August 9, 2014


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First data released from the Canadian Longitudinal Study on Aging Data

The first major data release from the Canadian Longitudinal Study on Aging (CLSA) is underway. The CLSA is the most comprehensive study of aging ever undertaken in Canada. The study will follow 50,000 individuals aged 45 to 85 for 20 years, collecting information about their physical, emotional and social health through telephone interviews, in-home interviews and physical assessments. To date, more than 40,000 participants have been recruited.

Abstracts

CALL FOR PROPOSALS:
North American Network in Aging Studies Conference
19-22 May 2015 Oxford, Ohio
DEADLINE 15 November 2014

We invite scholarship and research that provides fresh insights into changing manifestations and interpretations of age through engagement with cultural texts (e.g., literature, history, media, public policy, adaptive technology), as well as qualitative or other meaning-based approaches.

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Publications

KT
Health Care Administration and Organization
Health Care Innovation and Quality Assurance
Research Practice & Methodology
Aging

KT

Looking inside the black box: results of a theory-based process evaluation exploring the results of a randomized controlled trial of printed educational messages to increase primary care physicians’ diabetic retinopathy referrals Canada-flat-icon
Grimshaw J, Presseau J, Tetroe J, Eccles M, Francis J, Godin G, et al.
Implementation Science 2014;9(1):86

Background Theory-based process evaluations conducted alongside randomized controlled trials provide the opportunity to investigate hypothesized mechanisms of action of interventions, helping to build a cumulative knowledge base and to inform the interpretation of individual trial outcomes. Our objective was to identify the underlying causal mechanisms in a cluster randomized trial of the effectiveness of printed educational materials (PEMs) to increase referral for diabetic retinopathy screening. We hypothesized that the PEMs would increase physicians’ intention to refer patients for retinal screening by strengthening their attitude and subjective norm, but not their perceived behavioral control. Methods Design: A theory based process evaluation alongside the Ontario Printed Educational Material (OPEM) cluster randomized trial. Postal surveys based on the Theory of Planned Behavior were sent to a random sample of trial participants two months before and six months after they received the intervention. Setting: Family physicians in Ontario, Canada. Participants: 1,512 family physicians (252 per intervention group) from the OPEM trial were invited to participate, and 31.3% (473/1512) responded at time one and time two. The final sample comprised 437 family physicians fully completing questionnaires at both time points. Main outcome measures: Primary: behavioral intention related to referring patient for retinopathy screening; secondary: attitude, subjective norm, perceived behavioral control. Results At baseline, family physicians reported positive intention, attitude, subjective norm, and perceived behavioral control to advise patients about retinopathy screening suggesting limited opportunities for improvement in these constructs. There were no significant differences on intention, attitude, subjective norm, and perceived behavioral control following the intervention. Respondents also reported additional physician- and patient-related factors perceived to influence whether patients received retinopathy screening. Conclusions Lack of change in the primary and secondary theory-based outcomes provides an explanation for the lack of observed effect of the main OPEM trial. High baseline levels of intention to advise patients to attend retinopathy screening suggest that post-intentional and other factors may explain gaps in care. Process evaluations based on behavioral theory can provide replicable and generalizable insights to aid interpretation of randomized controlled trials of complex interventions to change health professional behavior.

Managing dementia symptoms and needs using technology.
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Kerssens C, Sattler M, Monteiro A.
Journal of gerontological nursing 2014 Jul;40(7):16-20

Dementia is a difficult and costly disease to manage. Although caregivers and patients have indicated they need support for activities of daily living and debilitating neuropsychological symptoms, most technology innovations focus on safety and social contact. This feasibility study tested a care technology designed to manage dementia symptoms and everyday routines using common, nonpharmacological interventions. It was implemented in two formal care environments (memory care, assisted living). In Sample 1, independent observers decided which symptoms were present or absent in individual residents pre-intervention and 1 and 2 months during the intervention. In Sample 2, independent observers determined the desired status (goals) for individual residents prior to intervention and evaluated resident status 1 and 2 months into the intervention. The intervention was associated with a reduction in symptoms and progression toward wellness goals, suggesting that nondrug interventions for managing symptoms and daily routines in dementia can be delivered effectively using advanced technology. Copyright 2014, SLACK Incorporated.

Staff Compliance With Protocols to Improve the Management of Behavioral and Psychological Symptoms of Dementia
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Mellor D, McCabe M, Bird M, Davison T, MacPherson S, Hallford D, et al.
Journal of gerontological nursing 2014 Jul 11:1-9

Using data from a larger study investigating the effectiveness of a structured clinical protocol to manage individuals in residential facilities who experience behavioral and psychological symptoms of dementia (BPSD), the current study investigated whether external clinical support in using the protocol with specific residents increased compliance in its use, over and above only providing a generic workshop about the protocol and management of BPSD. Results indicated that provision of the workshop, in addition to clinical support, was associated with significantly higher compliance. However, compliance was only found to be related to positive outcomes when staff received the generic workshop and not clinical support. When clinical support was provided, compliance was not related to outcomes or worse outcomes. These findings, when considered in the context of the results of the larger trial, suggest that the relationship among clinical support, compliance with BPSD protocols, and clinical outcomes for residents and staff is complex and needs further investigation.
Copyright 2014, SLACK Incorporated.

Oncology nurses and the experience of participation in an evidence-based practice project.
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Fridman M, Frederickson K.
Oncology nursing forum 2014 Jul 1;41(4):382-388

To illuminate the experiences of oncology nurses who participated in an evidence-based practice (EBP) project in an institution with an EBP organizational structure. RESEARCH APPROACH: A descriptive phenomenologic approach and in-depth interviews with each participant. SETTING: An oncology-focused academic medical center with an established organizational infrastructure for EBP. PARTICIPANTS: 12 RNs working in an oncology setting who participated in an EBP project. METHODOLOGIC APPROACH: Descriptive, qualitative phenomenologic approach through use of interviews and analysis of interview text. FINDINGS: Four essential themes (i.e., support, challenges, evolution, and empowerment) and 11 subthemes emerged that reflected nurses’ professional and personal growth, as well as the creation of a culture of EBP in the workplace. CONCLUSIONS: The participants described the EBP project as a positive, empowering personal and professional evolutionary experience with supports and challenges that resulted in improvements in patient care. INTERPRETATION: To the authors’ knowledge, the current study is the first qualitative study to demonstrate improved nursing outcomes (e.g., professional growth, improved nursing performance) and nurses’ perception of improved patient outcomes (e.g., ongoing healthcare collaboration, evidence-based changes in practice).

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Health Care Administration and Organization

Turnover of regulated nurses in long-term care facilities. Canada-flat-icon
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Chu CH, Wodchis WP, McGilton KS.
Journal of nursing management 2014 Jul;22(5):553-562

AIMS: To describe the relationship between nursing staff turnover in long-term care (LTC) homes and organisational factors consisting of leadership practices and behaviours, supervisory support, burnout, job satisfaction and work environment satisfaction. BACKGROUND: The turnover of regulated nursing staff [Registered Nurses (RNs) and Registered Practical Nurses (RPNs)] in LTC facilities is a pervasive problem, but there is a scarcity of research examining this issue in Canada. METHODS: The study was conceptualized using a Stress Process model. Distinct surveys were distributed to administrators to measure organisational factors and to regulated nurses to measure personal and job-related sources of stress and workplace support. In total, 324 surveys were used in the linear regression analysis to examine factors associated with high turnover rates. RESULTS: Higher leadership practice scores were associated with lower nursing turnover; a one score increase in leadership correlated with a 49% decrease in nursing turnover. A significant inverse relationship between leadership turnover and nurse turnover was found: the higher the administrator turnover the lower the nurse turnover rate. CONCLUSION: Leadership practices and administrator turnover are significant in influencing regulated nurse turnover in LTC. IMPLICATIONS FOR NURSING MANAGEMENT: Long-term care facilities may want to focus on building good leadership and communication as an upstream method to minimize nurse turnover. © 2013 John Wiley & Sons Ltd.

The Use of Unregulated Staff: Time for Regulation?
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Duffield CM, Twigg DE, Pugh JD, Evans G, Dimitrelis S, Roche MA.
Policy, politics & nursing practice 2014 Apr 4;15(1-2):42-48

Internationally, shortages in the nursing workforce, escalating patient demands, and financial constraints within the health system have led to the growth of unlicensed nursing support workers. Recently, in relation to the largest publicly funded health system (National Health Service), it was reported that extensive substitution of registered nurses with unskilled nursing support workers resulted in inadequate patient care, increased morbidity and mortality rates, and negative nurse outcomes. We argue that it is timely to consider regulation of nursing support workers with their role and scope of practice clearly defined. Further, the addition of these workers in a complementary model of care (rather than substitutive model) should also be explored in future research, in terms of impact on patient and nurse outcomes. © The Author(s) 2014

Care workers in long-term care for older people: challenges of quantity and quality
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Chen H, Lisa.
European Journal of Social Work 2014 06;17(3):383-401

This article, drawing on a qualitative study in England, the Netherlands and Taiwan, explores how countries with very different care systems address the challenge of securing sufficient numbers of care workers with appropriate skills in ageing care. The analysis exposes the salient features of care systems, ageing-care markets and the ageing-care workforce in the three countries. To support the analysis, examples of how the countries attempt to recruit and retain ageing-care workers are provided. Key findings are that to secure an adequate number of skilled ageing-care workers, job satisfaction, coherence between care and labour policies and equal working conditions across sectors are vital. A quality ageing-care worker requires regular professional supervision and support, resources for ongoing training and career development opportunities. Most importantly, securing a sufficient number of ageing-care workers and ensuring they have appropriate skills are not isolated challenges but are interlinked and require collaboration between a range of care actors.

Associations between state regulations, training length, perceived quality and job satisfaction among certified nursing assistants: cross-sectional secondary data analysis.
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Han K, Trinkoff AM, Storr CL, Lerner N, Johantgen M, Gartrell K.
International journal of nursing studies 2014 Aug;51(8):1135-1141

In the U.S., there are federal requirements on how much training and annual continuing education a certified nursing assistant must complete in order to be certified. The requirements are designed to enable them to provide competent and quality care to nursing home residents. Many states also require additional training and continuing education hours as improved nursing home quality indicators have been found to be related to increased training. OBJECTIVES: This study investigated the associations among state level regulations, initial training quality and focus, and job satisfaction in certified nursing assistants. DESIGN: Cross-sectional secondary data analysis. SETTINGS: This study used the National Nursing Home Survey and National Nursing Assistant Survey as well as data on state regulations of certified nursing assistant training. PARTICIPANTS: 2897 certified nursing assistants in 580 nursing homes who were currently working at a nursing home facility, who represented 680,846 certified nursing assistants in US. METHODS: State regulations were related to initial training and job satisfaction among certified nursing assistants using chi square tests and binomial logistic regression models. Analyses were conducted using SAS-callable SUDAAN to correct for complex sampling design effects in the National Nursing Home Survey and National Nursing Assistant Survey. Models were adjusted for personal and facility characteristics. RESULTS: Certified nursing assistants reporting high quality training were more likely to work in states requiring additional initial training hours (p=0.02) and were more satisfied with their jobs (OR=1.51, 95% CI=1.09-2.09) than those with low quality training. In addition, those with more training focused on work life skills were 91% more satisfied (OR=1.91, 95% CI=1.41-2.58) whereas no relationship was found between training focused on basic care skills and job satisfaction (OR=1.36, 95% CI=0.99-1.84). CONCLUSIONS: Certified nursing assistants with additional initial training were more likely to report that their training was of high quality, and this was related to job satisfaction. Job satisfaction was also associated with receiving more training that focused on work life skills. Federal training regulations should reconsider additional hours for certified nursing assistant initial training, and include work life skills as a focus. As job satisfaction has been linked to nursing home turnover, attention to training may improve satisfaction, ultimately reducing staff turnover. Copyright © 2014 Elsevier Ltd. All rights reserved.

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Health Care Innovation and Quality Assurance

Patient Safety Policy in Long-Term Care: A Research Protocol to Assess Executive WalkRounds to Improve Management of Early Warning Signs for Patient Safety.
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van Dusseldorp L, Hamers H, van Achterberg T, Schoonhoven L.
JMIR research protocols 2014 Jul 15;3(3):e36

At many hospitals and long-term care organizations (such as nursing homes), executive board members have a responsibility to manage patient safety. Executive WalkRounds offer an opportunity for boards to build a trusting relationship with professionals and seem useful as a leadership tool to pick up on soft signals, which are indirect signals or early warnings that something is wrong. Because the majority of the research on WalkRounds has been performed in hospitals, it is unknown how board members of long-term care organizations develop their patient safety policy. Also, it is not clear if these board members use soft signals as a leadership tool and, if so, how this influences their patient safety policies. OBJECTIVE: The objective of this study is to explore the added value and the feasibility of WalkRounds for patient safety management in long-term care. This study also aims to identify how executive board members of long-term care organizations manage patient safety and to describe the characteristics of boards. METHODS: An explorative before-and-after study was conducted between April 2012 and February 2014 in 13 long-term care organizations in the Netherlands. After implementing the intervention in 6 organizations, data from 72 WalkRounds were gathered by observation and a reporting form. Before and after the intervention period, data collection included interviews, questionnaires, and studying reports of the executive boards. A mixed-method analysis is performed using descriptive statistics, t tests, and content analysis. RESULTS: Results are expected to be ready in mid 2014. CONCLUSIONS: It is a challenge to keep track of ongoing development and implementation of patient safety management tools in long-term care. By performing this study in cooperation with the participating long-term care organizations, insight into the potential added value and the feasibility of this method will increase.

Understanding critical barriers to implementing a clinical information system in a nursing home through the lens of a socio-technical perspective.
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Or C, Dohan M, Tan J.
Journal of medical systems 2014 Sep;38(9):99-014-0099-9. Epub 2014 Jul 22

This paper addresses key barriers to implementing a clinical information system (CIS) in a Hong Kong nursing home setting, from a healthcare specific socio-technical perspective. Data was collected through field observations (n = 12) and semi-structured individual interviews (n = 18) of CIS stakeholders in a Hong Kong nursing home, and analyzed using the immersion/crystallization approach. Complex interactions relevant to our case were contextualized and interpreted within the perspective of the Sittig-Singh Healthcare Socio-Technical Framework (HSTF). Three broad clusters of implementation barriers from the eight HSTF dimensions were identified: (a) Infrastructure-based barriers, which relate to conflict between government regulations and system functional needs of users; lack of financial support; inconsistency between workflow, work policy, and procedures; and inadequacy of hardware-software infrastructural and technical support; (b) Process-based barriers, which relate to mismatch between the technology, existing work practice and workflow, and communication; low system speed, accessibility, and stability; deficient computer literacy; more experience in health care profession; clinical content inadequacy and unavailability; as well as poor system usefulness and user interface design; and (c) Outcome-based barriers, which relate to the lack of measurement and monitoring of system effectiveness. Two additional dimensions underlining the importance of the ability of a CIS to change are proposed to extend the Sittig-Singh HSTF. First, advocacy would promote the articulation and influence of changes in the system and subsequent outcomes by CIS stakeholders, and second, adaptability would ensure the ability of the system to adjust to emerging needs. The broad set of discovered implementation shortcomings expands prior research on why CIS can fail in nursing home settings. Moreover, our investigation offers a knowledge base and recommendations that can serve as a guide for future implementation strategies and policies in CIS initiatives.

Oral health champions in long-term care facilities-a pilot study.
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Amerine C, Boyd L, Bowen DM, Neill K, Johnson T, Peterson T.
Special care in dentistry 2014 Jul;34(4):164-170

This preintervention/postintervention pilot study examined impact of onsite support by a dental hygiene champion (DHC) on oral health and quality of life (QOL) of elderly residents in three long-term care facilities (LTCFs) in Arkansas. Oral health and oral health-related QOL were operationalized using the Oral Health Assessment Tool (OHAT) and Geriatric Oral Health Assessment Index (GOHAI), respectively. CNAs in Facility A received standardized oral health education/materials with onsite DHC support. Facility B received education/materials only. Facility C served as control. Data analyses included Wilcoxon-signed rank tests (OHAT) and repeated measures ANOVA (GOHAI) (p ≤ .05). OHAT postintervention data in Facility A showed significant improvements in three measured areas (tongue health, denture status, and oral cleanliness); in Facility B, one area (tongue health); and none in Facility C. No significant differences were found in GOHAI scores across facilities. Findings suggest that the presence of DHCs in LTCFs may positively impact the oral health of CNA-assisted residents. © 2014 Special Care Dentistry Association and Wiley Periodicals, Inc.

Nursing Assistants and Quality Nursing Home Care.
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Shaw PA.
Journal of the American Medical Directors Association 2014 Jul 15.

The view of nursing homes in the public press all too often highlights the quality of services that are poor. The latest in a series of government reports, this one by the Office of the Inspector General (February 2014),1 details serious care violations, harm, and even death. A New York Times Opinion piece (March 2014) written by a family member describes a facility as a place of decay, neglect, and startling screams, moans, and cries where staff are indifferent to suffering. Other recent news articles educate us about the harm of unnecessary drugging with antipsychotics, resident-on-resident aggression, and facilities where an overall decline in services jeopardizes residents.

Implementation of Mental Health Huddles on Dementia Care Units Canada-flat-icon
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Wagner LM, Huijbregts M, Sokoloff LG, Wisniewski R, Walsh L, Feldman S, et al.
Canadian Journal on Aging 2014 8;FirstView:1-11

Client-responsive behaviours occur commonly among residents in long-term care (LTC) settings; direct-care staff, however, receive little education, support, or opportunities to discuss and collaborate on managing such behaviours. Our participatory action project introduced mental health huddles to support staff in discussing and managing client-responsive behaviours in long-term care. This research project engaged direct-care staff (e.g., personal support workers, registered practical nurses, housekeeping staff, and registered nurses) in learning how to use these huddles. Staff workers used huddles as a forum to stay informed, review work, problem solve, and develop person-centered action plans. Fifty-six huddles occurred over a 12-week period; two to seven direct-care staff participated in each huddle. Focus groups indicated improved staff collaboration, teamwork, support, and communication when discussing specific responsive behaviours. Huddles provided LTC staff with the opportunity to collaborate and discuss strategies to optimize resident care. Further research on how huddles affect resident care outcomes is needed.

The impact of work culture on quality of care in nursing homes – a review study.
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Andre B, Sjovold E, Rannestad T, Ringdal GI.
Scandinavian journal of caring sciences 2014 Sep;28(3):449-457

The main aim of this review study was to identify which factors that characterise the relationship between work culture and quality of care in nursing homes. METHOD: This review study was structured through systematic search methods to identify articles that describe the relationship between work culture and quality of care in nursing homes. The database search yielded 14510 hits. Closer examination showed that 10401 of these hits were duplicates. Of the remaining 4109 articles, only 10 were related to our aim for the study. A qualitative method were used to explain and understand phenomena of work culture and quality if care in nursing homes. FINDINGS: Nine out of 10 articles in this review study emphasise the importance of leadership style and supportive management to increase quality of care in nursing homes. Increased empowerment, participation and influence were important factors for improving quality of care. Significant associations between work culture and quality of care and between empowerment and quality of care were reported. CONCLUSION: Nursing management and leaders must take in consideration that work culture is crucial for improving quality of care in nursing homes, and this study can be used to increase the focus on the work culture among healthcare personnel in nursing homes. Changes are necessary to increase healthcare personnel’s job satisfaction, empowerment, autonomy and influence in nursing homes. Giving empowerment to the healthcare personnel working in nursing homes is both an organisational and an interpersonal issue. Being given empowerment and influence over their own work situation, the healthcare workers can be more committed and involved in the goal of obtaining best possible care to the residents. © 2013 Nordic College of Caring Science.

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Research Practice & Methodology

The bias busters
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Yamey G.
BMJ (Clinical research ed.) 2014 Jul 23;349:g4748.

The quality, reliability, and value of the medical research enterprise have all come under scrutiny. Too much research funding continues to be wasted on poorly designed, poorly reported studies or studies plagued with biases and conflicts of interest. Gavin Yamey investigates a new center trying to address some of the problems at the heart of the crisis

Choosing the right journal for your systematic review
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Betini M, Volpato ES, Anastacio GD, de Faria RT, El Dib R.
Journal of evaluation in clinical practice 2014 Jul 5

The importance of systematic reviews (SRs) as an aid to decision making in health care has led to an increasing interest in the development of this type of study. When selecting a target journal for publication, authors generally seek out higher impact factor journals. This study aimed to determine the percentage of scientific medical journals that publish SRs according to their impact factors (>2.63) and to determine whether those journals require tools that aim to improve SR reporting and meta-analyses. METHODS: In our cross-sectional study showing how to choose the right journal for a SR, we selected and analysed scientific journals available in a digital library with a minimum Institute for Scientific Information impact factor of 2.63. RESULTS: We analysed 622 scientific journals, 435 (69.94%) of which publish SRs. Of those 435 journals, 135 (21.60%) provide instructions for authors that mention SRs. Three hundred journals (48.34%) do not discuss criteria for article acceptance in the instructions for authors section, but do publish SRs. Only 118 (27.00%) scientific journals require items to be reported in accordance with the specific SR reporting forms. CONCLUSIONS: The majority of the journals do not mention the acceptance of SRs in the instructions for authors section. Only a few journals require that SRs meet specific reporting guidelines, making interpretation of their findings across studies challenging. There is no correlation between the impact factor of the journal and its acceptance of SRs for publication. © 2014 John Wiley & Sons, Ltd.

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Aging

Awareness of dementia by family carers of nursing home residents dying with dementia: A post-death study.
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Penders YW, Albers G, Deliens L, Vander Stichele R, Van den Block L, on behalf of EURO IMPACT.
Palliative medicine 2014 Jul 18

High-quality palliative care for people with dementia should be patient-centered, family-focused, and include well-informed and shared decision-making, as affirmed in a recent white paper on dementia from the European Association for Palliative Care. AIM: To describe how often family carers of nursing home residents who died with dementia are aware that their relative has dementia, and study resident, family carer, and care characteristics associated with awareness. DESIGN: Post-death study using random cluster sampling. SETTING/PARTICIPANTS: Structured questionnaires were completed by family carers, nursing staff, and general practitioners of deceased nursing home residents with dementia in Flanders, Belgium (2010). RESULTS: Of 190 residents who died with dementia, 53.2% of family carers responded. In 28% of cases, family carers indicated they were unaware their relative had dementia. Awareness by family carers was related to more advanced stages of dementia 1 month before death (odds ratio = 5.4), with 48% of family carers being unaware when dementia was mild and 20% unaware when dementia was advanced. The longer the onset of dementia after admission to a nursing home, the less likely family carers were aware (odds ratio = 0.94). CONCLUSION: Family carers are often unaware that their relative has dementia, that is, in one-fourth of cases of dementia and one-fifth of advanced dementia, posing considerable challenges for optimal care provision and end-of-life decision-making. Considering that family carers of residents who develop dementia later after admission to a nursing home are less likely to be aware, there is room for improving communication strategies toward family carers of nursing home residents. © The Author(s) 2014.

Pressure ulcer multidisciplinary teams via telemedicine: a pragmatic cluster randomized stepped wedge trial in long term care. Canada-flat-icon
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Stern A, Mitsakakis N, Paulden M, Alibhai S, Wong J, Tomlinson G, et al.
BMC health services research 2014 Feb 24;14:83-6963-14-83

The study was conducted to determine the clinical and cost effectiveness of enhanced multi-disciplinary teams (EMDTs) vs. ‘usual care’ for the treatment of pressure ulcers in long term care (LTC) facilities in Ontario, Canada METHODS: We conducted a multi-method study: a pragmatic cluster randomized stepped-wedge trial, ethnographic observation and in-depth interviews, and an economic evaluation. Long term care facilities (clusters) were randomly allocated to start dates of the intervention. An advance practice nurse (APN) with expertise in skin and wound care visited intervention facilities to educate staff on pressure ulcer prevention and treatment, supported by an off-site hospital based expert multi-disciplinary wound care team via email, telephone, or video link as needed. The primary outcome was rate of reduction in pressure ulcer surface area (cm2/day) measured on before and after standard photographs by an assessor blinded to facility allocation. Secondary outcomes were time to healing, probability of healing, pressure ulcer incidence, pressure ulcer prevalence, wound pain, hospitalization, emergency department visits, utility, and cost. RESULTS: 12 of 15 eligible LTC facilities were randomly selected to participate and randomized to start date of the intervention following the stepped wedge design. 137 residents with a total of 259 pressure ulcers (stage 2 or greater) were recruited over the 17 month study period. No statistically significant differences were found between control and intervention periods on any of the primary or secondary outcomes. The economic evaluation demonstrated a mean reduction in direct care costs of $650 per resident compared to ‘usual care’. The qualitative study suggested that onsite support by APN wound specialists was welcomed, and is responsible for reduced costs through discontinuation of expensive non evidence based treatments. Insufficient allocation of nursing home staff time to wound care may explain the lack of impact on healing. CONCLUSION: Enhanced multi-disciplinary wound care teams were cost effective, with most benefit through cost reduction initiated by APNs, but did not improve the treatment of pressure ulcers in nursing homes. Policy makers should consider the potential yield of strengthening evidence based primary care within LTC facilities, through outreach by APNs. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT01232764.

Together but apart: Caring for a spouse with dementia resident in a care facility. Canada-flat-icon
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Hemingway D, MacCourt P, Pierce J, Strudsholm T.
Dementia (London, England) 2014 Jul 15

This longitudinal, exploratory study was designed to better understand the lived experience of spousal caregivers age 60 and older providing care to partners with Alzheimer’s disease and related dementias resident in a care facility. Twenty eight spousal caregivers were interviewed up to three times over a period of 2 years, and long-term care facility staff from four locations across British Columbia (BC), Canada participated in four focus groups. Thematic analysis of interview and focus group transcripts revealed a central, unifying theme ‘together but apart’. The results identify key targets for policy makers and service providers to support positive health and well-being outcomes for spousal caregivers providing care to their partners diagnosed with Alzheimer’s disease and related dementia and living in care facilities. © The Author(s) 2014

Costs of care for people with dementia just before and after nursing home placement: primary data from eight European countries.
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Wubker A, Zwakhalen SM, Challis D, Suhonen R, Karlsson S, Zabalegui A, et al.
The European journal of health economics: health economics in prevention and care 2014 Jul 29

Dementia is the most common cause of functional decline among elderly people and is associated with high costs of national healthcare in European countries. With increasing functional and cognitive decline, it is likely that many people suffering from dementia will receive institutional care in their lifetime. To delay entry to institutional care, many European countries invest in home and community based care services. OBJECTIVES: This study aimed to compare costs for people with dementia (PwD) at risk for institutionalization receiving professional home care (HC) with cost for PwD recently admitted to institutional long-term nursing care (ILTC) in eight European countries. Special emphasis was placed on differences in cost patterns across settings and countries, on the main predictors of costs and on a comprehensive assessment of costs from a societal perspective. METHODS: Interviews using structured questionnaires were conducted with 2,014 people with dementia and their primary informal caregivers living at home or in an ILTC facility. Costs of care were assessed with the resource utilization in dementia instrument. Dementia severity was measured with the standardized mini mental state examination. ADL dependence was assessed using the Katz index, neuropsychiatric symptoms using the neuropsychiatric inventory (NPI) and comorbidities using the Charlson. Descriptive analysis and multivariate regression models were used to estimate mean costs in both settings. A log link generalized linear model assuming gamma distributed costs was applied to identify the most important cost drivers of dementia care. RESULTS: In all countries costs for PwD in the HC setting were significantly lower in comparison to ILTC costs. On average ILTC costs amounted to 4,491 Euro per month and were 1.8 fold higher than HC costs (2,491 Euro). The relation of costs between settings ranged from 2.4 (Sweden) to 1.4 (UK). Costs in the ILTC setting were dominated by nursing home costs (on average 94 %). In the HC setting, informal care giving was the most important cost contributor (on average 52 %). In all countries costs in the HC setting increased strongly with disease severity. The most important predictor of cost was ADL independence in all countries, except Spain and France where NPI severity was the most important cost driver. A standard deviation increase in ADL independence translated on average into a cost decrease of about 22 %. CONCLUSION: Transition into ILTC seems to increase total costs of dementia care from a societal perspective. The prevention of long-term care placement might be cost reducing for European health systems. However, this conclusion depends on the country, on the valuation method for informal caregiving and on the degree of impairment.

Rural and remote dementia care challenges and needs: perspectives of formal and informal care providers residing in Saskatchewan, Canada. Canada-flat-icon
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Dal Bello-Haas VP, Cammer A, Morgan D, Stewart N, Kosteniuk J.
Rural and remote health 2014 Jul-Sep;14(3):2747

Rural and remote settings pose particular healthcare and service delivery challenges. Providing appropriate care and support for individuals with dementia and their families living in these communities is especially difficult, and can only be accomplished when the needs of care providers and the context and complexity of care provision are understood. This paper describes formal and informal caregivers’ perceptions of the challenges and needs in providing care and support for individuals with dementia living in rural and remote areas of Saskatchewan, Canada. METHODS: A mixed-methods exploratory approach was used to examine caregivers’ needs. This research was a component of a broader process evaluation designed to inform the initial and ongoing development of a community-based participatory research program in rural dementia care, which included the development of the Rural and Remote Memory Clinic (RRMC). Four approaches were used for data collection and analyses: (1) thematic analysis of consultation meetings with rural healthcare providers: documented discussions from consultation meetings that occurred in 2003-2004 with rural physicians and healthcare providers regarding plans for a new RRMC were analysed thematically; (2) telephone and mail questionnaires: consultation meeting participants completed a subsequent telephone or mail questionnaire (2003-2004) that was analysed descriptively; (3) thematic analysis of referral letters to the Rural and Remote Memory Clinic: physician referral letters over a five-year period (2003-2008) were analysed descriptively and thematically; and (4) examination of family caregiver satisfaction: four specific baseline questionnaire questions completed by family caregivers (2007-2010) were analysed descriptively and thematically. RESULTS: Both physician and non-physician healthcare providers identified increased facilities and care programs as needs. Physicians were much more likely than other providers to report available support services for patients and families as adequate. Non-physician providers identified improved services, better coordination of services, travel and travel burden related needs, and staff training and education needs as priorities. Physician needs, as determined via referral letters, included confirmation of diagnosis or treatment, request for further management suggestions, patient or family request, and consultation regarding difficult cases. One-third of informal caregivers expressed not being satisfied with the care received prior to the Rural and Remote Memory Clinic assessment visit, and identified lack of diagnosis and long wait times for services as key issues. CONCLUSIONS: Delivering services and providing care and support for individuals with dementia living in rural and remote communities are especially challenging. The need for increased extent of services was a commonality among formal and informal caregivers. Primary care physicians may seek confirmation of their diagnosis or may need assistance when dealing with difficult aspects of care, as identified by referral letters. Differences between the needs identified via referral letters and questionnaire responses of physicians may be a reflection of the rural or remote context of care provision. Informal caregiver needs were more aligned with non-physician healthcare providers with respect to the need for improved access to additional healthcare professionals and services. The findings have implications for regional policy development that addresses human and other resource shortages.

CMHC: Environment Scan on Canadian Seniors’ Transitions to Special Care Facilities Canada-flat-icon
October 2013

Released by the Canadian Mortgage and Housing Corporation (CMHC), the research report Environment Scan on Canadian Seniors’ Transitions to Special Care Facilities provides a comprehensive picture on how and why Canadian seniors move to long-term care facilities. To write the report, CMHC conducted a thorough literature review of best available evidence and compiled and analyzed Statistics Canada data on senior’s housing transitions.

Supportive Interventions for Informal Caregivers of People at the End of Life: A Rapid Review Canada-flat-icon
Health Quality Council Ontario; S Baidoobonso

This rapid review aimed to determine the effectiveness of supportive interventions in improving coping/ burden and distress for informal caregivers of patients who are at the end of life.

Excellence in Design: Optimal Living Space for People With Alzheimer’s Disease and Related Dementias
The Alzheimer’s Foundation of America, 2014

This white paper, Excellence in Design: Optimal Living Space for People With Alzheimer’s Disease and Related Dementias, addresses the evolving needs and desires of the growing population with cognitive impairment and their families by presenting recommendations for the design of care settings that would facilitate high-quality, comprehensive, person-centered care.

The Long Term Care Market: Nursing Homes, Home Care, Hospice Care, and Assisted Living
Kalorama Information
February 2014

This report, The Long Term Care Market: Nursing Homes, Home Care, Hospice Care, and Assisted Living, covers the most important segments of the long term care industry, each of which provide medical care and/or assistance with the activities of daily living (ADLs) on an ongoing basis:
Nursing care
Home care
Hospice care
Assisted living
For each of these critical markets, Kalorama provides a market size and forecast estimate.

Quality Outcomes Framework (QOF) Recorded Dementia Diagnoses Provisional 2013/14 data (UK)
Health & Social Care Information Centre
July 2014

This analysis looks at Quality Outcomes Framework (QOF) recorded dementia prevalence for 2012/13 and provisional data for 2013/14.

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Courses

Economic evaluation alongside clinical trials
5-7 November Glasgow Scotland
Fees: Public/academic £950, Commercial sector £1,480

The course is designed for individuals undertaking health economic evaluations in academia, consultancies and industry, as well as those involved in the design and analysis of clinical trials (statisticians and health service researchers).

The King’s Fund: Designing care environments for people with dementia
15-16 October 2014 Swimdon UK

In this two-day workshop you will find out how to make inexpensive changes to the design and fabric of the care environment that can have a considerable impact on the wellbeing of people with dementia.

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News

Research breaks new ground on adult caregiver support for each other Canada-flat-icon

A doctoral researcher in Toronto, Maria Bastawrous, is hoping to increase understanding and enhance healthcare guidelines when it comes to the role of adult caregivers in Canada — and how they support each other.

When Alzheimer’s strikes early; Alberta needs services designed for young sufferers, advocates say Canada-flat-icon

Nearly one in five Albertans diagnosed with Alzheimer’s is under the age of 65, and a new advocacy group met with Health Minister Fred Horne on Wednesday to tell him existing diagnoses and services in Alberta don’t meet their needs. “The needs of people with early-onset Alzheimer’s are much different than those in their 70s and 80s who have dementia – quite often our spouses are active, but they have many challenges at the same time,” said Lori Auld, one of the founding members of Early Onset Dementia Alberta.

Alzheimer’s Rate Falling in the United States, Studies Show

The number of new cases of dementia has been declining in recent decades in the United States, Germany and other developed countries, a trio of new studies shows.

Nurses Shift, Aiming for More Time With Patients

Now hospitals are changing traditional work practices, shifting more routine tasks to certified nurse assistants and other less highly skilled staffers. They are eliminating inefficient processes that make nurses walk as many as 5 miles around the hospital in a single shift. Some hospitals are aiming to triple the amount of time nurses spend with patients.

Critics sound off about Alberta’s long term care troubles Canada-flat-icon

Legislation states that anyone moving from out of province must live in Alberta for 12 months before being eligible for any kind of continuing care subsidy. If the Hirons family were to move to Airdrie, they would be on the hook for $7,500 per month for an entire year.

Smartphone app developed to provide long-term care residents’ families with up to date information on their loved ones receives award from OLTCA Canada-flat-icon

With the application, which is available at app stores and online, care providers document residents’ care plans and nurses’ notes, which are transmitted to family members, who then may choose to speak with their loved one or the care provider. The application, which can be customized, also allows family members to stay apprised of any changes in the care plan.

Governments of Canada and Alberta Announce Funding for Seniors’ Affordable Housing Canada-flat-icon

Today the Governments of Canada and Alberta announced a combined investment of some $47 million to help more low-income seniors in need of affordable housing. Five seniors’ lodges in Alberta will receive funding to build new or renovate existing units.

New funding to bring more classical music concerts to retirement homes Canada-flat-icon

A group called the Health Arts Society is bringing high-calibre classical music to retirement homes with a program called Concerts in Care. The non-profit group was founded by David Lemon in 2006 and has provided over 6,000 concerts to audiences of B.C. elders in residential care, and has chapters in provinces across Canada.

Alberta accused of dragging feet on fire safety at seniors’ facilities Canada-flat-icon

More than six months after a fatal fire swept through a Quebec seniors lodge killing 32 residents, the Alberta government has yet to reveal a plan to protect thousands of vulnerable Albertans in seniors homes.

Why we need to rethink the nursing home model Canada-flat-icon

How many nursing home beds are needed in Canada to care for frail, elderly people with high care needs? That’s a question that policy makers across the country are grappling with, given the aging population and especially the rapidly growing number of very elderly people over the age of 85.

B.C. nursing home menus face protein reduction due to rising meat prices Canada-flat-icon

Some nursing homes in B.C. have been cautioned that menus may need to be changed due to surging meat prices.

Too many employees are leaving the care sector, according to NCF survey (UK)

Although poised to bring a historic Care Act into force, politicians and healthcare professionals are being warned that the UK’s care sector faces a potential ageing workforce crisis that is already having an impact on the performance of services.

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Resources

Online learning module from The Joint Commission & AHRQ: Applying High Reliability Principles to Infection Prevention and Control in Long Term Care

Do you work in a nursing home, assisted living facility or related health care setting? View this easy-to-use, engaging e-learning tool designed for staff across all levels and disciplines. You will learn:
-how to apply high reliability principles to preventing and controlling infections in Long Term Care
-how each person’s role contributes to high reliability from scenarios that illustrate the application of these principles

Key learnings from the Pan Canadian Home Care Study Canada-flat-icon

A key objective in the development of the Safety at Home: A pan-Canadian home care safety study, released in 2013, was to compile the knowledge acquired and translate it into tools and resources to improve home care safety. The Canadian Patient Safety Institute and the Canadian Home Care Association worked with the research team to create a collection of information for home care providers, clients and families, and policy makers/academics:
Resources for home care providers – Resource guides on falls prevention and supporting caregivers at home; webinars on falls prevention, medication safety and human factors; links to journal articles; and a medication safety poster
Resources for family caregivers and clients – Resource guides on falls prevention and supporting caregivers at home; and a medication safety brochure
Resources for policy makers and academics – Policy briefs, reports, webinars on falls prevention, medication safety and human factors; links to journal articles; conference proceedings

AHRQ: Quality Improvement in Primary Care

Engaging primary care practices in Quality Improvement (QI) activities is essential to improving the health of the population, enhancing patient experiences and outcomes, and reducing the per capita cost of care, A new fact sheet from AHRQ, Quality Improvement in Primary Care: External Supports for Practices provides information and resources on four categories of external supports that can be used alone or in combination to assist practices: data feedback and benchmarking; practice facilitation or coaching; expert consultation, also called peer-to-peer mentoring; and shared learning, or learning collaboratives.

Geriatric Pain Knowledge Assessment

The Geriatric Pain Knowledge Assessment is designed to test your baseline knowledge of important concepts related to pain in older adults who reside in nursing homes. The assessment will help identify your nursing knowledge strengths and additional learning you may need to increase your clinical knowledge and improve the quality of care you provide.

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Opportunities

Come and work with TREC!!!
Research Associate – Special Projects Canada-flat-icon
TREC, Faculty of Nursing, University of Alberta
Open until filled

The TREC group at the University of Alberta is seeking a Research Associate – Special Projects. This position will report directly to the TREC Principal Investigator (PI) and provide support in a variety of research and revenue-generating activities with a significant focus on funding application support for the program.

Come and work with TREC!!!
Project Coordinator SNA & TMS Canada-flat-icon
TREC, Faculty of Nursing, University of Alberta
DEADLINE 14 August

Translating Research into Elder Care (TREC) is a collaborative partnership of investigators and decision makers whose aim is to improve quality of life and quality of care for older people in residential care. TREC began an integrated program of research in 2007. A new 6 year program began in 2014 and will involve multiple provinces. TREC consists of a set of inter-connected research projects. This role will focus on Social Network Analysis (SNA) and the Alberta Context Tool (ACT) with an additional focus on supporting the TREC Measurement System (TMS).

Come and work with TREC!!!
Research Assistant – Interviewers (Data Collection) Canada-flat-icon
TREC, Faculty of Nursing, University of Alberta
DEADLINE 14 August

The Research Assistant – Interviewers (Data Collection) are responsible for data collection for the Translating Research into Elder Care (TREC) program. TREC is a collaborative partnership of investigators and decision makers whose aim is to improve quality of life and quality of care for older people in residential care. The successful candidates will collect survey and other data at the unit level in 90 nursing homes across Alberta, British Columbia and Manitoba and will be appointed to work from hubs based in Calgary, Edmonton, Winnipeg, New Westminster, Kelowna and Kamloops. As nursing homes may be up to 110 km from the hub, the successful candidates must be prepared to travel.

Come and work with TREC!!!
Research Associate – TMS Canada-flat-icon
TREC, Faculty of Nursing, University of Alberta
Open until filled

The TREC group at the University of Alberta is seeking a Research Associate for the TREC Measurement System (TMS). The Research Associate – TMS is responsible for scientific and operational data oversight from the point where data collection is complete through to access of processed data by members of the research team and production of research outputs. This position will assist with other aspects of management of the TMS project as required.

Postdoctoral Fellow in Knowledge Translation Research Canada-flat-icon
Centre for Research in Family Health and Dalhousie University
START DATE: 1 September 2014

Objectives:
1. To develop and execute knowledge translation studies and patient orientated research under the supervision of Dr. Janet Curran (Academic Supervisor).
2. To participate in knowledge exchange activities with a multidisciplinary team at Dalhousie University and IWK Health Care Centre in addition to national and international academic and clinical leaders in knowledge translation.

TVN Theme Leads Program Canada-flat-icon
DEADLINE 25 August

TVN is launching a new, Theme Leads Program and is seeking to appoint four Theme Leads to play a central role in developing four patient-centred themes for research concerning the seriously ill, frail elderly are:
1 Improvement of End-of-Life (EOL) Care/Advance Care Planning (ACP)
2 Improvement of Acute/Critical Care
3 Optimization of Community & Residential Care
4 Optimization of Transitions of Care

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