the literature: organizational stress and restructuring, and limitations in readiness of researchers to work in the fast-paced healthcare environment, were identified as major barriers. Although the need for strong executive leadership was emphasized, “multi-system action” is needed for effective partnerships. CONCLUSION: Common approaches to research and knowledge translation are often not appropriate for addressing issues of health service design and health services organization. Nor is the research community providing expertise to many important activities that the healthcare system is taking to improve health services. A radical rethinking of how we prepare health service researchers; position research within the health system; and fund research activities and infrastructure is needed if the potential benefits of research are to be achieved. Lack of response to health system needs may contribute to research and ‘evidence-informed’ practice being further marginalized from healthcare operations. Interventions to address barriers must respond to the perspectives and experience of health leadership.

Organisational change in hospitals: a qualitative case-study of staff perspectives.
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C. Pomare, K. Churruca, J. C. Long, L. A. Ellis and J. Braithwaite.
BMC Health Serv Res 2019 Nov 14;19(1):840-019-4704-y
Organisational change in health systems is common. Success is often tied to the actors involved, including their awareness of the change, personal engagement and ownership of it. In many health systems, one of the most common changes we are witnessing is the redevelopment of long-standing hospitals. However, we know little about how hospital staff understand and experience such potentially far-reaching organisational change. The purpose of this study is to explore the understanding and experiences of hospital staff in the early stages of organisational change, using a hospital redevelopment in Sydney, Australia as a case study. METHODS: Semi-structured interviews were conducted with 46 clinical and non-clinical staff working at a large metropolitan hospital. Hospital staff were moving into a new building, not moving, or had moved into a different building two years prior. Questions asked staff about their level of awareness of the upcoming redevelopment and their experiences in the early stage of this change. Qualitative data were analysed using thematic analysis. RESULTS: Some staff expressed apprehension and held negative expectations regarding the organisational change. Concerns included inadequate staffing and potential for collaboration breakdown due to new layout of workspaces. These fears were compounded by current experiences of feeling uninformed about the change, as well as feelings of being fatigued and under-staffed in the constantly changing hospital environment. Nevertheless, balancing this, many staff reported positive expectations regarding the benefits to patients of the change and the potential for staff to adapt in the face of this change. CONCLUSIONS: The results of this study suggest that it is important to understand prospectively how actors involved make sense of organisational change, in order to potentially assuage concerns and alleviate negative expectations. Throughout the processes of organisational change, such as a hospital redevelopment, staff need to be engaged, adequately informed, trained, and to feel supported by management. The use of champions of varying professions and lead departments, may be useful to address concerns, adequately inform, and promote a sense of engagement among staff.

Assessing the accuracy of machine-assisted abstract screening with DistillerAI: a user study.
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G. Gartlehner, G. Wagner, L. Lux, et al.
Syst Rev 2019 Nov 15;8(1):277-019-1221-3
Web applications that employ natural language processing technologies to support systematic reviewers during abstract screening have become more common. The goal of our project was to conduct a case study to explore a screening approach that temporarily replaces a human screener with a semi-automated screening tool. METHODS: We evaluated the accuracy of the approach using DistillerAI as a semi-automated screening tool. A published comparative effectiveness review served as the reference standard. Five teams of professional systematic reviewers screened the same 2472 abstracts in parallel. Each team trained DistillerAI with 300 randomly selected abstracts that the team screened dually. For all remaining abstracts, DistillerAI replaced one human screener and provided predictions about the relevance of records. A single reviewer also screened all remaining abstracts. A second human screener resolved conflicts between the single reviewer and DistillerAI. We compared the decisions of the machine-assisted approach, single-reviewer screening, and screening with DistillerAI alone against the reference standard. RESULTS: The combined sensitivity of the machine-assisted screening approach across the five screening teams was 78% (95% confidence interval [CI], 66 to 90%), and the combined specificity was 95% (95% CI, 92 to 97%). By comparison, the sensitivity of single-reviewer screening was similar (78%; 95% CI, 66 to 89%); however, the sensitivity of DistillerAI alone was substantially worse (14%; 95% CI, 0 to 31%) than that of the machine-assisted screening approach. Specificities for single-reviewer screening and DistillerAI were 94% (95% CI, 91 to 97%) and 98% (95% CI, 97 to 100%), respectively. Machine-assisted screening and single-reviewer screening had similar areas under the curve (0.87 and 0.86, respectively); by contrast, the area under the curve for DistillerAI alone was just slightly better than chance (0.56). The interrater agreement between human screeners and DistillerAI with a prevalence-adjusted kappa was 0.85 (95% CI, 0.84 to 0.86%). CONCLUSIONS: The accuracy of DistillerAI is not yet adequate to replace a human screener temporarily during abstract screening for systematic reviews. Rapid reviews, which do not require detecting the totality of the relevant evidence, may find semi-automation tools to have greater utility than traditional systematic reviews.

Performance and usability of machine learning for screening in systematic reviews: a comparative evaluation of three tools.
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A. Gates, S. Guitard, J. Pillay, et al.
Syst Rev 2019 Nov 15;8(1):278-019-1222-2
We explored the performance of three machine learning tools designed to facilitate title and abstract screening in systematic reviews (SRs) when used to (a) eliminate irrelevant records (automated simulation) and (b) complement the work of a single reviewer (semi-automated simulation). We evaluated user experiences for each tool. METHODS: We subjected three SRs to two retrospective screening simulations. In each tool (Abstrackr, DistillerSR, RobotAnalyst), we screened a 200-record training set and downloaded the predicted relevance of the remaining records. We calculated the proportion missed and workload and time savings compared to dual independent screening. To test user experiences, eight research staff tried each tool and completed a survey. RESULTS: Using Abstrackr, DistillerSR, and RobotAnalyst, respectively, the median (range) proportion missed was 5 (0 to 28) percent, 97 (96 to 100) percent, and 70 (23 to 100) percent for the automated simulation and 1 (0 to 2) percent, 2 (0 to 7) percent, and 2 (0 to 4) percent for the semi-automated simulation. The median (range) workload savings was 90 (82 to 93) percent, 99 (98 to 99) percent, and 85 (85 to 88) percent for the automated simulation and 40 (32 to 43) percent, 49 (48 to 49) percent, and 35 (34 to 38) percent for the semi-automated simulation. The median (range) time savings was 154 (91 to 183), 185 (95 to 201), and 157 (86 to 172) hours for the automated simulation and 61 (42 to 82), 92 (46 to 100), and 64 (37 to 71) hours for the semi-automated simulation. Abstrackr identified 33-90% of records missed by a single reviewer. RobotAnalyst performed less well and DistillerSR provided no relative advantage. User experiences depended on user friendliness, qualities of the user interface, features and functions, trustworthiness, ease and speed of obtaining predictions, and practicality of the export file(s). CONCLUSIONS: The workload savings afforded in the automated simulation came with increased risk of missing relevant records. Supplementing a single reviewer’s decisions with relevance predictions (semi-automated simulation) sometimes reduced the proportion missed, but performance varied by tool and SR. Designing tools based on reviewers’ self-identified preferences may improve their compatibility with present workflows. SYSTEMATIC REVIEW REGISTRATION: Not applicable.

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Effect of the Geriatric Emergency Department Intervention on outcomes of care for residents of aged care facilities: A non-randomised trial.
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E. Marsden, A. Taylor, M. Wallis, et al.
Emerg Med Australas 2019 Nov 26
As the population of Australia ages, EDs will experience an increasing frequency of presentations of older adults from residential aged care facilities (RACFs). These presentations are often complex and time consuming in the chaotic and potentially hazardous ED environment. The Geriatric Emergency Department Intervention (GEDI) model was developed to optimise the care of frail older adults, especially RACF residents, in the ED. The aim of the present study was to evaluate the effectiveness of the GEDI model on the primary outcomes of disposition (admission, discharge or death) and ED length of stay for residents of RACFs, presenting to an ED in regional Queensland, Australia. METHODS: GEDI is a nurse-led, physician-championed, innovative model delivered by advanced practice nurses with expertise in gerontology. This quasi-experimental pragmatic study compared outcomes for RACF residents who presented to a regional Queensland ED during three time periods: pre-GEDI, interim GEDI and post-GEDI implementation of the GEDI model. Outcomes included disposition, ED length of stay, ED re-presentation and mortality. RESULTS: A significant increase in the likelihood of discharge from ED (hazard ratio 1.15, 95% confidence interval 1.05-1.26) and reductions in ED length of stay (hazard ratio 1.49, 95% confidence interval 1.24-1.78) were evident for RACF residents following the implementation of the GEDI intervention. There were no differences in mortality, ED re-presentation or in-hospital length of stay between the three time periods. CONCLUSION: There is a paucity of evidence to support the implementation of nurse-led teams in EDs designed to target older adults living in RACFs. The GEDI model was effective in reducing ED length of stay while increasing the likelihood of safe discharge for RACF residents.

Illuminating Meanings of Thriving for Persons Living in Nursing Homes.
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R. Baxter, P. O. Sandman, S. Bjork, Q. Lood and D. Edvardsson.
Gerontologist 2019 Nov 27
Thriving has been described as a multidimensional concept that can be used to explore place-related well-being; however, there has been limited research into the meaning of thriving in aged care. This study aimed to illuminate meanings of thriving as narrated by persons living in nursing homes. RESEARCH DESIGN AND METHODS: Narrative interviews were conducted with 21 persons residing in a rural Australian nursing home. The interviews were audio-recorded, transcribed, and interpreted using a phenomenological hermeneutic approach. RESULTS: Meanings of thriving could be understood as: Striving toward acceptance of being in a nursing home while maintaining a positive outlook; Feeling supported and cared for while maintaining a sense of independence; Balancing opportunities for solitude and company while living with others; and, Feeling a sense of home while residing in an institutional environment. The meanings of thriving, as presented through the interpretive lens of Gaston Bachelard’s “Poetics of Space,” encompassed having access to literal, metaphorical, and symbolic doors, as well as having the freedom to open, close, and use these doors however the person wishes. DISCUSSION: Exploring meanings of thriving in nursing homes could contribute towards understanding and implementing positive life-world constructs in research and practice. These findings could be used to inform and enhance person-centered care practices by maximizing opportunities for persons residing in nursing homes to have options and choices, and the agency to make decisions where possible, in relation to their everyday care and living environment.

Does a High-Energy High-Protein Diet Reduce Unintentional Weight Loss in Residential Aged Care Residents?
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L. Sossen, M. Bonham and J. Porter.
J Nutr Gerontol Geriatr 2019 Nov 26:1-13
Malnutrition and unintentional weight loss are known to occur in residential aged care facilities (RACFs). The use of oral nutritional supplements (ONS) and high-energy high-protein (HEHP) diets are two foodservice strategies that may be implemented in efforts to reduce unintentional weight loss in RACFs. This observational study aimed to determine whether incorporation of a structured high-energy high-protein diet (sHEHP) into the standard menu could reduce unintentional weight loss in RACF residents. RACFs in this study were facilities that provide long-term care to older adult residents. Weight change, body mass index and subjective global assessment scores of participants were measured at baseline and at six months across five RACFs receiving usual care with ONS or a sHEHP diet. Groups were different at baseline, with a high prevalence of severe malnutrition observed in the ONS group. Over the six-month period, there was a small but statistically significant difference in weight change within the groups: -1.64 +/- 3.62 kg, ONS group; 0.56 +/- 2.76 kg, sHEHP group, P = 0.0004. Both approaches investigated are feasible, however, future research using high-quality methods is needed to determine the most effective approach to deliver best practice nutrition care for residents into the future.

Strategies to prevent dehydration in older people with dementia: a literature review.
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K. Wilson and J. Dewing.
Nurs Older People 2019 Nov 26
Dehydration is prevalent in hospitalised older people and residents in care homes, and older people with dementia are particularly at risk. A literature review was conducted to determine the evidence-based interventions used to prevent and manage dehydration in older people with dementia. Three databases were searched for relevant literature: Applied Social Sciences Index and Abstracts, Cumulative Index to Nursing and Allied Health Literature, and MEDLINE, alongside hand-searching. In-depth reading of the 12 studies included in this literature review was undertaken. Five themes were identified in relation to the hydration of older people: physical and social environment; staff communication strategies; access to drinks; drinking vessels; and individual preferences. The evidence suggests that dehydration in older people with dementia is an ongoing concern that needs to be addressed. There is evidence supporting the use of essential nursing interventions to improve hydration, such as coloured cups and verbal prompts, but less is known about the barriers preventing nurses from implementing these evidence-based interventions.

Construction and Validation of Risk-adjusted Rates of Emergency Department Visits for Long-Stay Nursing Home Residents.
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H. Xu, J. R. Bowblis, Y. Li, T. V. Caprio and O. Intrator.
Med Care 2019 Nov 15
Long-stay nursing home (NH) residents are at high risk of having emergency department (ED) visits, but current knowledge regarding risk-adjusted ED rates is limited. OBJECTIVES: To construct and validate 3 quarterly risk-adjusted rates of long-stay residents’ ED use: any ED visit, ED visits without hospitalization or observation stay (outpatient ED), and potentially avoidable ED visits (PAED). RESEARCH DESIGN: The authors calculated quarterly NH risk-adjusted ED rates from 2011 Q2 to 2013 Q3 national Medicare claims and Minimum Data Set data. Using random-effect linear regressions, the authors validated these rates against Nursing Home Compare overall 5-star quality ratings and examined their associations with hospitalization rates to provide a quality context. SUBJECTS: Resident-quarter observations (7.3 million) from 15,235 unique NHs. RESULTS: Risk-adjusted rates of any ED, outpatient ED, and PAED averaged 9.7%, 3.4%, and 3.2%, respectively. Compared with NHs with 1 or 2 stars overall rating, NHs with >/=3 stars were significantly associated with lower rates of any ED visit, outpatient ED, and PAED (beta, -0.23%, -0.16%, and -0.11%, respectively; all P<0.01). Pearson Correlation coefficients between hospitalization rates and rates of any ED visit, outpatient ED, and PAED were 0.74, 0.31, and 0.46, respectively. CONCLUSIONS: The moderately negative associations of 5-star ratings with ED rates provide supportive evidence to their validity. Outpatient ED and PAED were moderately correlated to hospitalizations suggesting they provided more information about quality than any ED.

A cluster-randomized crossover trial of Montessori activities delivered by family carers to nursing home residents with behavioral and psychological symptoms of dementia.
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L. Mbakile-Mahlanza, E. S. van der Ploeg, L. Busija, C. Camp, H. Walker and D. W. O’Connor.
Int Psychogeriatr 2019 Nov 25:1-12
One-on-one structured Montessori-based activities conducted with people with dementia can improve agitation and enhance engagement. These activities may however not always be implemented by nursing home staff. Family members may present an untapped resource for enabling these activities. This study aimed to evaluate the impact of the Montessori activities implemented by family members on visitation experiences with people who have dementia. DESIGN: Cluster-randomized crossover design. SETTING: General and psychogeriatric nursing homes in the state of Victoria, Australia. PARTICIPANTS: Forty participants (20 residents and 20 carers) were recruited. INTERVENTION: During visits, family members interacted with their relative either through engaging in Montessori-based activities or reading a newspaper (the control condition) for four 30-minute sessions over 2 weeks. MEASUREMENTS: Residents’ predominant affect and engagement were rated for each 30-second interval using the Philadelphia Geriatric Center Affect Rating Scale and the Menorah Park Engagement Scale. The Pearlin Mastery Scale was used to rate carers satisfaction with visits. The 15-item Mutuality Scale measured the carers quality of their relationship with the resident. Carers’ mood and overall quality of life were measured using the Center for Epidemiological Studies Depression Scale and Carer-QoL questionnaires, respectively. RESULTS: Linear regressions within the generalized estimating equations approach assessed residents’ and carers’ outcomes. Relative to the control condition, the Montessori condition resulted in more positive engagement (b = 13.0, 95%CI 6.3-19.7, p < 0.001) and affect (b = 0.4, 95%CI 0.2-0.6, p < 0.001) for the residents and higher satisfaction with visits for carers (b = 1.7, 95%CI 0.45-3.00, p = 0.008). No correction was applied to p-values for multiple comparisons. CONCLUSION: This study strengthens the evidence base for the use of the Montessori programs in increasing well-being in nursing home residents. The findings also provide evidence that family members are an additional valuable resource in implementing structured activities such as the Montessori program with residents.

Challenges and needs of informal caregivers in elderly care: Qualitative research in four European countries, the TRACE project.
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E. Akgun-Citak, S. Attepe-Ozden, A. Vaskelyte, et al.
Arch Gerontol Geriatr 2019 Nov 5;87:103971
Providing informal care may affects caregivers’ life in different ways. Determining the needs of caregivers and supporting them can improve both the quality of life of the caregivers, as well as the elderly they take care of. OBJECTIVE: To explore the experiences and needs of the informal caregivers in four countries. DESIGN: Qualitative research method was used in the study. METHODS: The qualitative data was collected through focus groups and individual interviews between December 2016-May 2017. In all countries interviews were conducted in the mother language of the informants. Informants of the qualitative research were adult people who take primary care of an individual with chronic diseases, aged 65 years or older. Data were collected from 72 informal caregivers from four European countries. Inductive content analysis was performed. RESULTS: Informal caregivers identified 2 themes, 5 subthemes, 19 categories and 7 subtcategories. The themes highlighted two major issues: informal caregiver’s challenges and needs related to the management of care of elderly and caregivers’ personal needs. CONCLUSION: The important and charming results of the present study are, difficulties of managing caregiver’s own life, and coping with emotions are common in four countries. Identifying challenges and needs of informal caregivers enable healthcare professionals to develop care strategies and plan interventions focused to support and help to reduce the burden of care for elderly with chronic diseases.

Being the next of kin of an older person living in a nursing home: an interview study about quality of life.
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H. Rosen, L. Behm, B. Wallerstedt and G. Ahlstrom.
BMC Geriatr 2019 Nov 21;19(1):324-019-1343-4
The length of stay in nursing homes before death in Sweden has significantly decreased, and nearly one-third of people die within 6 weeks of entering a nursing home. Support for the next of kin is one of the cornerstones of palliative care, but the principles are not always adhered to as recommended when caring for the elderly, which can affect the quality of life of their next of kin. The aim of this study was to explore the experiences of quality of life among the next of kin of older persons who live in nursing homes before an educational intervention of palliative care. METHODS: This is an explorative qualitative interview study with 40 next of kin using qualitative content analysis performed at baseline before the implementation of the principles of palliative care in nursing homes. RESULTS: The next of kin’s experiences of quality of life were expressed in three themes: Orientation to the new life situation, Challenges in their relationship and the Significance of the quality of care in the nursing home. The next of kin experienced a sense of relief, although the older person was constantly on their minds, and they could feel lonely. The difference in the couple’slife situations was experienced as burdensome by the next of kin. The challenges in the relationship were described as stressful, related to a guilty conscience and the older person’s vulnerability. The nursing home could be a context facilitating good relations. The perceptions of quality of care in terms of person-centredness affected the quality of life of the next of kin. CONCLUSIONS: The findings show that four factors are decisive for the quality of life of next of kin: the relationships within the family, the degree of relief that nursing home care entails as compared to home care, the older person’s health status and whether the care is person-centred. Increased knowledge and education regarding palliative care in nursing homes are needed to better meet the needs of next of kin. Implementation of palliative care should take into account the need for support for next of kin. TRIAL REGISTRATION: NCT02708498, 15 March 2016.

Oral health care for patients with Alzheimer’s disease: An update.
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L. Marchini, R. Ettinger, T. Caprio and A. Jucan.
Spec Care Dentist 2019 May;39(3):262-273
Alzheimer’s disease and related disorders (ADRD) are among the age-associated chronic conditions that are most challenging to health care systems around the globe, as patients with dementia require full-time, intensive care for multiple years. Oral health care is negatively impacted by cognitive decline, and consequently poor oral health is common among people with ADRD. Poor oral health status is linked with many undesirable consequences for the well-being of people with ADRD, from excruciating local pain to life-threatening conditions, as aspiration pneumonia. In this paper, the authors provide an update on the most current concepts about Alzheimer’s disease epidemiology, etiology, and management, current oral health care for patients with Alzheimer’s disease, oral health promotion strategies for this population, as well as current research and future direction for improving oral health care for patients with Alzheimer’s disease. It concludes that oral health care should be included in the patient’s routine health care as early as possible in the progression of Alzheimer’s disease for preventing rapid oral health deterioration. Establishing oral hygiene routines and providing dental treatment that is customized to the patients’ individual needs and disease stage are important to achieve good oral health outcomes and prevent quality of life decline.

Older Men’s Definitions of Frailty – The Manitoba Follow-up Study.
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P. D. St John, S. S. McClement, A. U. Swift and R. B. Tate.
Can J Aging 2019 Mar;38(1):13-20
There is little empirical research into lay definitions of frailty. OBJECTIVES: (1) To explore the definitions of frailty among older men, and (2) to explore if these definitions match commonly used clinical definitions of frailty. METHODS: Analysis of open-ended questions to survey data from a prospective cohort study of older airmen. The definitions of frailty were elicited, and grouped according to themes. RESULTS: 147 men responded (mean age: 93). There was considerable heterogeneity in older men’s’ definitions of frailty, and no theme of frailty was predominant. The most common theme was impairment in activities of daily living. Older men’s’ definition of frailty was not consistent with any commonly used medical theory of frailty. CONCLUSIONS: Most older men think frailty is important, but their definitions are not consistent. Frailty may be a heterogeneous experience, which different people experience differently.

The Positive Effects of Viewing Gardens for Persons with Dementia.
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S. Goto, X. Shen, M. Sun, Y. Hamano and K. Herrup.
J Alzheimers Dis 2018;66(4):1705-1720
Dementia is highly prevalent among the worldwide elderly population. Only a small number of the currently marketed drugs are effective in controlling its symptoms, and none has any effect on its progression. Further, as the condition advances, even these pharmaceuticals lose their efficiency, and new research into interventions that might improve the life quality of patients at the end stage of dementia and their families is increasingly rare. In our previous studies, we explored the benefits of exposure to nature, in the form of a Japanese garden, for persons with advanced dementia. In the current work, we extended our observations to two new locations and a new set of subjects with a different ethnic composition with the goal of identifying interventions that might improve their quality of life. We found that, even in these new settings, garden observation not only relieved physiological stress, it improved qualitative measures such as verbalization and memory retrieval. We present data that viewing the garden is a holistic experience rather a solely visual stimulus. Our new data further support the conclusion that garden observation is worth including in the care planning schedule of advanced dementia patients. Its low cost and easy availability make it an economical adjunct to current pharmacological methods that has the potential to improve the quality of life of people with dementia.

Altering the boundaries of everyday life in a nursing home context.
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M. Mondaca, S. Josephsson, L. Borell, A. Katz and L. Rosenberg.
Scand J Occup Ther 2019 Oct;26(6):441-451
Despite global and local policy frameworks that explicitly aim to privilege participation and active engagement of older adults living in nursing homes, this group often has limited possibilities to engage in occupations and to have influence in their everyday lives. AIM: To explore how older adults’ engagement and influence in an occupation can emerge in everyday life in a nursing home setting. MATERIAL AND METHODS: A participatory qualitative approach was applied. Older adults living in a nursing home participated in a Book Club that was created collaboratively between researchers, residents, and the nursing home community. FINDINGS: The analysis identified qualities of altering the boundaries of everyday life and addressing the uncertain conditions for influence and engagement as processes actualized by the residents when engaging in the Book Club. Further analysis identified how these processes involved ordinariness, familiarity, fellowship, and connectedness. CONCLUSION AND SIGNIFICANCE: Engagement and influence in occupation in a nursing home is possible when enabling partnerships and resourcefulness among the residents. However, such enablement is not guaranteed and needs to be actively upheld by the nursing home community in order to build practices aligned with policy frameworks of participation.

Effects of dog-assisted intervention on quality of life in nursing home residents with dementia.
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A. Karefjard and L. Nordgren.
Scand J Occup Ther 2019 Oct;26(6):433-440
People with dementia often have a poor quality of life. Therefore, methods that can improve their life situation must be identified. One promising method is dog-assisted intervention. AIM: This study aimed to investigate the effects of dog-assisted intervention on quality of life in nursing home residents with dementia. MATERIALS AND METHODS: A one-group, pretest post-test study design was used. Quality of life was measured using the QUALID in 59 nursing home residents prior to and after a dog-assisted intervention. Non-parametric tests were used to analyze the data, and effect sizes were calculated. RESULTS: The participants’ total scores improved significantly between baseline and post-test 1 (p = < 0.001) and worsened significantly at post-test 2 (p = 0.025). The largest effect size was found for the item ‘Verbalization suggests discomfort’ (p = 0.001). CONCLUSION: The results indicate that dog-assisted interventions can have positive effects on quality of life in nursing home residents with moderate to severe dementia. SIGNIFICANCE: The results contribute to a growing knowledge base about non-pharmacological methods that can be used in dementia care. Occupational therapists should consider dog-assisted interventions when planning activities that can reduce the illness burden and improve the quality of life for people with dementia.

How people with dementia perceive a therapeutic robot called PARO in relation to their pain and mood: A qualitative study.
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L. Pu, W. Moyle and C. Jones.
J Clin Nurs 2019 Nov 18
Interacting with social robots, such as the robotic seal PARO, has been shown to improve mood and acute pain for people with dementia. Little attention has been paid to the effect of PARO on people with dementia and chronic pain. OBJECTIVE: To explore how people with mild to moderate dementia and chronic pain perceive PARO as an alternative intervention to manage their pain and mood. DESIGN: A descriptive qualitative approach nested within a pilot randomised controlled trial. METHODS: Participants with dementia and chronic pain were recruited from three residential aged care facilities. They interacted with PARO for 30 min, five days a week over a six-week period. A sample of 11 participants completed individual semi-structured interviews at the end of the intervention. Data were collected from January 2018 to January 2019. Inductive thematic analysis was undertaken. Reporting of findings followed the COREQ checklist. RESULTS: Four themes emerged from the data: (1) Perceptions of PARO; (2) Therapeutic effects of PARO; (3) Limitations of PARO; and (4) Program improvement. Residents with dementia expressed positive attitudes towards the use of PARO and acknowledged the therapeutic benefits of PARO on mood improvement and relaxation for pain relief but also mentioned the limitations of its weight, voice and characteristics. Residents’ responses could also fluctuate during the intervention process, and individual preferences need to be considered. CONCLUSIONS: The PARO intervention is a promising intervention to improve positive emotion and there is some anecdotal evidence that pain may be decreased from the perspectives of people living with chronic pain and dementia. RELEVANCE TO CLINICAL PRACTICE: Long-term care staff may incorporate PARO therapy into daily dementia care. Understanding of individual’s preferences may enhance the implementation of PARO for pain management in this group.

Using frailty and quality of life measures in clinical care of the elderly in Canada to predict death, nursing home transfer and hospitalisation – the frailty and ageing cohort study.
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T. Rosenberg, P. Montgomery, V. Hay and R. Lattimer.
BMJ Open 2019 Nov 12;9(11):e032712-2019-032712
To assess the value of using frailty measures in primary care for predicting death, nursing home transfer (NHT) and hospital admission. DESIGN: Cohort study. SETTING AND PARTICIPANTS: All 380 people, mean age 88.4, living in the community and receiving home-based primary geriatric care from one practice in Victoria, Canada. INTERVENTIONS/MEASUREMENTS: A 60 min baseline assessment which included: Clinical Frailty Scale (CFS), EuroQol EQ-5D-5L (EQ-5D), EuroQol Visual Analogue Scale (EQ-VAS) and Gait Speed (Gaitspeed). OUTCOMES: Death, NHT and hospital admission. RESULTS: During 18 months of follow-up, there were 39 (10.3%) deaths, 48 (12.6%) NHTs and 93 (24.5%) individuals admitted to hospital. All three outcomes were predicted by: CFS Level 6+7/4+5 (HR death 5.92, 95% CI 3.12 to 11.22, NHT 6.00, 95% CI 3.37 to 10.66 and hospital admission 2.92, 95% CI 1.93 to 4.40); EQ-5D Quintile 1/Quintile 5 (death 6.26, 95% CI 2.11 to 18.62; NHT 3.18, 95% CI 1.29 to 7.82 and hospital admission 2.94, 95% CI 1.47 to 5.87); EQ-VAS Q1/Q5 (death 7.0, 95% CI 2.34 to 20.93; NHT 3.38, 95% CI 1.22 to 9.35 and hospital admission 6.69, 95% CI 3.20 to 13.99) and Gaitspeed (death 5.87, 95% CI 1.78 to 19.34; NHT 8.51, 95% CI 3.18 to 22.79 and hospital admission 11.05, 95% CI 5.45 to 22.40). Medical diagnoses, multiple comorbidities and polypharmacy were weaker predictors of these outcomes. Cox regression analyses showed CFS (adjusted HR 2.88, 95% CI 1.23 to 6.68), EQ-VAS (0.96, 95% CI 0.93 to 0.98), estimated glomerular filtration rate (0.97, 95% CI 0.95 to 1.00) and haemoglobin (0.97, 95% CI 0.94 to 0.99) were independently associated with death. Gaitspeed (0.13, 95% CI 0.03 to 0.57), Geriatric Depression Scale (1.39, 95% CI 1.07 to 1.82) and dementia diagnosis (4.61, 95% CI 1.86 to 11.44) were associated with NHT. Only CFS (1.75, 95% CI 1.21 to 2.51) and EQ-VAS (0.98, 95% CI 0.96 to 0.99) were associated with hospital admission. No other diagnoses, polypharmacy nor multiple comorbidities predicted these outcomes. CONCLUSIONS: For elderly people, standardised simple measures of frailty and health status were stronger predictors of death, NHT and hospital admission than medical diagnoses. Consideration should be given to adding these measures into usual medical care for this age group.

A review of coronial investigations into medication-related deaths in residential aged care.
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N. Jokanovic, N. Ferrah, J. J. Lovell, et al.
Res Social Adm Pharm 2019 Apr;15(4):410-416
Residential aged care is a complex and challenging clinical setting where medication errors continue to occur despite efforts to improve medication safety. No studies have sought to review and synthesize coronial investigations into medication-related deaths in Australian residential aged care facilities (RACFs). OBJECTIVE: To review coronial investigations into medication-related deaths in Australian RACFs. METHODS: A national review of medication-related deaths between July 2000 and July 2013 reported to Australian Coroners was performed. Data were extracted from the National Coronial Information System and errors categorized according to stages of the medication management cycle. RESULTS: The database search identified thirty coronial investigations into deaths. Single medication classes were implicated in 22 deaths; including opioids (n=7), antipsychotics (n=4) and antidepressants (n=3). Eight deaths resulted from two or more medication classes. Thirteen deaths reported stages of medication errors, including administration (n=9) and monitoring (n=4). Coroners made recommendations following three deaths; including education and training on dose administration aids, regulation of personal care workers, and protocol-based renal function monitoring for residents taking digoxin. CONCLUSIONS: Deaths involving high-risk medications occurred primarily at the stages of administration and monitoring. Few investigations resulted in specific recommendations, however it is unknown whether these were implemented.

Modifiable factors associated with neuropsychiatric symptoms in nursing homes: The impact of unmet needs and psychotropic drugs.
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A. R. Ferreira, M. R. Simoes, E. Moreira, J. Guedes and L. Fernandes.
Arch Gerontol Geriatr 2020 Jan – Feb;86:103919
This study aimed to explore neuropsychiatric symptoms’ (NPS) risk factors in a sample of nursing home residents. METHODS: A cross-sectional study was conducted. Residents over 65 years were included, unless they had a known major psychiatric diagnosis. The Neuropsychiatric Inventory (NPI) was completed, and other measures included residents’ sociodemographic characteristics, cognition, functional impairment, regular drugs and number of needs. To explore potential risk factors, a logistic regression was conducted with the presence of NPS (NPI-10>/=1) as dependent variable. Additional exploratory analyses were conducted based on a sub-syndrome approach, and three multivariate models were repeated considering the psychotic, affective and behaviour syndromes as dependent variables. RESULTS: A total of 140 residents were included (age: 83.71+/-7.29 years). More than half (50.4%) presented at least one NPS. NPI-10 showed significant correlations with cognition (rs=-0.177, p=0.042), functional impairment (rs=0.174, p=0.043), unmet needs (rs=0.245, p=0.004) and nervous system-acting drugs (rs=0.271, p=0.002), particularly anxiolytics (rs=0.175, p=0.047), antidepressants (rs=0.204, p=0.019) and hypnotics/sedatives (U=2434.5, p=0.028). However, in the multivariate analysis only unmet needs (OR=1.30; 95% CI: 1.008-1.670) and hypnotic/sedatives (OR=4.66; 95% CI: 1.132-19.144) showed an independent association with the presence of NPS. Regarding the additional models, unmet needs and literacy, antidepressants and hypnotic/sedatives, and cognitive status, showed to contribute to explain the variability of psychotic, affective and behaviour syndromes, respectively. CONCLUSIONS: Identifiable and modifiable factors, including unmet needs and prescribed psychotropic drugs, could have contributed to NPS in this sample, suggesting a role for targeted non-pharmacological and person-centred approaches directed to residents’ unmet needs.

Projections of older people living with dementia and costs of dementia care in the United Kingdom, 2019–2040

CPEC Working Paper 5 | Raphael Wittenberg, Bo Hu, Luis Barraza-Araiza, Amritpal Rehill
November 2019
This report, commissioned by Alzheimer’s Society, provides projections of the number of older people (aged 65 and over) living with dementia and the costs of health care, social care and unpaid care for older people living with dementia from 2019 to 2040 in the UK


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Events & Training Opportunities

Webinar AI-empowered knowledge translation

Thursday 12 December 10:00-11:00 MT
Presenter: Samira Rahimi
Learning objectives:
At the end of this presentation the audience will:
1. Obtain a basic understanding of Artificial Intelligence (AI),
2. Obtain a basic understanding of how AI applications relate to KT,
3. Describe opportunities and challenges for AI to improve KT.

Webinar Dementia caregiving as a public health priority: how can help?

Thursday 12 December 12:00-13:30 MT
Presenters: Anthony Levinson and Richard Sztramko
The Public Health Agency of Canada’s National Dementia Strategy identifies that caregivers face significant physical, mental, and financial impacts as a result of caring for a person living with dementia. Caregivers experience high levels of stress and are at a higher risk of injury and depression. As an essential part of the care team, supports must be provided to improve the quality of life for both the person living with dementia and the caregiver as well. The need for evidence-based caregiver education has been identified by national and provincial dementia strategies and the Health Quality Ontario Standard for dementia.

iGeriCare was developed by experts in geriatrics, mental health, and e-learning at McMaster University to provide evidence-based dementia education for informal family caregivers of persons living with dementia. The free, open-access web-based program allows caregivers to access resources from their own homes, at their own pace with the ability to easily share the experience with other family members and caregivers. iGeriCare’s features include ten multi-media lessons, curated resources, and is host to live, online events where viewers can interact directly with experts in dementia and geriatrics. Since July 2018, over 90,000 visitors have come to the site to experience the lessons, live events, and explore the resources.

Join Drs. Anthony Levinson and Richard Sztramko as they discuss why dementia, caregiver wellness, and brain health are important public health issues. Learn about the evidence regarding the effectiveness of web-based caregiver education. Explore iGeriCare’s features and hear about how the program was designed, developed, and implemented and the results of the qualitative research performed to date.

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Making it easier for people with dementia to stay physically active

The Unending Indignities of Alzheimer’s (US)

Transforming Culture in Health Care

How to explain anything to anyone: 4 steps to clearer communication

When should I take the next (career) step?

3 Ways to Help People Understand What Your Data Means

Quebec open to physician-assisted death for Alzheimer’s

Alberta government phases out seniors advocate, rolls role into health advocate

Study finds gender differences in success rates for Canadian scientific research grants

University of Regina dementia research project receives $3 million grant from Employment and Social Development Canada

The Power of Zombie Statistics: Systematic Review Edition

‘I’m in touch with nature’: the care homes connecting residents with the outdoors

Seniors’ homes using ‘trespass orders’ to ban family members from visiting

Why researchers should share their analytic code

Science funders gamble on grant lotteries. A growing number of research agencies are assigning money randomly.

The Society for Implementation Research Collaboration is excited to announce the launch of a new journal titled Implementation Research and Practice (IRaP)

Sustaining effective quality improvement: building capacity for resilience in the practice facilitator workforce

Quality measurement and nursing homes: measuring what matters

Writing for Impact in Post-acute and Long-term Care

Scaling and Spreading Innovation in Health Care Delivery
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