February 11, 2020

Calls for Abstracts
Events & Training Opportunities


New TREC article
Association of Work Environment With Missed and Rushed Care Tasks Among Care Aides in Nursing Homes.
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Y. Song, M. Hoben, P. Norton and C. A. Estabrooks.
JAMA Netw Open 2020 Jan 3;3(1):e1920092
In Canada, approximately 81% of residents of nursing homes live with mild to severe cognitive impairment. Care needs of this population are increasingly complex, but resources, such as staffing, for nursing homes continue to be limited. Staff risk missing or rushing care tasks and interfering with quality of care and life. Objective: To assess the association of work environment with missing and rushing essential care tasks in nursing homes. Design, Setting, and Participants: This cross-sectional study used survey data collected from a random sample of 93 urban nursing homes in Western Canada, stratified by health region, owner-operator model, and facility size, between May and December 2017. All 5411 eligible care aides were invited to participate, and 4016 care aides agreed and completed structured, computer-assisted interviews in person. Analyses were conducted from July 4, 2018, to February 27, 2019. Main Outcomes and Measures: Self-reported number of essential care tasks missed (range, 0-8) or rushed (range, 0-7) in the most recent shift. Two-level random intercept hurdle regressions controlled for care aide, care unit, and nursing home characteristics. Results: Of 4016 care aides, 2757 (68.7%) were 40 years or older, 3574 (89.1%) were women, and 1353 (66.3%) spoke English as an additional language. For their most recent shift, 2306 care aides (57.4%) reported missing at least 1 essential care task and 2628 care aides (65.4%) reported rushing at least 1 essential care task. Care aides on units with more favorable work environments (eg, more effective leadership, better work culture, higher levels of buffering resources) were less likely to miss any care tasks (odds ratio, 1.59; 95% CI, 1.34-1.90; P < .001) and less likely to rush any care task (odds ratio, 1.66; 95% CI, 1.38-1.99; P < .001). Conclusions and Relevance: This study found that rates of missed and rushed essential care in Canadian nursing homes were high and were higher in units with less favorable work environments. This finding suggests that work environment should be added to the list of modifiable factors associated with improving nursing home care, as it may be an important pathway for improving quality of care. Further research is needed to understand associations of missed and rushed care and of improving work environments with outcomes among residents of nursing homes.

TREC research in the news
Missed meals, walks and toileting: U of A study reveals essential tasks missed in nursing home care

57 per cent of care aides reported missing at least one essential task during their last shift.

Feedback Requested: 24-Hour Movement Guidelines for Adults and Older Adults
Survey on 24-Hour Movement Guidelines for Adults and Older Adults

The Canadian Society for Exercise Physiology (CSEP)
You are invited to complete this survey on stakeholder and members of the general public opinions of a draft version of the 24-Hour Movement Guidelines for Adults and Older Adults. Soliciting this feedback is part of an effort to assess your level of agreement with the content and wording of the 24-Hour Movement Guidelines for Adults and Older Adults. Your feedback is valuable and will inform potential revisions to the 24-Hour Guidelines for Adults and Older Adults, as well as strategies for Guideline promotion.

New article by Anita Kothari
Building an integrated knowledge translation (IKT) evidence base: colloquium proceedings and research direction.
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L. Boland, A. Kothari, C. McCutcheon, I. D. Graham and Integrated Knowledge Translation Research Network.
Health Res Policy Syst 2020 Jan 20;18(1):8-019-0521-3
Integrated knowledge translation (IKT) is a model of research co-production, whereby researchers partner with knowledge users throughout the research process and who can use the research recommendations in practice or policy. IKT approaches are used to improve the relevance and impact of research. As an emerging field, however, the evidence underpinning IKT is in active development. The Integrated Knowledge Translation Research Network represents a collaborative interdisciplinary team that aims to advance the state of IKT science. METHODS: In 2017, the Integrated Knowledge Translation Research Network issued a call to its members for concept papers to further define IKT, outline an IKT research agenda, and inform the Integrated Knowledge Translation Research Network’s special meeting entitled, Integrated Knowledge Translation State of the Science Colloquium, in Ottawa, Canada (2018). At the colloquium, authors presented concept papers and discussed knowledge-gaps for a research agenda and implications for advancing the IKT field. We took detailed field notes, audio-recorded the meeting and analysed the data using qualitative content analysis. RESULTS: Twenty-four participants attended the meeting, including researchers (n = 11), trainees (n = 6) and knowledge users (n = 7). Seven overarching categories emerged from these proceedings – IKT theory, IKT methods, IKT process, promoting partnership, definitions and distinctions of key IKT terms, capacity-building, and role of funders. Within these categories, priorities identified for future IKT research included: (1) improving clarity about research co-production/IKT theories and frameworks; (2) describing the process for engaging knowledge users; and (3) identifying research co-production/IKT outcomes and methods for evaluation. CONCLUSION: The Integrated Knowledge Translation State of the Science Colloquium initiated a research agenda to advance IKT science and practice. Next steps will focus on building a theoretical and evidence base for IKT.

New article by Whitney Berta
Context, complexity and process in the implementation of evidence-based innovation: a realist informed review.
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K. D. Dryden-Palmer, C. S. Parshuram and W. B. Berta.
BMC Health Serv Res 2020 Feb 3;20(1):81-020-4935-y
This review of scholarly work in health care knowledge translation advances understanding of implementation components that support the complete and timely integration of new knowledge. We adopt a realist approach to investigate what is known from the current literature about the impact of, and the potential relationships between, context, complexity and implementation process. METHODS: Informed by two distinct pathways, knowledge utilization and knowledge translation, we utilize Rogers’ Diffusion of Innovations theory (DOI) and Harvey and Kitson’s integrated- Promoting Action on Research Implementation in Health Service framework (PARIHS) to ground this review. Articles from 5 databases; Medline, Scopus, PsycInfo, Web of Science, and Google Scholar and a search of authors were retrieved. Themes and patterns related to these implementation components were extracted. Literature was selected for inclusion by consensus. Data extraction was iterative and was moderated by the authors. RESULTS: A total of 67 articles were included in the review. Context was a central component to implementation. It was not clear how and to what extent context impacted implementation. Complexity was found to be a characteristic of context, implementation process, innovations and a product of the relationship between these three elements. Social processes in particular were reported as influential however; descriptions of how these social process impact were limited. Multiple theoretical and operational models were found to ground implementation processes. We offer an emerging conceptual model to illustrate the key discoveries. CONCLUSIONS: The review findings indicate there are dynamic relationship between context, complexity and implementation process for enhancing uptake of evidence-based knowledge in hospital settings. These are represented in a conceptual model. Limited empiric evidence was found to explain the nature of the relationships.

New article by Shannon Scott
Digital Technology Distraction for Acute Pain in Children: A Meta-analysis.
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M. Gates, L. Hartling, J. Shulhan-Kilroy, et al.
Pediatrics 2020 Feb;145(2):10.1542/peds.2019-1139. Epub 2020 Jan 22
Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown. OBJECTIVE: To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures. DATA SOURCES: Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Institute of Electrical and Electronics Engineers Xplore, Ei Compendex, Web of Science, and gray literature sources. STUDY SELECTION: Quantitative studies of digital technology distraction for acutely painful conditions or procedures in children. DATA EXTRACTION: Performed by 1 reviewer with verification. Outcomes were child pain and distress. RESULTS: There were 106 studies (n = 7820) that reported on digital technology distractors (eg, virtual reality and video games) used during common procedures (eg, venipuncture, dental, and burn treatments). No studies reported on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (standardized mean difference [SMD] -0.48; 95% confidence interval [CI] -0.66 to -0.29; 46 randomized controlled trials [RCTs]; n = 3200), observer-reported pain (SMD -0.68; 95% CI -0.91 to -0.45; 17 RCTs; n = 1199), behavioral pain (SMD -0.57; 95% CI -0.94 to -0.19; 19 RCTs; n = 1173), self-reported distress (SMD -0.49; 95% CI -0.70 to -0.27; 19 RCTs; n = 1818), observer-reported distress (SMD -0.47; 95% CI -0.77 to -0.17; 10 RCTs; n = 826), and behavioral distress (SMD -0.35; 95% CI -0.59 to -0.12; 17 RCTs; n = 1264) compared with usual care. LIMITATIONS: Few studies directly compared different distractors or provided subgroup data to inform applicability. CONCLUSIONS: Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over nondigital distractors is not established. Context, preferences, and availability should inform the choice of distractor.

New article by Alison Kitson
Engaging older adults in self-management talk in healthcare encounters: a systematic review protocol.
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M. T. Lawless, P. Drioli-Phillips, M. M. Archibald and A. L. Kitson.
Syst Rev 2020 Jan 16;9(1):15-020-1276-1
Clinical practice guidelines for the management of complex chronic conditions in older adults encourage healthcare providers to engage patients in shared decision-making about self-management goals and actions. Yet, healthcare decision-making and communication for this population can pose significant challenges. As a result, healthcare professionals may struggle to help patients define and prioritise their values, goals, and preferences in ways that are clinically and personally meaningful, incorporating physical functioning and quality of life, when faced with numerous diagnostic and treatment alternatives. The aim of this systematic review is to locate and synthesise a body of fine-grained observational research on communication between professionals, older adults, and carers regarding self-management in audio/audio-visually recorded naturalistic interactions. METHODS/DESIGN: The paper describes a systematic review of the published conversation analytic and discourse analytic research, using an aggregative thematic approach and following the PRISMA-P guidelines. This review will include studies reporting on adult patients (female or male) aged >/= 60 years whose consultations are conducted in English in any healthcare setting and stakeholders involved in their care, e.g. general practitioners, nurses, allied health professionals, and family carers. We will search nine electronic databases and the grey literature and two independent reviewers will screen titles and abstracts to identify potential studies. Discrepancies will be resolved via consultation with the review team. The methodological quality of the final set of included studies will be appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research and a detailed description of the characteristics of the included studies using a customised template. DISCUSSION: This is the first systematic review to date to locate and synthesise the conversation analytic research on how healthcare professionals raise and pursue talk about self-management with older adults in routine clinical interactions. Amalgamating these findings will enable the identification of effective and potentially trainable communication practices for engaging older adults in healthcare decision-making about the self-management goals and actions that enable the greatest possible health and quality of life in older adulthood. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019139376.

Calls for Abstracts

Alberta SPOR Summer Insititute 2020

11-13 May, Calgary, AB
DEADLINE 28 February
Each year, researchers, patients, clinicians, students, policymakers and more, gather to share insights, connect with colleagues and promote patient-oriented research. In 2020, we’re working together to explore, evaluate and share the impact and opportunities of patient-oriented research.

Join us for an outstanding line-up of engaging speakers, workshops on patient-oriented research topics, networking opportunities with colleagues, and capacity building opportunities for patient-oriented research.


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


How Practice Facilitation Strategies Differ by Practice Context.
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A. M. Nguyen, A. Cuthel, D. K. Padgett, et al.
J Gen Intern Med 2019 Oct 21
Practice facilitation is an implementation strategy used to build practice capacity and support practice changes to improve health care outcomes. Yet, few studies have investigated how practice facilitation strategies are tailored to different primary care contexts. OBJECTIVE: To identify contextual factors that drive facilitators’ strategies to meet practice improvement goals, and how these strategies are tailored to practice context. DESIGN: Semi-structured, qualitative interviews analyzed using inductive (open coding) and deductive (thematic) approaches. This study was conducted as part of a larger study, HealthyHearts New York City, which evaluated the impact of practice facilitation on adoption of cardiovascular disease prevention and treatment guidelines. PARTICIPANTS: 15 facilitators working in two practice contexts: small independent practices (SIPs) and Federally Qualified Health Centers (FQHCs). MAIN MEASURES: Strategies facilitators use to support and promote practice changes and contextual factors that impact this approach. KEY RESULTS: Contextual factors were described similarly across settings and included the policy environment, patient needs, site characteristics, leadership engagement, and competing priorities. We identified four facilitation strategies used to tailor to contextual factors and support practice change: (a) remain flexible to align with practice and organizational priorities; (b) build relationships; (c) provide value through information technology expertise; and (d) build capacity and create efficiencies. Facilitators in SIPs and FQHCs described using the same strategies, often in combination, but tailored to their specific contexts. CONCLUSIONS: Despite significant infrastructure and resource differences between SIPs and FQHCs, the contextual factors that influenced the facilitator’s change process and the strategies used to address those factors were remarkably similar. The findings emphasize that facilitators require multidisciplinary skills to support sustainable practice improvement in the context of varying complex health care delivery settings.


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Health Care Administration and Organization

Exploring the knowledge, attitudes and perceived learning needs of formal carers of people with dementia.
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R. Attard, R. Sammut and A. Scerri.
Nurs Older People 2020 Feb 5
An appropriate level of knowledge, a positive attitude and awareness of learning needs are essential to provide high-quality care to people living with dementia. AIM: To explore the knowledge, attitudes and perceived learning needs of formal carers of residents living with dementia in one long-term care facility. METHOD: Questionnaires were sent to nurses and nursing assistants working in one long-term care facility in Malta. A total of 207 completed responses were received from these formal carers. The questionnaire comprised scales: the Alzheimer’s Disease Knowledge Scale, the Dementia Attitude Scale and the Dementia Learning Needs Assessment tool. RESULTS: Formal carers’ knowledge about dementia was satisfactory. Increased knowledge was associated with being a nurse and working on a specialist dementia unit. Overall, formal carers’ attitudes towards people with dementia were positive. Nurses identified managing behaviour that challenges as the most important learning need, while for nursing assistants it was how to assist family caregivers in coping with Alzheimer’s disease. Nurses and nursing assistants considered learning about the use of technology to be the least important learning need. Being a nurse and working in a specialist dementia unit were predictors of better knowledge. Working in specialist dementia units was also a predictor of positive attitudes towards people with dementia. CONCLUSION: Policymakers should be aware that continued investment in specialist dementia units should be an intermediate and long-term goal because of the projected increase in the number of people living with dementia and the need to ensure these individuals receive optimum care.

Forecasting Content and Stage in a Nursing Home Information Technology Maturity Instrument Using a Delphi Method.
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G. L. Alexander, C. Deroche, K. Powell, A. S. Mohammad, L. Popejoy and R. Koopman.
J Med Syst 2020 Feb 5;44(3):60-020-1528-6
Health information technology capabilities in some healthcare sectors, such as nursing homes, are not well understood because measures for information technology uptake have not been fully developed, tested, validated, or measured consistently. The paper provides a report of the development and testing of a new instrument measuring nursing home information technology maturity and stage of maturity. Methods incorporated a four round Delphi panel composed of 31 nursing home experts from across the nation who reported the highest levels of information technology sophistication in a separate national survey. Experts recommended 183 content items for 27 different content areas specifying the measure of information technology maturity. Additionally, experts ranked each of the 183 content items using an IT maturity instrument containing seven stages (stages 0-6) of information technology maturity. The majority of content items (40% (n = 74)) were associated with information technology maturity stage 4, corresponding to facilities with external connectivity capability. Over 11% of the content items were at the highest maturity stage (Stage 5 and 6). Content areas with content items at the highest stage of maturity are reflected in nursing homes that have technology available for residents or their representatives and used extensively in resident care. An instrument to assess nursing home IT maturity and stage of maturity has important implications for understanding health service delivery systems, regulatory efforts, patient safety and quality of care.

A systematic review of the impact of ‘missed care’ in primary, community and nursing home settings.
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K. Sworn and A. Booth.
J Nurs Manag 2020 Feb 3
Missed care occurs when any aspect of required patient care is omitted or delayed. Little attention has examined missed care in primary, community and nursing home settings. DATA SOURCES: PubMed, CINAHL, Google Scholar (July 2018). RESULTS: The search identified 15 metrics papers (2004-2019) and 8 empirical papers (2015-2018) (5 studies) Empirical studies were rated as good quality. Missed care impacts on safety in community/primary care contexts and differs from acute care. Causes of missed care include acuity, complexity of cases, volume of care, organisational factors. KEY ISSUE: Metrics have been adapted to community/nursing home contexts but in a non-standardised way. Tools are required to evaluate missed care within a culture of personal reflection and quality improvement. CONCLUSION: The prominence of missed acute care should not distract from its impact in primary, community care and nursing home settings. Nurse leaders should consider causes for missed care, how it is conceptualised and evaluated. IMPLICATIONS FOR NURSING MANAGEMENT AND LEADERSHIP: This review offers evidence for exploring, measuring and evaluating missed care locally.

The Role of the Palliative Care Registered Nurse in the Nursing Facility Setting.
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S. E. Hickman, M. Parks, K. T. Unroe, M. Ott and M. Ersek.
J Hosp Palliat Nurs 2020 Feb 1
There is a growing recognition of significant, unmet palliative care needs in nursing facilities, yet limitations in the workforce limit access to palliative care services. Attention to palliation is particularly important when there are efforts to reduce hospitalizations to help ensure there are no unintended harms associated with treating residents in place. A specialized palliative care registered nurse (PCRN) role was developed as part of the OPTIMISTIC (Optimizing Patient Transfers, Impacting Medical quality, and Improving Symptoms: Transforming Institutional Care) program, a federally funded project to reduce potentially avoidable hospitalizations. Working in collaboration with existing clinical staff and medical providers, the PCRN focuses on managing symptoms, advance care planning, achieving goal concordant care, and promoting quality of life. The PCRN serves as a resource for families through education and support. The PCRN also provides education and mentorship to staff to increase their comfort, knowledge, and skills with end-of-life care. The goals of this article are to provide an overview of the PCRN role and its implementation in nursing facilities and describe core functions that are transferrable to other contexts.

Partnering to Educate Nurses in Long-Term Care.
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C. Selleck, R. Jablonski, R. S. Miltner, J. Deupree, G. McGhan and J. Powell.
J Contin Educ Nurs 2020 Feb 1;51(2):75-81
Despite a 2008 national call to retool a health care workforce for an aging America, the geriatrics-trained workforce is declining while the U.S. population continues to age. Formalized academic-practice partnerships between long-term care facilities and schools of nursing are one response to strengthening the work-force caring for older adults. This article details the activities of an intentional, synergistic, 3-year partnership between National HealthCare Corporation (NHC) and University of Alabama at Birmingham (UAB) School of Nursing. The partnership focused on providing continuing education and leadership development for NHC nurses while also providing nursing faculty with access to clinicians and patients in long-term care for the purposes of education, research, and quality improvement. The ultimate goal for both partners was improved patient outcomes.

Dementia-Related Education and Support Service Availability, Accessibility, and Use in Rural Areas: Barriers and Solutions.

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M. Bayly, D. Morgan, A. Froehlich Chow, J. Kosteniuk and V. Elliot.
Can J Aging 2020 Jan 24:1-41
This scoping review mapped and synthesized published literature related to education and support services for individuals with dementia and their caregivers living rurally. Specifically, we investigated education and support service needs, availability and use of services, barriers to service access and use, and solutions to these barriers. Empirical, English-language articles (2,381) were identified within MEDLINE, CINAHL, PSYCINFO, and EMBASE. Articles were screened according to Arksey and O’Malley’s (2005) five-stage scoping review methodology and the recommendations of Levac et al. (2010). Findings suggest limited availability of rural dementia-related support and education services, particularly respite care and day programs. Service use varied across studies, with barriers including low knowledge regarding services, practicality, and resource issues (e.g., transportation, financial), values and beliefs, stigma, and negative perceptions of services. Solutions included tailored and person-centred services, technological service provision, accessibility assistance, inter-organization collaboration, education regarding services, and having a “point of entry” to service use.

Nurses’ experiences of working under time pressure in care for older persons.
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B. Dierckx de Casterle, E. Mertens, J. Steenacker and Y. Denier.
Nurs Ethics 2020 Jan 24:969733019895797
The international health workforce crisis had led to an increasing shortage of nurses, which has substantial implications for the quality of patient care. This shortage potentially results in nurse-perceived time pressure, which can be particularly challenging for nurses who provide care for older persons. OBJECTIVE: This study aimed to show how geriatric nurses experience working under time pressure, perceive its impact on care and deal with time pressure in daily care. RESEARCH DESIGN: A qualitative descriptive interview design was used. PARTICIPANTS AND RESEARCH CONTEXT: Purposive sampling led to the inclusion of 11 nurses from three geriatric nursing wards in two general hospitals in Flanders (Belgium). Data were collected using semi-structured in-depth interviews and analysed using the QUAGOL (Qualitative Analysis Guide of Leuven). ETHICAL CONSIDERATIONS: The study protocol was approved by the Ethics Committee of the University Hospitals Leuven (Ethics committee of the University Hospitals Leuven). FINDINGS: In all interviews, time pressure was described as ubiquitous in the daily care of older persons. A sense of failure in providing care was the common thread in many interviews. Nurses felt compelled to ‘reduce’ good-quality care to basic care by focusing on the physical and visible aspects of care. Nevertheless, personal experiences with time pressure and strategies to cope with it differed among the interviewees. These variations were related to the working environment and the nurses themselves. They underscored the importance of nurses’ perspectives for a good understanding of the phenomenon of time pressure. DISCUSSION AND CONCLUSION: Working under time pressure in the care of older persons leads to various important challenges for nursing ethics. The findings show that providing care that promotes the human dignity of older persons in busy working environments in which care is rationed is an important ethical challenge. As such, our study offers a baseline for further research and discussion on how to support nurses working under time pressure.

European Collaborative and Interprofessional Capability Framework for Prevention and Management of Frailty-a consensus process supported by the Joint Action for Frailty Prevention (ADVANTAGE) and the European Geriatric Medicine Society (EuGMS).
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R. Roller-Wirnsberger, S. Lindner, A. Liew, et al.
Aging Clin Exp Res 2020 Jan 22
Interprofessional collaborative practice (ICP) is currently recommended for the delivery of high-quality integrated care for older people. Frailty prevention and management are key elements to be tackled on a multi-professional level. AIM: This study aims to develop a consensus-based European multi-professional capability framework for frailty prevention and management. METHODS: Using a modified Delphi technique, a consensus-based framework of knowledge, skills and attitudes for all professions involved in the care pathway of older people was developed within two consultation rounds. The template for the process was derived from competency frameworks collected in a comprehensive approach from EU-funded projects of the European Commission (EC) supported best practice models for health workforce development. RESULTS: The agreed framework consists of 25 items structured in 4 domains of capabilities. Content covers the understanding about frailty, skills for screening and assessment as well as management procedures for every profession involved. The majority of items focused on interprofessional collaboration, communication and person-centred care planning. DISCUSSION: This framework facilitates clarification of professionals’ roles and standardizes procedures for cross-sectional care processes. Despite a lack of evidence for educational interventions, health workforce development remains an important aspect of quality assurance in health care systems. CONCLUSIONS: The multi-professional capability framework for frailty prevention and management incorporated interprofessional collaborative practice, consistent with current recommendations by the World Health Organization, Science Advice for Policy by European Academies and the European Commission.

Work-Related Burdens and Requirements for Health Promotion Programs for Nursing Staff in Different Care Settings: A Cross-Sectional Study.
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A. K. Otto, L. L. Bischoff and B. Wollesen.
Int J Environ Res Public Health 2019 Sep 25;16(19):10.3390/ijerph16193586
Nursing staff in all settings have multiple work-related problems due to patient handling and occupational stressors, which result in high stress levels and low back pain. In this context the importance of health promotion becomes apparent. The aim of this study is to analyse whether nursing staff (in elderly care, hospitals, home care, or trainees) show different levels of work-related burdens and whether they require individualized components in health promotion programs. N = 242 German nurses were included in a quantitative survey (Health survey, Screening Scale (SSCS) of Trier Inventory for Chronic Stress, Slesina). The differences were tested using Chi(2)-Tests, Kruskal-Wallis Test and one-way ANOVA. Nurses differed in stress loads and were chronically stressed (F(3236) = 5.775, p = 0.001). Nurses in home care showed the highest SSCS-values with time pressure as the most important straining factor. The physical strains also placed a particular burden on nurses in home care, whereas they still reported higher physical well-being in contrast to nurses in elderly care (Chi(2) = 24.734, p < 0.001). Nurses in elderly care and home care preferred strength training whereas nurses in hospitals and trainees favoured endurance training. Targeted programs are desirable for the reduction of work-related burdens. While nurses in elderly care and home care need a combination of ergonomic and strength training, all nurses require additional stress management. Planning should take into account barriers like perceived additional time consumption. Therefore, health promotion programs for all settings should be implemented during working time at the work setting and should consider the working schedule.

Professional stress and social support feelings, coping strategies, and burn-out of caregivers in care facilities for dependent elderly people.
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S. Tonna.
Geriatr Psychol Neuropsychiatr Vieil 2019 Sep 1;17(3):327-335
Caregivers in dependent elderly people facilities may develop a burn-out, but few studies have been conducted on the subject. The aim of this study is to evaluate the feelings of professional stress and social support, coping strategies and caregivers’ burn-out including nurses, caregivers and medical psychologists, to identify the different coping strategies according to the burn-out level, and to analyze the links between burn-out, perceived work stress and perceived social support. Seven facilities were contacted, but only three sent back valid response questionnaires. Twenty-one caregivers completed the questionnaires (socio-demographic data, MBI, Brief Cope, SSQ6, JSS). Results showed a low level of burn-out and perceived stress and a satisfactory perceived social support. Functional coping strategies were used, especially by caregivers with lower burn-out level (positive reinterpretation) unlike caregivers with moderate or high burn-out level that used more dysfunctional strategies (substance abuse). Significant links were found between perceived work stress and emotional exhaustion, and between personal accomplishment, perceived social support and emotional exhaustion, and between perceived work stress and perceived social support. These results show the relevance of creating working groups for caregivers in stress situations. The groups help to develop or maintain functional coping strategies and provide adequate social support for the healthcare team. Taking into account burn-out improves caregivers’ job satisfaction and care quality for the residents.

Getting to grips with the process of decision-making in long-term care. Descriptive cases illustrate the chaotic reality of the construction of preferences.
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C. M. van Leersum, A. Moser, B. van Steenkiste, J. R. L. M. Wolf and T. van der Weijden.
PLoS One 2019 May 24;14(5):e0217338
Clients facing decision-making for long-term care are in need of support and accessible information. Construction of preferences, including context and calculations, for clients in long-term care is challenging because of the variability in supply and demand. This study considers clients in four different sectors of long-term care: the nursing and care of the elderly, mental health care, care of people with disabilities, and social care. The aim is to understand the construction of preferences in real-life situations. METHOD: Client choices were investigated by qualitative descriptive research. Data were collected from 16 in-depth interviews and 79 client records. Interviews were conducted with clients and relatives or informal caregivers from different care sectors. The original client records were explored, containing texts, letters, and comments of clients and caregivers. All data were analyzed using thematic analysis. RESULTS: Four cases showed how preferences were constructed during the decision-making process. Clients discussed a wide range of challenging aspects that have an impact on the construction of preferences, e.g. previous experiences, current treatment or family situation. This study describes two main characteristics of the construction of preferences: context and calculation. CONCLUSION: Clients face diverse challenges during the decision-making process on long-term care and their construction of preferences is variable. A well-designed tool to support the elicitation of preferences seems beneficial.

Barriers and facilitators to implementing dementia care mapping in care homes: results from the DCM™ EPIC trial process evaluation.
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A. W. Griffiths, R. Kelley, L. Garrod, et al.
BMC Geriatr 2019 Feb 8;19(1):37-019-1045-y
Psychosocial person-centred interventions are considered best practice for addressing complex behaviours and care needs such as agitation and anxiety, and for improving the quality of life of people with dementia in care homes. Dementia Care Mapping (DCM) is an established practice development tool and process aimed to help care home staff deliver more person-centred care. To date, few studies have evaluated the efficacy of DCM and have found mixed results. These results are suggested to be the outcome of intervention implementation, which may be impacted by a range of factors. This study reports the barriers and facilitators to DCM implementation in care homes found during the process evaluation conducted as part of a randomized controlled trial. METHODS: Eighteen of the 31 DCM intervention care homes were recruited to participate in the embedded process evaluation. Semi-structured interviews were conducted with 83 participants, comprising care home managers, trained DCM users (mappers), expert external mappers, staff members, relatives, and residents. RESULTS: Barriers and facilitators to DCM implementation were found at the mapper level (e.g. motivation and confidence), the DCM intervention level (e.g. understanding of DCM) and the care home level (e.g. staffing issues, manager support). Further barriers caused by the burden of trial participation were also identified (e.g. additional paperwork). CONCLUSIONS: Implementing DCM is complex and a greater consideration of potential barriers and facilitators in planning future studies and in practice could help improve implementation. TRIAL REGISTRATION: Current Controlled Trials ISRCTN82288852 , registered 16/01/2014.

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Health Care Innovation and Quality Assurance

Defining sustainability in practice: views from implementing real-world innovations in health care.
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R. Urquhart, C. Kendell, E. Cornelissen, et al.
BMC Health Serv Res 2020 Feb 4;20(1):87-020-4933-0
One of the key conceptual challenges in advancing our understanding of how to more effectively sustain innovations in health care is the lack of clarity and agreement on what sustainability actually means. Several reviews have helped synthesize and clarify how researchers conceptualize and operationalize sustainability. In this study, we sought to identify how individuals who implement and/or sustain evidence-informed innovations in health care define sustainability. METHODS: We conducted in-depth, semi-structured interviews with implementation leaders and relevant staff involved in the implementation of evidence-based innovations relevant to cancer survivorship care (n = 27). An inductive approach, using constant comparative analysis, was used for analysis of interview transcripts and field notes. RESULTS: Participants described sustainability as an ongoing and dynamic process that incorporates three key concepts and four important conditions. The key concepts were: (1) continued capacity to deliver the innovation, (2) continued delivery of the innovation, and (3) continued receipt of benefits. The key conditions related to (2) and (3), and included: (2a) innovations must continue in the absence of the champion or person/team who introduced it and (3a) adaptation is critical to ensuring relevancy and fit, and thus to delivering the intended benefits. CONCLUSIONS: Participants provided a nuanced view of sustainability, with both continued delivery and continued benefits only relevant under certain conditions. The findings reveal the interconnected elements of what sustainability means in practice, providing a unique and important perspective to the academic literature.

Strategies for the implementation of palliative care education and organizational interventions in long-term care facilities: A scoping review.
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D. Collingridge Moore, S. Payne, L. Van den Block, J. Ling, K. Froggatt and PACE.
Palliat Med 2020 Feb 3:269216319893635
The number of older people dying in long-term care facilities is increasing; however, care at the end of life can be suboptimal. Interventions to improve palliative care delivery within these settings have been shown to be effective in improving care, but little is known about their implementation. AIM: The aim of this study was to describe the nature of implementation strategies and to identify facilitators and/or barriers to implementing palliative care interventions in long-term care facilities. DESIGN: Scoping review with a thematic synthesis, following the ENTREQ guidelines. DATA SOURCES: Published literature was identified from electronic databases, including MEDLINE, EMBASE, PsycINFO and CINAHL. Controlled, non-controlled and qualitative studies and evaluations of interventions to improve palliative care in long-term care facilities were included. Studies that met the inclusion criteria were sourced and data extracted on the study characteristics, the implementation of the intervention, and facilitators and/or barriers to implementation. RESULTS: The review identified 8902 abstracts, from which 61 studies were included in the review. A matrix of implementation was developed with four implementation strategies (facilitation, education/training, internal engagement and external engagement) and three implementation stages (conditions to introduce the intervention, embedding the intervention within day-to-day practice and sustaining ongoing change). CONCLUSION: Incorporating an implementation strategy into the development and delivery of an intervention is integral in embedding change in practice. The review has shown that the four implementation strategies identified varied considerably across interventions; however, similar facilitators and barriers were encountered across the studies identified. Further research is needed to understand the extent to which different implementation strategies can facilitate the uptake of palliative care interventions in long-term care facilities.

Learning from complaints in healthcare: a realist review of academic literature, policy evidence and front-line insights.
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J. van Dael, T. W. Reader, A. Gillespie, A. L. Neves, A. Darzi and E. K. Mayer.
BMJ Qual Saf 2020 Feb 4
A global rise in patient complaints has been accompanied by growing research to effectively analyse complaints for safer, more patient-centric care. Most patients and families complain to improve the quality of healthcare, yet progress has been complicated by a system primarily designed for case-by-case complaint handling. AIM: To understand how to effectively integrate patient-centric complaint handling with quality monitoring and improvement. METHOD: Literature screening and patient codesign shaped the review’s aim in the first stage of this three-stage review. Ten sources were searched including academic databases and policy archives. In the second stage, 13 front-line experts were interviewed to develop initial practice-based programme theory. In the third stage, evidence identified in the first stage was appraised based on rigour and relevance, and selected to refine programme theory focusing on what works, why and under what circumstances. RESULTS: A total of 74 academic and 10 policy sources were included. The review identified 12 mechanisms to achieve: patient-centric complaint handling and system-wide quality improvement. The complaint handling pathway includes (1) access of information; (2) collaboration with support and advocacy services; (3) staff attitude and signposting; (4) bespoke responding; and (5) public accountability. The improvement pathway includes (6) a reliable coding taxonomy; (7) standardised training and guidelines; (8) a centralised informatics system; (9) appropriate data sampling; (10) mixed-methods spotlight analysis; (11) board priorities and leadership; and (12) just culture. DISCUSSION: If healthcare settings are better supported to report, analyse and use complaints data in a standardised manner, complaints could impact on care quality in important ways. This review has established a range of evidence-based, short-term recommendations to achieve this.

A mixed methods quality improvement study to implement nurse practitioner roles and improve care for residents in long-term care facilities.
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K. Kilpatrick, E. Tchouaket, M. Jabbour and S. Hains.
BMC Nurs 2020 Jan 29;19:6-019-0395-2. eCollection 2020
To better meet long-term care (LTC) residents’ (patients in LTC) needs, nurse practitioners (NPs) were proposed as part of a quality improvement initiative. No research has been conducted in LTC in Quebec Canada, where NP roles are new. We collected provider interviews, field notes and resident outcomes to identify how NPs in LTC influence care quality and inform the wider implementation of these roles in Quebec. This paper reports on resident outcomes and field notes. Methods: Research Design: This mixed methods quality improvement study included a prospective cohort study in six LTC facilities in Quebec. Participants: Data were collected from September 2015-August 2016. The cohort consisted of all residents (n = 538) followed by the nurse practitioners. Nurse practitioner interventions (n = 3798) related to medications, polypharmacy, falls, restraint use, transfers to acute care and pressure ulcers were monitored. Analysis: Bivariate analyses and survival analysis of occurrence of events over time were conducted. Content analysis was used for the qualitative data. Results: Nurse practitioners (n = 6) worked half-time in LTC with an average caseload ranging from 42 to 80 residents. Sites developed either a shared care or a consultative model. The average age of residents was 82, and two thirds were women. The most common diagnosis on admission was dementia (62%, n = 331). The number of interventions/resident (range: 2.2-16.3) depended on the care model. The average number of medications/resident decreased by 12% overall or 10% for each 30-day period over 12 months. The incidence of polypharmacy, falls, restraint use, and transfers to acute care decreased, and very few pressure ulcers were identified. Conclusions: The implementation of NPs in LTC in Quebec can improve care quality for residents. Results show that the average number of medications per day per resident, the incidence of polypharmacy, falls, restraint use, and transfers to acute care all decreased during the study, suggesting that a wider implementation of NP roles in LTC is a useful strategy to improve resident care. Although additional studies are needed, the implementation of a consultative model should be favoured as our project provides preliminary evidence of the contributions of these new roles in LTC in Quebec.

Barriers and facilitators to palliative care education in nursing and residential homes: a rapid review.
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J. Manson, C. Gardiner and L. McTague.
Int J Palliat Nurs 2020 Jan 2;26(1):32-44
There is insufficient high-quality evidence to suggest that palliative care education can impact care home settings. AIMS: To identify, appraise and synthesise all available evidence on the barriers and facilitators to providing palliative care education in residential and nursing care homes and to generate recommendations to increase the effectiveness of future palliative care education programmes in care homes. METHODS: A rapid review searching CINAHL, Medline and ProQuest. One author screened full-text articles for inclusion. Any uncertainties were discussed with a second author. FINDINGS: Twenty-two articles were included in the full review. Analysis of the included articles revealed the following overlapping themes: structural systems; cultural and personal issues; and knowledge translation issues with interaction. CONCLUSION: Addressing the barriers and facilitators when designing palliative care education programmes for care homes will lead to more successful outcomes.

Recommendations for Improving Antimicrobial Stewardship in Long-Term Care Settings Through Collaboration.
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C. Adre, R. L. P. Jump and S. S. Spires.
Infect Dis Clin North Am 2020 Mar;34(1):129-143
Antimicrobial stewardship is a collaborative venture and antimicrobial stewardship in long-term care (LTC) settings is no exception. There are many barriers to implementing effective antimicrobial stewardship programs in LTC settings, including constrained financial resources, limited access to physicians and pharmacists with antimicrobial stewardship training, minimal on-site infectious syndrome diagnostics and laboratory expertise, and high rates of staff turnover. This article suggests that collaboration at the level of health care facilities and systems, with public health departments, with laboratory partners, and among personnel, including nursing staff, prescribers, and pharmacists, can lead to effective antimicrobial stewardship programs in LTC settings.

Outcomes of health information technology utilization in nursing homes: Do implementation processes matter?
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D. J. Hamann and K. C. Bezboruah.
Health Informatics J 2020 Jan 29:1460458219899556
We examined several outcomes of health information technology utilization in nursing homes and how the processes used to implement health information technology affected these outcomes. We hypothesized that one type of health information technology, electronic medical records, will improve efficiency and quality-related outcomes, and that the use of effective implementation processes and change leadership strategies will improve these outcomes. We tested these hypotheses by creating an original survey based on the case study literature, which we sent to the top executives of nursing homes in seven US states. The administrators reported that electronic medical record adoption led to moderately positive efficiency and quality outcomes, but its adoption was unrelated to objective quality indicators obtained from regulatory agencies. Improved electronic medical record implementation processes, however, were positively related to administrator-reported efficiency and quality outcomes and to decreased deficiency citations at the next regulatory visit to the nursing home. Change leadership processes did not matter as much as technological implementation processes.

“Navigation to prioritizing the patient” – first-line nurse managers’ experiences of participating in a quality improvement collaborative.
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B. M. Sjolie, T. A. Hartviksen and T. Bondas.
BMC Health Serv Res 2020 Jan 22;20(1):55-020-4918-z
First-line nurse managers are central to quality improvement work when changing work practices into better patient outcomes. Quality improvement collaboratives have been adopted widely to support quality management in healthcare services and shared learning. We have little knowledge of the first-line nurse managers’ own perspectives concerning their need for support and knowledge in quality improvement work. Therefore, the aim of this study was to gain understanding of first line nurse managers’ experiences in leading quality improvement work in their own organization when participating in a quality improvement collaborative. METHODS: An interpretive approach was chosen following Graneheim and Lundman’s qualitative content analysis. Data was collected through three focus group interviews with first-line nurse managers representing different workplaces: the local hospital, a nursing home, and a homecare service in a rural area of Norway. RESULTS: “Navigation to prioritizing the patient” emerged as an overarching metaphor to describe the first-line nurse managers experiences of leading quality improvement work, based on three themes: 1) fellowship for critical thinking and prioritizing the patient; 2) mastering the processes in quality improvement work; and 3) the everyday reality of leadership as a complex context. CONCLUSIONS: A quality improvement collaborative encompassing knowledge transfer and reflection may create an important fellowship for health care leaders, encouraging and enabling quality improvement work in their own organization. It is crucial to invite all leaders from an organization to be able to share the experience and continue their collaboration with their staff in the organization. Continuity over time, following up elements of the quality improvement work at joint meetings, involvement by users, and self-development of and voluntary involvement in the quality improvement collaborative seem to be important for knowledge development in quality improvement. The supportive elements of the quality improvement collaborative fellowship were crucial to critical thinking and to the first-line nurse managers’ own development and security in mastering the quality improvement work processes. They preferred prioritizing the patients in quality improvement work, despite haste and obstructive situations in an everyday context.


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Organizational Culture and Change

Setting Priorities to Inform Assessment of Care Homes’ Readiness to Participate in Healthcare Innovation: A Systematic Mapping Review and Consensus Process

Bunn F, Goodman C, Corazzini K, Sharpe R, Handley M, Lynch J, et al.
International Journal of Environmental Research and Public Health 2020;17(3)
Organisational context is known to impact on the successful implementation of healthcare initiatives in care homes. We undertook a systematic mapping review to examine whether researchers have considered organisational context when planning, conducting, and reporting the implementation of healthcare innovations in care homes. Review data were mapped against the Alberta Context Tool, which was designed to assess organizational context in care homes. The review included 56 papers. No studies involved a systematic assessment of organisational context prior to implementation, but many provided post hoc explanations of how organisational context affected the success or otherwise of the innovation. Factors identified to explain a lack of success included poor senior staff engagement, non-alignment with care home culture, limited staff capacity to engage, and low levels of participation from health professionals such as general practitioners (GPs). Thirty-five stakeholders participated in workshops to discuss findings and develop questions for assessing care home readiness to participate in innovations. Ten questions were developed to initiate conversations between innovators and care home staff to support research and implementation. This framework can help researchers initiate discussions about health-related innovation. This will begin to address the gap between implementation theory and practice.

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Research Practice and Methodology

Using a ‘rich picture’ to facilitate systems thinking in research coproduction.
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K. P. Conte and S. Davidson.
Health Res Policy Syst 2020 Jan 31;18(1):14-019-0514-2
In coproduction research, traditional ‘end-users’ are involved in the entire research process. The aim is to facilitate research translation by improving the timeliness and relevance of research. Because end-users often come from multiple sectors and hold diverse perspectives and priorities, involving them in coproduction can be challenging. Tools and approaches are needed to support coproduction teams to successfully navigate divergent viewpoints while producing rigorous but meaningful research outcomes. Rich pictures are a systems thinking tool to help make sense of complexity. In this paper, we describe how we developed and applied a ‘rich picture’ in a coproduction project with policy-level partners. METHODS: Guided by systems thinking principles, we conducted a systemic analysis of ethnographic fieldnotes collected as part of a broader study that examined the dynamics between an IT system and the implementation of the state-wide childhood obesity prevention programmes it was designed to monitor. Translating qualitative themes into metaphor and imagery, we created a visual depiction of the system to reflect the experience of the system’s users (health promotion practitioners) and facilitated a workshop with policy-level programme administrators (i.e. participants, n = 7). Our aim was to increase the transparency of the system for our research partners and to spark new insights to improve the quality of programme implementation. RESULTS: Guided by provocative questions, participants discussed and challenged each other’s thinking on the current functioning of the system. They identified future lines of inquiry to explore for quality improvement. Participants strongly agreed that the picture was a constructive way to engage with the ethnographic data but were challenged by the information and its implications. The opportunity for participants to co-learn from each other as well as from the picture was an added value. CONCLUSION: In the context of the facilitated workshop, the rich picture enabled research partners to engage with complex research findings and gain new insights. Its value was harnessed via the guided participatory process. This demonstrates the importance that, in the future, such tools should be accompanied by practices that enable participants to think with and apply systems thinking concepts and principles.

Operationalizing the Disablement Process for Research on Older Adults: A Critical Review.
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N. E. Lane, C. M. Boyd, T. A. Stukel and W. P. Wodchis.
Can J Aging 2020 Jan 31:1-14
Self-care disability is difficulty with or dependence on others to perform activities of daily living, such as eating and dressing. Disablement is worsening self-care disability measured over time. The disablement process model (DPM) is often used to conceptualize gerontology research on self-care disability and disablement; however, no summary of variables that align with person-level DPM constructs exists. This review summarizes the results of 88 studies to identify the nature and role of variables associated with disability and disablement in older adults according to the person-level constructs (e.g., demographic characteristics, chronic pathologies) in the DPM. It also examines the evidence for cross-sectional applications of the DPM and identifies common limitations in extant literature to address in future research. Researchers can apply these results to guide theory-driven disability and disablement research using routinely collected health data from older adults.

Occupational stress facing nurse academics-A mixed-methods systematic review.
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C. Singh, W. Cross, I. Munro and D. Jackson.
J Clin Nurs 2019 Dec 19
To better understand occupational stress faced by nurse academics. METHODS: A mixed-methods systematic review, following the Joanna Briggs Institute [JBI], (Joanna Briggs Institute Reviewers’ Manual: 2014 edition, 2014) process. Studies were assessed for quality and risk of bias by using standardised critical appraisal instruments from the Joanna Briggs Institute. In addition, processes and reporting were checked against the Equator guidelines. See Appendix S1. RESULTS: The review revealed that nursing academics do experience occupational stress, including burnout. Occupational stress for academic nurses is associated with various factors including work-life balance, workload issues, resources and support, and adapting to change. However, much of the literature focuses on nurses during the initial transition from clinical to academic environment, with rather less focus on established mid-to-late career nurse academics. DISCUSSION: Occupational stress and burnout are evident in the university academic workforce, adversely affecting the well-being of academic nurses, and the long-term sustainability of the academic nursing workforce. While there is considerable literature focusing on the novice academic nurse, particularly during the transition period, rather less is known about occupational stress among academic nurses across the career trajectory. Various strategies to deal with the negative consequences of occupational stress are identified, including (a) quality mentors for novice and younger nursing academics; (b) training in resilience building for novice academics; (c) supporting collegial relationships and reducing bullying; (d) assistance for professional development and research; (e) better support and resources to overcome increasing workloads; and (f) greater work-related empowerment to enhance job satisfaction. CONCLUSION: There is a need for a broader whole-of-career research focus to more fully identify, explore and mitigate the occupational stressors that negatively affect the academic nurse workforce. RELEVANCE TO CLINICAL PRACTICE: A strong and resilient academic nurse workforce is essential for the sustainability of the profession. Organisations should review their work practices and provide greater work-related empowerment to reduce occupational stressors among nursing academics.

Stakeholder Engagement in Late-Stage Translation Research and Implementation Science: Perspectives From the National Heart, Lung, and Blood Institute.
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G. A. Mensah, J. S. Curry, M. M. Engelgau and L. E. Johnson.
Glob Heart 2019 Jun;14(2):191-194
Stakeholder engagement is crucial for turning discovery into health. Although it is a highly effective approach for research in general, it is an essential component in late-stage translation research and implementation science in which the central objective is to accelerate the sustained uptake and integration of proven-effective interventions into routine clinical and public health practice. Where the stakeholder is an entire community, the term community engagement has often been used and has traditionally been defined as “the process of working collaboratively with groups of people who are affiliated by geographic proximity, special interests, or similar situations with respect to issues affecting their well-being.” More recently, this definition has been expanded to specifically incorporate pre-study needs assessment, shared decision making about study themes and specific aims, data collection and analysis, interpretation and dissemination of research findings, and plans for scale-up and spread of research findings. In this article, the authors explore the scientific foundations of stakeholder engagement in biomedical research and public health practice. They highlight the strategic vision goals and objectives of the National Heart, Lung, and Blood Institute and the commitment to advance dissemination and implementation research and community-engaged participatory research. The authors conclude with comments on the stakeholder engagement efforts in the National Heart, Lung, and Blood Institute-funded TREIN/Hy-TREC consortium’s work published in this issue of Global Heart and their perspectives on the challenges and opportunities as we chart the future together.

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Impact of Prior Home Care on Length of Stay in Residential Care for Australians With Dementia.
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H. J. Welberry, H. Brodaty, B. Hsu, S. Barbieri and L. R. Jorm.
J Am Med Dir Assoc 2020 Jan 31
To assess the impact of home care on length-of-stay within residential care. DESIGN: A retrospective observational data-linkage study. SETTING AND PARTICIPANTS: In total there were 3151 participants from the 45 and Up Study in New South Wales, Australia with dementia who entered residential care between 2010 and 2014. METHODS: Survey data collected from 20062009 were linked to administrative data for 20062016. The highest level of home care a person accessed prior to residential care was defined as no home care, home support, low-level home care, and high-level home care. Multinomial logistic regression and Cox proportional hazards were used to investigate differences in activities of daily living, behavioral, and complex healthcare scales at entering residential care; and length-of-stay in residential care. RESULTS: People with prior high-level home care entered residential care needing higher assistance compared with the no home care group: activities of daily living [odds ratio (OR) 3.41, 95% confidence interval (CI) 2.145.44], behavior (OR 2.61, 95% CI 1.694.03), and complex healthcare (OR 2.02, 95% CI 1.063.84). They had a higher death rate, meaning shorter length-of-stay in residential care (<2 years after entry: hazard ratio 1.12; 95% CI 0.891.42; 2-4 years: hazard ratio 1.49; 95% CI 1.012.21). Those using low-level home care were less likely to enter residential care needing high assistance compared to the no home care group (activities of daily living: OR 0.61, 95% CI 0.450.81; behavioral: OR 0.72, 95% CI 0.540.95; complex healthcare: OR 0.51, 95% CI 0.330.77). There was no difference between the home support and no home care groups. CONCLUSIONS: High-level home care prior to residential care may help those with dementia stay at home for longer, but the low-level care group entered residential care at low assistance levels, possibly signaling lack of informal care and barriers in accessing higher-level home care. IMPLICATIONS: Better transition options from low-level home care, including more timely availability of high-level care packages, may help people with dementia remain at home longer.

Why Not a Global Postural Reeducation as an Alternative Therapy Applied to Alzheimer’s Patients in Nursing Homes? A Pioneer Randomized Controlled Trial.
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J. Todri, A. Todri and O. Lena.
Dement Geriatr Cogn Disord 2020 Jan 31;48(3-4):172-179
The classical gymnastics has always given great importance to exercises of -rachis extension and abduction of the arms during deep inhalation to acquire a greater -thoracic capacity. OBJECTIVE: The aim of this study is to organize the concentration and the self-limited capacity of patients with Alzheimer’s disease (AD) thanks to the physical and -respiratory exercise modalities of global postural reeducation. DESIGN: A randomized controlled trial was conducted. SETTING: Nursing homes. PARTICIPANTS: Patients with probable AD diagnosis. INTERVENTION: The global postural reeducation method (GPR) was implemented for a total of 72 treatment sessionswith a frequency of 3 times a week, for 24 weeks consecutively. MAIN OUTCOME MEASURES: The Neuropsychiatric Inventory, Mini Mental State Examination, Geriatric Depression Scale, Quality of Life in Alzheimer’s Disease and Tinetti Scale and respiratory rate frequency (RSP/F) were applied. RESULTS: Ninety elderly people participated in this study, precisely 50 women and 40 men aged 67-92 years (mean age = 81.17, SD = 5.24). The therapy had a significant effect on the difference between groups in all the outcomes (p 0.05). CONCLUSION: This study demonstrated a very good tolerance rate on behalf of the significant results achieved.

Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings.
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F. Cowdell, Y. T. Jadotte, S. J. Ersser, et al.
Cochrane Database Syst Rev 2020 Jan 23;1:CD011377
Ageing has a degenerative effect on the skin, leaving it more vulnerable to damage. Hygiene and emollient interventions may help maintain skin integrity in older people in hospital and residential care settings; however, at present, most care is based on “tried and tested” practice, rather than on evidence. OBJECTIVES: To assess the effects of hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings. SEARCH METHODS: We searched the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, Embase, and CINAHL, up to January 2019. We also searched five trials registers. SELECTION CRITERIA: Randomised controlled trials comparing hygiene and emollient interventions versus placebo, no intervention, or standard practices for older people aged >/= 60 years in hospital or residential care settings. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures as expected by Cochrane. Primary outcomes were frequency of skin damage, for example, complete loss of integrity (tears or ulceration) or partial loss of integrity (fissuring), and side effects. Secondary outcomes included transepidermal water loss (TEWL), stratum corneum hydration (SCH), erythema, and clinical scores of dryness or itch. We used GRADE to assess the quality of evidence. MAIN RESULTS: We included six trials involving 1598 residential care home residents; no included trial had a hospital setting. Most participants had a mean age of 80+ years; when specified, more women were recruited than men. Two studies included only people with diagnosed dry skin. Studies were conducted in Asia, Australasia, Europe, and North America. A range of hygiene and emollient interventions were assessed: a moisturising soap bar; combinations of water soak, oil soak, and lotion; regular application of a commercially available moisturiser; use of two different standardised skin care regimens comprising a body wash and leave-on body lotion; bed bath with “wash gloves” containing numerous ingredients; and application of a hot towel after usual care bed bath. In five studies, treatment duration ranged from five days to six months; only one study had post-treatment follow-up (one to eight days from end of treatment). Outcomes in the hot towel study were measured 15 minutes after the skin was wiped with a dry towel. Three studies each had high risk of attrition, detection, and performance bias. Only one trial (n = 984) assessed frequency of skin damage via average monthly incidence of skin tears during six months of treatment. The emollient group (usual care plus twice-daily application of moisturiser) had 5.76 tears per month per 1000 occupied bed-days compared with 10.57 tears in the usual care only group (ad hoc or no standardised skin-moisturising regimen) (P = 0.004), but this is based on very low-quality evidence, so we are uncertain of this result. Only one trial (n = 133) reported measuring side effects. At 56 +/- 4 days from baseline, there were three undesirable effects (itch (mild), redness (mild/moderate), and irritation (severe)) in intervention group 1 (regimen consisting of a moisturising body wash and a moisturising leave-on lotion) and one event (mild skin dryness) in intervention group 2 (regimen consisting of body wash and a water-in-oil emulsion containing emollients and 4% urea). In both groups, the body wash was used daily and the emollient twice daily for eight weeks. There were zero adverse events in the usual care group. This result is based on very low-quality evidence. This same study also measured TEWL at 56 +/- 4 days in the mid-volar forearm (n = 106) and the lower leg (n = 105). Compared to usual care, there may be no difference in TEWL between intervention groups, but evidence quality is low. One study, which compared application of a hot towel for 10 seconds after a usual care bed bath versus usual care bed bath only, also measured TEWL at 15 minutes after the skin was wiped with a dry towel for one second. The mean TEWL was 8.6 g/m(2)/h (standard deviation (SD) 3.2) in the hot towel group compared with 8.9 g/m(2)/h (SD 4.1) in the usual care group (low-quality evidence; n = 42), showing there may be little or no difference between groups. A lower score is more favourable. Three studies (266 participants) measured SCH, but all evidence is of very low quality; we did not combine these studies due to differences in treatments (different skin care regimens for eight weeks; wash gloves for 12 weeks; and single application of hot towel to the skin) and differences in outcome reporting. All three studies showed no clear difference in SCH at follow-up (ranging from 15 minutes after the intervention to 12 weeks from baseline), when compared with usual care. A clinical score of dryness was measured by three studies (including 245 participants); pooling was not appropriate. The treatment groups (different skin care regimens for eight weeks; a moisturising soap bar used for five days; and combinations of water soak, oil soak, and lotion for 12 days) may reduce dryness compared to standard care or no intervention (results measured at 5, 8, and 56 +/- 4 days after treatment was initiated). However, the quality of evidence for this outcome is low. Outcomes of erythema and clinical score of itch were not assessed in any included studies. AUTHORS’ CONCLUSIONS: Current evidence about the effects of hygiene and emollients in maintaining skin integrity in older people in residential and hospital settings is inadequate. We cannot draw conclusions regarding frequency of skin damage or side effects due to very low-quality evidence. Low-quality evidence suggests that in residential care settings for older people, certain types of hygiene and emollient interventions (two different standardised skin care regimens; moisturising soap bar; combinations of water soak, oil soak, and lotion) may be more effective in terms of clinical score of dryness when compared with no intervention or standard care. Studies were small and generally lacked methodological rigour, and information on effect sizes and precision was absent. More clinical trials are needed to guide practice; future studies should use a standard approach to measuring treatment effects and should include patient-reported outcomes, such as comfort and acceptability.

Validity of Plate Diagrams for Estimation of Energy and Protein Intake of Nursing Home Residents Receiving Texture-Modified Diet: An enable Study.
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A. Ott, M. Voigt, C. C. Sieber and D. Volkert.
J Am Med Dir Assoc 2020 Jan 27
Nursing home (NH) residents receiving texture-modified diet (TMD) are at risk of inadequate nutritional intake and subsequent malnutrition. It is essential to monitor dietary intake to take corrective actions, if necessary. Plate diagrams (PDs) are widely used to assess dietary intake in institutions but little is known about their validity for TMD. DESIGN: Dietary intake at main meals was assessed by nursing personnel via PDs and scientific personnel via weighing records (WRs). SETTING AND PARTICIPANTS: 17 NH residents receiving TMD on a regular basis. METHODS: Intake from main meals (breakfast, lunch, and dinner) at 48 days was estimated by nursing personnel in quarters of the offered amount [nothing, (1/4), (1/2), (3/4), all, all plus second helping (54), or I do not know] and by scientific personnel via WRs. PD estimation was multiplied by the energy and protein content of the offered meal determined by WR and compared to WR intake results. Sums of daily PD quarters were drawn against WR intake results. RESULTS: Energy and protein intake from main meals separately and in total per day were highly correlated (r > 0.854, all P .05). Mean differences [+/-standard deviation (SD)] between PD and WR were 13.9 (+/-68.6) kcal, which is 1.7% of the mean weighed caloric intake, and 0.2 (+/-3.3) g protein, which is 0.5% of the mean weighed protein intake per day. Daily energy and protein intake from main meals determined by WR varies widely within each category of summed daily intake quarters; for example, a sum of PD quarters of 12 (ie, “all eaten at all meals”) showed corresponding WR intake levels from 394.6 to 1368.9 kcal and 16.3 to 63.0 g protein. CONCLUSIONS AND IMPLICATIONS: Energy and protein intake from TMD estimated by PD corresponds very well to WR-determined intake, if the energy and protein content of the offered meals is known.

Factors Associated With Perceived Worsened Physical Health Among Older Adults Who Are Newly Enrolled Long-term Services and Supports Recipients.
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J. L. Travers, K. B. Hirschman, A. L. Hanlon, L. Huang and M. D. Naylor.
Inquiry 2020 Jan-Dec;57:46958019900835
Limited information exists on the perceived health of older adults new to receiving long-term services and supports (LTSS) compared with the year prior, posing challenges to the anticipation of health care need and optimization of wellness efforts for this growing population. In response, we sought to identify differences in perceived worsened physical health across three LTSS types (nursing home, assisted living, and home and community-based services) along with health-related quality of life (HRQoL) characteristics associated with older adults’ ratings of perceived worsened physical health at the start of receiving LTSS. Enrolled LTSS recipients completed a single interview assessing their HRQoL. Bivariate and multivariable logistic regression analyses were performed to determine associations in LTSS types and HRQoL characteristics with perceived worsened physical health among older adults (>/=60 years old) since 1 year prior to study enrollment. Among the 467 LTSS recipients, perceived physical health was rated as worse than the previous year by 36%. Bivariate analyses revealed no differences in perceived worsened physical health across LTSS types. In adjusted analyses, religiousness/spirituality and better mental and general health perception had a decreased odds of being associated with perceived worsened physical health (P < .05). Participants with major changes in their health in the past 6 months were more likely to report perceived worsened physical health (P < .001). Findings provide information that may be used to target efforts to enhance perceived physical health and improve quality of life among LTSS enrollees.

Effects of a smartphone-based videoconferencing program for older nursing home residents on depression, loneliness, and quality of life: a quasi-experimental study.
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H. H. Tsai, C. Y. Cheng, W. Y. Shieh and Y. C. Chang.
BMC Geriatr 2020 Jan 28;20(1):27-020-1426-2
Smartphones can optimize the opportunities for interactions between nursing home residents and their families. However, the effectiveness of smartphone-based videoconferencing programs in enhancing emotional status and quality of life has not been explored. The purpose of this study was to evaluate of the effect of a smartphone-based videoconferencing program on nursing home residents’ feelings of loneliness, depressive symptoms and quality of life. METHODS: This study used a quasi-experimental research design. Older residents from seven nursing homes in Taiwan participated in this study. Nursing homes (NH) were randomly selected as sites for either the intervention group (5 NH) or the control group (2 NH); NH residents who met the inclusion criteria were invited to participate. The intervention group was comprised of 32 participants; the control group was comprised of 30 participants. The intervention group interacted with their family members once a week for 6 months using a smartphone and a “LINE” application (app). Data were collected with self-report instruments: subjective feelings of loneliness, using the University of California Los Angeles Loneliness Scale; depressive symptoms, using the Geriatric Depression Scale; and quality of life using the SF-36. Data were collected at four time points (baseline, and at 1-month, 3-months and 6-months from baseline). Data were analysed using the generalized estimating equation approach. RESULTS: After the intervention, as compared to those in the control group, participants in interventional group had significant decreases in baseline loneliness scores at 1 months (beta = – 3.41, p < 0.001), 3 months (beta = – 5.96, p < 0.001), and 6 months (beta = – 7.50, p < 0.001), and improvements in physical role (beta = 36.49, p = 0.01), vitality (beta = 13.11, p < 0.001) and pain scores (beta = 16.71, p = 0.01) at 6 months. However, changes in mean depression scores did not significantly differ between groups. CONCLUSIONS: Smartphone-based videoconferencing effectively improved residents’ feelings of loneliness, and physiological health, vitality and pain, but not depressive symptoms. Future investigations might evaluate the effectiveness of other media-based technologies in nursing homes as well as their effectiveness within and between different age cohorts.

Music Lessons: Exploring the Role and Meaning of Music for Older Adults with Dementia.
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K. D. Dryden-Palmer, C. S. Parshuram and W. B. Berta.
BMC Health Serv Res 2020 Feb 3;20(1):81-020-4935-y
This review of scholarly work in health care knowledge translation advances understanding of implementation components that support the complete and timely integration of new knowledge. We adopt a realist approach to investigate what is known from the current literature about the impact of, and the potential relationships between, context, complexity and implementation process. METHODS: Informed by two distinct pathways, knowledge utilization and knowledge translation, we utilize Rogers’ Diffusion of Innovations theory (DOI) and Harvey and Kitson’s integrated- Promoting Action on Research Implementation in Health Service framework (PARIHS) to ground this review. Articles from 5 databases; Medline, Scopus, PsycInfo, Web of Science, and Google Scholar and a search of authors were retrieved. Themes and patterns related to these implementation components were extracted. Literature was selected for inclusion by consensus. Data extraction was iterative and was moderated by the authors. RESULTS: A total of 67 articles were included in the review. Context was a central component to implementation. It was not clear how and to what extent context impacted implementation. Complexity was found to be a characteristic of context, implementation process, innovations and a product of the relationship between these three elements. Social processes in particular were reported as influential however; descriptions of how these social process impact were limited. Multiple theoretical and operational models were found to ground implementation processes. We offer an emerging conceptual model to illustrate the key discoveries. CONCLUSIONS: The review findings indicate there are dynamic relationship between context, complexity and implementation process for enhancing uptake of evidence-based knowledge in hospital settings. These are represented in a conceptual model. Limited empiric evidence was found to explain the nature of the relationships.

Psychotropic Medication Prescribing Practice Among Residents With Dementia in Nursing Homes: A Person-Centered Care Approach.
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P. Basnet, G. J. Acton and P. Requeijo.
J Gerontol Nurs 2020 Feb 1;46(2):9-17
Despite multiple national initiatives to improve quality of life in nursing home (NH) residents with dementia, inefficiencies still exist regarding inappropriate psychotropic medication use to manage communication of distress. The goals of the current article are to: (a) create a person-centered care plan/process for NH community staff to manage challenging dementia behaviors; (b) provide guidelines for geriatric practitioners (GPs) to decrease psychotropic medication use in residents with dementia; (c) discuss organizational culture and its relationship to the management of non-cognitive neuropsychiatric symptoms (NPS) of dementia; and (d) emphasize nonpharmacological approaches as first-line treatment of NPS in NH residents with dementia.

Sexual Expression in Alberta’s Continuing Care Homes: Capacity, Consent, and Co-decision-making.
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J. Brassolotto, L. Howard and A. Manduca-Barone.
Can J Aging 2020 Jan 24:1-10
In this article, we explore the role of substitute decision-makers (SDMs) in matters of sexual expression for continuing care residents with diminished cognitive capacity. We examine how Alberta’s current use of SDMs can enable an “all-or-none” approach to competence, wherein a person either has capacity to make all decisions or is incapable of making any. Three factors facilitate an environment in which this approach can influence residents’ sexual expression. These include the wording of current legislation, lack of resources for SDMs, and relational dynamics between SDMs and care staff. We provide a critical review of existing legislation and empirical evidence of its challenges in practice. Though we focus on the Alberta context, there is reason to believe that similar issues persist in other Western jurisdictions. We offer several recommendations for how we can better support residents’ sexual autonomy in continuing care and avoid pitfalls of the “all-or-none” approach to competence.

A group intervention to improve quality of life for people with advanced dementia living in care homes: the Namaste feasibility cluster RCT.
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K. Froggatt, A. Best, F. Bunn, et al.
Health Technol Assess 2020 Jan;24(6):1-140
People with advanced dementia who live and die in nursing homes experience variable quality of life, care and dying. There is a need to identify appropriate, cost-effective interventions that facilitate high-quality end-of-life care provision. OBJECTIVES: To establish the feasibility and acceptability to staff and family of conducting a cluster randomised controlled trial of the Namaste Care intervention for people with advanced dementia in nursing homes. DESIGN: The study had three phases: (1) realist review and (2) intervention refinement to inform the design of (3) a feasibility cluster randomised controlled trial with a process evaluation and economic analysis. Clusters (nursing homes) were randomised in a 3 : 1 ratio to intervention or control (usual care). The nature of the intervention meant that blinding was not possible. SETTING: Nursing homes in England providing care for people with dementia. PARTICIPANTS: Residents with advanced dementia (assessed as having a Functional Assessment Staging Test score of 6 or 7), their informal carers and nursing home staff. INTERVENTION: Namaste Care is a complex group intervention that provides structured personalised care in a dedicated space, focusing on enhancements to the physical environment, comfort management and sensory engagement. MAIN OUTCOME MEASURES: The two contender primary outcome measures were Comfort Assessment in Dying – End of Life Care in Dementia for quality of dying (dementia) and Quality of Life in Late Stage Dementia for quality of life. The secondary outcomes were as follows: person with dementia, sleep/activity (actigraphy), neuropsychiatric symptoms, agitation and pain; informal carers, satisfaction with care at the end of life; staff members, person-centred care assessment, satisfaction with care at the end of life and readiness for change; and other data – health economic outcomes, medication/service use and intervention activity. RESULTS: Phase 1 (realist review; 86 papers) identified that a key intervention component was the activities enabling the development of moments of connection. In phase 2, refinement of the intervention enabled the production of a user-friendly 16-page A4 booklet. In phase 3, eight nursing homes were recruited. Two homes withdrew before the intervention commenced; four intervention and two control homes completed the study. Residents with advanced dementia (n = 32) were recruited in intervention (n = 18) and control (n = 14) homes. Informal carers (total, n = 12: intervention, n = 5; control, n = 7) and 97 staff from eight sites (intervention, n = 75; control, n = 22) were recruited over a 6-month period. Recruitment is feasible. Completion rates of the primary outcome questionnaires were high at baseline (100%) and at 4 weeks (96.8%). The Quality of Life in Late Stage Dementia was more responsive to change over 24 weeks. Even where economic data were missing, these could be collected in a full trial. The intervention was acceptable; the dose varied depending on the staffing and physical environment of each care home. Staff and informal carers reported changes for the person with dementia in two ways: increased social engagement and greater calm. No adverse events related to the intervention were reported. CONCLUSIONS: A subsequent definitive trial is feasible if there are amendments to the recruitment process, outcome measure choice and intervention specification. FUTURE WORK: In a full trial, consideration is needed of the appropriate outcome measure that is sensitive to different participant responses, and of clear implementation principles for this person-centred intervention in a nursing home context. TRIAL REGISTRATION: Current Controlled Trials ISRCTN14948133. FUNDING: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 6. See the NIHR Journals Library website for further project information.; Namaste Care is a programme of respectful stimulation for nursing home residents who have advanced dementia. It is person-focused and reflects residents’ individual likes and interests. It is claimed that Namaste Care improves quality of life for residents, family and staff, and quality of dying for residents, and can be provided without additional cost. This study explored how feasible it would be to conduct a large study in the future to understand the effects of Namaste Care on people with advanced dementia. Our literature review showed that Namaste Care enables people with advanced dementia to have moments of connection with others. We refined some Namaste Care resources through working with care home staff, family and volunteers to create a user-friendly booklet. Eight care homes were recruited to our 6-month trial; four homes were supported to introduce Namaste Care, two continued as usual and two withdrew. In the four intervention homes, residents with advanced dementia received Namaste Care. Staff used standard measures to assess (1) residents’ responses and (2) the economic costs and benefits of Namaste Care. Researchers made observation visits. Records of activity in Namaste Care sessions were completed, and interviews were held with staff and family. Residents wore an ActiGraph (Activinsights Ltd, Kimbolton, UK) device that recorded their levels of sleep and activity. The length and frequency of Namaste Care sessions varied. Nursing homes incurred additional costs but could see ways to reduce those. All residents accepted wearing an ActiGraph device. Staff completed the data collection tools; some measures were more informative than others. Data from interviews showed that most people had positive experiences of Namaste Care. The findings support the view that Namaste Care has benefits for people with advanced dementia in nursing homes. We consider that, with some changes, this trial offers a model for a large study to show whether or not Namaste Care could be promoted more widely.

Development and validation of a conceptual model and strategy adoption guidelines for persons with dementia at risk of getting lost.
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N. A. Neubauer and L. Liu.
Dementia (London) 2020 Jan 22:1471301219898350.
Various solutions are available to address critical wandering; however, no guideline exists to allow for the successful adoption of these strategies. This study developed and validated a conceptual model and series of guidelines to facilitate choice of wander-management strategies. Face and content validity of the model and guidelines were assessed through an online and paper survey, individual interviews and focus groups across stakeholders. Directed content analysis was performed. Overall impression of the conceptual model and guidelines was positive. Valued features included the guidelines’ ability to help users in choosing proactive wander-management strategies. Suggested changes included revisions in terminology and more factors and strategies to be added to the model and guidelines. This work is being disseminated and used by persons with dementia, caregivers, health practitioners and community service providers to identify strategies to mitigate the risks associated with critical wandering.

Psychosocial Interventions for Family Carers of People With Dementia: A Systematic Review and Meta-Analysis.
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A. Teahan, A. Lafferty, E. McAuliffe, et al.
J Aging Health 2020 Jan 19:898264319899793
This study aimed to review and synthesize findings of the effectiveness of psychosocial interventions aimed at improving outcomes for family carers of people with dementia. Method: A systematic review and meta-analysis were conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We systematically searched the following databases: Cochrane, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Excerpta Medica Database (EMBASE), and Applied Social Sciences Index and Abstracts (ASSIA). RevMan 5 software was used to conduct meta-analysis and subgroup analysis using a random-effects model. Results: The search yielded 22 high-quality intervention articles that were suitable for further meta-analysis. Meta-analysis revealed that psychosocial interventions have a small to moderate significant effect on carer burden (standardized mean difference [SMD] = -0.34, confidence interval [CI] = [-0.59, -0.09]), depression (SMD = -0.36, CI = [-0.60, -0.13]), and general health (SMD = 0.34, CI = [0.18, 0.51]). Discussion: Psychosocial interventions had a positive impact on carer outcomes; however, these results should be interpreted with caution, given the significant level of heterogeneity in study designs. Future research could examine contextual and implementation mechanisms underlying psychosocial interventions to develop effective support systems for family carers of people with dementia.

Use of prophylactic antivirals and care home characteristics associated with influenza in care homes with confirmed outbreaks.
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A. Shah, A. D. Harries, P. Cleary, M. McGivern and S. Ghebrehewet.
Public Health 2019 Dec;177:48-56
To assess the association of antiviral prophylaxis and care home characteristics with the spread and severity of influenza-like illness in care homes with influenza outbreaks in North West England in the 2017/2018 influenza season. STUDY DESIGN: This is a retrospective observational study. METHODS: Routinely collected outbreak surveillance data reported to Public Health England were extracted from health protection electronic records. Data included use of antiviral prophylaxis, influenza-like illness or confirmed influenza, hospital admissions and deaths. Care home characteristics were obtained from the Care Quality Commission website. Single variable analysis and multivariable logistic regression were used to examine associations between care home characteristics, antiviral prophylaxis and influenza-related outcomes. RESULTS: In the 109 homes, there were 3498 residents; of whom, 855 (24%) developed an influenza-like illness. Antiviral prophylaxis was given to residents of 67 of the 109 care homes with outbreaks (61%). A significantly higher attack rate was observed among residents of homes given antiviral prophylaxis (27%) than among residents of homes not given antivirals (20%) (P < 0.001). Significantly more deaths occurred in homes for people with learning disabilities and homes that received antiviral prophylaxis (P < 0.001). CONCLUSIONS: In homes given antiviral prophylaxis, there were a higher number of residents with influenza-like illness and deaths. To improve our understanding of the impact of antiviral prophylaxis use in real life, enhanced and timely data collection is needed for identification of temporal associations between exposure and administration of antiviral prophylaxis. Consideration needs also to be given to ensure people with learning disabilities are protected through the seasonal influenza vaccine and timely antiviral prophylaxis when appropriate.

Modelling factors of urinary incontinence in institutional older adults with dementia.
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H. C. Li, K. M. Chen and H. F. Hsu.
J Clin Nurs 2019 Dec;28(23-24):4504-4512
This study applied structural equation modelling to explore the relationships among agitated behaviours, depression, cognitive function and activities of daily living, as well as associations between these factors and urinary incontinence). BACKGROUND: A high prevalence of urinary incontinence is found among institutional older adults with dementia. People with urinary incontinence suffer from increased financial burden and social isolation and experience reduced quality of life. DESIGN: Cross-sectional correlational research. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. METHODS: In total, 226 older adults with dementia were recruited through convenience sampling at 15 long-term care facilities in southern Taiwan. The urinary incontinence frequency, agitated behaviours, depression, cognitive function and activities of daily living were evaluated using bladder records, the Cohen-Mansfield Agitation Inventory, the Cornell Scale for Depression in Dementia, the Mini-Mental State Examination and the Barthel Index, respectively. RESULTS: Activities of daily living performance was found to be significantly associated with urinary incontinence; however, age, cognitive function, depression and agitated behaviours were not significantly related to urinary incontinence. Age did not have effects on any of the variables tested in this model, whereas activities of daily living performance was significantly associated with cognitive function and depression. Results further showed that cognitive function and depression were mediators between activities of daily living and agitated behaviours. CONCLUSION: Enhanced activities of daily living independency directly reduced urinary incontinence, improved cognitive function, decreased degrees of depression and indirectly reduced agitated behaviours. RELEVANCE TO CLINICAL PRACTICE: The findings could serve as a valuable reference for long-term care facilities in providing effective urinary incontinence care and prevention to older adults with dementia.

NICE Guideline: Supporting adult carers (UK)

January 2020
This guideline covers support for adults (aged 18 and over) who provide unpaid care for anyone aged 16 or over with health or social care needs. It aims to improve the lives of carers by helping health and social care practitioners identify people who are caring for someone and give them the right information and support. It covers carers’ assessments, practical, emotional and social support and training, and support for carers providing end of life care.

This guideline covers general principles that apply to all adult carers. Recommendations about supporting carers of people with specific health needs can be found in NICE guidance on those conditions.


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Events & Training Opportunities

Co-Design: A How-To Workshop for Facilitating Community-Led Innovation

Tamarack Institute, 4-5 March, Toronto, ON $750-$850
Instructors: Lisa Attygalle, Liz Weaver,
How can you bring diverse members of your community together to develop creative new ideas, innovative approaches to persistent problems, and build alignment and momentum for action?

Over the past 17 years the Tamarack Institute has been helping communities come together in creative ways for community change. This workshop will give you the tools and practice to host and lead these collaborative Co-Design sessions effectively. We will go deep on different approaches to engage the community to innovate together, understand what makes these kinds of gatherings distinct, and provide you with tools that you can use to host them.

Building on our deep practice knowledge in Community Engagement and Community Innovation, this is a unique opportunity to learn how to combine these practices for positive community change.

Music and Alzheimer’s disease: New Insights Webinar

brainXchange Wednesday 19 February 10:00-11:00 MT
Presenter: Corinne Fischer
This webinar will provide an overview of our understanding of the effect of music on the Alzheimer brain. Specifically, we will review the existing literature focusing on the cognitive effects of passive music exposure, with a particular focus on familiar music.

In addition, we will present data from a recent study involving St. Michael’s Hospital and the Faculty of Music at the University of Toronto that demonstrates the benefits of passive familiar music exposure on cognitive performance and brain connectivity in Alzheimer’s disease.

Michael Smith Foundation for Health Research’s 3-day Train-the-Trainer workshop (BC residents only)

15-17 April, Vancouver, BC, $498
Calling all BC-based KT professionals! Want to develop your training and group facilitation skills? Register today for the Michael Smith Foundation for Health Research’s (MSFHR) three-day Train-the-Trainer workshop. This workshop is designed to teach participants how to develop and lead participatory activities and create engaging processes for diverse groups of learners. The workshop is intended for individuals who are interested in working with their organizations (universities, health authorities, research institutes, etc.) to deliver workshops on KT and research use.

How evaluators bring qualitative data into program evaluations Online

Thursday 27 February, 10:00 MT
Presenters: Jill Lohmeier, Shanna Rose Thompson, Laura Lagendyk, Noelle Wyman Roth
Our panel of evaluators will discuss how they use qualitative data to strengthen their program evaluations. The panelists conduct evaluations in the health, education and not for profit sectors.

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Dementia and housing (UK)

The British Standards Institute and the Alzheimer’s Society have developed a Code of Practice for the housing sector. It identifies key areas that will help to support people living with dementia. They include:
adaptations, built environment, design and access to outdoor space
assistive technologies, including telecare
training of all staff in the housing sector

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