January 14, 2020



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New TREC article
Sustainment, Sustainability, and Spread Study (SSaSSy): protocol for a study of factors that contribute to the sustainment, sustainability, and spread of practice changes introduced through an evidence-based quality-improvement intervention in Canadian nursing homes.
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W. B. Berta, A. Wagg, L. Cranley, et al.
Implement Sci 2019 Dec 19;14(1):109-019-0959-2
BACKGROUND: Implementation scientists and practitioners, alike, recognize the importance of sustaining practice change, however post-implementation studies of interventions are rare. This is a protocol for the Sustainment, Sustainability and Spread Study (SSaSSy). The purpose of this study is to contribute to knowledge on the sustainment (sustained use), sustainability (sustained benefits), and spread of evidence-based practice innovations in health care. Specifically, this is a post-implementation study of an evidence-informed, Care Aide-led, facilitation-based quality-improvement intervention called SCOPE (Safer Care for Older Persons (in long-term care) Environments). SCOPE has been implemented in nursing homes in the Canadian Provinces of Manitoba (MB), Alberta (AB) and British Columbia (BC). Our study has three aims: (i) to determine the role that adaptation/contextualization plays in sustainment, sustainability and spread of the SCOPE intervention; (ii) to study the relative effects on sustainment, sustainability and intra-organizational spread of high-intensity and low-intensity post-implementation “boosters”, and a “no booster” condition, and (iii) to compare the relative costs and impacts of each booster condition. METHODS/DESIGN: SSaSSy is a two-phase mixed methods study. The overarching design is convergent, with qualitative and quantitative data collected over a similar timeframe in each of the two phases, analyzed independently, then merged for analysis and interpretation. Phase 1 is a pilot involving up to 7 units in 7 MB nursing homes in which SCOPE was piloted in 2016 to 2017, in preparation for phase 2. Phase 2 will comprise a quasi-experiment with two treatment groups of low- and high-intensity post-implementation “boosters”, and an untreated control group (no booster), using pretests and post-tests of the dependent variables relating to sustained care and management practices, and resident outcomes. Phase 2 will involve 31 trial sites in BC (17 units) and AB (14 units) nursing homes, where the SCOPE trial concluded in May 2019. DISCUSSION: This project stands to advance understanding of the factors that influence the sustainment of practice changes introduced through evidence-informed practice change interventions, and their associated sustainability. Findings will inform our understanding of the nature of the relationship of fidelity and adaptation to sustainment and sustainability, and afford insights into factors that influence the intra-organizational spread of practice changes introduced through complex interventions.

New article by Carole Estabrooks
A cluster randomized clinical trial to evaluate the effectiveness of the Implementation of Infant Pain Practice Change (ImPaC) Resource to improve pain practices in hospitalized infants: a study protocol.
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M. Bueno, B. Stevens, M. A. Barwick, et al.
Trials 2020 Jan 6;21(1):16-019-3782-9
BACKGROUND: Hospitalized infants undergo multiple painful procedures daily. Despite the significant evidence, procedural pain assessment and management continues to be suboptimal. Repetitive and untreated pain at this vital developmental juncture is associated with negative behavioral and neurodevelopmental consequences. To address this knowledge to practice gap, we developed the web-based Implementation of Infant Pain Practice Change (ImPaC) Resource to guide change in healthcare professionals’ pain practice behaviors. This protocol describes the evaluation of the intervention effectiveness and implementation of the Resource and how organizational context influences outcomes. METHODS: An effectiveness-implementation hybrid type 1 design, blending a cluster randomized clinical trial and a mixed-methods implementation study will be used. Eighteen Neonatal Intensive Care Units (NICUs) across Canada will be randomized to intervention (INT) or standard practice (SP) groups. NICUs in the INT group will receive the Resource for six months; those in the SP group will continue with practice as usual and will be offered the Resource after a six-month waiting period. Data analysts will be blinded to group allocation. To address the intervention effectiveness, the INT and SP groups will be compared on clinical outcomes including the proportion of infants who have procedural pain assessed and managed, and the frequency and nature of painful procedures. Data will be collected at baseline (before randomization) and at completion of the intervention (six months). Implementation outcomes (feasibility, fidelity, implementation cost, and reach) will be measured at completion of the intervention. Sustainability will be assessed at six and 12 months following the intervention. Organizational context will be assessed to examine its influence on intervention and implementation outcomes. DISCUSSION: This mixed-methods study aims to determine the effectiveness and the implementation of a multifaceted online strategy for changing healthcare professionals’ pain practices for hospitalized infants. Implementation strategies that are easily and effectively implemented are important for sustained change. The results will inform healthcare professionals and decision-makers on how to address the challenges of implementing the Resource within various organizational contexts. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03825822. Registered 31 January 2019.

National Dementia Survey
High Quality Ideas and Promising Practices for Dementia in Canada

DEADLINE 30 January

Dementia Advocacy Canada (DAC), www.dementiacanada.com, in partnership with the Canadian Foundation of Healthcare Improvement (CFHI), www.cfhi-fcass.ca, is conducing a survey to identify the best programs and services to support people living with dementia and their families in Canada. The plan is gather high quality ideas and then share them across the country so that anyone impacted by dementia might benefit.The survey topics include:
Dementia diagnosis
Post diagnostic support for persons with dementia
Dementia education for care partners
Support to navigate the healthcare system
There are no right or wrong answers. The survey takes approximately 10 minutes to complete

New book chapter by Greta Cummings, Alison Kitson, Lars Wallin, and Gill Harvey
The Chain of Codified Knowledge: Organisational Enactment of Evidence-Based Health Care in Four High-Income Countries
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Roman Kislov, Paul Wilson, Greta Cummings, Anna Ehrenberg, Wendy Gifford, Janet Kelly, Alison Kitson, Lena Pettersson, Lars Wallin, Gill Harvey
Transitions and Boundaries in the Coordination and Reform of Health Services: Building Knowledge, Strategy and Leadership Cham: Springer International Publishing; 2020. p. 243-267
Kislov and colleagues draw on multiple qualitative case studies of evidence-based nursing conducted in Sweden, Canada, Australia and the UK to describe the chain of codified knowledge which reflects the institutionalisation of evidence-based practice as organisational “business as usual”. This chain is dominated by performance standards, policies and procedures and locally collected data, i.e. various forms of “evidence by proxy” which are, at best, informed by research only partly or indirectly, but are nevertheless perceived as credible evidence. This chapter reveals dual effects of this codification dynamic on evidence-based practice and highlights the influence of macro-level ideological, historical and technological factors on the composition and circulation of codified knowledge. It concludes by outlining the practical implications of the study for change agency in health-care reform.

New articles by Shannon Scott
Feasibility, user experiences, and preliminary effect of Conversation Cards for Adolescents© on collaborative goal-setting and behavior change: protocol for a pilot randomized controlled trial.
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M. Kebbe, A. Farmer, M. P. Dyson, et al.
Pilot Feasibility Stud 2019 Dec 18;5:149-019-0533-3. eCollection 2019
Background: Adolescents and providers can benefit from practical tools targeting lifestyle modification for obesity prevention and management. We created Conversation Cards for Adolescents(c) (CCAs), a patient-centered communication and behavior change tool for adolescents and providers to use in clinical practice. The purpose of our study is to (i) assess the feasibility of CCAs in a real-world, practice setting to inform full-scale trial procedures, (ii) assess user experiences of CCAs, and (iii) determine the preliminary effect of CCAs on changing behavioral and affective-cognitive outcomes among adolescents. Methods: Starting in early 2019, this prospective study is a nested mixed-methods, theory-driven, and pragmatic pilot randomized controlled trial with a goal to enroll 50 adolescents (13-17 years old) and 9 physicians practicing at the Northeast Community Health Centre in Edmonton, Alberta, Canada. Adolescents will collaboratively set one S.M.A.R.T. (specific, measurable, attainable, realistic, timely) goal with their physician to implement over a 3-week period; however, only those randomized to the experimental group will use CCAs to inform their goal. Outcome assessments at baseline and follow-up (3 weeks post-baseline) will include behavioral, affective-cognitive, and process-related outcomes. Discussion: In examining the feasibility, user experiences, and preliminary effect of CCAs, our study will add contributions to the obesity literature on lifestyle modifications among adolescents in a real-world, practice setting as well as inform the scalability of our approach for a full-scale effectiveness randomized controlled trial on behavior change. Trial registration: ClinicalTrials.gov Identifier: NCT03821896.

Fading Confidence: A Qualitative Exploration of Parents Experiences Caring for a Febrile Child.
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A. P. Thompson, A. Le, L. Hartling and S. D. Scott.
J Clin Nurs 2019 Dec 31
AIMS AND OBJECTIVES: The purpose of this study was to explore parents’ experiences with pediatric fever to understand their needs for information and support. BACKGROUND: Pediatric fever is a normal part of childhood and multiple episodes of fever are a common occurrence between infancy and adulthood. Despite this expectation, pediatric fever often sparks fear and anxiety amongst parents. Existing research has primarily focused on measuring parental deficits, so a more in-depth exploration is helpful to understand the complexities of caring for a febrile child. DESIGN: Qualitative descriptive study. METHODS: Purposive sampling of N = 15 parents from a pediatric emergency department presenting with a febrile child. Semi-structured interviews were conducted in-person or via telephone. Thematic analysis was used to understand the data in light of our research question. Reporting follows the consolidated criteria for reporting qualitative research (COREQ) checklist. RESULTS: We found themes of, 1) parental confidence through caregiving tasks, 2) emergent feelings of inadequacy, 2a) referrals and limitations of community practice, 3) information needs, and 4) information sources. Whereas parents were initially confident accessing information, providing care, making decisions, and managing symptoms; new signs/symptoms sparked a change in parents’ emotions, coping, and behaviour. Parents routinely search for information about pediatric fever and value reliable, accessible resources. CONCLUSIONS: Our findings highlight parents’ strengths assessing fever and effectively managing symptoms. We are encouraged by the potential for these results to inform the development of empowering resources to help parents make child health decisions during pediatric fever. RELEVANCE TO CLINICAL PRACTICE: Findings provide an evidence base for researchers, clinicians, and policy-makers to improve care for pediatric patients and families. Parents want clear, reliable, and accessible information about decision-points associated with pediatric fever. Resources with an empowerment focus may help parents maintain a sense of control when caring for a febrile child.

New article by Janet Squires
Identifying relevant concepts and factors for the sustainability of evidence-based practices within acute care contexts: a systematic review and theory analysis of selected sustainability frameworks.
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L. Nadalin Penno, B. Davies, I. D. Graham, et al.
Implement Sci 2019 Dec 19;14(1):108-019-0952-9
BACKGROUND: There is growing recognition among healthcare professionals that the sustainability of evidence-based practices (EBPs) within different settings is variable and suboptimal. Understanding why a particular EBP might be sustained in one setting and not another remains unclear. Recent reviews illustrate the need to identify and analyze existing frameworks/models/theories (F/M/Ts) that focus solely on the sustainability of EBPs in specific healthcare settings, such as acute care, to illuminate key determinants and facilitate appropriate selection to guide practice and research. METHODS: We conducted a systematic review to extract sustainability frameworks. This involved using two available syntheses of the literature and a systematic search of four databases from January 2015 to July 2018: CINHAL, MEDLINE, Embase, and ProQuest. We included studies published in English, and if they included sustainability F/M/Ts recommended for use in acute care or an unspecified healthcare organization/setting. F/M/Ts explicitly recommended for use in public health and or community settings were excluded. We then conducted a comparative analysis of F/M/Ts using a modified theory analysis approach, to understand the theoretical underpinnings of each F/M/T, their determinants and concepts hypothesized to influence the sustained use of EBPs within an acute care context. RESULTS: Of 2967 identified citations from the 2 available syntheses and the systematic review, 8 F/M/Ts met the inclusion criteria. We identified 37 core factors, of which 16 were recorded as common factors (occurring within 4 or more of the 8 included F/M/Ts). All factors grouped into 7 main themes: innovation, adopters, leadership and management, inner context, inner processes, outer context, and outcomes. CONCLUSIONS: This systematic review is the first to include a comprehensive analysis of healthcare sustainability F/M/Ts for the sustained use of EBPs in acute care settings. Findings reveal insights into sustainability as a “process or ongoing stage of use” following initial implementation, suggesting this construct should be added to the definition of sustainability. Results provide a resource of available F/M/Ts and hypothesized factors to consider for acute care team members who are planning or currently implementing EBPs with the goal of improving patient outcomes. It also provides a basis for future research on sustainability in acute care.

New article from Alzheimer’s Society of Canada
Canadian charter of rights for people with dementia.
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J. Mann.
Dementia (London) 2020 Jan;19(1):63-67.
The stigma of dementia reaches into virtually every aspect of their day-to-day life. Its impact so negative and strong, its effect so all-encompassing that you feel you need to stand up and say … ENOUGH. STOP. Then what? The Alzheimer Society of Canada’s Advisory Group of People with Dementia (henceforth known as the ‘Advisory Group’) came up with an answer: develop Canada’s first-ever Canadian Charter of Rights for People with Dementia.

 

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Grants & Awards

CIHR Opportunity for Early Career Researchers: Call for expressions of interest to the Spring 2020 Observer Program

DEADLINE 13 February
CIHR is pleased to continue to offer an Observer program for Early Career Researchers (ECRs) to participate as an observer in the peer review process of the Project Grant: Spring 2020 competition. This program is designed as an opportunity for Early Career Researchers to observe face-to-face peer review committee meetings and gain valuable insights on the review process.

 

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Publications

 

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

KT

Palliative Care Evidence Review Service (PaCERS): a knowledge transfer partnership.
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M. Mann, A. Woodward, A. Nelson and A. Byrne.
Health Res Policy Syst 2019 Dec 16;17(1):100-019-0504-4
The importance of linking evidence into practice and policy is recognised as a key pillar of a prudent approach to healthcare; it is of importance to healthcare professionals and decision-makers across the world in every speciality. However, rapid access to evidence to support service redesign, or to change practice at pace, is challenging. This is particularly so in smaller specialties such as Palliative Care, where pressured multidisciplinary clinicians lack time and skill sets to locate and appraise the literature relevant to a particular area. Therefore, we have initiated the Palliative Care Evidence Review Service (PaCERS), a knowledge transfer partnership through which we have developed a clear methodology to conduct evidence reviews to support professionals and other decision-makers working in palliative care.PaCERS methodology utilises modified systematic review methods as there is no agreed definition or an accepted methodology for conducting rapid reviews. This paper describes the stages involved based on our iterative recent experiences and engagement with stakeholders, who are the potential beneficiaries of the research. Uniquely, we emphasise the process and opportunities of engagement with the clinical workforce and policy-makers throughout the review, from developing and refining the review question at the start through to the importance of demonstrating impact. We are faced with the challenge of the trade-off between the timely transfer of evidence against the risk of impacting on rigour. To address this issue, we try to ensure transparency throughout the review process. Our methodology aligns with key principles of knowledge synthesis in defining a process that is transparent, robust and improving the efficiency and timeliness of the review.Our reviews are clinically or policy driven and, although we use modified systematic review methods, one of the key differences between published review processes and our review process is in our relationship with the requester. This streamlining approach to synthesising evidence in a timely manner helps to inform decisions faced by clinicians and decision-makers in healthcare settings, supporting, at pace, knowledge transfer and mobilisation.

A literature review of knowledge translation and partnership research training programs for health researchers.
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H. Tait and A. Williamson.
Health Res Policy Syst 2019 Dec 16;17(1):98-019-0497-z
BACKGROUND: Researchers and policy-makers are increasingly working together with the goal of creating research that is focused on solving real-world problems; however, knowledge translation (KT) activities, and the partnerships they often require, can be challenging. The aim of this review is to determine the extent of the literature on training programs designed to improve researcher competency in KT and to describe existing training methods that may be used by those hoping to build capacity for partnership research. METHODS: MEDLINE, EMBASE, PsycINFO and CINAHL were searched for peer review articles published between January 2000 and July 2019. Studies were eligible for inclusion in the review if they described the development of, curriculum for, or evaluation of KT and/or partnership research training programs. Data extraction included information on evaluation methods, outcomes and implications as well as the format, aims and themes of each capacity-building program. RESULTS: The review identified nine published articles that met inclusion criteria – four papers described training events, two papers described participant experiences of specific learning sessions within a larger training course, two papers described part time secondments for KT capacity-building and one paper described a plan for KT training embedded within an existing research training course. All programs were delivered face-to-face, all included practical skills-building opportunities, and all employed multiple learning modalities such as seminars and small group discussions. Evaluation of the training programs was primarily conducted through qualitative interviews or feedback surveys. CONCLUSION: To date, few KT training initiatives have been described in the literature and none of these have been rigorously evaluated. The present review offers insights into the planning, development and participant experiences associated with the small number of training initiatives that have been described. There is insufficient evidence available at present to identify the most effective models for training researchers in KT and partnership skills.

Translating academic research into guidance to support healthcare improvement: how should guidance development be reported?
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S. Turner, C. A. Sharp, J. Sheringham, S. Leamon and N. J. Fulop.
BMC Health Serv Res 2019 Dec 27;19(1):1000-019-4792-8
BACKGROUND: There is interest internationally in improving the uptake of research evidence to inform health care quality and safety. This article focusses on guidance development from research studies as one method for improving research uptake. While we recognise that implementation strategies on the demand side for encouraging the uptake of research are important, e.g. knowledge brokers and university-practice collaborations, this article focusses on the production aspect of how guidance development is reported and the consequent influence this may have on end-users receptivity to evidence, in addition to other demand-side processes. MAIN TEXT: The article considers the following question: how is guidance developed and what are the implications for reporting? We address this question by reviewing examples of guidance development reporting from applied health research studies, then describe how we produced guidance for a national study of evidence use in decision-making on adopting innovations. The starting point for reflecting on our experiences is a vignette of the guidance launch event at a national conference. CONCLUSIONS: Implications for reporting guidance development and supporting improvement are discussed. These include the need to (a) produce reporting standards for the production of guidance to match reporting standards for other research methods, (b) acknowledge the informal or emergent aspects of producing guidance and its role within a wider knowledge mobilization strategy, (c) consider guidance development from projects as part of a wider knowledge mobilization strategy, and (d) encourage a receptive environment for guidance development and use, including researcher training, durable funding to support impact, and closer relations between research and practice.

 

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Health Care Administration and Organization

Embracing Cultural Diversity – Leadership Perspectives on Championing Meaningful Engagement for Residents Living with Advanced Dementia.
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S. H. J. du Toit, L. Baldassar, C. L. Raber, et al.
J Cross Cult Gerontol 2019 Dec 20
Resource constraints and high staff turnover are perceived as substantial barriers to high quality residential aged care. Achieving relationship-focused, person-centered care (PCC) is an ongoing challenge. This paper reports on an international project that explored how residential care leadership understand meaningful engagement for residents with dementia from culturally and linguistically diverse (CALD) backgrounds. This paper critically appraises the process, and outcomes, of an adapted Delphi method. Participants were the residential care leadership (i.e. staff in supervisory capacity) from four international facilities. Participation in the Delphi process was limited even though surveys were designed to require minimal time for completion. No participants opted for the alternative option of being interviewed. Findings indicate that residential care leadership recognised the importance of meaningful engagement for residents from CALD backgrounds. Limitations of time, resources and policy infrastructure were cited as barriers to achieving PCC. These findings suggest that facility leadership understand the importance of PCC, but identify multiple barriers rather than enablers for delivering PCC. Alternative methods, such as collecting data in interactive sessions allowing real-time discussion should be initiated to more effectively engage residential care leaders for a collaborative approach to explore PCC practices.

Sequential Two-Stage Network and Thematic Analysis for Exploring an Interdisciplinary Care Approach in Nursing Homes.
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M. S. Park, G. T. Kim, S. J. Lee, M. S. Kim, E. H. Jeong and S. O. Chang.
Comput Inform Nurs 2019 Sep;37(9):473-481
Since various groups of older adults with different conditions and levels of function coexist in nursing homes, it is necessary to develop integrated care strategies through collaboration among experts across related fields. The purposes of this study are to identify the regularity of information sharing in managing daily function for older adults, with a special focus on interdisciplinary cooperation, and to explore a practical care strategy for nursing home residents. The collaborative methods of network and thematic analysis were done by conducting in-depth interviews with 33 interdisciplinary experts working at seven nursing homes. This study proposed three relationships and three themes as interrelated key factors for providing interdisciplinary care to the elderly at various levels of function based on the experiences accumulated by the practitioners. First, independent sharing is required to make professional judgments about how daily function in older adults changes from reported baselines. Second, practitioners accurately judge clinical situations and supplement experts’ judgments through partial sharing. Finally, all interdisciplinary consensus through complete sharing achieves the ultimate goal of maintaining remaining function in older adults. These findings can be the first step in developing practical care guidelines for interdisciplinary use, and the results can be used to develop integrated assessment and intervention strategies.

The role of dietitians in residential aged care: How do cooks and chefs perceive their contribution?
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O. Farrer, L. Sasanelli, L. Matwiejczyk, A. Yaxley and M. Miller.
Australas J Ageing 2019 Jun;38(2):85-90
OBJECTIVE: This study aimed to explore how dietitians could work with cooks and chefs to contribute to best practice. METHODS: Data from interviews and focus groups comprising 38 chefs, cooks and food service managers were analysed. Inductive line-by-line coding of transcripts was conducted within a critical realist framework. Coding was completed independently by two authors before reaching consensus on themes. RESULTS: Four main themes emerged: (i) knowledge sharing; (ii) communication; (iii) collaboration; and (iv) accessibility. Participants praised dietitians’ knowledge and expertise, but some raised concerns about inconsistency in the advice they received. CONCLUSION: Dietitians working in residential aged care are ideally positioned to act as advocates for residents and food services. However, findings suggest that experiences of working with dietitians are mixed. Aged care menu guidelines and quality measures could assist, not only in promoting a consistent approach to dietetic advice, but also a system for benchmarking satisfaction and best practice.

Changes in residents’ seating needs and perception of stakeholders since implementation of a provincial wheelchair program.
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D. R. McEachern and W. B. Mortenson.
Disabil Rehabil Assist Technol 2019 Dec 17:1-6
Background: People living in long-term care frequently have inadequate access to properly fitted wheelchairs. This can lead to potential problems with mobility, positioning, comfort, and skin integrity. A provincial programme to provide individually fitted lightweight wheelchairs to residents started in January 2016; however, no research has evaluated programme outcomes.Objectives: To identify seating needs of residents before and after implementation of a provincial wheelchair programme at two long term care facilities in Vancouver and to explore stakeholders experiences with this programme.Methods: A pre/post study design was used which involved chart reviews to collect Seating Identification Tool (SIT), and interviews with stakeholders having experience with the provincial programme to gather information on their experiences. SIT data were analysed using a Wilcoxon Signed-Rank test and interviews were analysed thematically.Findings: SIT scores improved by 2 (median) which was statistically significant for the 22 residents with pre/post data available. Prevalence of seating needs decreased on average by 18%. Among the six stakeholders interviewed, themes identified included: wheelchairs/cushions provided addressed many residents’ needs; and saved residents and their families money and stress; and there is still ongoing need for more specialised equipment for frail residents (not covered by this programme).Conclusion: This study provides some evidence regarding the benefits of the introduction of this programme in two care homes and identifies potential changes that might improve wheelchair seating among residents with more severe seating needs. Further research is required on how these equipment changes might affect their mobility or participation in activities. Implications for rehabilitationThese findings appear to support the provision of lightweight individually fitted wheelchairs and moderate pressure redistribution cushions by occupational therapists in long-term care through this programme.Regular use of the SIT (i.e., on admission, condition change, annual care conference, and as needed) may be beneficial to ensure residents are properly screened for seating needs.Collaboration with the resident appears to be important to ensure equipment on provision and follow-up are meeting residents’ needs.Recommend future research on the use of tilt in space wheelchairs for residents’ in long-term care.

Co-designing technology with people with dementia and their carers: Exploring user perspectives when co-creating a mobile health application.
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S. O’Connor.
Int J Older People Nurs 2019 Dec 14:e12288
AIMS: To explore the perspectives of those involved in co-designing a mobile application with people with dementia and their carers. BACKGROUND: People with dementia suffer physical and psychological problems as their illness progresses and require a range of health and social care services to meet their needs. Mobile applications are being developed to support individuals to manage long-term conditions, but patients and carers are not always involved in designing this technology, which can lead to poor quality health apps. A digital initiative was launched to involve people with dementia and their carers in creating a mobile app that would support communication and enable them to share memories together. DESIGN: An exploratory, descriptive approach was used. METHODS: In-depth interviews with people with dementia, their carers, and others involved in co-creating a mobile health application were conducted. Data analysis was undertaken using the framework approach. RESULTS: The views of people with dementia, their carers, and project staff were similar regarding the complexity of the co-design process, and the value the mobile app had for people with dementia and their families. Being involved in co-production seemed to have numerous benefits for people with dementia and their carers as they gained new knowledge and skills, friendships, and a sense of achievement in creating a unique app that would benefit many people. The app also appeared useful in stimulating memory and cognitive function, aiding communication, and providing a sense of normalcy for people living with dementia and their carers. CONCLUSION: Mobile health applications can facilitate interaction between people with dementia and their carer network that could improve their quality of life. Further research on which co-design process is best suited to people with dementia and whether technology created via this participatory method is more effective or not in improving health outcomes is required. IMPLICATIONS FOR PRACTICE: Nurses should have knowledge of and education about technology and how it can promote health and wellbeing of persons with dementia. Nurses who care for people with dementia and their families should support them in taking part in or leading the design of technologies that meet their needs. Participatory design methods should be taught in nursing education so the profession can provide guidance to patients and their families on co-creating health products and services.

Factors related to perceived caring among older people residing in long-term care facilities: a cross-sectional study.
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H. L. Hwang and C. T. Tu.
Scand J Caring Sci 2019 Dec 12
BACKGROUND: Healthcare providers who exhibit caring behaviours promote quality of care. Theoretical and empirical models have promoted a three-dimensional paradigm of care perception. However, the perception of elderly residents in long-term care facilities related to caring has not been investigated. OBJECTIVES: This study explored factors related to the elderly’s perception of healthcare providers’ caring in long-term care facilities. METHODS: A cross-sectional survey was conducted among 461 elderly residents living in 57 long-term care facilities in southern Taiwan. A structured questionnaire included demographic information, facility characteristics and the 12-item Caring Scale for Institutionalized Elders. Hierarchical regression analysis was used to determine significant factors related to the elderly residents’ caring perceptions. FINDINGS: A hierarchical regression model showed 49.9% of the variance in elderly’s perception of caring. Significant related factors included resident’s age, number of comorbidities, need for caring, time spent being cared for, bed-to-nurse staffing ratios and accreditation status. CONCLUSIONS: Improved Registered Nurse staffing ratios with a higher level of accreditation status yield better perceptions of caring among residential elderly. Those with comorbid diseases and fewer caring needs have a higher perception of healthcare provider caring. IMPLICATIONS: The related factors of elderly’s perceived caring provide long-term care managers and nursing staff with beneficial information to develop strategies that can manage residents with high expected-care needs. Policies to improve the accreditation standards of long-term care facilities are needed.

The effect of care burden on formal caregiver’s quality of work life: a mixed-methods study.
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B. Kalanlar and N. Kuru Alici.
Scand J Caring Sci 2019 Dec 12
BACKGROUND: The health of caregivers is as important as that of the elderly they care for. Although several studies have stressed the necessity and importance of reducing the care burden on formal caregivers and increasing the quality of their working lives, this issue has not been addressed both qualitatively and quantitatively from the caregivers’ perspective. AIM: This study is a comprehensive assessment of the effects of formal caregivers’ care burden on the quality of their working lives. METHOD: A convergent design of mixed methods was used. This study was conducted with 110 formal caregivers at an Elderly Care and Rehabilitation Center between 1 and 31 January 2019. Additional semi-structured interviews were conducted with 10 of the respondents. Descriptive statistics were used for quantitative analysis and thematic statistics for qualitative analysis. The quantitative and qualitative data were merged and integrated for a mixed-method analysis. RESULTS: The relationship between the quality of working life and care burden was statistically significant for the formal caregivers. The results of the interviews supported this relationship. Four themes emerged from the interviews: the effects of caregiving on care staff, the effects of caregiving on caregivers’ daily lives, the requirements for providing better care and caregivers’ description of caregiving in a few words. CONCLUSION: Given that the care burden of formal caregivers affects the quality of their working lives, this burden should be assessed on a regular basis and efforts needed to be made to reduce it and improve the quality of their working lives.

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Health Care Innovation and Quality Assurance

Evaluating the implementation of the PACE Steps to Success Programme in long-term care facilities in seven countries according to the RE-AIM framework.
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M. Oosterveld-Vlug, B. Onwuteaka-Philipsen, M. Ten Koppel, et al.
Implement Sci 2019 Dec 19;14(1):107-019-0953-8
BACKGROUND: The PACE ‘Steps to Success’ programme is a complex educational and development intervention for staff to improve palliative care in long-term care facilities (LTCFs). In a cluster randomized controlled trial, this programme has been implemented in 37 LTCFs in 7 European countries. Alongside an effectiveness study, a process evaluation study was conducted. This paper reports on the results of this process evaluation, of which the aim was to provide a more detailed understanding of the implementation of the PACE Programme across and within countries. METHODS: The process evaluation followed the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and involved various measures and tools, including diaries for country trainers, evaluation questionnaires for care staff, attendance lists and interviews (online and face-to-face, individual and in groups) with country trainers, managers, PACE coordinators and other staff members. Based on key elements of the PACE Programme, a priori criteria for a high, medium and low level of the RE-AIM components Reach, Adoption, Implementation and intention to Maintenance were defined. Qualitative data on factors affecting each RE-AIM component gathered in the online discussion groups and interviews were analysed according to the principles of thematic analysis. RESULTS: The performance of the PACE Programme on the RE-AIM components was highly variable within and across countries, with a high or medium score for in total 28 (out of 37) LTCFs on Reach, for 26 LTCFs on Adoption, for 35 LTCFs on Implementation and for 34 LTCFs on intention to Maintenance. The factors affecting performance on the different RE-AIM components could be classified into three major categories: (1) the PACE Programme itself and its way of delivery, (2) people working with the PACE Programme and (3) contextual factors. Several country-specific challenges in implementing the PACE Programme were identified. CONCLUSIONS: The implementation of the PACE Programme was feasible but leaves room for improvement. Our analysis helps to better understand the optimal levels of training and facilitation and provides recommendations to improve implementation in the LTC setting. The results of the process evaluation will be used to further adapt and improve the PACE Programme prior to its further dissemination. TRIAL REGISTRATION: The PACE study was registered at www.isrctn.com-ISRCTN14741671 (FP7-HEALTH-2013-INNOVATION-1 603111) July 30, 2015.

Evaluating person-centredness for frail older persons in nursing homes before and after implementing a palliative care intervention.
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C. Bokberg, L. Behm, B. Wallerstedt and G. Ahlstrom.
Nurs Open 2019 Nov 19;7(1):439-448
Aim: To evaluate person-centeredness in nursing homes from the perspective of frail older persons, before and after implementing an educational intervention about palliative care. Design: A crossover design. Methods: Forty-four older persons living in nursing homes were interviewed. A convergent mixed-method was used to analyse data. Results: The older persons expressed feelings of unsafety related to shortcomings in staff. These shortcomings implied that the responsibilities of everyday activities and making the residents’ existence more bearable were transferred to the next of kin. The dropout rate related to death and not enough energy was considerably high (51%) even though one of the inclusion criteria was to have enough energy to manage a 1-hr interview. This result supports previous research describing the difficulties in retaining older persons in research and indicated that the dose of the intervention was not sufficient to improve person-centred care.

The Living Lab In Ageing and Long-Term Care: A Sustainable Model for Translational Research Improving Quality of Life, Quality of Care and Quality of Work.
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H. Verbeek, S. M. G. Zwakhalen, J. M. G. A. Schols, G. I. J. M. Kempen and J. P. H. Hamers.
J Nutr Health Aging 2020;24(1):43-47
There is a strong need in long-term care for scientific research, so older people and their families, health care professionals, policy makers, and educators can benefit from new advancements and best available evidence in every day care practice. This paper presents the model of a sustainable and successful interdisciplinary collaboration between scientists, care providers and educators in long-term care: the “Living Lab in Ageing and Long-Term Care” by Maastricht University in the Netherlands. Its mission is to contribute with scientific research to improving i) quality of life of older people and their families; ii) quality of care and iii) quality of work of those working in long-term care. Key working mechanisms are the Linking Pins and interdisciplinary partnership using a team science approach, with great scientific and societal impact. A blueprint for the model is discussed, describing its business model and challenges in getting the model operational and sustainable are discussed.

Process evaluation of a complex intervention to optimize quality of prescribing in nursing homes (COME-ON study).
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P. Anrys, G. Strauven, S. Roussel, et al.
Implement Sci 2019 Dec 11;14(1):104-019-0945-8
BACKGROUND: The COME-ON study was a cluster-controlled trial of a complex intervention that consisted of a blended training program, local interdisciplinary meetings, and interdisciplinary case conferences in Belgian nursing homes. The intervention was associated with significant improvements in the appropriateness of prescribing. The aims of this study were to describe the implementation of the intervention and to explore the experiences of participants, for the purpose of identifying factors associated with implementation and perceived impact and to draw lessons for future implementation. METHODS: We performed a mixed-method process evaluation. Questionnaires and reports were used to collect quantitative data on implementation and experiences from the 24 NHs and participating healthcare professionals (coordinating physicians, general practitioners, pharmacists, and nurses) in the intervention group. Multidisciplinary focus groups focusing on factors associated with implementation and perceived impact were conducted in 11 NHs. RESULTS: Overall, the rate of implementation and the satisfaction of participants were good, despite some variability between NHs and HCPs. Although perceived impact on nursing home residents varied, most participants perceived a positive impact for themselves. Factors associated with implementation and perceived impact were identified at different levels: intervention, healthcare professionals, organization, and external context. The interdisciplinary and face-to-face approaches were recognized as key elements for the success of the intervention, despite organizational constraints. The attitude of general practitioners was identified both as a barrier to and a facilitator for implementation and its success. The professional role and competency of the pharmacist influenced perceived impact. The pre-existing relationships between HCPs and the presence of a leader facilitated implementation and perceived impact. Remuneration was deemed necessary for the study and for future implementation. CONCLUSIONS: Overall, the intervention, and more specifically its interdisciplinary aspect, was well implemented and appreciated by HCPs. This probably contributed to the positive effect on the appropriateness of prescribing. Future implementation must take into account the various factors found to affect implementation and perceived impact, in order to maximize effect and sustainability. Trial registration Current Controlled Trials ISRCTN66138978; registered 18 November 2015, retrospectively registered, https://www.isrctn.com/ISRCTN66138978.

 

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Research Practice and Methodology

“Fractal Heuristics” for Mixed Methods Research: Applying Abbott’s “Fractal Distinctions” as a Conceptual Metaphor for Method Integration
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Felix Knappertsbusch.
Journal of Mixed Methods Research 2019 12/19; 2020/01:1558689819893573
With the interest in advancing integration in the field of mixed methods research (MMR), researchers need powerful metaphors for conceiving and implementing mixing strategies. This article contributes to the field of MMR by showing how Abbott?s ?fractal distinctions? provide a valuable heuristic for the application of method combinations as well as the methodological reflection of MMR. Based on its core notion, the ?self-similarity? of methods approaches, I propose three heuristic guidelines: (a) deliberately seek out qualitative aspects in quantitative methods (and vice versa); (b) assume a nonessentialist, theory-oriented approach toward method integration; and (c) aim to reconcile rigor and innovation in empirical research. I discuss similarities between fractal heuristics and other conceptualizations of difference-within, including dialectical and feminist approaches to MMR.

Feasibility and acceptability of living systematic reviews: results from a mixed-methods evaluation.
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T. Millard, A. Synnot, J. Elliott, S. Green, S. McDonald and T. Turner.
Syst Rev 2019 Dec 14;8(1):325-019-1248-5
BACKGROUND: Living systematic reviews (LSRs) offer an approach to keeping high-quality evidence synthesis continually up to date, so the most recent, relevant and reliable evidence can be used to inform policy and practice, resulting in improved quality of care and patient health outcomes. However, they require modifications to authoring and editorial processes and pose technical and publishing challenges. Several teams within Cochrane and the international Living Evidence Network have been piloting living systematic reviews. METHODS: We conducted a mixed-methods evaluation with participants involved in six LSRs (three Cochrane and three non-Cochrane). Up to three semi-structured interviews were conducted with 27 participants involved with one or more of the pilot LSRs. Interviews explored participants’ experiences contributing to the LSR, barriers and facilitators to their conduct and opportunities for future development. Pilot team members also completed monthly surveys capturing time for key tasks and the number of citations screened for each review. RESULTS: Across the pilot LSRs, search frequency was monthly to three-monthly, with some using tools such as machine learning and Cochrane Crowd to screen searches. Varied approaches were used to communicate updates to readers. The number of citations screened varied widely between the reviews, from three to 300 citations per month. The amount of time spent per month by the author team on each review also varied from 5 min to 32 h. Participants were enthusiastic to be involved in the LSR pilot. They highlighted the importance of a motivated and well-organised team; the value of technology enablers to improve workflow efficiencies; the need to establish reliable and efficient processes to sustain living reviews; and the potential for saving time and effort in the long run. Participants highlighted challenges with the current publication processes, managing ongoing workload and the lack of resources to support LSRs in the long term. CONCLUSIONS: Findings to date support feasibility and acceptability of LSR production. There are challenges that need to be addressed for living systematic reviews to be sustainable and have maximum value. The findings from this study will be used in discussions with the Cochrane community, key decision makers and people more broadly concerned with LSRs to identify and develop priorities for scale-up.

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Aging

Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits

Ezekiel Oluwasayo Ijaopo and Ruth Oluwasolape Ijaopo.
Journal of Aging Research 2019;2019.
Background. Dementia remains a growing concern for societies globally, particularly as people now live longer. About 90% of individuals with advanced dementia suffer from eating problems that lead to general health decline and ultimately impacts upon the physical, psychological, and economic wellbeing of the individuals, caregivers, and the wider society. Objective. To evaluate the burdens and perceived benefits of tube feeding in individuals with advanced dementia. Design. Narrative review. Methods. Computerized databases, including PubMed, Embase, Medline, CINAHL, PsycInfo, and Google Scholar were searched from 2000 to 2019 to identify research papers, originally written in or translated into English language, which investigated oral versus tube feeding outcome in individuals with advanced dementia. Results. Over 400 articles were retrieved. After quality assessment and careful review of the identified articles, only those that met the inclusion criteria were included for review. Conclusion. Tube feeding neither stops dementia disease progression nor prevents imminent death. Each decision for feeding tube placement in individuals with advanced dementia should be made on a case-by-case basis and involve a multidisciplinary team comprising experienced physicians, nurses, family surrogates, and the relevant allied health professionals. Careful considerations of the benefit-harm ratio should be discussed and checked with surrogate families if they would be consistent with the wishes of the demented person. Further research is required to establish whether tube feeding of individuals with advanced dementia provides more burdens than benefits or vice-versa and evaluate the impacts on quality of life and survival.

Reducing time in acute hospitals: A stepped-wedge randomised control trial of a specialist palliative care intervention in residential care homes.
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L. Forbat, W. M. Liu, J. Koerner, et al.
Palliat Med 2020 Jan 2:269216319891077
BACKGROUND: Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. AIM: To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. DESIGN: Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. SETTING/PARTICIPANTS: 1700 residents in 12 Australian care homes for older people. RESULTS: Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: -0.44, -0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK pound0.98 m). CONCLUSION: The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.

Residential Greenness and Frailty Among Older Adults: A Longitudinal Cohort in China.
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A. Zhu, L. Yan, C. Wu and J. S. Ji.
J Am Med Dir Assoc 2019 Dec 20
OBJECTIVES: Frailty is an accumulation of deficits characterized by reduced resilience to stressors and increased vulnerability to adverse outcomes. There is evolving evidence on the health benefits of residential greenness, but little is known about its impact on frailty. DESIGN: A longitudinal cohort study. SETTING AND PARTICIPANTS: We included older adults aged >/=65 years from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) with a 12-year follow-up. METHODS: We assessed residential greenness by calculating the Normalized Difference Vegetation Index (NDVI) in the 500 m radius around participants’ residence. We used 39 self-reported health items to construct a frailty index (FI) as a proportion of accumulated deficits. We defined an FI of 0.21 as frail. We used the mixed effects logistic regression models to examine the association between residential greenness and frailty, adjusted for a number of covariates. RESULTS: We had 16,238 participants, with a mean age of 83.0 years (standard deviation: 11.5). The mean baseline NDVI and FI were 0.40, and 0.12, respectively. Compared to the participants living in the lowest quartile of residential greenness, those in the highest quartile had a 14% [odds ratio (OR): 0.86, 95% confidence interval (CI): 0.77, 0.97] lower odds of frailty. The association was stronger among urban vs rural residents. Additionally, each 0.1-unit increase in annual average NDVI was related to a 2% higher odds of improvement in the frailty status (OR: 1.02, 95% CI: 1.00, 1.04). CONCLUSIONS AND IMPLICATIONS: Our study suggests that higher levels of residential greenness are related to a lower likelihood of frailty, specifically in urban areas.

Pain Patterns and Treatment Among Nursing Home Residents With Moderate-Severe Cognitive Impairment.
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M. Ersek, P. V. Nash, M. M. Hilgeman, et al.
J Am Geriatr Soc 2019 Dec 23
OBJECTIVES: To examine the frequency and severity of pain and use of pain therapies among long-term care residents with moderate to severe dementia and to explore the factors associated with increased pain severity. DESIGN: Prospective individual data were collected over 1 to 3 days for each participant. SETTING: Sixteen long-term care facilities in Alabama, Georgia, Pennsylvania, and New Jersey. PARTICIPANTS: Residents with moderate to severe cognitive impairment residing in a long-term care facility for at least 7 days were enrolled (N = 205). Residents were 47% female, predominantly white (69%), and 84 years old, on average (SD = 10 years). MEASUREMENTS: A comprehensive pain assessment protocol was used to evaluate pain severity and characteristics through medical record review, interviews with nursing home staff, physical examinations, as well as pain observation tools (Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale and Pain Intensity Measure for Persons With Dementia). Known correlates were also assessed (agitation, depression, and sleep). RESULTS: Experts’ pain evaluations indicated that residents’ usual pain was mild (mean = 1.6/10), and most experienced only intermittent pain (70%). However, 45% of residents experienced moderate to severe worst pain. Of residents, 90% received a pain therapy, with acetaminophen (87%) and opioids (32%) commonly utilized. Only 3% had a nondrug therapy documented in the medical record. The only resident characteristic that was significantly associated with pain severity was receipt of an opioid in the past week. CONCLUSION: Using a comprehensive pain assessment protocol, we found that most nursing home residents with moderate to severe dementia had mild usual, intermittent pain and the vast majority received at least one pain therapy in the previous week. Although these findings reflect improvements in pain management compared with older studies, there is still room for improvement in that 45% of the sample experienced moderate to severe pain at some point in the previous week.

Deprescribing in Older People Approaching End of Life: A Randomized Controlled Trial Using STOPPFrail Criteria.
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D. Curtin, E. Jennings, R. Daunt, et al.
J Am Geriatr Soc 2019 Dec 23
OBJECTIVES: Older people approaching end of life are commonly prescribed multiple medications, many of which may be inappropriate or futile. Our objective was to examine the effect of applying the STOPPFrail, a recently developed deprescribing tool, to the medication regimens of older patients with advanced frailty. DESIGN: Randomized controlled trial. SETTING: Two acute hospitals in Ireland. PARTICIPANTS: Adults 75 years or older (n = 130) with advanced frailty and polypharmacy (five or more drugs), transferring to long-term nursing home care. INTERVENTION: A STOPPFrail-guided deprescribing plan was presented to attending physicians who judged whether or not to implement recommended medication changes. MEASUREMENTS: The primary outcome was the change in the number of regular medications at 3 months. Secondary outcomes included unscheduled hospital presentations, falls, quality of life, monthly medication costs, and mortality. RESULTS: Intervention (n = 65) and control group (n = 65) participants were prescribed a mean (plus or minus standard deviation [SD]) of 11.5 (+/-3.0) and 10.9 (+/-3.5) medications, respectively, at baseline. The mean (SD) change in the number of medications at 3 months was -2.6 (+/-2.73) in the intervention group and -.36 (+/-2.60) in the control group (mean difference = 2.25 +/- .54; 95% confidence interval [CI] = 1.18-3.32; P < .001). The mean change in monthly medication cost was -$74.97 (+/-$148.32) in the intervention group and -$13.22 (+/-$110.40) in the control group (mean difference $61.74 +/- $26.60; 95% CI = 8.95-114.53; P = .02). No significant differences were found between groups for any of the other secondary outcomes. CONCLUSION: STOPPFrail-guided deprescribing significantly reduced polypharmacy and medication costs in frail older people. No significant differences between groups were observed with regard to falls, hospital presentations, quality of life, and mortality, although the trial was likely underpowered to detect differences in these outcomes.

Mood and behavioral problems are important predictors of quality of life of nursing home residents with moderate to severe dementia: A cross-sectional study.
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M. Henskens, I. M. Nauta, S. Vrijkotte, K. T. Drost, M. V. Milders and E. J. A. Scherder.
PLoS One 2019 Dec 20;14(12):e0223704
OBJECTIVES: To examine the predictors associated with quality of life of nursing home residents with dementia, in order to identify which predictors are most important and hold most promise for future intervention studies. METHODS/DESIGN: This cross-sectional analysis of data collected in two intervention trials included 143 participants with moderate to severe dementia who resided in 40 psychogeriatric wards in 13 nursing homes. The outcome measure quality of life was assessed with the Qualidem. Predictors examined were demographic factors, cognition, mood, behavioral problems, and comorbid conditions. RESULTS: Linear mixed regression analyses showed that all nine domains of quality of life showed independent (negative) associations with either depression, agitation, apathy, or a combination of these predictors. Agitation, apathy, depression, and the presence of neurological disease explained 50% of the variance in total quality of life. Male gender, psychiatric/mood disorders, and having one or more comorbid conditions was associated with worse social relations, while the presence of comorbid neurological diseases was associated with more social isolation and a worse care relationship. The presence of endocrine/metabolic disorders and pulmonary disorders was associated with less restless tense behavior. CONCLUSIONS: Different domains of quality of life showed different associations, confirming the multidimensionality of quality of life in nursing home residents with dementia. Quality of life is independently associated with mood and behavioral problems, comorbid conditions, and gender. This knowledge may help to identify older persons at risk of a lower quality of life, and to offer targeted interventions to improve quality of life. TRIAL REGISTRATION: Dutch Trial registration NTR5641.

Predictors of functional decline in nursing home residents: the Shelter project.
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M. Fedecostante, G. Onder, P. Eusebi, et al.
J Gerontol A Biol Sci Med Sci 2019 Dec 20
BACKGROUND: The aim of our study was to identify independent predictors of functional decline in older nursing home (NH) residents, taking into account both resident and facility characteristics. METHODS: longitudinal observational study involving 1760 older (>/= 65 years) residents of NH participating in the SHELTER* study (57 NH in 8 countries). All residents underwent a comprehensive geriatric assessment using the interRAI LTCF. Functional decline was defined as an increase of at least one point in the MDS Long Form ADL scale during a one year follow-up. Facility and country effect were taken into account. RESULTS: During the study period 891 (50,6%) NH residents experienced ADL decline. Residents experiencing ADL decline were older, had lower disability at baseline, were more frequently affected by severe dementia and by urinary incontinence and used more antipsychotics. In the mixed effect logistic regression model factors independently associated with a higher risk of functional decline were dementia and urinary incontinence, whereas the presence of a geriatrician was a protective factor. CONCLUSION: Both resident and facility characteristics are associated with the risk of functional decline in NH residents. Increasing the quality of healthcare by involving a geriatrician in residents’ care might be an important strategy to improve the outcome of this vulnerable population.

Adjusting to life in a residential aged care facility: Perspectives of people with dementia, family members and facility care staff.
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T. E. Davison, V. Camoes-Costa and A. Clark.
J Clin Nurs 2019 Nov;28(21-22):3901-3913
AIMS AND OBJECTIVES: To determine factors that facilitate or impede adjustment to residential aged care (RAC) from the perspectives of residents with dementia, families of residents with dementia and facility staff. BACKGROUND: The transition to a RAC facility can be highly stressful for people with dementia and their families, but we lack an understanding of how people with dementia experience this transition. Knowledge on adjustment to the new environment is essential in order to develop procedures and interventions that better support residents. DESIGN AND METHODS: This study consisted of interviews with 12 residents with dementia who had resided at a RAC facility for six months or less; 14 family members of RAC residents with dementia; and 12 RAC facility staff members. Parallel interview schedules were constructed, with questions on the experience of relocating to RAC for a person with dementia and views on enablers and barriers to successful adjustment. Thematic analysis guided the analysis of data. The study adhered to the consolidated criteria for reporting qualitative research (COREQ) guidelines (see Supplementary File S1). RESULTS: Adjustment to RAC appeared variable, with several residents reporting poor acceptance of their circumstances several months after the relocation. The three groups were largely congruent regarding the importance of support from families and staff, and the development of new relationships with other residents, but not all residents had succeeded in forming friendships. The provision of meaningful activities and opportunities to exert autonomy day-to-day were seen as critical, but staff experienced challenges in providing individualised care due to lack of dedicated time to engage with residents. CONCLUSION AND RELEVANCE TO CLINICAL PRACTICE: There is a need for evaluated interventions to help people with dementia to successfully transition to RAC. Attention should be paid to the way in which care is coordinated within the RAC sector, to enable staff to provide individualised approaches to facilitate adjustment.

Balancing medication use in nursing home residents with life-limiting disease.
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K. Paque, M. Elseviers, R. Vander Stichele, et al.
Eur J Clin Pharmacol 2019 Jul;75(7):969-977
PURPOSE: Balancing medications that are needed and beneficial and avoiding medications that may be harmful is important to prevent drug-related problems, and improve quality of life. The aim of this study is to describe medication use, the prevalence of deprescribing of medications suitable for deprescribing, and the prevalence of new initiation of potentially inappropriate medications (PIMs) in nursing home (NH) residents with life-limiting disease in Flanders. METHODS: NH residents aged >/= 65, suffering from end stage organ failure, advanced cancer, and/or dementia (n = 296), were included in this cross-sectional study with retrospective analyses of medication use at the time of data collection (t2) and 3 to 6 months before (t1). The appraisal of appropriateness of medications was done using a list of medications documented as suitable for deprescribing, and STOPPFrail criteria. RESULTS: Residents’ (mean age 86 years, 74% female) mean number of chronic medications increased from 7.4 (t1) to 7.9 (t2). In 31% of those using medications suitable for deprescribing, at least one medication was actually deprescribed. In 30% at least one PIM from the group of selected PIMs was newly initiated. In the subgroup (n = 76) for whom deprescribing was observed, deprescribing was associated with less new initiations of PIMs (r = – 0.234, p = 0.042). CONCLUSION: Medication use remained high at the end of life for NH residents with life-limiting disease, and deprescribing was limited. However, in the subgroup of 76 residents for whom deprescribing was observed, less new PIMs were initiated.

What influences the sustainability of an effective psychosocial intervention for people with dementia living in care homes? A 9 to 12-month follow-up of the perceptions of staff in care homes involved in the WHELD randomised controlled trail.
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J. Fossey, L. Garrod, C. Tolbol Froiland, C. Ballard, V. Lawrence and I. Testad.
Int J Geriatr Psychiatry 2019 May;34(5):674-682
OBJECTIVES: The study aims to understand the factors that care home staff felt enabled or hindered them in continuing to use the well-being and health for people with dementia (WHELD) psychosocial approach in their care home and investigate whether there was sustained activity 9 to 12 months after the study ended. METHODS: This qualitative study is part of a wider clinical trial, which demonstrated effectiveness of a psychosocial intervention on quality of life outcomes and neuropsychiatric symptoms for residents. Forty-seven care home staff within nine care homes in the United Kingdom participated in focus groups, between 9 and 12 months after the intervention had finished. Inductive thematic analysis was used to identify themes and interpret the data. RESULTS: The findings highlighted that staff continued to use a range of activities and processes acquired through the research intervention, after the study had ended. Three overarching themes were identified as influential: “recognising the value” of the approach for residents and staff, “being well practiced” with sufficient support and opportunity to consolidate skills prior to the withdrawal of the researchers, and “taking ownership of the approach” to incorporate it as usual care. CONCLUSIONS: The WHELD approach can be sustained where the value of the approach is recognised, and sufficient support is provided during initial implementation for staff to build skills and confidence for it to become routine care. Further follow-up is required to understand longer term use and the impact for residents.

Story-Sharing Intervention to Improve Depression and Well-Being in Older Adults Transitioning to Long-Term Care.
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G. J. Sullivan, D. J. Hain, C. Williams and D. Newman.
Res Gerontol Nurs 2019 Mar 1;12(2):81-90
Older adults frequently experience depression and reduced well-being when transitioning to long-term care (LTC) that can lead to increased risk for mortality. In the current randomized controlled trial, older adults (N = 93) who were transitioning to LTC facilities in Southeast Florida were enlisted. It was hypothesized that when transitioning to LTC (a) story sharing (i.e., sharing stories in groups) could lead to reduced depression and improved well-being, and (b) baseline sociodemographic characteristics could predict depression and well-being. Baseline results revealed that participants were not depressed and had moderate well-being, and postintervention results indicated that there were no significant improvements in depression (p = 0.35) and well-being (p = 0.41). Some baseline sociodemographic characteristics predicted depression (p = 0.04) and well-being (p = 0.03). Future research should incorporate moderate depression as an inclusion criterion and more weeks of story-sharing sessions. Targets: Adults age 65 and older transitioning to LTC. Intervention Description: Two to three participants met as a group to share five stories over 3 weeks. Mechanisms of Action: Story sharing will improve well-being. Outcomes: Participant level of well-being will improve, and sociodemographic characteristics and factors related to the move will predict risk for depression and reduced well-being. [Res Gerontol Nurs. 2019; 12(2):81-90.].

The last week of life of nursing home residents with advanced dementia: a retrospective study.
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F. Toscani, S. Finetti, F. Giunco, et al.
BMC Palliat Care 2019 Dec 27;18(1):117-019-0510-x
BACKGROUND: Barriers to palliative care still exist in long-term care settings for older people, which can mean that people with advanced dementia may not receive of adequate palliative care in the last days of their life; instead, they may be exposed to aggressive and/or inappropriate treatments. The aim of this multicentre study was to assess the clinical interventions and care at end of life in a cohort of nursing home (NH) residents with advanced dementia in a large Italian region. METHODS: This retrospective study included a convenience sample of 29 NHs in the Lombardy Region. Data were collected from the clinical records of 482 residents with advanced dementia, who had resided in the NH for at least 6 months before death, mainly focusing on the 7 days before death. RESULTS: Most residents (97.1%) died in the NH. In the 7 days before death, 20% were fed and hydrated by mouth, and 13.4% were tube fed. A median of five, often inappropriate, drugs were prescribed. Fifty-seven percent of residents had an acknowledgement of worsening condition recorded in their clinical records, a median of 4 days before death. CONCLUSIONS: Full implementation of palliative care was not achieved in our study, possibly due to insufficient acknowledgement of the appropriateness of some drugs and interventions, and health professionals’ lack of implementation of palliative interventions. Future studies should focus on how to improve care for NH residents.

Comparison Between Multicomponent Exercise and Walking Interventions in Long-Term Nursing Homes: A Randomized Controlled Trial.
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C. Rezola-Pardo, A. Rodriguez-Larrad, J. Gomez-Diaz, et al.
Gerontologist 2019 Dec 17
BACKGROUND AND OBJECTIVES: There is evidence that exercise interventions counteract the functional and cognitive decline experienced by long-term nursing home (LTNH) residents. To determine the most effective exercise intervention, we compared the effects of a multicomponent exercise intervention and a walking intervention on physical and cognitive performance, habitual physical activity, affective function, and quality of life among older adults living in LTNHs. RESEARCH DESIGN AND METHODS: This 3-month single-blind randomized controlled trial (NCT03996083) involved 81 participants at 9 LTNHs randomly assigned to a multicomponent (MG) or a walking (WG) group. The MG participated in a twice-a-week individualized and progressive program composed of strength and balance exercises for 3 months. The WG was also individualized and participants walked up to 20 min per day. The primary outcome was the score on the short physical performance battery (SPPB). Secondary outcomes included other physical performance tests, habitual physical activity, cognitive performance, affective function, and quality of life. RESULTS: Compared with the WG, the MG group showed greater improvements in physical performance, including the SPPB (p < .05). No significant differences were observed in cognitive performance or habitual physical activity. Both groups showed improvements in anxiety and quality of life (p < .05). DISCUSSION AND IMPLICATIONS: Although both interventions were effective in maintaining or improving affective function, the MG conferred greater improvements in physical function. Therefore, multicomponent interventions would be preferable over walking-only interventions. Otherwise, individualized and progressive walking interventions should be implemented to face the rapid decline in functionality encountered in LTNHs.

Suicide Prevention Interventions for Older People in Nursing Homes and Long-Term Care Facilities: A Systematic Review.
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N. Chauliac, E. Leaune, V. Gardette, E. Poulet and A. Duclos.
J Geriatr Psychiatry Neurol 2019 Dec 16:891988719892343
BACKGROUND: The death rate due to suicide among older people is high, especially among men. Because many older people live in nursing homes or long-term care facilities in high-income countries, reviewing the impact of prevention strategies on the suicidal behavior of residents in these settings is of interest. METHODS: Following PRISMA guidelines, we performed a systematic review of the existing literature found in Pubmed, Scopus, Web of Science, PsycINFO, and Sociological Abstracts, focusing on interventions to prevent suicidal behavior or ideation in nursing home residents. The studies’ quality was evaluated according to TIDieR and MMAT. RESULTS: Only 6 studies met the inclusion criteria. Four of them described various “gatekeeper” trainings for nursing home staff and 2 described interventions focused on residents. Only 1 study was randomized. Gatekeeper training studies were mostly before/after comparisons. No intervention demonstrated a direct effect on suicidal ideation or behaviors. One study showed that “life review” had a long-lasting effect on depression scores and another that gatekeeper training led to changes in the care of suicidal residents. CONCLUSIONS: Interventions to prevent suicidal ideation or behaviors in nursing homes are not rigorously evaluated, and no conclusion can be drawn on their effectiveness in preventing suicidal behaviors. We propose to better evaluate gatekeeper training for staff as well as peer support. Individual interventions targeting residents could be modified for broader implementation.

Understanding quality of life and well-being for people living with advanced dementia.
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S. Hughes, B. Woods, K. Algar-Skaife and C. Hedd Jones.
Nurs Older People 2019 Mar 22;31(2):18-24
AIM: To investigate the quality of life (QoL) and well-being of people living with advanced dementia in care homes. METHOD: A mixed-methods approach was taken combining participant observations, interviews with the participants’ families and carers, and quantitative measurements. The quantitative measures included AwareCare assessments, QoL in Late-Stage Dementia scale ratings and semi-structured interviews with relatives and staff members. Ryff’s psychological well-being framework, the Fairness, Respect, Equality, Identity, Dignity, Autonomy principles, and Kitwood’s indicators of well-being, were examined to attempt to identify contributors to QoL for people living with advanced dementia. RESULTS: Participants had limited verbal abilities, but used non-vocal behaviours to communicate. These behaviours influenced their QoL and well-being. CONCLUSION: The indicators of well-being in Kitwood’s personhood model were helpful in describing how relatives and staff perceived the QoL of the person with dementia.

 

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Resources

Stakeholder engagement in research: The research-modified IAP2 spectrum

What options are available to researchers for engaging stakeholders in a research project? What responsibilities do researchers have to stakeholders over the course of that project? Despite increasing inclusion of stakeholders in research, there seems to be little guidance on how to do this effectively. Here is an adapted a framework developed by the International Association for Public Participation (IAP2 2018) for examining how the public are engaged in government decision making

How are nursing homes doing when it comes to staffing? This tool helps you find out (US data only)

Every quarter, the Long Term Care Community Coalition publishes staffing information for every nursing home in the country. They recently released stats for 2Q 2019, the most recent period reported by CMS. LTCCC is a New York state-based consortium of consumer, community, civic and professional organizations that focuses on systemic issues that affect the quality of care and dignity in long-term care.

Knowledge Translation Competency Framework

The Knowledge Translation Competency Framework is a tool presenting the knowledge and observable behaviours that are required to successfully fulfill the tasks and responsibilities related to the various activities associated with knowledge translation practices.

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News

3 steps to having difficult — but necessary — conversations

Women don’t call their research ‘novel’ or ‘excellent’ as often as men do

10 steps to map out a strategic plan for your career

Caring for dementia patients in pain

Key Ingredients of an Ideal System for High‐Quality Community Care for Persons With Dementia

The wonderful world of long term care

Global Convergence: Aging and Long-Term Care Policy Challenges in the Developing World

If You Want To Look Smart, Ask These Questions

Best evidence, but does it really change practice?

Older People Need Geriatricians. Where Will They Come From?

Nursing home quality: what matters to patients

How to Manage in a Culture of Continuous Improvement

NHS pressures ‘put medical breakthroughs at risk’

Spent, fearful nurses sound alarm at HSC in Winnipeg

It shouldn’t be this hard to navigate health and social care systems

Prioritizing Prevention to Combat Multidrug Resistance in Nursing Homes: A Call to Action

Working 9 to 5, not the way to make an academic living: observational analysis of manuscript and peer review submissions over time

The TV repeats and old songs that help people with dementia

We’re Getting Old, but We’re Not Doing Anything About It

Science Under Attack: How Trump Is Sidelining Researchers and Their Work

Florence Nightingale and the changing face of nursing

When Individuals Are More Innovative Than Teams

‘The entire system is in crisis.’ Ontario bill aims to prevent couples from being separated in long-term care
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Opportunities

Clinical Editor: Journal of Emergency Nursing

DEADLINE: 15 January
In a time of rapid and substantial growth in manuscript submissions, international reach and impact metrics, the Journal of Emergency Nursing, the official journal of the Emergency Nurses Association, is seeking applications for the position of Clinical Editor to join the senior editorial leadership team.

Associate Editor: Journal of Healthcare Quality

DEADLINE: 29 February
The Associate Editor will help facilitate peer review for submitted manuscripts and assist in driving the Journal’s editorial strategy. In this exciting role, the Associate Editor helps provide the vision, energy, and leadership to produce a bimonthly journal, which provides impactful research and communication about health care quality research through print and electronic media to multiple audiences including clinical investigators, health care executives and managers, nurses, physicians, and other healthcare professionals as well as policy-makers.

Call for Application – Expert Group members Digital Health Transformation

DEADLINE: 31 January
Would you like to become part of a sustainable platform for international cooperation in digital health? Meet experts in your field from the EU, US, Canada, China, Japan and South Korea? Participate in three workshops worldwide? Contribute to a roadmap with proposals for future collaboration? IDIH will set up an expert-driven “Digital Health Transformation Forum”, consisting of four Expert Groups (EGs), which aims to become a long-lasting mechanism for international dialogue in digital health. Each EG operates on a chosen “focus topic” and is chaired by a scientific expert, supported by a facilitator (a member of the IDIH consortium). The EGs will have at least six members each, including the EG Chairs. Selected EG members will be financially supported by the IDIH project to participate in EG activities. It is aimed to achieve a balance regarding the number of EG members from each region targeted by IDIH to ensure that all countries and regions are similarly represented.

Patient Engagement Specialist, Strategy for Patient-Oriented
Research (SPOR)

Surrey BC
DEADLINE: Open until filled
Are you looking for an opportunity to use your excellent communication and interpersonal skills to engage strategically with partners? Join us at Fraser Health as the Patient Engagement Specialist, Strategy for Patient-Oriented Research (SPOR) based in Surrey, BC. This role is responsible for implementing and evaluating the patient engagement strategy for patient-oriented health research in the Fraser region with all research stakeholders, including patients, family and friend caregivers, academic researchers, clinicians, policy makers, decision-makers, other health organizations, academic institutions, and not-for-profit community organizations. This role directly supports research teams in patient engagement planning and implementation, including team training and patient partner recruitment.

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