October 24

Calls for Abstracts
Grants & Awards


New TREC Article
Oral/dental items in the resident assessment instrument – minimum Data Set 2.0 lack validity: results of a retrospective, longitudinal validation study
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M. Hoben, J.W. Poss, P.G. Norton and C.A. Estabrooks.
Population Health Metrics 2016;14(1):36

Oral health in nursing home residents is poor. Robust, mandated assessment tools such as the Resident Assessment Instrument – Minimum Data Set (RAI-MDS) 2.0 are key to monitoring and improving quality of oral health care in nursing homes. However, psychometric properties of RAI-MDS 2.0 oral/dental items have been challenged and criterion validity of these items has never been assessed.

New TREC Article
Individual and organizational predictors of health care aide job satisfaction in long term care
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S. A. Chamberlain, M. Hoben, J. E. Squires and C. A. Estabrooks.
BMC Health Serv Res 2016 Oct 13;16(1):577

BACKGROUND: Unregulated health care aides provide the majority of direct health care to residents in long term care homes. Lower job satisfaction as reported by care aides is associated with increased turnover of staff. Turnover leads to inferior job performance and negatively impacts quality of care for residents. This study aimed to determine the individual and organizational variables associated with job satisfaction in care aides. METHODS: We surveyed a sample of 1224 care aides from 30 long term care homes in three Western Canadian provinces. The care aides reported their job satisfaction and their perception of the work environment. We used a hierarchical, mixed-effects ordered logistic regression to model the relative odds of care aide job satisfaction for individual, care unit, and facility factors. RESULTS: Care aide exhaustion, professional efficacy, and cynicism were associated with job satisfaction. Factors in the organizational context that are associated with increased care aide job satisfaction include: leadership, culture, social capital, organizational slack-staff, organizational slack-space, and organizational slack-time. CONCLUSIONS: Our findings suggest that organizational factors account for a greater increase in care aide job satisfaction than do individual factors. These features of the work environment are modifiable and predict care aide job satisfaction. Efforts to improve care aide work environment and quality of care should focus on organizational context.

Dissemination tool by Dr. Greta Cummings & Dr. Jude Spiers

The EXACT Research Team

The EXACT video was created as a dissemination tool for the study findings. Please feel free to share it widely with colleagues and others who you think may benefit from it.

New article by Dr. Jo Rycroft-Malone
Mobilising knowledge in complex health systems: a call to action
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B.J. Holmes, A. Best, H. Davies, D. Hunter, M. Kelly, M. Marshall, J. Rycroft-Malone
Evid Policy 2016

Worldwide, policymakers, health system managers, practitioners and researchers struggle to use evidence to improve policy and practice. There is growing recognition that this challenge relates to the complex systems in which we work. The corresponding increase in complexity-related discourse remains primarily at a theoretical level. This paper moves the discussion to a practical level, proposing actions that can be taken to implement evidence successfully in complex systems. Key to success is working with, rather than trying to simplify or control, complexity. The integrated actions relate to co-producing knowledge, establishing shared goals and measures, enabling leadership, ensuring adequate resourcing, contributing to the science of knowledge-to-action, and communicating strategically.

Calls for Abstracts

CALL FOR ABSTRACTS: 5-7 April 2017, Oxford UK
RCN International Nursing Research conference and exhibition 2017

Deadline 14 November, University of Oxford Examination School, Oxford UK

The RCN Research Society invites the submissions of contemporary research abstracts, which make a fresh contribution to a body of knowledge. Papers which use research to reflect on current issues in nursing are particularly welcome as well as abstracts which, debate developments in research methods, research management and research policy, and innovative methodological papers.

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Grants & Awards

Evidence into Practice Programme Grant

Deadline 16 November, The Health Foundation (UK)

This new programme of grants from the Health Foundation of up to £50,000 will fund the development of tools and resources, based on completed research studies, to support the implementation of findings in practice. Successful proposals will be those that appear most creative, innovative and likely to have impact.

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Health Care Administration and Organization
Health Care Innovation and Quality Assurance


Lessons Learnt from Implementing an Organizational Strategy for Evidence-Informed Decision Making Canada-flat-icon

M. Ward, M. Dobbins, & L. Peirson.
Public Health Panorama 2016;2(3):327-332.

Peel Public Health is one of Canada’s largest public health departments, with 650 staff serving 1.4 million residents. We describe the components, processes and lessons learnt from an organization-wide initiative being implemented by a local public health department to build capacity for evidence-informed decision-making (EIDM).

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Health Care Administration and Organization

Developing and Implementing Peer-Led Intervention to Support Staff in Long-Term Care Homes Manage Grief
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J. Vis, K. Ramsbottom, J. Marcella, et al.
SAGE Open 2016 SAGE Publications;6(3)

Front-line staff in long-term care (LTC) homes often form strong emotional bonds with residents. When residents die, staffs’ grief often goes unattended, and may result in disenfranchised grief. The aim of this article is to develop, implement, and assess the benefits of a peer-led debriefing intervention to help staff manage their grief and provide LTC homes an organizational approach to support them. This research was nested within a 5-year participatory action research to develop and implement palliative care programs within four LTC homes in Canada. Data specific to this debriefing intervention included questionnaires from six peer debriefers, field observations of six debriefings, and qualitative interviews with 23 staff participants. An original peer-led debriefing intervention (INNPUT) for LTC home staff was developed and implemented. Data revealed that the intervention offered staff an opportunity to express grief in a safe context with others, an opportunity for closure and acknowledgment. The INNPUT intervention benefits staff and offers an innovative, sustainable, easy to use strategy for LTC homes.

Perspectives on caregiving: A qualitative evaluation of certified nursing assistants
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N. Kusmaul and M. Bunting.
Geriatr Nurs 2016 Oct 12

This study sought Certified Nursing Assistants’ (CNAs) perspectives on the activities that compose quality care. CNAs provide the majority of hands on care in nursing homes positioning them to have a unique perspective on factors that constitute good quality care. Using semi-structured interviews, 23 CNAs from New York State nursing homes were asked to identify factors they felt were components of good care. Interviews were recorded, transcribed verbatim, and coded using open coding. Three themes emerged: (1) technical aspects of care; (2) care of the environment; and (3) a little bit more. Our results emphasize the complexities of providing care that go beyond items that can be regulated. Assessments of quality care should incorporate the voices of CNAs.

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Health Care Innovation and Quality Assurance

Educational interventions to empower nursing home residents: a systematic literature review
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D. Schoberer, H. Leino-Kilpi, H. E. Breimaier, R. J. Halfens and C. Lohrmann.
Clin Interv Aging 2016 Sep 28;11:1351-1363

PURPOSE OF THE STUDY: Health education is essential to improve health care behavior and self-management. However, educating frail, older nursing home residents about their health is challenging. Focusing on empowerment may be the key to educating nursing home residents effectively. This paper examines educational interventions that can be used to empower nursing home residents. METHODS: A systematic literature search was performed of the databases PubMed, CINAHL, CENTRAL, PsycINFO, and Embase, screening for clinical trials that dealt with resident education and outcomes in terms of their ability to empower residents. An additional, manual search of the reference lists and searches with SIGLE and Google Scholar were conducted to identify gray literature. Two authors independently appraised the quality of the studies found and assigned levels to the evidence reported. The results of the studies were grouped according to their main empowering outcomes and described narratively. RESULTS: Out of 427 identified articles, ten intervention studies that addressed the research question were identified. The main educational interventions used were group education sessions, motivational and encouragement strategies, goal setting with residents, and the development of plans to meet defined goals. Significant effects on self-efficacy and self-care behavior were reported as a result of the interventions, which included group education and individual counseling based on resident needs and preferences. In addition, self-care behavior was observed to significantly increase in response to function-focused care and reasoning exercises. Perceptions and expectations were not improved by using educational interventions with older nursing home residents. CONCLUSION: Individually tailored, interactive, continuously applied, and structured educational strategies, including motivational and encouraging techniques, are promising interventions that can help nursing home residents become more empowered. Empowering strategies used by nurses can support residents in their growth and facilitate their self-determination. Further research on the empowerment of residents using empowerment scales is needed.

Do interventions with staff in long-term residential facilities improve quality of care or quality of life for people with dementia? A systematic review of the evidence
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N. A. Hodgson.
Int Psychogeriatr 2016 Oct 17:1-2

The review by Bird and colleagues (2016), published in this issue of International Psychogeriatrics, is notable for jointly examining the effect of dementia care interventions on both staff and resident quality outcomes. This is an important contribution to improving dementia care because it recognizes the dynamic and dyadic relationship between residents and their caregivers in residential settings. While evidence exists on the dyadic effect of family caregiver intervention on dementia patient outcomes (Gitlin and Hodgson, 2015), less attention has been given to formal caregivers in institutional settings (Dellefield et al., 2015).

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The impact of personality on person-centred care: a study of care staff in Swedish nursing homes
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T. Elfstrand Corlin, P. J. Kajonius and A. Kazemi.
Int J Older People Nurs 2016 Oct 3

AIM AND OBJECTIVE: In this study, we explore how personal and situational factors relate to the provision of person-centred care (PCC) in nursing homes. Specifically, we focus on the relationship between the care staff’s personality traits and provision of PCC and to what extent perceptions of the working environment influences this relationship. BACKGROUND: The ultimate goal of elderly care is to meet the older person’s needs and individual preferences (PCC). Interpersonal aspects of care and the quality of relationship between the care staff and the older person are therefore central in PCC. DESIGN AND METHODS: A cross-sectional Swedish sample of elderly care staff (N = 322) completed an electronic survey including measures of personality (Mini-IPIP) and person-centred care (Individualized Care Inventory, ICI). A principal component analysis was conducted on the ICI-data to separate the user orientation (process quality) of PCC from the preconditions (structure quality) of PCC. RESULTS: Among the five factors of personality, neuroticism was the strongest predictor of ICI user orientation. ICI preconditions significantly mediated this relationship, indicating the importance of a supportive working environment. In addition, stress was introduced as a potential explanation and was shown to mediate the impact of neuroticism on ICI preconditions. CONCLUSIONS: Personality traits have a significant impact on user orientation, and the perception of a supportive and stress free working environment is an important prerequisite for achieving high-quality person-centred elderly care. IMPLICATIONS FOR PRACTICE: Understanding how personality is linked to the way care staff interacts with the older person adds a new perspective on provision of person-centred elderly care.

Oral health educational interventions for nursing home staff and residents
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M. Albrecht, R. Kupfer, D. R. Reissmann, I. Muhlhauser and S. Kopke.
Cochrane Database Syst Rev 2016 Sep 30;9:CD010535

BACKGROUND: Associations between nursing home residents’ oral health status and quality of life, respiratory tract infections, and nutritional status have been reported. Educational interventions for nurses or residents, or both, focusing on knowledge and skills related to oral health management may have the potential to improve residents’ oral health. OBJECTIVES: To assess the effects of oral health educational interventions for nursing home staff or residents, or both, to maintain or improve the oral health of nursing home residents. SEARCH METHODS: We searched the Cochrane Oral Health Trials Register (to 18 January 2016), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, 2015, Issue 12), MEDLINE Ovid (1946 to 18 January 2016), Embase Ovid (1980 to 18 January 2016), CINAHL EBSCO (1937 to 18 January 2016), and Web of Science Conference Proceedings (1990 to 18 January 2016). We searched ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials to 18 January 2016. In addition, we searched reference lists of identified articles and contacted experts in the field. We placed no restrictions on language or date of publication when searching the electronic databases. SELECTION CRITERIA: Randomised controlled trials (RCTs) and cluster-RCTs comparing oral health educational programmes for nursing staff or residents, or both with usual care or any other oral healthcare intervention. DATA COLLECTION AND ANALYSIS: Two review authors independently screened articles retrieved from the searches for relevance, extracted data from included studies, assessed risk of bias for each included study, and evaluated the overall quality of the evidence. We retrieved data about the development and evaluation processes of complex interventions on the basis of the Criteria for Reporting the Development and Evaluation of Complex Interventions in healthcare: revised guideline (CReDECI 2). We contacted authors of relevant studies for additional information. MAIN RESULTS: We included nine RCTs involving 3253 nursing home residents in this review; seven of these trials used cluster randomisation. The mean resident age ranged from 78 to 86 years across studies, and most participants were women (more than 66% in all studies). The proportion of residents with dental protheses ranged from 62% to 87%, and the proportion of edentulous residents ranged from 32% to 90% across studies.Eight studies compared educational interventions with information and practical components versus (optimised) usual care, while the ninth study compared educational interventions with information only versus usual care. All interventions included educational sessions on oral health for nursing staff (five trials) or for both staff and residents (four trials), and used more than one active component. Follow-up of included studies ranged from three months to five years.No study showed overall low risk of bias. Four studies had a high risk of bias, and the other five studies were at unclear risk of bias.None of the trials assessed our predefined primary outcomes ‘oral health’ and ‘oral health-related quality of life’. All trials assessed our third primary outcome, ‘dental or denture plaque’. Meta-analyses showed no evidence of a difference between interventions and usual care for dental plaque (mean difference -0.04, 95% confidence interval (CI) -0.26 to 0.17; six trials; 437 participants; low quality evidence) or denture plaque (standardised mean difference -0.60, 95% CI -1.25 to 0.05; five trials; 816 participants; low quality evidence). None of the studies assessed adverse events of the intervention. AUTHORS’ CONCLUSIONS: We found insufficient evidence to draw robust conclusions about the effects of oral health educational interventions for nursing home staff and residents. We did not find evidence of meaningful effects of educational interventions on any measure of residents’ oral health; however, the quality of the available evidence is low. More adequately powered and high-quality studies using relevant outcome measures are needed.

Age and sex differences in hospitalisation of nursing home residents: a systematic review
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F. Hoffmann and K. Allers.
BMJ Open 2016 October 01;6(10)

Objectives Nursing home residents (NHRs) are frequently suffering from multimorbidity, functional and cognitive impairment, often leading to hospital admissions. Studies have found that male NHRs are more often hospitalised. The influence of age is inconclusive. We aimed to investigate the epidemiology of hospitalisations in NHRs, particularly focusing on age-specific and sex-specific differences.Design A systematic review was performed in PubMed, CINAHL and Scopus. Quality of studies was assessed.Setting Studies conducted in nursing homes were included.Participants Nursing home residents.Primary and secondary outcomes Outcome measures were the prevalence, incidence or duration of all-cause hospitalisation by age or sex.Results We identified 21 studies, 13 were conducted in the USA. The proportion of residents being hospitalised ranged across studies from 6.8% to 45.7% for various time periods of follow-up. A total of 20 studies assessed the influence of sex and found that hospitalisations are more often in male NHRs. A total of 16 studies conducted multivariate analyses and the OR of hospitalisation for males was between 1.22 and 1.67. Overall, 18 studies assessed the influence of age. Some studies showed an increasing proportion of admissions with increasing age, but several studies also found decreasing hospitalisations above the age of about 80–85 years. 8 of 13 studies conducting multivariate analyses included age as a continuous variable. Only 1 study reported stratified analyses by age and sex. 2 studies investigating primary causes of hospitalisation stratified by sex found some differences in main diagnoses.Discussion Male NHRs are more often hospitalised than females, but reasons for that are not well investigated. The influence of age is less clear, but there seems to be no clear linear relationship between age and the proportion being hospitalised. Further studies should investigate age and sex differences in frequencies and reasons for hospitalisation in NHRs.

Inappropriate Fentanyl Prescribing Among Nursing Home Residents in the United States
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K. M. Fain, C. Castillo-Salgado, D. D. Dore, J. B. Segal, A. R. Zullo and G. C. Alexander.
J Am Med Dir Assoc 2016 Oct 6

OBJECTIVE: We quantified transdermal fentanyl prescribing in elderly nursing home residents without prior opioid use or persistent pain, and the association of individual and facility traits with opioid-naive prescribing. DESIGN: Cross-sectional study. SETTING: Linked Minimum Data Set (MDS) assessments; Online Survey, Certification and Reporting (OSCAR) records; and Medicare Part D claims. PARTICIPANTS: From a cross-section of all long-stay US nursing home residents in 2008 with an MDS assessment and Medicare Part D enrollment, we identified individuals (>/=65 years old) who initiated transdermal fentanyl, excluding those with Alzheimer disease, severe cognitive impairment, cancer, or receipt of hospice care. MEASUREMENTS: We used Medicare Part D to select beneficiaries initiating transdermal fentanyl in 2008 and determined whether they were “opioid-naive,” defined as no opioid dispensing during the previous 60 days. We obtained resident and facility characteristics from MDS and OSCAR records and defined persistent pain as moderate-to-severe, daily pain on consecutive MDS assessments at least 90 days apart. We estimated associations of patient and facility attributes and opioid-naive fentanyl initiation using multilevel mixed effects logistic regression modeling. RESULTS: Among 17,052 residents initiating transdermal fentanyl, 6190 (36.3%) were opioid-naive and 15,659 (91.8%) did not have persistent pain. In the regression analysis with adjustments, residents who were older (ages >/=95 odds ratio [OR] 1.69, 95% confidence interval [CI] 1.46-1.95) or more cognitively impaired (moderate-to-severe cognitive impairment, OR 1.99, 95% CI 1.73-2.29) were more likely to initiate transdermal fentanyl without prior opioid use. CONCLUSION: Most nursing home residents initiating transdermal fentanyl did not have persistent pain and many were opioid-naive. Changes in prescribing practices may be necessary to ensure Food and Drug Administration warnings are followed, particularly for vulnerable subgroups, such as the cognitively impaired.

Association of Nondisease-Specific Problems with Mortality, Long-Term Care, and Functional Impairment among Older Adults Who Require Skilled Nursing Care after Dialysis Initiation
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C. B. Bowling, L. Plantinga, R. K. Hall, A. Mirk, R. Zhang and N. Kutner.
Clin J Am Soc Nephrol 2016 Oct 12

BACKGROUND AND OBJECTIVES: The majority of older adults who initiate dialysis do so during a hospitalization, and these patients may require post-acute skilled nursing facility (SNF) care. For these patients, a focus on nondisease-specific problems, including cognitive impairment, depressive symptoms, exhaustion, falls, impaired mobility, and polypharmacy, may be more relevant to outcomes than the traditional disease-oriented approach. However, the association of the burden of nondisease-specific problems with mortality, transition to long-term care (LTC), and functional impairment among older adults receiving SNF care after dialysis initiation has not been studied. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We identified 40,615 Medicare beneficiaries >/=65 years old who received SNF care after dialysis initiation between 2000 and 2006 by linking renal disease registry data with the Minimum Data Set. Nondisease-specific problems were ascertained from the Minimum Data Set. We defined LTC as >/=100 SNF days and functional impairment as dependence in all four essential activities of daily living at SNF discharge. Associations of the number of nondisease-specific problems (</=1, 2, 3, and 4-6) with 6-month mortality, LTC, and functional impairment were examined. RESULTS: Overall, 39.2% of patients who received SNF care after dialysis initiation died within 6 months. Compared with those with </=1 nondisease-specific problems, multivariable adjusted hazard ratios (95% confidence interval) for mortality were 1.26 (1.19 to 1.32), 1.40 (1.33 to 1.48), and 1.66 (1.57 to 1.76) for 2, 3, and 4-6 nondisease-specific problems, respectively. Among those who survived, 37.1% required LTC; of those remaining who did not require LTC, 74.7% had functional impairment. A higher likelihood of transition to LTC (among those who survived 6 months) and functional impairment (among those who survived and did not require LTC) was seen with a higher number of problems. CONCLUSIONS: Identifying nondisease-specific problems may help patients and families anticipate LTC needs and functional impairment after dialysis initiation.

Prevention of falls, malnutrition and pressure ulcers among older persons – nursing staff’s experiences of a structured preventive care process
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C. Lannering, M. Ernsth Bravell and L. Johansson.
Health Soc Care Community 2016 Oct 12

A structured and systematic care process for preventive work, aimed to reduce falls, pressure ulcers and malnutrition among older people, has been developed in Sweden. The process involves risk assessment, team-based interventions and evaluation of results. Since development, this structured work process has become web-based and has been implemented in a national quality registry called ‘Senior Alert’ and used countrywide. The aim of this study was to describe nursing staff’s experience of preventive work by using the structured preventive care process as outlined by Senior Alert. Eight focus group interviews were conducted during 2015 including staff from nursing homes and home-based nursing care in three municipalities. The interview material was subjected to qualitative content analysis. In this study, both positive and negative opinions were expressed about the process. The systematic and structured work flow seemed to only partly facilitate care providers to improve care quality by making better clinical assessments, performing team-based planned interventions and learning from results. Participants described lack of reliability in the assessments and varying opinions about the structure. Furthermore, organisational structures limited the preventive work.

Advance care planning for older people in Australia presenting to the emergency department from the community
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M. Street, G. Ottmann, M. J. Johnstone, J. Considine and P. M. Livingston.
Health Soc Care Community 2015 Sep;23(5):513-522

The purpose of this retrospective, cross-sectional study was to determine the prevalence of advance care planning (ACP) among older people presenting to an Emergency Department (ED) from the community or a residential aged care facility. The study sample comprised 300 older people (aged 65+ years) presenting to three Victorian EDs in 2011. A total of 150 patients transferred from residential aged care to ED were randomly selected and then matched to 150 people who lived in the community and attended the ED by age, gender, reason for ED attendance and triage category on arrival. Overall prevalence of ACP was 13.3% (n = 40/300); over one-quarter (26.6%, n = 40/150) of those presenting to the ED from residential aged care had a documented Advance Care Plan, compared to none (0%, n = 0/150) of the people from the community. There were no significant differences in the median ED length of stay, number of investigations and interventions undertaken in ED, time seen by a doctor or rate of hospital admission for those with an Advance Care Plan compared to those without. Those with a comorbidity of cerebrovascular disease or dementia and those assessed with impaired brain function were more likely to have a documented Advance Care Plan on arrival at ED. Length of hospital stay was shorter for those with an Advance Care Plan [median (IQR) = 3 days (2-6) vs. 6 days (2-10), P = 0.027] and readmission lower (0% vs. 13.7%). In conclusion, older people from the community transferred to ED were unlikely to have a documented Advance Care Plan. Those from residential aged care who were cognitively impaired more frequently had an Advance Care Plan. In the ED, decisions of care did not appear to be influenced by the presence or absence of Advance Care Plans, but length of hospital admission was shorter for those with an Advance Care Plan.

Eating Behaviors and Dietary Changes in Patients With Dementia
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G. Cipriani, C. Carlesi, C. Lucetti, S. Danti and A. Nuti.
American Journal of Alzheimer’s Disease and Other Dementias 2016 October 18

Background: Eating problems and dietary changes have been reported in patients with dementia.Objectives: The aim of this article is to explore the generalized problems with nutrition, diet, feeding, and eating reported among patients with dementia.Methods: Medline and Google Scholar searches were conducted for relevant articles, chapters, and books published before 2016. Search terms used included behavioral and psychological symptoms of dementia, dementia, dietary changes, eating behavior. Publications found through this indexed search were reviewed for further relevant references.Results: Abnormal eating behaviors, eating problems, and dietary changes are present in most people with dementia, especially in the later stages of the condition.Conclusion: Individuals with dementia frequently develop serious feeding difficulties and changes in eating and dietary habits. The changes may be secondary to cognitive impairment or apraxia, or the result of insufficient caregiving, or the consequence of metabolic or neurochemical abnormalities occurring as part of the dementing process.

nutritionDay in Nursing Homes-The Association of Nutritional Intake and Nutritional Interventions With 6-Month Mortality in Malnourished Residents
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M. Streicher, M. Themessl-Huber, K. Schindler, C. C. Sieber, M. Hiesmayr and D. Volkert.
J Am Med Dir Assoc 2016 Oct 11

OBJECTIVES: Malnutrition in older persons is associated with an increased risk of mortality. Useful strategies to counteract malnutrition are nutritional interventions, such as fortified diets, oral nutritional supplements (ONS), tube feeding, and parenteral nutrition. Presently, it is not known if these strategies can reduce mortality risk of nursing home (NH) residents who are malnourished or at risk of malnutrition. Thus, the aim of this study was to investigate if nutritional intake and interventions are associated with mortality in this specific population. DESIGN: One-day cross-sectional study with outcome evaluation after 6 months, repeated in yearly intervals since 2007. SETTING: A total of 507 NH units from 15 countries. PARTICIPANTS: NH residents participating in the nutritionDay between 2007 and 2014, aged 65 years or older with a poor nutritional status (body mass index 5 kg in the last year or at risk of malnutrition or malnourished according to NH staff). MEASUREMENTS: Data on resident and unit level were collected on nutritionDay and mortality status was assessed 6 months later. Residents’ nutrition (intake at lunch on nutritionDay) and nutritional interventions (diet, use of ONS, supplementary tube feeding, supplementary parenteral nutrition) were of interest as influencing factors of 6-month mortality, adjusted for 23 potential confounders (residents’ nutritional status, general residents’ characteristics, and unit characteristics). Univariate generalized estimating equations were performed for all variables and significant predictors (P 5 kg in the last year or at risk of malnutrition or malnourished according to NH staff). MEASUREMENTS: Data on resident and unit level were collected on nutritionDay and mortality status was assessed 6 months later. Residents’ nutrition (intake at lunch on nutritionDay) and nutritional interventions (diet, use of ONS, supplementary tube feeding, supplementary parenteral nutrition) were of interest as influencing factors of 6-month mortality, adjusted for 23 potential confounders (residents’ nutritional status, general residents’ characteristics, and unit characteristics). Univariate generalized estimating equations were performed for all variables and significant predictors (P 5 kg in the last year, body mass index <20 kg/m2, residents’ country region, and increasing age were also associated with a higher mortality risk. CONCLUSIONS: Poor intake at lunch on nutritionDay was a strong predictor of mortality, whereas the use of nutritional interventions was not associated with 6-month mortality in NH residents who are malnourished or at risk of malnutrition. The reasons for these findings need to be clarified.

The correlates of anxiety among older adults in nursing homes and other residential aged care facilities: a systematic review
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A. S. Creighton, T. E. Davison and D. W. Kissane.
Int J Geriatr Psychiatry 2016 Oct 17

OBJECTIVE: To synthesize and summarize the studies examining the correlates and predictors of anxiety in older adults living in residential aged care. METHODS: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, five electronic databases were searched using key terms and subject headings, as well as reference lists of relevant papers. The search was limited to peer-reviewed literature published in English. Eligible studies examined the association between at least one correlate/factor and anxiety disorders or symptoms in aged care residents aged 50+ years. RESULTS: A total of 3741 articles were identified, of which 34 studies (with a total of 1 543 554 participants) were included in this review. Correlates associated with anxiety included pain, use of anti-depressants/lithium, depression, and lower perceived quality of life. Less consistent and/or less studied variables included younger age, female gender, higher educational level, functional dependence, subjective health status, more prescribed medications, impaired vision, insomnia, external locus of control, fear of falling, attachment, hope, meaning in life, and the influence of social, environmental, and staff/policy correlates. CONCLUSIONS: While several variables were found to have strong associations with anxiety in aged care residents, a number of factors have been examined by only one or two studies. Further research (preferably prospective studies) is therefore needed to reliably confirm findings and to help plan and develop preventative and intervention strategies.

Depressive Symptoms and Associated Factors in Institutionalized Elderly
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J. Jerez-Roig, N. P. de Oliveira, B. F. de Lima Filho, et al.
Exp Aging Res 2016 Oct-Dec;42(5):479-491

Background/Study Context: Depression is a common psychiatric disorder in the elderly that leads to a decrease in quality of life and functional impairment, among other health problems. The study of depressive symptoms in institutionalized elderly is scarce in Latin America and can contribute to plan prevention and treatment actions in order to improve health conditions for the residents as well as quality of life. Therefore, the aim of this study is to determine the prevalence of depressive symptoms and identify its associated factors in institutionalized elderly. METHODS: A cross-sectional study is presented herein, carried out in 10 nursing homes of the municipality of Natal (Northeast Brazil). All individuals over the age of 60 were included. The Geriatric Depression Scale (GDS-15) was applied to verify the depressive symptoms, as well as sociodemographic variables related to the institution and health conditions (comorbidities, medication, body mass index, level of physical activity, mobility, and functional and cognitive capacities). Bivariate analysis was carried out using the chi-square Pearson’s test (or Fisher’s test) and the linear trend chi-square. Finally, logistic regression was utilized for multivariate analysis. RESULTS: The final sample was constituted of 142 elderly, mostly of the female sex (78.9%), with an average age of 79.3 (SD: 8.2). Of these, 65 individuals presented depressive symptoms, with a 45.77% prevalence (95% confidence interval [CI]: 37.80-53.97%). The final model verified an association between the presence of depressive symptoms and functional impairment, prevalence ratio (PR) = 1.58 (95% CI: 1.04-2.42), and arterial hypertension, PR = 1.57 (95% CI: 1.07-2.31), adjusted by fecal incontinence, sex, and age. CONCLUSION: Depressive symptoms were present in almost half of the sample of institutionalized elderly, and this condition was associated with functional impairment and arterial hypertension. The results of this work indicate the importance of monitoring depression as well as intervening on these modifiable aspects, to avoid the cascade of negative outcomes associated with this disease and also improve the quality of life of this population group.

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Implementing Music Care in Continuing Care

9 November, 9:00 am – 12:00 pm, Edmonton Clinic Health Academy, University of Alberta

We will be discussing issues related to implementing music care in continuing care, including identifying key decisions that need to be made before implementation can take place. We will look at what music care programs currently exist and what the various barriers may be. Speakers will discuss music care programming in their respective organizations, including why they chose the program, what issues/challenges they have faced, and how they have overcome these barriers. This event will be held in-person at the Edmonton Clinic Health Academy (ECHA), room 2-140 and room 10331A at the Rockyview General Hospital (RGH) in Calgary. Registration is also available to attend via video or teleconference on the VC Scheduler.

Non UofA

Assessing Empirical Evidence for KTE Readiness Canada-flat-icon

9 November, 2:00-4:00 pm MT, The Institute for Work and Health, Toronto

The Toronto chapter of KTECOP invites you to a presentation by Dr. Travis Sztainert from the Gambling Research Exchange Ontario (GREO). Not all research evidence is born equal; it exists on a continuum of readiness for use. So even though there may be evidence about an identified problem, it may not yet be ready for use. The purpose of the End of Grant Readiness Tool is to help you decide how ready your evidence might be, and the corresponding KTE activities that may be relevant. In this presentation to the Toronto chapter of the KTE COP, you’ll learn about a new tool to help individuals involved in knowledge translation & exchange (KTE) — e.g., researchers, knowledge brokers, and others — to assess research for KTE potential. Registration is free but space is limited. Please preregister online: http://assessing-kte-readiness.eventbrite.ca A webinar option is available. Login details will be emailed to registrants shortly before the event.


KT Canada Rounds: A network analysis perspective to implementation science; lessons learned from a mixed methods study of Public Health Units in Ontario Canada-flat-icon

10 November 10:00-11:00 am MT

Learning Objectives: To understand the principles of social network analysis; To illustrate different potentials for application of network analysis to study predictors, processes, and outcomes of implementation; To discuss the value of Mixed Methods in designing network studies. This session is offered by WebEx from St. Michael’s Hospital in Toronto. All registration requests should be sent to Gail Klein: kleing@smh.ca by Wednesday, November 9th at 12:00 PM ET.

How does a knowledge broker ‘fit’ in the world of KT? Canada-flat-icon

4 November, 1:00-2:00 pm MT

The next webinar “How does a knowledge broker ‘fit’ in the world of KT?” features Alison Hoens (Physical Therapy Knowledge Broker, University of British Columbia & Research, Education and Practice Coordinator for Physiotherapy, Providence Health Care).

Fireside Chat on the Development of Implementation Science & Future Directions

26 October, 1:00-2:00 pm MT

Dr. David Chambers will host a fireside chat with the two former Deputy Directors in the area of Implementation Science, Dr. Russell Glasgow and Dr. Jon Kerner. Topics for discussion include a key history of dissemination and implementation at the National Cancer Institute, National Institutes of Health, and the field more broadly, as well as future directions, key research needs, and other priority areas. This will mark a new suite of Advanced Topics in Implementation Science webinars as we invite friends and colleagues to join us for informal conversations around relevant D&I topics.

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Certificate in Knowledge Mobilization Canada-flat-icon

$895 for Course #1 in 2017, University of Guelph

The Certificate in Knowledge Mobilization is designed to develop participants’ knowledge, skills and values with respect to knowledge mobilization (KMb) and build capacity to select and apply KMb tools and techniques to move knowledge into action. There are 3 online courses available in 2017.

End of Grant KT Workshop Canada-flat-icon

$300, 15 November, Toronto

We are pleased to offer our End of Grant Knowledge Translation (KT) Course on November 15th, 2016 (9am – 4:00pm) at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto. This course is designed to provide grant writers with the needed tools to write the KT portion of their grant applications. Course attendees will use their own grants to develop an end of grant KT plan. Topics include: A framework for end of grant KT; Assessing impact of research – how to use and interpret bibliometrics and altmetrics; Approach to media and social media. Registration deadline: November 2, 2016. To register: please contact Gail Klein. You will be required to send your registration fee and a one page summary of the project you will be working on for your end of grant KT plan. Space is limited and registration is on a first come first serve basis.

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‘More is not always better’: More drugs mean seniors more likely to land in hospital, says study Canada-flat-icon

The long and growing list of prescription drugs consumed by Canada’s elderly is actually making them more likely to end up in hospital, not less so, suggests a striking new study.

RNs may not be replaced by LPNs as nurse on duty in nursing homes, arbitrator rules Canada-flat-icon

A ruling by Arbitrator David Jones in a dispute between United Nurses of Alberta and an Edmonton nursing home operator has upheld the union’s interpretation of the Nursing Homes Operation Regulation, which requires such facilities to have a Registered Nurse, Certified Graduate Nurse or Registered Psychiatric Nurse on the premises 24/7.

KT Services at Centre for Healthcare Innovation Canada-flat-icon

You’ve likely read Kate’s post about how we define Knowledge Translation, or KT. But, if you’re left wondering what the George & Fay Yee Centre for Healthcare Innovation’s (CHI) KT services are (and specifically, what we can do for you and how to get the ball rolling), this is the post for you.

Canadian Frailty Network: Fall 2016 Network News Canada-flat-icon

Canadian Frailty Network (CFN) has just published its 2015-16 Annual Report. The report celebrates how the collective efforts of a CFN community of more than 3,500 stakeholders will make system change and improved care for older frail citizens “possible.” A link is available to read CFN’s submission to the federal Finance Committee 2017 and learn more about frailty assessment.

Long-Term Care Sector Performance Canada-flat-icon

Long-term care homes are an important part of health care in Ontario, providing loved ones with the 24-hour care needed for complex health conditions. Tens of thousands of people in Ontario rely on nursing, medical treatment, physiotherapy, and other services offered in long-term care homes.

List of dementia environmental risk factors drawn up (UK)

A shortlist of environmental factors that may contribute to the risk of developing dementia has been drawn up by experts.

Announcing KT Alberta Canada-flat-icon

The Alberta SPOR KT Platform is pleased to introduce KT Alberta. KT Alberta will be a community for people working in the area of health-related knowledge translation, whether as researchers, practitioners, administrators and/or policy-makers. We will be announcing more about KT Alberta in the next few weeks.

Editorial: Lower the volume on quality reporting

What you don’t measure, you can’t improve. But if you measure everything, you are at risk of sending false signals about what’s important and what’s not. This is especially true when measuring healthcare quality, a movement that began in earnest in the late 1990s and now has exploded into a mini-industry. Quality measurement helps determine physician and hospital reimbursement, Medicare star ratings, insurer networks and more.

Canada fails to support frail older adults between hospital visits Canada-flat-icon

The truth is, our health system often fails when it comes to addressing the complex care needs of frail patients between urgent health events. We rarely deliver quality chronic care, comprehensive home care or continuous care, and in particular, poorly handle transitions between care settings and providers.

Doctors want more funding for seniors’ health care in next health accord Canada-flat-icon

Canadian doctors want the federal government to commit more funding to seniors’ care in the next health accord, according to the president of the Canadian Medical Association. Dr. Cindy Forbes will be presenting a list of recommendations at the association’s annual meeting this week in Vancouver that will include requests for more funding in provinces with larger populations of seniors, coverage of prescription drugs and for long-term care, home care and caregivers.

High Blood Pressure May Hike Dementia Risk (US)

High blood pressure, particularly in middle age, might open the door to dementia, the American Heart Association warns in a new scientific statement.

What is TIHM for dementia? (UK)

TIHM (Technology Integrated Health Management) for dementia is a major new research study funded and monitored by NHS England and Innovate UK. It will test how cutting edge technology placed in people’s homes could be used to improve the lives of people with dementia and their carers.

Sudden Drops in Blood Pressure Tied to Higher Odds for Dementia (US)

There seems to be an association between sudden drops in blood pressure upon standing up — a condition called orthostatic hypotension — and an increased risk for dementia, according to a new study. The study of 6,000 Dutch people could only point to an association between sudden low blood pressure and dementia, and couldn’t prove cause-and-effect. However, a geriatrician in the United States said the link is worth investigating.

Lunch With Your Faculty Interviewers

The point of a campus visit is primarily to demonstrate your collegiality. By the time you make it to this stage of the search, the department is quite convinced about your research, writing, and overall productivity. Now they want to know that you can talk about your research and teaching — and your potential colleagues’ research and teaching — in an engaging, productive and constructive way.

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White Book on Frailty

IAGG, Global Aging Research Network (GARN)

It aims to promote preventive interventions against disability and to provide information on how to adequately implement frailty into everyday clinical practice. To this effect, the book highlights current knowledge on the identification of target population, the assessment of frail old adult, and the development of tailored intervention programs. We now know that early detection and intervention is critical to addressing frailty.

Developing Ontario’s Dementia Strategy: A Discussion Paper Canada-flat-icon

Government of Ontario, Alzheimer Society of Ontario, September 2016

Together, we can move dementia care toward a more person-centered care. Read this consultation paper to learn how, with the right supports available, people living with dementia and their care partners will be able to stay healthy and live well. Virtually everyone in Ontario will be touched by dementia. Everyone is encouraged to provide input into the Ontario Dementia Strategy.

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Post-doctoral Fellowship Opportunity, Macquarie University

Macquarie University, position based in Melbourne

The Centre for Healthcare Resilience and Implementation Science (CHRIS) and The Australian Genomics Health Alliance (AGHA) are seeking a Post-doctoral Research Fellow for a collaborative project focusing on the implementation of genetics services into Australian healthcare organisations. Under the supervision of Dr Natalie Taylor and Professor Jeffrey Braithwaite (of AIHI), and Associate Professor Clara Gaff and Dr Melissa Martyn (AGHA members based with Melbourne Genomics), the Post-doctoral Research Fellow will lead research into the implementation of genomic sequencing service provision.

Post-doctoral Fellowship: Ottawa Hospital Research Institute Canada-flat-icon

Deadline 31 October

The Ottawa Centre for Implementation Research at the Ottawa Hospital Research Institute (www.ohri.ca/ocir) invites applications for a two year post-doctoral fellowship position focusing on behavioural approaches to evaluation in implementation science. We are seeking a talented individual with ambitions to advance their career by capitalizing on being involved in a range of multi-disciplinary collaborative projects. The successful candidate will have the opportunity to gain experience and expand their professional network through collaboration with investigators from a range of disciplines. Opportunities for professional development include publications, presentations at scientific conferences, involvement in grant writing, exposure to new methodological approaches, and interaction with health system stakeholders. Working primarily with Dr. Justin Presseau and Dr. Jeremy Grimshaw, the candidate will be expected to contribute to a variety of research projects incorporating mixed methods.

Post-doctoral Fellowship: McGill University Canada-flat-icon

Open until filled

McGill Biomedical Ethics Unit / Studies of Translation, Ethics, and Medicine (STREAM) is inviting applications for a postdoctoral research fellow (PDF) with a background in systematic review, clinical trials, or ethics. Special consideration will be given to candidates knowledgeable in research ethics, statistics, or meta-science. The project will examine how risk, benefit, burdens, and clinical hypotheses evolve as new drugs are developed- and whether there are ways to improve efficiencies in clinical development. The PDF will work under the supervision of Jonathan Kimmelman, alongside several coinvestigators (Alex London, Dean Fergusson, and Spencer Hey).

Student Competition: Integrated Knowledge Translation Experiences Canada-flat-icon

Deadline 14 November

We invite trainees to tell us about their experiences using an integrated knowledge translation approach in their work. The most interesting and well-told examples will win a prize of $1,000 from CHIPS (CAHSPR) for research expenses. Winners will also be asked to present at the next CAHSPR conference (if they plan to attend). Two prizes will be awarded.

Researcher Competition: Integrated Knowledge Translation Cases Canada-flat-icon

Deadline 30 January 2017

We invite researchers to tell us about their experiences using an integrated knowledge translation approach in their work. The most interesting and well-told examples will compiled into a CHIPS (CAHSPR) IKT Casebook that will be published for wider distribution. We also intend to host a session at the 2017 CAHSPR meeting and invite the authors of the chosen cases to present them (if they plan to attend).

Cochrane seeks members for its inaugural Scientific Committee

Deadline 25 November

Cochrane is looking for skilled and experienced methodologists, researchers, and editors to form a Scientific Committee – an independent forum providing guidance to the Editor in Chief to ensure that Cochrane Reviews always represent the best methodological practice in evidence synthesis.

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