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Gruneir A, Chamberlain SA, Jensen C, Cummings G, Hoben M, Boamah S, Bosco C, Ekhlas S, Bolt SR, Rappon T, Berta WB, Squires J, Estabrooks CA. Burnout Among Nursing Home Care Aides and the Effects on Resident Outcomes. Med Care Res Rev 2024; 81:233-244. [PMID: 38158788 PMCID: PMC11092296 DOI: 10.1177/10775587231220072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024]
Abstract
While burnout among health care workers has been well studied, little is known about the extent to which burnout among health care workers impacts the outcomes of their care recipients. To test this, we used a multi-year (2014-2020) survey of care aides working in approximately 90 nursing homes (NHs); the survey focused on work-life measures, including the Maslach Burnout Inventory (MBI) and work-unit identifier. Resident Assessment Instrument Minimum Data Set (RAI-MDS 2.0) data were obtained on all residents in the sampled NHs during this time and included a unit identifier for each resident. We used multi-level models to test associations between the MBI emotional exhaustion and cynicism sub-scales reported by care aides and the resident outcomes of antipsychotics without indication, depressive symptoms, and responsive behaviors among residents on units. In 2019/2020, our sample included 3,547 care aides and 10,117 residents in 282 units. The mean frequency of emotional exhaustion and cynicism across units was 43% and 50%, respectively. While residents frequently experienced antipsychotics without indication 1,852 (18.3%), depressive symptoms 2,089 (20.7%), and responsive behaviors 3,891 (38.5%), none were found to be associated with either emotional exhaustion or cynicism among care aides.
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Affiliation(s)
| | | | | | | | - Matthias Hoben
- University of Alberta, Edmonton, Canada
- York University, Toronto, Ontario, Canada
| | | | | | | | | | - Tim Rappon
- McMaster University, Hamilton, Ontario, Canada
| | | | - Janet Squires
- Ottawa Health Research Institute, Ontario, Canada
- University of Ottawa, Ontario, Canada
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Egbujie BA, Turcotte LA, Heckman GA, Morris JN, Hirdes JP. Functional Decline in Long-Term Care Homes in the First Wave of the COVID-19 Pandemic: A Population-based Longitudinal Study in Five Canadian Provinces. J Am Med Dir Assoc 2024; 25:282-289. [PMID: 37839468 DOI: 10.1016/j.jamda.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/30/2023] [Accepted: 09/03/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE We aimed to examine whether functional decline accelerated during the first wave of the COVID-19 pandemic (March to June 2020) for persons in long-term care facilities (LTCs) in Canada compared with the pre-pandemic period. DESIGN We conducted a population-based longitudinal study of persons receiving care in LTC homes in 5 Canadian provinces before and during the COVID-19 pandemic. SETTING AND PARTICIPANTS Residents in 1326 LTC homes within the Canadian provinces of Alberta, British Columbia, Manitoba, Newfoundland & Labrador, and Ontario between January 31, 2019, and June 30, 2020, with activities of daily living Hierarchy scale less than 6 and so, who still have potential for decline (6 being the worst of the 0-6 scale). METHODS We fit a generalized estimating equation model with adjustment for repeated measures to obtain the adjusted odds of functional decline between COVID period exposed and unexposed pre-pandemic residents. RESULTS LTC residents experienced slightly higher rates of functional decline during the first wave of the COVD-19 pandemic compared with the pre-pandemic period (23.3% vs 22.3%; P < .0001). The adjusted odds of functional decline were slightly greater during the pandemic (odds ratio [OR], 1.17; 95% CI, 1.15-1.20). Likewise, residents receiving care in large homes (OR, 1.20; 95% CI, 1.17-1.24) and urban-located LTC homes (OR, 1.20; 95% CI, 1.17-1.23), were more likely to experience functional decline during the COVID-19 pandemic. The odds of functional decline were also only significantly higher during the pandemic for LTC home residents in British Columbia (OR, 1.17; 95% CI, 1.11-1.23) and Ontario (OR, 1.25; 95% CI, 1.21-1.29). CONCLUSIONS AND IMPLICATIONS This study provides evidence that the odds of experiencing functional decline were somewhat greater during the first wave of the COVID-19 pandemic. It highlights the need to maintain physical activity and improve nutrition among older adults during periods of stress. The information would be helpful to health administrators and decision-makers seeking to understand how the COVID-19 pandemic and associated public health measures affected LTC residents' health outcomes.
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Affiliation(s)
- Bonaventure A Egbujie
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Luke A Turcotte
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Schlegel Research Chair in Geriatric Medicine, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - John N Morris
- Hebrew SeniorLife, Institute for Aging Research, Boston, MA, USA
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Ripley S, Alizadehsaravi N, Affoo R, Hunter S, Middleton LE, Moody E, Weeks LE, McArthur C. Resident-, family-, and staff-identified goals for rehabilitation of long-term care residents with dementia: a qualitative study. BMC Geriatr 2024; 24:108. [PMID: 38287257 PMCID: PMC10825995 DOI: 10.1186/s12877-024-04674-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Long-term care (LTC) residents with dementia can benefit from rehabilitation to improve function and quality of life. However, specific goals for rehabilitation with this population are not always clear. The purpose of this study was to describe the goals for rehabilitation for LTC residents with dementia from the perspective of residents, family, and staff. METHODS This was a phenomenological qualitative study. LTC residents with moderate to severe dementia, family members, and staff were recruited from two LTC homes in Halifax, Nova Scotia. Data were collected through semi-structured interviews and field notes from observations with residents while they were being active within the home. Data were analyzed via the principles of thematic content analysis, mapped onto the International Classification of Functioning, Disability, and Health (ICF) Model, and reported by the participant group (i.e., residents, family, or staff). RESULTS The 15 participants were three female residents aged 82 to 98 years, seven predominantly (86%) female family members aged 56 to 74 years, and five staff members (two females, three males, aged 22 to 55 years) who were physiotherapists, a physiotherapy assistant, a healthcare aide, and a registered licenced practical nurse. Most identified goals fell within the activities and participation constructs of the ICF model and focused on maintaining or improving function, mobility, and quality of life. Specific themes included preventing falls, walking or locomoting, stair climbing, maintaining activities of daily living, engaging in enjoyable exercise, maintaining independence and human connections, keeping busy, leaving the home for activities, and participating in group activities. CONCLUSIONS Rehabilitation goals for LTC residents living with dementia often focus on quality of life and functional activities and participation in LTC and family activities and events. Function and quality of life are interrelated, whereby functional goals influence quality of life. While some goals focus on improvement in function, maintenance or prevention of decline were also key elements. Future work should ensure rehabilitation interventions are developed relative to individually identified goals, and interventional success is measured in relation to the goal.
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Affiliation(s)
- Sara Ripley
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | | | - Rebecca Affoo
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Susan Hunter
- Western University, 1151 Richmond Street, N6A 3K7, London, ON, Canada
| | - Laura E Middleton
- University of Waterloo, 200 University Avenue West, N2L 3G1, Waterloo Ontario, Canada
- Schlegel-UW Research Institute for Aging, 250 Laurelwood Drive, N2J 0E2, Waterloo, ON, Canada
| | - Elaine Moody
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
- Centre of Excellence, Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI, Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Lori E Weeks
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
- Centre of Excellence, Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI, Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada
| | - Caitlin McArthur
- Dalhousie University, 5869 University Avenue, B3H 1X7, Halifax Nova Scotia, Canada.
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Punia H, Kaasalainen S, Ploeg J, Strachan P, Sussman T. Exploring the Role of Nurses in Advance Care Planning Within Long-Term Care Homes: A Qualitative Study. SAGE Open Nurs 2024; 10:23779608241249335. [PMID: 38690399 PMCID: PMC11060033 DOI: 10.1177/23779608241249335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 03/27/2024] [Accepted: 04/07/2024] [Indexed: 05/02/2024] Open
Abstract
Background Residents in long-term care homes (LTCHs) are often diagnosed with chronic, life-limiting illnesses, and it is now a common site to provide high levels of care and eventual death. There is an urgent need to address communication gaps and uncertainties surrounding resident's end of life preferences. Nurses are well situated to be key facilitators of necessary advance care planning (ACP), ensuring residents have discussions with family, substitute decision-makers and healthcare providers regarding future health and personal care preferences. However, LTCHs present unique challenges for nurses due to not only complex comorbidities but also staffing dynamics. Purpose This study explored the experiences and perceptions of Registered Nurses (RNs) and Registered Practical Nurse (RPNs) in LTCHs regarding their role in engaging residents and families in ACP discussions. Methods Qualitative interpretive descriptive methodology was used. Data were collected from two LTCHs in Southern Ontario with a sample of 15 nurses (7 RNs and 8 RPNs). Analysis involved review of semistructured interviews, field notes, and utilizing constant comparison within an inductive approach. Results Power and authority dynamics in LTCH's was an overarching theme in the data, with four subthemes: (1) Nurses lacking clarity about ACP, (2) nurses' uncertainty regarding their role in ACP, (3) nurses feeling uncomfortable engaging in ACP discussions, and (4) nurses struggling to support families in ACP discussions. Conclusion Recommendations for nurses, healthcare providers, LTCH administrators, and policy makers include: (1) development of policies which support, from a systemic level, nurses to feel safe while engaging in ACP; (2) reassessing LTCH's hierarchical structure, and clarifying RN, RPN, and interdisciplinary team members roles in ACP; (3) developing culture change that allows a team and person-centered approach to ACP; and (4) providing ongoing education and mentorship for nurses to manage family dynamics and expand their understanding of ACP beyond a biomedical lens.
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Affiliation(s)
- Harveer Punia
- School of Nursing, McMaster University, Hamilton, Canada
| | | | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Canada
| | | | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Canada
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Carbone S, Berta W, Law S, Kuluski K. Long-term care transitions during a global pandemic: Planning and decision-making of residents, care partners, and health professionals in Ontario, Canada. PLoS One 2023; 18:e0295865. [PMID: 38100397 PMCID: PMC10723734 DOI: 10.1371/journal.pone.0295865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
The COVID-19 pandemic appears to have shifted the care trajectories of many residents and care partners in Ontario who considered leaving LTC to live in the community for a portion or the duration of the pandemic. This type of care transition-from LTC to home care-was highly uncommon prior to the pandemic, therefore we know relatively little about the planning and decision-making involved. The aim of this study was to describe who was involved in LTC to home care transitions in Ontario during the COVID-19 pandemic, to what extent, and the factors that guided their decision-making. A qualitative description study involving semi-structured interviews with 32 residents, care partners and health professionals was conducted. Transition decisions were largely made by care partners, with varied input from residents or health professionals. Stakeholders considered seven factors, previously identified in a scoping review, when making their transition decisions: (a) institutional priorities and requirements; (b) resources; (c) knowledge; (d) risk; (e) group structure and dynamic; (f) health and support needs; and (g) personality preferences and beliefs. Participants' emotional responses to the pandemic also influenced the perceived need to pursue a care transition. The findings of this research provide insights towards the planning required to support LTC to home care transitions, and the many challenges that arise during decision-making.
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Affiliation(s)
- Sarah Carbone
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Susan Law
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
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Fowokan A, Giosa JL, Saari M, Holyoke P. Mapping a comprehensive assessment tool to a holistic definition of health for person-centred care planning in home care: a modified eDelphi study. BMC Health Serv Res 2023; 23:1268. [PMID: 37974144 PMCID: PMC10655331 DOI: 10.1186/s12913-023-10203-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 10/23/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Researchers in the Netherlands proposed the Pillars for Positive Health (PPH) as a broadly encompassing health definition to support more realistic and meaningful care planning for people living with chronic disease and other life-long health conditions. The PPH was subsequently converted to the My Positive Health (MPH) spider web visualization tool. This study sought to identify opportunities for more person-centred care planning at the point of care in home care, using the MPH tool as a framework to link comprehensive assessment and dialogue-based goal-setting. METHODS A modified eDelphi method was used to conduct domain mapping with a purposively sampled expert panel (n = 25). The panel consisted of researchers, health care providers, older adults and caregivers. A two-stage eDelphi process was conducted, with each stage consisting of three survey rounds. In the first stage, participants were asked to map 201 elements of the interRAI Home Care (interRAI HC) comprehensive assessment tool to the six MPH domains or "No pillar of best fit". The second stage focused on identifying opportunities to adapt or expand comprehensive assessment as it relates to the MPH domains. RESULTS In Stage 1, 189 of 201 elements reached consensus in domain mapping. These included: 80 elements for Bodily Functions, 32 for Daily Functioning, 32 for Mental Wellbeing, 24 for Quality of Life, 10 for Participation, and 1 for Meaningfulness. Ten elements were identified to have no pillar of best fit. The 12 elements that did not reach consensus in Stage 1 formed the basis for Stage 2, where expert panel participants proposed four new assessment elements in Meaningfulness and Participation and 11 additional descriptors across the six MPH domains. Of these, two elements and nine of the 11 descriptors reached consensus. CONCLUSION Findings show that elements of the interRAI HC are oriented toward the physical, functional, and mental health domains. Consequently, complementary assessment elements and/or tools may be needed to support comprehensive assessment of 'Meaningfulness' and 'Participation' in person-centred home and community care. Additional descriptors may also be needed to aid communication regarding the understanding and application of MPH domains.
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Affiliation(s)
- A Fowokan
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, L3R 6H3, Canada
| | - J L Giosa
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, L3R 6H3, Canada.
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - M Saari
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, L3R 6H3, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON, M5T 1P8, Canada
| | - P Holyoke
- SE Research Centre, SE Health, 90 Allstate Parkway, Suite 800, Markham, ON, L3R 6H3, Canada
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Song Y, Bolt S, Thorne T, Norton P, Poss J, Fu F, Squires J, Cummings G, Estabrooks CA. Nursing assistants' use of best practices and pain in older adults living in nursing homes. J Am Geriatr Soc 2023; 71:3413-3423. [PMID: 37565426 DOI: 10.1111/jgs.18527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/15/2023] [Accepted: 07/01/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Inadequate pain management persists in nursing homes. Nursing assistants provide the most direct care in nursing homes, and significantly improving the quality of care requires their adoption of best care practices informed by the best available evidence. We assessed the association between nursing assistants' use of best practices and residents' pain levels. METHODS We performed a cross-sectional analysis of data collected between September 2019 and February 2020 from a stratified random sample of 87 urban nursing homes in western Canada. We linked administrative data (the Resident Assessment Instrument-Minimum Data Set [RAI-MDS], 2.0) for 10,093 residents and survey data for 3547 nursing assistants (response rate: 74.2%) at the care unit level. Outcome of interest was residents' pain level, measured by the pain scale derived from RAI-MDS, 2.0. The exposure variable was nursing assistants' use of best practices, measured with validated self-report scales and aggregated to the unit level. Two-level random-intercept multinomial logistic regression accounted for the clustering effect of residents within care units. Covariates included resident demographics and clinical characteristics and characteristics of nursing assistants, unit, and nursing home. RESULTS Of the residents, 3305 (30.3%) were identified as having pain. On resident care units with higher levels of best practice use among nursing assistants, residents had 32% higher odds of having mild pain (odds ratio, 1.32; 95% confidence interval, 1.01-1.71; p = 0.040), compared with residents on care units with lower levels of best practice use among nursing assistants. The care units did not differ in reported moderate or severe pain among residents. CONCLUSIONS We observed that higher unit-level best practice use among nursing assistants was associated with mild resident pain. This association warrants further research to identify key individual and organizational factors that promote effective pain assessment and management.
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Affiliation(s)
- Yuting Song
- School of Nursing, Qingdao University, Qingdao, China
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Sascha Bolt
- School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Trina Thorne
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Peter Norton
- Department of Family Medicine, University of Calgary, Calgary, Canada
| | - Jeff Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Fangfang Fu
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Janet Squires
- School of Nursing, University of Ottawa, Ottawa, Canada
| | - Greta Cummings
- College of Health Sciences, University of Alberta, Edmonton, Canada
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Carbone S, Berta W, Law S, Kuluski K. "We have to save him": a qualitative study on care transition decisions in Ontario's long-term care settings during the COVID-19 pandemic. BMC Geriatr 2023; 23:598. [PMID: 37752444 PMCID: PMC10523656 DOI: 10.1186/s12877-023-04295-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 09/08/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has contributed to a global crisis in long-term care (LTC) with devastating consequences for residents, families and health professionals. In Ontario, Canada the severity of this crisis has prompted some care partners to move residents home with them for the duration or a portion of the pandemic. This type of care transition, from LTC to home care, was highly unusual pre-pandemic and arguably suboptimal for adults with complex needs. This paper presents the findings of a qualitative study to better understand how residents, care partners, and health professionals made care transition decisions in Ontario's LTC settings during the pandemic. METHODS Semi-structured interviews were conducted with 32 residents, care partners and health professionals who considered, supported or pursued a care transition in a LTC setting in Ontario during the pandemic. Crisis Decision Theory was used to structure the analysis. RESULTS The results highlighted significant individual and group differences in how participants assessed the severity of the crisis and evaluated response options. Key factors that had an impact on decision trajectories included the individuals' emotional responses to the pandemic, personal identities and available resources. CONCLUSIONS The findings from this study offer novel important insights regarding how individuals and groups perceive and respond to crisis events.
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Affiliation(s)
- Sarah Carbone
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada.
| | - Whitney Berta
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Susan Law
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Kerry Kuluski
- Institute for Better Health Trillium Health Partners, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada
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Hogeveen S, Hirdes JP, Heckman G, Keller H. Determinants of access of frail, community-residing older adults to geriatricians in Ontario. J Am Geriatr Soc 2023; 71:2810-2821. [PMID: 37143397 DOI: 10.1111/jgs.18382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 03/07/2023] [Accepted: 03/15/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Little is known about determinants of access to community-based geriatricians. The Geriatric 5Ms™ describe geriatricians' core competencies and inform referrals to specialists for older adults with complex needs. We explored the association of the Geriatric 5Ms™ and other characteristics with outpatient access to geriatricians by home care (HC) clients. METHODS This was a population-based, retrospective cohort study of frail community-dwelling HC clients (≥60 years) with complex needs (n = 196,444). Health assessment information was linked to health services data in Ontario, Canada, 2012-2015. Multivariable generalized estimating equations were used to identify characteristics associated with geriatrician contact (≥1 visit in 90 days post-HC admission), including derived Geriatric 5Ms™ score, and predisposing, enabling, and need factors obtained from clinical assessments. RESULTS Only 5.2% of the cohort had outpatient geriatrician contact in Ontario, Canada. Derived Geriatric 5Ms™ score was associated with higher odds of contact, but the model had modest discriminatory power (c-statistic = 0.67). In the broader multivariable model, based on empirically included factors and adjusted for regional differences, age, worsening of decision-making, dementia, hallucinations, Parkinsonism, osteoporosis, and caregiver distress/institutionalization risk were associated with higher odds of geriatrician contact. Female sex, difficulties accessing home, impaired locomotion, recovery potential, hemiplegia/hemiparesis, and cancer, were associated with lower odds of contact. This model had good discriminatory power (c-statistic = 0.77). CONCLUSIONS Few frail, community-dwelling older adults receiving HC had any outpatient geriatrician contact. While the derived Geriatric 5Ms™ score was associated with contact, a broader empirical model performed better than the Geriatric 5Ms™ in predicting contact with an outpatient geriatrician. Contact was mainly driven by conditions common in older adults, but evidence suggests that geriatricians are not evaluating the most medically complex and unstable older adults in the community. These findings suggest a need to re-examine the referral process for geriatricians and the allocation of limited specialized resources.
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Affiliation(s)
- Sophie Hogeveen
- McMaster Institute for Research on Aging, McMaster University, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph's Health System, Toronto, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Heather Keller
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
- Kinesiology and Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Wrotek M, Kalbarczyk M. Predictors of long-term care use - informal home care recipients versus private and public facilities residents in Poland. BMC Geriatr 2023; 23:512. [PMID: 37620838 PMCID: PMC10463875 DOI: 10.1186/s12877-023-04216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 08/04/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND The population aging, together with the shrinking caring potential of families, is a major challenge for social policy in the coming years. The aim of the study is to identify the factors that determine not only the use of long-term care (LTC) but also the selection of individual types of such care in Poland. METHODS Using unique data collected from inpatient LTC facilities in Poland and the Survey on Health, Ageing and Retirement in Europe (SHARE) database, we estimate logistic regressions explaining the choice of LTC solution. RESULTS Our results suggest that social inequalities play a role in choosing the type of LTC. Better educated people choose private institutions, while people without support network use more often social residential homes. The impact of multimorbidity on choosing different types of inpatient facilities is limited, thus the number of ADL limitations remains a better indicator of long term care utilization. CONCLUSIONS The study confirms that social inequalities influence decisions about the choice of LTC. However, multi-morbidity is a predictor of using LTC to a limited extent. The differences in LTC selection determinants between women and men are noticeable.
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Affiliation(s)
- Małgorzata Wrotek
- Faculty of Economic Sciences, University of Warsaw, Długa 44/50, Warsaw, 00-241, Poland.
| | - Małgorzata Kalbarczyk
- Faculty of Economic Sciences, University of Warsaw, Długa 44/50, Warsaw, 00-241, Poland
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11
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Turcotte LA, McArthur C, Poss JW, Heckman G, Mitchell L, Morris J, Foebel AD, Hirdes JP. Long-Term Care Resident Health and Quality of Care During the COVID-19 Pandemic: A Synthesis Analysis of Canadian Institute for Health Information Data Tables. Health Serv Insights 2023; 16:11786329231174745. [PMID: 37220547 PMCID: PMC10196682 DOI: 10.1177/11786329231174745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Objective Long-term care (LTC) homes ("nursing homes") were challenged during the first year of the COVID-19 pandemic in Canada. The objective of this study was to measure the impact of the COVID-19 pandemic on resident admission and discharge rates, resident health attributes, treatments, and quality of care. Design Synthesis analysis of "Quick Stats" standardized data table reports published yearly by the Canadian Institute for Health Information. These reports are a pan-Canadian scorecard of LTC services rendered, resident health characteristics, and quality indicator performance. Setting and participants LTC home residents in Alberta, British Columbia, Manitoba, and Ontario, Canada that were assessed with the interRAI Minimum Data Set 2.0 comprehensive health assessment in fiscal years 2018/2019, 2019/2020 (pre-pandemic period), and 2020/2021 (pandemic period). Methods Risk ratio statistics were calculated to compare admission and discharge rates, validated interRAI clinical summary scale scores, medication, therapy and treatment provision, and seventeen risk-adjusted quality indicator rates from the pandemic period relative to prior fiscal years. Results Risk of dying in the LTC home was greater in all provinces (risk ratio [RR] range 1.06-1.18) during the pandemic. Quality of care worsened substantially on 6 of 17 quality indicators in British Columbia and Ontario, and 2 quality indicators in Manitoba and Alberta. The only quality indicator where performance worsened during the pandemic in all provinces was the percentage of residents that received antipsychotic medications without a diagnosis of psychosis (RR range 1.01-1.09). Conclusions and implications The COVID-19 pandemic has unveiled numerous areas to strengthen LTC and ensure that resident's physical, social, and psychological needs are addressed during public health emergencies. Except an increase in potentially inappropriate antipsychotic use, this provincial-level analysis indicates that most aspects of resident care were maintained during the first year of the COVID-19 pandemic.
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Affiliation(s)
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, NS, Canada
| | - Jeff W Poss
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lori Mitchell
- Home Care Program, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada
| | | | - Andrea D Foebel
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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12
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Hogeveen S, Donaghy-Hughes M, Nova A, Saari M, Sinn CLJ, Northwood M, Heckman G, Geffen L, Hirdes JP. The interRAI COVID-19 vulnerability screener: Results of a health surveillance initiative for vulnerable adults in the community during the COVID-19 pandemic. Arch Gerontol Geriatr 2023; 113:105056. [PMID: 37207541 PMCID: PMC10159666 DOI: 10.1016/j.archger.2023.105056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/26/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023]
Abstract
During the pandemic, the interRAI COVID-19 Vulnerability Screener (CVS) was used to identify community-dwelling older adults or adults with disabilities at risk of negative outcomes and facilitate triage for follow-up with health/social services. The interRAI CVS, a standardized self-report instrument administered virtually by a lay-person, includes COVID-19-related items and psychosocial and physical vulnerability. Our objective was to describe those assessed and identify sub-groups at highest risk of adverse outcomes. Seven community-based organizations in Ontario, Canada, implemented the interRAI CVS. We used descriptive statistics to report results and created a priority indicator for monitoring and/or intervention based on possible COVID-19 symptoms and psychosocial/physical vulnerabilities. We used logistic regression to examine the association between priority level and risk of poor outcomes using fair/poor self-rated health as a proxy measure. The sample included 942 adults assessed (April-November 2020; mean age=79). About 10% of individuals reported potential COVID-19 symptoms and <1% had a positive COVID-19 test/diagnosis. Of those with psychosocial/physical vulnerabilities (73.1%), most common were depressed mood (20.9%), loneliness (21.6%), and limited access to food/medications (7.5%). Overall, 45.7% had a recent doctor or nurse practitioner visit. Odds of fair/poor self-reported health were highest among those who reported both possible symptoms of COVID-19 and psychosocial/physical vulnerabilities (OR 10.9, 95% CI 5.96-20.12) compared to those with neither symptoms nor psychosocial/physical vulnerabilities. The sample represents a population largely unaffected by COVID-19 itself but with identified vulnerabilities. The interRAI CVS allows community providers to stay connected and obtain a better understanding of vulnerable individuals' needs during the pandemic.
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Affiliation(s)
- Sophie Hogeveen
- McMaster Institute for Research on Aging, McMaster University, MIP Suite 109A, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - Megan Donaghy-Hughes
- Canadian College of Naturopathic Medicine, 1255 Sheppard Ave East, North York, ON M2K1E2, Canada.
| | - Amanda Nova
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada.
| | - Margaret Saari
- SE Research Centre, 90 Allstate Parkway, Suite 300, Markham, Ontario L3R 6H3, Canada.
| | - Chi-Ling Joanna Sinn
- McMaster Institute for Research on Aging, McMaster University, MIP Suite 109A, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - Melissa Northwood
- Faculty of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada.
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada.
| | - Leon Geffen
- Samson Institute for Ageing Research, 9 Gorge Road, Vredehoek 8001, South Africa.
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, 200 University Ave. W, Waterloo, ON N2L 3G1, Canada.
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13
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McArthur C, Alizadehsaravi N, Quigley A, Affoo R, Earl M, Moody E. Scoping review of methods for engaging long-term care residents living with dementia in research and guideline development. BMJ Open 2023; 13:e067984. [PMID: 37080615 PMCID: PMC10124307 DOI: 10.1136/bmjopen-2022-067984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES To describe: (1) methods used to engage long-term care (LTC) residents living with dementia in research and guideline development; (2) the outcomes of engagement; and (3) barriers and facilitators to engagement. DESIGN Scoping review. SEARCH STRATEGY We conducted searches in Academic Search Premier (EBSCO), APA PsychInfo (EBSCO), CINAHL (EBSCO), Medline (OVID), Embase (Elsevier), Web of Science and the Cochrane database, and a structured grey literature search in July 2021 and updated in March 2023. We included studies that described or evaluated resident engagement, defined as including residents living with dementia in the process of developing healthcare guidelines or research which could include collaborators or partners in planning, execution or dissemination of the guideline or research. Title, abstracts and full-texts were screened for eligibility by two team members using a pilot-tested process. Data were extracted from included studies independently and in duplicate by two team members using a pre-tested data extraction form. Results were narratively synthesised according to the research question they addressed. RESULTS We identified three studies for inclusion. Residents were engaged at the beginning of the research projects through interviews, focus groups, and consultations. None of the included articles described the outcomes of engagement. Barriers to engagement were predominantly at the resident level, including impaired verbal communication limiting resident's abilities to participate in discussions, while increased time to support engagement was reported as a barrier at the resident and research team levels. CONCLUSIONS We found a small body of literature describing the engagement of LTC residents in health research and guideline development. Future work should explore alternative methods to engage LTC residents living with dementia, including art-based methods, and the effect of including resident engagement. Guideline developers and researchers should ensure adequate time and human resources are allocated to support engagement.
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Affiliation(s)
- Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Adria Quigley
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rebecca Affoo
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marie Earl
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elaine Moody
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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14
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Public Reporting of Performance Indicators in Long-Term Care in Canada: Does it Make a Difference? Can J Aging 2022; 41:565-576. [PMID: 35403595 DOI: 10.1017/s0714980821000714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Evidence of the impact of public reporting of health care performance on quality improvement is not yet sufficient for definitive conclusions to be drawn, despite the important policy implications. This study explored the association of public reporting of performance indicators of long-term care facilities in Canada with performance trends. We considered 16 performance indicators in long-term care in Canada, 8 of which are publicly reported at a facility level, whereas the other 8 are not publicly reported, between the fiscal years 2011-2012 and 2018-2019. Data from 1,087 long-term care facilities were included. Improving trends were observed among publicly reported indicators more often than among indicators that were not publicly reported. Our analysis also suggests that the association between publication of data and improvement is stronger among indicators for which there was no improvement prior to publication and among the worst performing facilities.
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15
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Kuhnow J, Hoben M, Weeks LE, Barber B, Estabrooks CA. Factors Associated with Falls in Canadian Long Term Care Homes: a Retrospective Cohort Study. Can Geriatr J 2022; 25:328-335. [PMID: 36505912 PMCID: PMC9684024 DOI: 10.5770/cgj.25.623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Half of Canadians living in long-term care (LTC) homes will fall each year resulting in consequences to independence, quality of life, and health. The objective in this study was to analyze factors that contribute to, or are protective against, falls in Canadian LTC homes. Methods We analyzed of a retrospective cohort of a stratified random sample of Canadian LTC homes in Western Canada from 2011-2017. We accessed variables from the RAI-MDS 2.0 to assess the association of the dependent variable "fall within the last 31-180 days" with multiple independent factors, using generalized estimating equation models. Results A total of 28,878 LTC residents were analyzed. Factors found to increase the odds of falling were other fractures (OR 3.64 [95% confidence interval; CI 3.27, 4.05]), hip fractures (OR 3.58 [3.27, 3.93]), moderately impaired cognitive skills (OR 2.45 [2.28, 2.64]), partial support to balance standing (OR 2.44 [2.30, 2.57]), wandering (OR 2.31 [2.18, 2.44]). Conclusion A range of factors identified were associated with falls for people living in LTC homes. Individual physical ability represented the largest group of independent factors contributing to falls. Residents who experience any fracture or an acute change in behaviour, mobility, or activities of daily living (ADL) should be considered at increased risk of falls.
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Affiliation(s)
- Jason Kuhnow
- Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Matthias Hoben
- School of Health Policy & Management, York University, Toronto, ON
| | - Lori E. Weeks
- School of Nursing, Dalhousie University, Halifax, NS
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16
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Kajdacsy-Balla Amaral AC, Hill AD, Pinto R, Fu L, Morinville A, Heckman G, Hébert P, Hirdes J. The effects of acute care hospitalization on health and cost trajectories for nursing home residents: A matched cohort study. Medicine (Baltimore) 2022; 101:e31021. [PMID: 36254032 PMCID: PMC9575775 DOI: 10.1097/md.0000000000031021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Thirty five percent to sixty seven percent of admissions to acute care hospitals from nursing homes are potentially preventable. Limited data exist regarding clinical and cost trajectories post an acute care hospitalization. To describe clinical impact and post-hospitalization costs associated with acute care admissions for nursing home residents. Analysis of population-based data. The 65,996 nursing home residents from a total of 645 nursing homes. Clinical outcomes assessed with the Changes in Health, End-stage disease and Symptoms and Signs (CHESS) scores, and monthly costs. Post-index date, hospitalized residents worsened their clinical conditions, with increases in CHESS scores (CHESS 3 + 24.5% vs 7.6%, SD 0.46), more limitations in activities of daily living (ADL) (86.1% vs 76.0%, SD 0.23), more prescriptions (+1.64 95% CI 1.43-1.86, P < .001), falls (30.9% vs 18.1%, SD 0.16), pressure ulcers (16.4% vs 8.6%, SD 0.37), and bowel incontinence (47.3% vs 39.3%, SD 0.35). Acute care hospitalizations for nursing home residents had a significant impact on their clinical and cost trajectories upon return to the nursing home. Investments in preventive strategies at the nursing home level, and to mitigate functional decline of hospitalized frail elderly residents may lead to improved quality of care and reduced costs for this population. Pre-hospitalization costs were not different between the hospitalized and control groups but showed an immediate increase post-hospitalization (CAD 1882.60 per month, P < .001).
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Affiliation(s)
- Andre Carlos Kajdacsy-Balla Amaral
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrea D Hill
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | | | | | - Anne Morinville
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - George Heckman
- Research Institute for Ageing, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul Hébert
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - John Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
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17
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Boscart V, Davey M, Crutchlow L, Heyer M, Johnson K, Taucar LS, Costa AP, Heckman G. Effective Chronic Disease Interventions in Nursing Homes: A Scoping Review Based on the Knowledge-to-Action Framework. Clin Gerontol 2022; 45:1073-1086. [PMID: 31902314 DOI: 10.1080/07317115.2019.1707339] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: The purpose of this scoping review was two-fold: 1) to identify effective intervention studies addressing chronic disease for seniors living in nursing homes (e.x. chronic heart failure, diabetes, dementia, etc.), and 2) to describe how consistently the studies' reported their stages of the Knowledge-to-Action framework (2006).Methods: This scoping review involved a systematic search of CINAHL, EMBASE, PubMed and Scopus of intervention studies, published in English and French between 1997 and 2018, that focused on the development, implementation and/or evaluation of a chronic disease management guideline or best practice for older adults 65+ residing within a nursing home (NH). Authors abstracted information specific to the seven stages of the Knowledge-to-Action framework (identifying problem, tailoring to local context, barriers and facilitators to intervention delivery, implementation, monitoring, outcome criteria, and sustainability).Results: Six studies met the inclusion criteria. Procedures for monitoring knowledge use and outcome evaluation were thoroughly described. Other stages of the Knowledge-to-Action framework were not consistently reported, including problem identification related to older adults' needs and within the context of NHs, intervention implementation, evaluation, and sustainability. Of the six studies included, only two met all the pre-defined evaluation outcomes.Conclusions: Given the need for chronic disease management in NHs, researchers are encouraged to report on intervention studies using the Knowledge-to-Action framework to optimize the likelihood that interventions will be suitable for the context of their delivery and introduce sustainable change.Clinical implications: To answer what interventions should be introduced to residents in long-term care, research must clearly demonstrate efficacy, provide enough detail for methods to be reproducible in applied contexts, and consider strategies for sustainability and the holistic needs of residents.
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Affiliation(s)
- Veronique Boscart
- School of Health and Life Sciences, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Canada
| | - Meaghan Davey
- Schlegel Centre for Advancing Seniors Care, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Lauren Crutchlow
- Schlegel Centre for Advancing Seniors Care, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Michelle Heyer
- Schlegel Centre for Advancing Seniors Care, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Keia Johnson
- Schlegel Centre for Advancing Seniors Care, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Linda Sheiban Taucar
- Schlegel Centre for Advancing Seniors Care, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Andrew P Costa
- Schlegel Centre for Advancing Seniors Care, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - George Heckman
- Schlegel Centre for Advancing Seniors Care, Conestoga College Institute of Technology and Advanced Learning, Kitchener, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Research Institute for Aging and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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18
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Sussman T, Lawrence J, Pimienta R. "This is how I want it": Exploring the use of a workbook with persons with dementia to support advance care planning engagement. DEMENTIA 2022; 21:2601-2618. [PMID: 36151606 PMCID: PMC9583280 DOI: 10.1177/14713012221127358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This mixed method sequential study reports focus group and pilot intervention
findings that (1) explore the views of persons with dementia and their
caregivers on using a self-directed advance care planning engagement workbook
(Your Conversation Starter Kit) and (2) uncover the
conditions that encouraged and hindered workbook use. In Phase 1, we conducted
five focus groups consisting of 10 persons with dementia and eight family
members/caregivers from two urban Canadian cities to explore overall impressions
of the workbook and factors that might affect its use. In Phase 2, we
empirically explored the factors identified in Phase 1 by distributing the
workbook to 24 persons with dementia. The combined findings suggest that the
workbook offers promise in supporting advance care planning engagement for
persons with dementia in the early stages of their condition. Involving
family/caregivers and clarifying some of the ranked questions might improve the
workbook’s use. Persons with dementia without familial support or those who have
never contemplated advance care planning may require additional guidance prior
to workbook distribution.
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Affiliation(s)
- Tamara Sussman
- School of Social Work, 5620McGill University, Montreal, Canada
| | - Jack Lawrence
- School of Social Work, 5620McGill University, Montreal, Canada
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19
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Predictive factors of nonfatal self-harm among community-dwelling older adults assessed for support services. Int Psychogeriatr 2022; 34:813-826. [PMID: 33336632 DOI: 10.1017/s1041610220003853] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Older adults receiving support services are a population at risk for self-harm due to physical illness and functional impairment, which are known risk factors. This study aims to investigate the relative importance of predictive factors of nonfatal self-harm among older adults assessed for support services in New Zealand. METHODS interRAI-Home Care (HC) national data of older adults (aged ≥ 60) were linked to mortality and hospital discharge data between January 1, 2012 and December 31, 2016. We calculated the crude incidence of self-harm per 100,000 person-years, and gender and age-adjusted standardized incidence ratios (SIRs). The Fine and Gray competing risk regression model was fitted to estimate the hazard ratio (HR; 95% CIs) of self-harm associated with various demographic, psychosocial, clinical factors, and summary scales. RESULTS A total of 93,501 older adults were included. At the end of the follow-up period, 251 (0.27%) people had at least one episode of nonfatal self-harm and 36,333 (38.86%) people died. The overall incidence of nonfatal self-harm was 160.39 (95% CI, 141.36-181.06) per 100,000 person-years and SIR was 5.12 (95% CI, 4.51-5.78), with the highest incidence in the first year of follow-up. Depression diagnosis (HR, 3.02, 2.26-4.03), at-risk alcohol use (2.38, 1.30-4.35), and bipolar disorder (2.18, 1.25-3.80) were the most significant risk factors. Protective effects were found with cancer (0.57, 0.36-0.89) and severe level of functional impairment measured by Activities of Daily Living (ADL) Hierarchy Scale (0.56, 0.35-0.89). CONCLUSION Psychiatric factors are the most significant predictors for nonfatal self-harm among older adults receiving support services. Our results can be used to inform healthcare professionals for timely identification of people at high risk of self-harm and the development of more efficient and targeted prevention strategies, with specific attention to individuals with depression or depressive symptoms, particularly in the first year of follow-up.
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20
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Meulenbroeks I, Raban MZ, Seaman K, Westbrook J. Therapy-based allied health delivery in residential aged care, trends, factors, and outcomes: a systematic review. BMC Geriatr 2022; 22:712. [PMID: 36031624 PMCID: PMC9420184 DOI: 10.1186/s12877-022-03386-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Background Allied health professionals in residential aged care facilities (RACFs) make important contributions to the physical and mental wellbeing of residents. Yet to date, health services research in RACFs has focused almost exclusively on nursing disciplines. This review aims to synthesise the current evidence on allied health services in RACF; specifically, how therapy-based allied health is delivered, what factors impact the quantity delivered, and the impact of services on resident outcomes and care quality. Methods Empirical peer-reviewed and grey literature focusing on allied health service delivery in RACFs from the past decade was identified through systematic searches of four databases and over 200 targeted website searches. Information on how allied health delivered, factors impacting service delivery, and impact on resident outcomes were extracted. The quality of included studies was appraised using the Mixed Methods Appraisal Tool (MMAT) and the AACODS (Authority, Accuracy, Coverage, Objectivity, Date, Significance) checklist. Results Twenty-eight unique studies were included in this review; 26 peer-reviewed and two grey literature studies. Sixteen studies discussed occupational therapy and 15 discussed physiotherapy, less commonly studied professional groups included dieticians (n = 9), allied health assistants (n = 9), and social workers (n = 6). Thirteen studies were assigned a 100% quality rating. Levels of allied health service provision were generally low and varied. Five studies examined the association between system level factors and allied health service provision, and seven studies examined facility level factors and service provision. Higher levels of allied health provision or access to allied health services, specifically physiotherapy, occupational therapy, and nutrition, were associated with reduced falls with injury, improved care quality, activities of daily living scores, nutritional status, and meal satisfaction in five studies. Conclusion Evidence on how allied health is delivered in RACFs, and its impact on resident health outcomes, is lacking globally. While there are some indications of positive associations between allied health staffing and resident outcomes and experiences, health systems and researchers will need commitment to consistent allied health data collection and health services research funding in the future to accurately determine how allied health is delivered in RACFs and its impact on resident wellbeing. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-03386-9.
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21
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Giosa JL, Saari M, Holyoke P, Hirdes JP, Heckman GA. Developing an evidence-informed model of long-term life care at home for older adults with medical, functional and/or social care needs in Ontario, Canada: a mixed methods study protocol. BMJ Open 2022; 12:e060339. [PMID: 35953249 PMCID: PMC9379487 DOI: 10.1136/bmjopen-2021-060339] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic exacerbated existing challenges within the Canadian healthcare system and reinforced the need for long-term care (LTC) reform to prioritise building an integrated continuum of services to meet the needs of older adults. Almost all Canadians want to live, age and receive care at home, yet funding for home and community-based care and support services is limited and integration with primary care and specialised geriatric services is sparse. Optimisation of existing home and community care services would equip the healthcare system to proactively meet the needs of older Canadians and enhance capacity within the hospital and residential care sectors to facilitate access and reduce wait times for those whose needs are best served in these settings. The aim of this study is to design a model of long-term 'life care' at home (LTlifeC model) to sustainably meet the needs of a greater number of community-dwelling older adults. METHODS AND ANALYSIS An explanatory sequential mixed methods design will be applied across three phases. In the quantitative phase, secondary data analysis will be applied to historical Ontario Home Care data to develop unique groupings of patient needs according to known predictors of residential LTC home admission, and to define unique patient vignettes using dominant care needs. In the qualitative phase, a modified eDelphi process and focus groups will engage community-based clinicians, older adults and family caregivers in the development of needs-based home care packages. The third phase involves triangulation to determine initial model feasibility. ETHICS AND DISSEMINATION This study has received ethics clearance from the University of Waterloo Research Ethics Board (ORE #42182). Results of this study will be disseminated through peer-reviewed publications and local, national and international conferences. Other forms of knowledge mobilisation will include webinars, policy briefs and lay summaries to elicit support for implementation and pilot testing phases.
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Affiliation(s)
- Justine L Giosa
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - Margaret Saari
- SE Research Centre, SE Health, Markham, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
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22
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Northwood M, Turcotte LA, McArthur C, Egbujie BA, Berg K, Boscart VM, Heckman GA, Hirdes JP, Wagg AS. Changes in Urinary Continence After Admission to a Complex Care Setting: A Multistate Transition Model. J Am Med Dir Assoc 2022; 23:1683-1690.e2. [PMID: 35870485 DOI: 10.1016/j.jamda.2022.06.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/14/2022] [Accepted: 06/18/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVES To examine changes in urinary continence for post-acute, Complex Continuing Care hospital patients from time of admission to short-term follow-up, either in hospital or after discharge to long-term care or home with services. DESIGN Retrospective cohort study of patients in Complex Continuing Care hospitals using clinical data collected with interRAI Minimum Data Set 2.0 and interRAI Resident Assessment Instrument Home Care. SETTING AND PARTICIPANTS Adults aged 18 years and older, admitted to Complex Continuing Care hospitals in Ontario, Canada, between 2009 and 2015 (n = 78,913). METHODS A multistate transition model was used to characterize the association between patient characteristics measured at admission and changes in urinary continence state transitions (continent, sometimes continent, and incontinent) between admission and follow-up. RESULTS The cohort included 27,896 patients. At admission, 9583 (34.3%) patients belonged to the continent state, 6441 (23.09%) patients belonged to the sometimes incontinent state, and the remaining 11,872 (42.6%) patients belonged to the incontinent state. For patients who were continent at admission, the majority (62.7%) remained continent at follow-up. However, nearly a quarter (23.9%) transitioned to the sometimes continent state, and an additional 13.4% became incontinent at follow-up. Several factors were associated with continence state transitions, including cognitive impairment, rehabilitation potential, stroke, Parkinson's disease, Alzheimer's disease and related dementias, and hip fracture. CONCLUSIONS AND IMPLICATIONS This study suggests that urinary incontinence is a prevalent problem for Complex Continuing Care hospital patients and multiple factors are associated with continence state transitions. Standardized assessment of urinary incontinence is helpful in this setting to identify patients in need of further assessment and patient-centered intervention and as a quality improvement metric to examine changes in continence from admission to discharge.
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Affiliation(s)
| | - Luke A Turcotte
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Katherine Berg
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | | | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada; Schlegel Research Chair in Geriatric Medicine, Schlegel-University of Waterloo Research Institute for Aging, Waterloo, Ontario, Canada
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Adrian S Wagg
- Department of Medicine, Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
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Vellani S, Green E, Kulasegaram P, Sussman T, Wickson-Griffiths A, Kaasalainen S. Interdisciplinary staff perceptions of advance care planning in long-term care homes: a qualitative study. BMC Palliat Care 2022; 21:127. [PMID: 35836164 PMCID: PMC9284816 DOI: 10.1186/s12904-022-01014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Residents living in long-term care homes (LTCH) have complex care needs, multiple chronic conditions, increasing frailty and cognitive impairment. A palliative approach that incorporates advance care planning (ACP) should be integrated with chronic disease management, yet it is not a norm in most LTCHs. Despite its growing need, there remains a lack of staff engagement in the ACP process. Objectives The aim of this study was to explore the perceptions and experiences of interdisciplinary staff related to the practice of ACP in LTCHs. Methods This study is part of a larger Canadian project, iCAN ACP, that aims to increase uptake, and access to ACP for older Canadians living with frailty. An exploratory qualitative design using an interpretive descriptive approach was employed utilizing focus groups and semi-structured interviews with staff from four LTCHs in Ontario, Canada. Findings There were 98 participants, including nurses (n = 36), physicians (n = 4), personal support workers (n = 34), support staff (n = 23), and a public guardian (n = 1). Three common themes and nine subthemes were derived: a) ongoing nature of ACP; b) complexities around ACP conversations; and c) aspirations for ACP becoming a standard of care in LTCHs. Discussion The findings of this study provide important contributions to our understanding of the complexities surrounding ACP implementation as a standard of practice in LTCHs. One of the critical findings relates to a lack of ACP conversations prior to admission in the LTCHs, by which time many residents may have already lost cognitive abilities to engage in these discussions. The hierarchical nature of LTCH staffing also serves as a barrier to the interdisciplinary collaboration required for a successful implementation of ACP initiatives. Participants within our study expressed support for ACP communication and the need for open lines of formal and informal interdisciplinary communication. There is a need for revitalizing care in LTCHs through interdisciplinary care practices, clarification of role descriptions, optimized staffing, capacity building of each category of staff and commitment from the LTCH leadership for such care. Conclusion The findings build on a growing body of research illustrating the need to improve staff engagement in ACP communication in LTCHs. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01014-2.
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Affiliation(s)
- Shirin Vellani
- Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 3Z1, Canada
| | - Elizabeth Green
- Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 3Z1, Canada
| | - Pereya Kulasegaram
- Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 3Z1, Canada
| | - Tamara Sussman
- Faculty of Arts, School of Social Work, McGill University, 3506 University St, Montreal, QC, H3A 2A7, Canada
| | - Abby Wickson-Griffiths
- Faculty of Nursing, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S0A2, Canada
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 3Z1, Canada.
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Miguel Cruz A, Marshall S, Daum C, Perez H, Hirdes J, Liu L. Data silos undermine efforts to characterize, predict, and mitigate dementia-related missing person incidents. Healthc Manage Forum 2022; 35:333-338. [PMID: 35678379 PMCID: PMC9615336 DOI: 10.1177/08404704221106156] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is estimated that up to 60% of people living with dementia go missing at least once during the course of their disease. Databases on missing incidents involving people living with dementia are managed in silos with minimal or incomplete data. A national strategy for the collection of data on missing incidents of people living with dementia would optimize time and resources spent on police and search and rescue and enhance chances of saving lives of those who go missing. Such a strategy would be a first step toward developing strategies to prevent future missing person incidents among this population. The objectives of this manuscript are to: (1) describe the issues and challenges related to the lack of integrated data on people living with dementia at risk of going missing, and (2) propose directions to create a national database.
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Affiliation(s)
- Antonio Miguel Cruz
- 3158University of Alberta, Edmonton, Alberta, Canada.,Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada.,8430University of Waterloo, Waterloo, Ontario, Canada
| | | | | | - Hector Perez
- 8430University of Waterloo, Waterloo, Ontario, Canada
| | - John Hirdes
- 8430University of Waterloo, Waterloo, Ontario, Canada
| | - Lili Liu
- 8430University of Waterloo, Waterloo, Ontario, Canada
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Delivering person-centred palliative care in long-term care settings: is humanism a quality of health-care employees or their organisations? AGEING & SOCIETY 2022. [DOI: 10.1017/s0144686x22000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Reflecting on sustained calls for patient-centredness and culture change in long-term care, we evaluated the relative importance of personal and organisational predictors of palliative care, hypothesising the former as weaker predictors than the latter. Health-care employees (N = 184) from four Canadian long-term care homes completed a survey of person-centred care, self-efficacy, employee wellbeing and occupational characteristics. Using backward stepwise regression models, we examined the relative contributions of these variables to person-centred palliative care. Specifically, blocks of variables representing personal, organisational and occupational characteristics; palliative care self-efficacy; and employee wellbeing were simultaneously regressed on variables representing aspects of person-centred care. The change in R2 associated with the removal of each block was examined to determine each block's overall contribution to the model. We found that occupational characteristics (involvement in care planning), employee wellbeing (compassion satisfaction) and self-efficacy were reliably associated with person-centred palliative care (p < 0.05). Facility size was not associated, and facility profit status was less consistently associated. Demographic characteristics (gender, work experience, education level) and some aspects of employee wellbeing (burnout, secondary trauma) were also not reliably associated. Overall, these results raise the possibility that humanistic care is less related to intrinsic characteristics of employees, and more related to workplace factors, or to personal qualities that can be cultivated in the workplace, including meaningful role engagement, compassion and self-efficacy.
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Mulla RT, Turcotte LA, Wellens NI, Angevaare MJ, Weir J, Jantzi M, Hébert PC, Heckman GA, van Hout H, Millar N, Hirdes JP. Prevalence and predictors of influenza vaccination in long-term care homes: a cross-national retrospective observational study. BMJ Open 2022; 12:e057517. [PMID: 35437252 PMCID: PMC9016404 DOI: 10.1136/bmjopen-2021-057517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To compare facility-level influenza vaccination rates in long-term care (LTC) homes from four countries and to identify factors associated with influenza vaccination among residents. DESIGN AND SETTING Retrospective cross-sectional study of individuals residing in LTC homes in New Brunswick (Canada), New Zealand, Switzerland, and the Netherlands between 2017 and 2020. PARTICIPANTS LTC home residents assessed with interRAI assessment system instruments as part of routine practice in New Brunswick (n=7006) and New Zealand (n=34 518), and national pilot studies in Switzerland (n=2760) and the Netherlands (n=1508). End-of-life residents were excluded from all country cohorts. OUTCOMES Influenza vaccination within the past year. RESULTS Influenza vaccination rates among LTC home residents were highest in New Brunswick (84.9%) and lowest in Switzerland (63.5%). For all jurisdictions where facility-level data were available, substantial interfacility variance was observed. There was approximately a fourfold difference in the coefficient of variation for facility-level vaccination rates with the highest in Switzerland at 37.8 and lowest in New Brunswick at 9.7. Resident-level factors associated with vaccine receipt included older age, severe cognitive impairment, medical instability, health conditions affecting a greater number of organ systems and social engagement. Residents who displayed aggressive behaviours and smoke tobacco were less likely to be vaccinated. CONCLUSION There are opportunities to increase influenza vaccine uptake at both overall country and individual facility levels. Enhanced vaccine administration monitoring programmes in LTC homes that leverage interRAI assessment systems should be widely adopted.
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Affiliation(s)
- Reem T Mulla
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Luke Andrew Turcotte
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Nathalie Ih Wellens
- HES-SO La Source Institute and School of Nursing, Lausanne, Switzerland
- Public Health and Social Affairs of the Canton of Vaud, Directorate General of Health, Lausanne, Switzerland
| | - Milou J Angevaare
- Department of Medicine for Older People & Department of General Practice, Amsterdam Public Health research institute, Amsterdam UMC - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Julie Weir
- New Brunswick Association of Nursing Homes, Fredericton, New Brunswick, Canada
| | - Micaela Jantzi
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Paul C Hébert
- Université de Montréal, Montreal, Québec, Canada
- Centre Hospitalier de l'Université de Montréal, Montreal, Québec, Canada
| | - George A Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Hein van Hout
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Garland A, Keller H, Quail P, Boscart V, Heyer M, Ramsey C, Vucea V, Choi N, Bains I, King S, Oshchepkova T, Kalashnikova T, Kroetsch B, Steer J, Heckman G. BABEL (Better tArgeting, Better outcomes for frail ELderly patients) advance care planning: a comprehensive approach to advance care planning in nursing homes: a cluster randomised trial. Age Ageing 2022; 51:6552807. [PMID: 35325020 PMCID: PMC8946666 DOI: 10.1093/ageing/afac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/24/2021] [Indexed: 11/23/2022] Open
Abstract
Background Nursing home (NH) residents should have the opportunity to consider, discuss and document their healthcare wishes. However, such advance care planning (ACP) is frequently suboptimal. Objective Assess a comprehensive, person-centred ACP approach. Design Unblinded, cluster randomised trial. Setting Fourteen control and 15 intervention NHs in three Canadian provinces, 2018–2020. Subjects 713 residents (442 control, 271 intervention) aged ≥65 years, with elevated mortality risk. Methods The intervention was a structured, \documentclass[12pt]{minimal}
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}{}$\sim$\end{document}60-min discussion between a resident, substitute decision-maker (SDM) and nursing home staff to: (i) confirm SDMs’ identities and role; (ii) prepare SDMs for medical emergencies; (iii) explain residents’ clinical condition and prognosis; (iv) ascertain residents’ preferred philosophy to guide decision-making and (v) identify residents’ preferred options for specific medical emergencies. Control NHs continued their usual ACP processes. Co-primary outcomes were: (a) comprehensiveness of advance care planning, assessed using the Audit of Advance Care Planning, and (b) Comfort Assessment in Dying. Ten secondary outcomes were assessed. P-values were adjusted for all 12 outcomes using the false discovery rate method. Results The intervention resulted in 5.21-fold higher odds of respondents rating ACP comprehensiveness as being better (95% confidence interval [CI] 3.53, 7.61). Comfort in dying did not differ (difference = −0.61; 95% CI −2.2, 1.0). Among the secondary outcomes, antimicrobial use was significantly lower in intervention homes (rate ratio = 0.79, 95% CI 0.66, 0.94). Conclusions Superior comprehensiveness of the BABEL approach to ACP underscores the importance of allowing adequate time to address all important aspects of ACP and may reduce unwanted interventions towards the end of life.
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Affiliation(s)
- Allan Garland
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather Keller
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Patrick Quail
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Veronique Boscart
- School of Health and Life Sciences, Conestoga College, Kitchener, Ontario, Canada
| | - Michelle Heyer
- School of Health and Life Sciences, Conestoga College, Kitchener, Ontario, Canada
| | - Clare Ramsey
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Vanessa Vucea
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Nora Choi
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ikdip Bains
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Seema King
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tatiana Oshchepkova
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Brittany Kroetsch
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Jessica Steer
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - George Heckman
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Outcomes of advance care directives after admission to a long-term care home: DNR the DNH? BMC Geriatr 2022; 22:22. [PMID: 34979935 PMCID: PMC8725447 DOI: 10.1186/s12877-021-02699-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Residents of long-term care homes (LTCH) often experience unnecessary and non-beneficial hospitalizations and interventions near the end-of-life. Advance care directives aim to ensure that end-of-life care respects resident needs and wishes. Methods In this retrospective cohort study, we used multistate models to examine the health trajectories associated with Do-Not-Resuscitate (DNR) and Do-Not-Hospitalize (DNH) directives of residents admitted to LTCH in Ontario, Alberta, and British Columbia, Canada. We adjusted for baseline frailty-related health instability. We considered three possible end states: change in health, hospitalization, or death. For measurements, we used standardized RAI-MDS 2.0 LTCH assessments linked to hospital records from 2010 to 2015. Results We report on 123,003 LTCH residents. The prevalence of DNR and DNH directives was 71 and 26% respectively. Both directives were associated with increased odds of transitioning to a state of greater health instability and death, and decreased odds of hospitalization. The odds of hospitalization in the presence of a DNH directive were lowered, but not eliminated, with odds of 0.67 (95% confidence interval 0.65–0.69), 0.63 (0.61–0.65), and 0.47 (0.43–0.52) for residents with low, moderate and high health instability, respectively. Conclusion Even though both DNR and DNH orders are associated with serious health outcomes, DNH directives were not frequently used and often overturned. We suggest that policies recommending DNH directives be re-evaluated, with greater emphasis on advance care planning that better reflects resident values and wishes.
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Hirdes JP, Morris JN, Perlman CM, Saari M, Betini GS, Franco-Martin MA, van Hout H, Stewart SL, Ferris J. Mood Disturbances Across the Continuum of Care Based on Self-Report and Clinician Rated Measures in the interRAI Suite of Assessment Instruments. Front Psychiatry 2022; 13:787463. [PMID: 35586405 PMCID: PMC9108209 DOI: 10.3389/fpsyt.2022.787463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/25/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mood disturbance is a pervasive problem affecting persons of all ages in the general population and the subset of those receiving services from different health care providers. interRAI assessment instruments comprise an integrated health information system providing a common approach to comprehensive assessment of the strengths, preferences and needs of persons with complex needs across the continuum of care. OBJECTIVE Our objective was to create new mood scales for use with the full suite of interRAI assessments including a composite version with both clinician-rated and self-reported items as well as a self-report only version. METHODS We completed a cross-sectional analysis of 511,641 interRAI assessments of Canadian adults aged 18+ in community mental health, home care, community support services, nursing homes, palliative care, acute hospital, and general population surveys to develop, test, and refine new measures of mood disturbance that combined clinician and self-rated items. We examined validity and internal consistency across diverse care settings and populations. RESULTS The composite scale combining both clinician and self-report ratings and the self-report only variant showed different distributions across populations and settings with most severe signs of disturbed mood in community mental health settings and lowest severity in the general population prior to the COVID-19 pandemic. The self-report and composite measures were strongly correlated with each other but differed most in populations with high rates of missing values for self-report due to cognitive impairment (e.g., nursing homes). Evidence of reliability was strong across care settings, as was convergent validity with respect to depression/mood disorder diagnoses, sleep disturbance, and self-harm indicators. In a general population survey, the correlation of the self-reported mood scale with Kessler-10 was 0.73. CONCLUSIONS The new interRAI mood scales provide reliable and valid mental health measures that can be applied across diverse populations and care settings. Incorporating a person-centered approach to assessment, the composite scale considers the person's perspective and clinician views to provide a sensitive and robust measure that considers mood disturbances related to dysphoria, anxiety, and anhedonia.
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Affiliation(s)
- John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | | | - Margaret Saari
- SE Research Centre, SE Health and Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Gustavo S Betini
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | | | - Hein van Hout
- Department of General Practice and Medicine for Older Persons, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Shannon L Stewart
- Faculty of Education, Western University (Canada), London, ON, Canada
| | - Jason Ferris
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Rushing Care by Care Aides Associated With Experiences of Responsive Behaviors From Residents in Nursing Homes. J Am Med Dir Assoc 2021; 23:954-961.e2. [PMID: 34818521 DOI: 10.1016/j.jamda.2021.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 10/20/2021] [Accepted: 10/23/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Residents with cognitive impairment favor "slow care," so rushed care may cause additional responsive behaviors (eg, verbal threats, hitting) among residents. We assessed the association of rushed care (physical and social) by care aides with their experiences of responsive behaviors from residents. DESIGN Cross-sectional analysis of survey data. SETTING AND PARTICIPANTS A total of 3547 care aides (response rate: 69.97%) in 282 care units in a stratified random sample (health region, nursing home size, owner-operator model) of 87 urban nursing homes in Western Canada. METHODS Data collection occurred between September 2019 and February 2020. The dependent variables were care aide self-report of 4 types of verbal and physical responsive behavior (yes/no). The independent variables were care aide self-report of rushed physical care (count, range = 0-6) and rushed social care (yes/no). We conducted a 2-level random-intercept logistic regression with each dependent variable, controlling for care aide, care unit, and nursing home characteristics. RESULTS In their most recent shift, 2182 (61.5%) care aides reported having rushed at least 1 physical care task and 1782 (50.2%) reported having rushed talking with residents (social care task). When care aides rushed an additional physical care task, they had 8% higher odds of reporting having experienced yelling and screaming [odds ratio (OR) 1.08, 95% CI 1.01-1.15; P = .019]. When care aides rushed social care (talking with residents), they had 70% higher odds of reporting having experienced yelling and screaming (OR 1.70, 95% CI 1.28-2.25; P < .001). We observed the same pattern for the other types of responsive behaviors. CONCLUSIONS AND IMPLICATIONS Rushing of physical or social care tasks by care aides was associated with increased likelihood of responsive behaviors from residents. One approach to reducing both rushed care and resident responsive behaviors may be to improve the care environment for care aides and residents.
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Kaasalainen S, Sussman T, Nicula M, Lawrence J, Thompson G, McCleary L, Wickson-Griffiths A, You JJ. Evaluating the Implementation of the Conversation Starter Kit in Long Term Care. SAGE Open Nurs 2021; 7:23779608211051824. [PMID: 34746381 PMCID: PMC8564126 DOI: 10.1177/23779608211051824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Advance care planning can improve the quality of life for residents in
long-term care homes and reduce stress for families. However, care home
staff and families often lack knowledge about advance care planning, making
it especially difficult for residents with dementia to communicate their
care plan wishes. A Conversation Starter Kit may increase advance care
planning awareness among staff and families. Objectives This study evaluated an advance care planning intervention, the Conversation
Starter Kit booklet, for use in long term care homes. Methods Data were collected at three long-term care homes in southern Ontario. We
collected data from 55 residents who were able to make decisions on their
own paired with 11 family members of these residents. We also collected data
from 24 family members of residents who were unable to make decisions on
their own. This study used a quasi-experimental, one group pre/post design.
Quantitative surveys were administered before and after a three-month
advance care planning intervention. An additional structured interview was
completed at the end of the intervention period, which included both closed
and open-ended questions to assess perceptions about the booklet's use or
non-use. Results Residents reported more engagement in advance care planning after completing
the Conversation Starter Kit booklet, particularly related to asking
questions to health care providers about health care decisions. Family
members reported feeling very certain that they would be able to make
decisions on behalf of the resident but felt less certain after completing
the booklet, implying the booklet raised their awareness of the types of
decisions they might need to make, hopefully prompting them to be more
prepared for decisions in the future. Conclusions An advance care planning intervention – The Conversation Starter Kit booklet
- appears acceptable and easy to use for residents and family
members/friends in long-term care and can improve resident engagement in
advance care planning. Although using the booklet may decrease efficacy for
decision making among family members of long-term care residents, it may
highlight the importance of more actionable engagement in advance care
planning among residents, their families/friends, and staff.
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Affiliation(s)
| | - Tamara Sussman
- Faculty of Arts, School of Social Work, McGill University, Montreal, QC, Canada
| | - Maria Nicula
- Health Research Methodology, McMaster University, Hamilton, ON, Canada
| | - Jack Lawrence
- Faculty of Arts, School of Social Work, McGill University, Montreal, QC, Canada
| | - Genevieve Thompson
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba,Winnipeg, MB, Canada
| | - Lynn McCleary
- Faculty of Applied Health Sciences, Brock University, St. Catharines, ON, Canada
| | | | - John J You
- Division of General Internal and Hospitalist Medicine, Credit Valley Hospital, Mississauga, Ontario, Canada
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Rangrej J, Kaufman S, Wang S, Kerem A, Hirdes J, Hillmer MP, Malikov K. Identifying Unexpected Deaths in Long-Term Care Homes. J Am Med Dir Assoc 2021; 23:1431.e21-1431.e28. [PMID: 34678267 DOI: 10.1016/j.jamda.2021.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Predicting unexpected deaths among long-term care (LTC) residents can provide valuable information to clinicians and policy makers. We study multiple methods to predict unexpected death, adjusting for individual and home-level factors, and to use as a step to compare mortality differences at the facility level in the future work. DESIGN We conducted a retrospective cohort study using Resident Assessment Instrument Minimum Data Set assessment data for all LTC residents in Ontario, Canada, from April 2017 to March 2018. SETTING AND PARTICIPANTS All residents in Ontario long-term homes. We used data routinely collected as part of administrative reporting by health care providers to the funder: Ontario Ministry of Health and Long-Term Care. This project is a component of routine policy development to ensure safety of the LTC system residents. METHODS Logistic regression (LR), mixed-effect LR (mixLR), and a machine learning algorithm (XGBoost) were used to predict individual mortality over 5 to 95 days after the last available RAI assessment. RESULTS We identified 22,419 deaths in the cohort of 106,366 cases (mean age: 83.1 years; female: 67.7%; dementia: 68.8%; functional decline: 16.6%). XGBoost had superior calibration and discrimination (C-statistic 0.837) over both mixLR (0.819) and LR (0.813). The models had high correlation in predicting death (LR-mixLR: 0.979, LR-XGBoost: 0.885, mixLR-XGBoost: 0.882). The inter-rater reliability between the models LR-mixLR and LR-XGBoost was 0.56 and 0.84, respectively. Using results in which all 3 models predicted probability of actual death of a resident at <5% yielded 210 unexpected deaths or 0.9% of the observed deaths. CONCLUSIONS AND IMPLICATIONS XGBoost outperformed other models, but the combination of 3 models provides a method to detect facilities with potentially higher rates of unexpected deaths while minimizing the possibility of false positives and could be useful for ongoing surveillance and quality assurance at the facility, regional, and national levels.
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Affiliation(s)
- Jagadish Rangrej
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada; Ontario Ministry of Long-Term Care, Toronto, ON, Canada
| | - Sam Kaufman
- Analytics and Evidence Branch, Corporate Services Division, Ontario Ministry of Attorney General, Toronto, ON, Canada
| | - Sping Wang
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada; Ontario Ministry of Long-Term Care, Toronto, ON, Canada
| | - Aidin Kerem
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada; Ontario Ministry of Long-Term Care, Toronto, ON, Canada
| | - John Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Michael P Hillmer
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada; Ontario Ministry of Long-Term Care, Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Kamil Malikov
- Health Data Science Branch, Capacity Planning and Analytics Divisions, Ontario Ministry of Health, Toronto, ON, Canada; Ontario Ministry of Long-Term Care, Toronto, ON, Canada; Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
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Kuspinar A, Hirdes JP, Berg K, McArthur C. Predicting First Time Falls: Validating a Novel Algorithm in Long Term Care. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2021. [DOI: 10.1080/02703181.2021.1942391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - John P. Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Katherine Berg
- Department of Physical Therapy and Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
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McArthur C, Quigley A, Affoo R, Earl M, Moody E. Protocol for a scoping review on the methods for engaging long-term care residents with dementia in research and guideline development. BMJ Open 2021; 11:e051602. [PMID: 34433610 PMCID: PMC8388280 DOI: 10.1136/bmjopen-2021-051602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Patient engagement is important when developing health guidelines to ensure high-quality and patient-centred recommendations. However, patient engagement in research and guideline development remains suboptimal, particularly for vulnerable populations, including residents with dementia living in long-term care (LTC) who are often not included in research and guideline development because of perceived and actual challenges with their health, memory, concentration and communication. Optimal strategies and methods for engaging LTC residents with dementia in research and guideline development remain unknown. METHODS AND ANALYSIS We will conduct a scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension to answer the research questions: (1) What methods have been used to engage LTC residents with dementia in research and guideline development? (2) What are the outcomes of resident engagement? (3) What are the barriers and facilitators to resident engagement? Systematic searches for peer-reviewed articles will be conducted in: Academic Search Premier (EBSCO), APA PsycINFO (EBSCO), CINAHL (EBSCO), Medline (OVID), Embase (Elsevier), Web of Science, and Cochrane Database and in grey literature. Two team members will screen articles and extract data. Results will be presented according to the research question they address. We will engage stakeholders including residents, family members, healthcare providers and representatives from relevant organisations throughout the study. ETHICS AND DISSEMINATION The scoping review will synthesise what is known about resident engagement in research and guideline development. It may identify gaps in the literature about the optimal methods to engage residents in performing research and developing guidelines and reveal opportunities for new methods. The results will be helpful for researchers and policy-makers seeking to develop guidelines and researchers engaging in topics that reflect the priorities and experiences of people with dementia. Results of the scoping review will be disseminated via publication in a peer-reviewed journal and conference presentations, and a one-page lay summary will be shared with our engaged stakeholders.
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Affiliation(s)
- Caitlin McArthur
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Adria Quigley
- Center for Outcomes Research and Evaluation (CORE), McGill University Health Centre, Montreal, Québec, Canada
| | - Rebecca Affoo
- School of Communication Sciences and Disorders, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marie Earl
- School of Physiotherapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elaine Moody
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
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Sussman T, Kaasalainen S, Lawrence J, Hunter PV, Bourgeois-Guerin V, Howard M. Using a self-directed workbook to support advance care planning with long term care home residents. BMC Palliat Care 2021; 20:121. [PMID: 34325675 PMCID: PMC8323265 DOI: 10.1186/s12904-021-00815-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 07/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND While advance care planning (ACP) has been shown to improve the quality of end-of-life (EOL) communication and palliative care, it is rarely practiced in long term care (LTC) homes, where staff time to support the process is limited. This study examines the potential of a publicly available self-directed ACP workbook distributed to LTC residents to encourage ACP reflection and communication. METHODS Recruitment took place across three LTC homes, between June 2018 and July 2019. To be eligible, residents had to have medical stability, cognitive capacity, and English literacy. The study employed a mixed methods concurrent design using the combination of ranked (quantitative) and open (qualitative) workbook responses to examine documented care preferences and ACP reflections and communications. RESULTS 58 residents initially agreed to participate in the study of which 44 completed self-directed ACP workbooks. Our combined quantitative and qualitative results suggested that the workbooks supported the elicitation of a range of resident care preferences of relevance for EOL care planning and decision making. For example, ranked data highlighted that most residents want to remain involved in decisions pertaining to their care (70%), even though less than half expect their wishes to be applied without discretion (48%). Ranked data further revealed many residents value quality of life over quantity of life (55%) but a sizable minority are concerned they will not receive enough care at EOL (20%). Open comments affirmed and expanded on ranked data by capturing care preferences not explored in the ranked data such as preferences around spiritual care and post mortem planning. Analysis of all open comments also suggested that while the workbook elicited many reflections that could be readily communicated to family/friends or staff, evidence that conversations had occurred was less evident in recorded workbook responses. CONCLUSIONS ACP workbooks may be useful for supporting the elicitation of resident care preferences and concerns in LTC. Developing follow up protocols wherein residents are supported in communicating their workbook responses to families/friends and staff may be a critical next step in improving ACP engagement in LTC. Such protocols would require staff training and an organizational culture that empowers staff at all levels to engage in follow up conversations with residents.
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Affiliation(s)
- Tamara Sussman
- McGill University School of Social Work, 3506 University St. #300, Montreal, QC, H3A 2A7, Canada.
| | - Sharon Kaasalainen
- Faculty of Health Sciences, School of Nursing, Health Sciences Centre, McMaster University, 1280 Main Street West, Hamilton, ON, 2J20L8S 4K1, Canada
| | - Jack Lawrence
- McGill University School of Social Work, 3506 University St. #300, Montreal, QC, H3A 2A7, Canada
| | - Paulette V Hunter
- University of Saskatchewan, St Thomas More College, Psychology, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada
| | - Valerie Bourgeois-Guerin
- Department of Psychology, University of Quebec in Montreal, 100 Sherbrook St West, Montreal, QC, H3C 3P8, Canada
| | - Michelle Howard
- Department of Family Medicine, David Braley Health Sciences Centre, McMaster University, 100 Main Street West, 5th floor, Hamilton, On, L8P 1H6, Canada
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Vellani S, Boscart V, Escrig-Pinol A, Cumal A, Krassikova A, Sidani S, Zheng N, Yeung L, McGilton KS. Complexity of Nurse Practitioners' Role in Facilitating a Dignified Death for Long-Term Care Home Residents during the COVID-19 Pandemic. J Pers Med 2021; 11:433. [PMID: 34069545 PMCID: PMC8161387 DOI: 10.3390/jpm11050433] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 12/21/2022] Open
Abstract
Due to the interplay of multiple complex and interrelated factors, long-term care (LTC) home residents are increasingly vulnerable to sustaining poor outcomes in crisis situations such as the COVID-19 pandemic. While death is considered an unavoidable end for LTC home residents, the importance of facilitating a good death is one of the primary goals of palliative and end-of-life care. Nurse practitioners (NPs) are well-situated to optimize the palliative and end-of-life care needs of LTC home residents. This study explores the role of NPs in facilitating a dignified death for LTC home residents while also facing increased pressures related to the COVID-19 pandemic. The current exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes was recruited. Data were generated using semi-structured interviews and examined using thematic analysis. Three categories were derived: (a) advance care planning and goals of care discussions; (b) pain and symptom management at the end-of-life; and (c) care after death. The findings suggest that further implementation of the NP role in LTC homes in collaboration with LTC home team and external partners will promote a good death and optimize the experiences of residents and their care partners during the end-of-life journey.
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Affiliation(s)
- Shirin Vellani
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Veronique Boscart
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Canadian Institute for Seniors Care, Conestoga College, Kitchener, ON N2G 4M4, Canada
| | - Astrid Escrig-Pinol
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Mar Nursing School, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Alexia Cumal
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Alexandra Krassikova
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON M5B 1Z5, Canada;
| | - Nancy Zheng
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
| | - Lydia Yeung
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
| | - Katherine S. McGilton
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
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Applying the Knowledge-to-Action Framework to Engage Stakeholders and Solve Shared Challenges with Person-Centered Advance Care Planning in Long-Term Care Homes. Can J Aging 2021; 41:110-120. [PMID: 33583447 DOI: 10.1017/s0714980820000410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
As they near the end of life, long term care (LTC) residents often experience unmet needs and unnecessary hospital transfers, a reflection of suboptimal advance care planning (ACP). We applied the knowledge-to-action framework to identify shared barriers and solutions to ultimately improve the process of ACP and improve end-of-life care for LTC residents. We held a 1-day workshop for LTC residents, families, directors/administrators, ethicists, and clinicians from Manitoba, Alberta, and Ontario. The workshop aimed to identify: (1) shared understandings of ACP, (2) barriers to respecting resident wishes, and (3) solutions to better respect resident wishes. Plenary and group sessions were recorded and thematic analysis was performed. We identified four themes: (1) differing provincial frameworks, (2) shared challenges, (3) knowledge products, and 4) ongoing ACP. Theme 2 had four subthemes: (i) lacking clarity on substitute decision maker (SDM) identity, (ii) lacking clarity on the SDM role, (iii) failing to share sufficient information when residents formulate care wishes, and (iv) failing to communicate during a health crisis. These results have informed the development of a standardized ACP intervention currently being evaluated in a randomized trial in three Canadian provinces.
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Chai Y, Luo H, Yip PSF, Perlman CM, Hirdes JP. Factors Associated With Hospital Presentation of Self-Harm Among Older Canadians in Long-Term Care: A 12-Year Cohort Study. J Am Med Dir Assoc 2021; 22:2160-2168.e18. [PMID: 33454310 DOI: 10.1016/j.jamda.2020.12.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES This study aimed to examine the incidence of, and factors associated with, hospital presentation for self-harm among older Canadians in long-term care (LTC). DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS The LTC data were collected using Resident Assessment Instrument-Minimum Data Set (RAI-MDS) and Resident Assessment Instrument-Home Care (RAI-HC), and linked to the Discharge Abstract Database (DAD) with hospital records of self-harm diagnosis. Adults aged 60+ at first assessment between April 1, 2003, and March 31, 2015, were included. METHODS Adjusted hazard ratios (HRs) of self-harm for potentially relevant factors, including demographic, clinical, and psychosocial characteristics, were calculated using Fine & Gray competing risk models. RESULTS Records were collated of 465,870 people in long-term care facilities (LTCF), and 773,855 people receiving home care (HC). Self-harm incidence per 100,000 person-years was 20.76 [95% confidence interval (CI) 20.31-25.40] for LTCF and 46.64 (44.24-49.12) for HC. In LTCF, the strongest risks were younger age (60-74 years vs 90+: HR, 6.00; 95% CI, 3.24-11.12), psychiatric disorders (bipolar disorder: 3.46; 2.32-5.16; schizophrenia: 2.31; 1.47-3.62; depression: 2.29; 1.80-2.92), daily severe pain (2.01; 1.30-3.11), and daily tobacco consumption (1.78; 1.29-2.45). For those receiving HC, the strongest risk factors were younger age (60-74 years vs 90+: 2.54; 1.97-3.28), psychiatric disorders (2.20; 1.93-2.50), daily tobacco consumption (2.08; 1.81-2.39), and frequent falls (1.98; 1.46-2.68). All model interactions between setting and factors were significant. CONCLUSIONS AND IMPLICATIONS There was lower incidence of hospital presentation for self-harm for LTCF residents than HC recipients. We found sizable risks of self-harm associated with several modifiable risk factors, some of which can be directly addressed by better treatment and care (psychiatric disorders and pain), whereas others require through more complex interventions that target underlying factors and causes (tobacco and falls). The findings highlight a need for setting- and risk-specific prevention strategies to address self-harm in the older populations.
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Affiliation(s)
- Yi Chai
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
| | - Hao Luo
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; Department of Computer Science, The University of Hong Kong, Hong Kong, China.
| | - Paul S F Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China; The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, China
| | - Christopher M Perlman
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - John P Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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Cheung G, Mah TM, Barak Y, Hirdes JP. Determinants of Non-emergency Use of Control Interventions in Older Canadian Psychiatric Inpatients: Analysizing the InterRAI Mental Health Electronic Health Records. Front Psychiatry 2021; 12:744341. [PMID: 34616324 PMCID: PMC8488129 DOI: 10.3389/fpsyt.2021.744341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The use of control interventions (CIs; acute control medications, physical/mechanical restraint) is associated with negative physical and psychological outcomes, particularly in older adults who are physically vulnerable. The aims of this study were to: (i) report the rates of CI use in older psychiatric inpatients (age 65 - 84 and age 85+), and compare them with younger age groups (18 - 44, age 45 - 64); and (ii) identify the factors associated with non-emergency CI use in older psychiatric inpatients. Methods: Routinely collected interRAI Mental Health assessments from 2005 - 2018 in Ontario, Canada, were analyzed to determine the rates of CI use. Logistic regression models were used to examine the sociodemographic and clinical determinants of non-emergency and any CI use. Results: There were 226,119 (female: 48.6%) interRAI assessments, and 85% of those assessed were under 65 years of age. The rates of non-emergency CI use in the four age groups were: 18 - 44 = 9.4%, 45 - 64 = 8.3%, 65 - 84 = 9.9%, 85+ = 13.2%. The most significant determinants of non-emergency CI use in older adults were highest impairments in activities of daily living (ADL Short Form score 8-16: OR = 2.72, 95% CI = 2.42 - 3.06), highest levels of aggression (Aggressive Behavior Scale score 4 - 6: OR = 1.76, 95% CI = 1.57 - 1.98), and highest levels of positive psychotic symptoms (Positive Symptoms Scale score 9+: OR = 1.65, 95% CI = 1.43 - 1.90). Delirium, cognitive disorder diagnosis, cognitive impairment, and falls were also associated with increased CI use odds, as were having the reasons for admission be danger to self, danger to others or inability to care for self. Females were less likely to have non-emergency CI use (OR = 0.84, 95% CI = 0.73 - 0.95). Patients admitted from long-term care homes had significantly greater odds of non-emergency CI use compared with community admissions (OR = 1.18; 95% CI = 1.07 - 1.29). Conclusion: The higher rates of non-emergency CI use in older psychiatric inpatients is concerning. Alternative non-pharmacological and person-centered management strategies should be considered to support older psychiatric inpatients with functional impairment, positive symptoms, aggressive behavior, cognitive impairment and delirium. The use of CIs could be incorporated as a quality improvement activity to monitor changes at various service provision levels.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Tina M Mah
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Yoram Barak
- Department of Psychological Medicine, School of Medicine, University of Otago, Dunedin, New Zealand
| | - John P Hirdes
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Musa MK, Akdur G, Hanratty B, Kelly S, Gordon A, Peryer G, Spilsbury K, Killett A, Burton J, Meyer J, Fortescue S, Towers AM, Irvine L, Goodman C. Uptake and use of a minimum data set (MDS) for older people living and dying in care homes in England: a realist review protocol. BMJ Open 2020; 10:e040397. [PMID: 33191266 PMCID: PMC7668360 DOI: 10.1136/bmjopen-2020-040397] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Care homes provide nursing and social care for older people who can no longer live independently at home. In the UK, there is no consistent approach to how information about residents' medical history, care needs and preferences are collected and shared. This limits opportunities to understand the care home population, have a systematic approach to assessment and documentation of care, identifiy care home residents at risk of deterioration and review care. Countries with standardised approaches to residents' assessment, care planning and review (eg, minimum data sets (MDS)) use the data to understand the care home population, guide resource allocation, monitor services delivery and for research. The aim of this realist review is to develop a theory-driven understanding of how care home staff implement and use MDS to plan and deliver care of individual residents. METHODS AND ANALYSIS A realist review will be conducted in three research stages.Stage 1 will scope the literature and develop candidate programme theories of what ensures effective uptake and sustained implementation of an MDS.Stage2 will test and refine these theories through further iterative searches of the evidence from the literature to establish how effective uptake of an MDS can be achieved.Stage 3 will consult with relevant stakeholders to test or refine the programme theory (theories) of how an MDS works at the resident level of care for different stakeholders and in what circumstances. Data synthesis will use realist logic to align data from each eligible article with possible context-mechanism-outcome configurations or specific elements that answer the research questions. ETHICS AND DISSEMINATION The University of Hertfordshire Ethics Committee has approved this study (HSK/SF/UH/04169). Findings will be disseminated through briefings with stakeholders, conference presentations, a national consultation on the use of an MDS in UK long-term care settings, publications in peer-reviewed journals and in print and social media publications accessible to residents, relatives and care home staff. PROSPERO REGISTRATION NUMBER CRD42020171323; this review protocol is registered on the International Prospective Register of Systematic Reviews.
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Affiliation(s)
- Massirfufulay Kpehe Musa
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Gizdem Akdur
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Barbara Hanratty
- Population Health Sciences Institute, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, United Kingdom
- NIHR Applied Research Collaboration, North East and North Cumbra, UK
| | - Sarah Kelly
- Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Adam Gordon
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- NIHR Applied Research Collaboration, East Midlands, UK
| | - Guy Peryer
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Karen Spilsbury
- School of Healthcare, University of Leeds, Leeds, UK
- NIHR Applied Research Collaboration, Yorkshire and Humber, UK
| | - Anne Killett
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jennifer Burton
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Julienne Meyer
- National Care Forum/Care for Older People, School of Health Sciences, Division of Nursing, City, University of London, London, United Kingdom
| | | | - Ann-Marie Towers
- Centre for Health Services Studies, University of Kent, Canterbury, UK
- NIHR Applied Research Collaboration, Kent Surrey and Sussex, UK
| | - Lisa Irvine
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
| | - Claire Goodman
- Centre for Research in Public health and Community Care (CRIPACC), School of Health and Social Work, University of Hertfordshire, Hatfield, United Kingdom
- NIHR Applied Research Collaboration, East of England, UK
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Gallant NL, Peckham A, Marchildon G, Hadjistavropoulos T, Roblin B, Stopyn RJN. Provincial legislative and regulatory standards for pain assessment and management in long-term care homes: a scoping review and in-depth case analysis. BMC Geriatr 2020; 20:458. [PMID: 33167897 PMCID: PMC7650170 DOI: 10.1186/s12877-020-01758-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 09/08/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Among Canadian residents living in long-term care (LTC) facilities, and especially among those with limited ability to communicate due to dementia, pain remains underassessed and undermanaged. Although evidence-based clinical guidelines for the assessment and management of pain exist, these clinical guidelines are not widely implemented in LTC facilities. A relatively unexplored avenue for change is the influence that statutes and regulations could exert on pain practices within LTC. This review is therefore aimed at identifying the current landscape of policy levers used across Canada to assess and manage pain among LTC residents and to evaluate the extent to which they are concordant with evidence-based clinical guidelines proposed by an international consensus group consisting of both geriatric pain and public policy experts. METHODS Using scoping review methodology, a search for peer-reviewed journal articles and government documents pertaining to pain in Canadian LTC facilities was carried out. This scoping review was complemented by an in-depth case analysis of Alberta, Saskatchewan, and Ontario statutes and regulations. RESULTS Across provinces, pain was highly prevalent and was associated with adverse consequences among LTC residents. The considerable benefits of using a standardized pain assessment protocol, along with the barriers in implementing such a protocol, were identified. For most provinces, pain assessment and management in LTC residents was not specifically addressed in their statutes or regulations. In Alberta, Saskatchewan, and Ontario, regulations mandate the use of the interRAI suite of assessment tools for the assessment and reporting of pain. CONCLUSION The prevalence of pain and the benefits of implementing standardized pain assessment protocols has been reported in the research literature. Despite occasional references to pain, however, existing regulations do not recommend assessments of pain at the frequency specified by experts. Insufficient direction on the use of specialized pain assessment tools (especially in the case of those with limited ability to communicate) that minimize reliance on subjective judgements was also identified in current regulations. Existing policies therefore fail to adequately address the underassessment and undermanagement of pain in older adults residing in LTC facilities in ways that are aligned with expert consensus.
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Affiliation(s)
- Natasha L. Gallant
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
| | - Allie Peckham
- Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd Street, Phoenix, AZ 85004 USA
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Gregory Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Thomas Hadjistavropoulos
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
| | - Blair Roblin
- Institute of Health Policy, Management and Evaluation, University of Toronto, 425–155 College Street, Toronto, Ontario M5T 3M6 Canada
| | - Rhonda J. N. Stopyn
- Department of Psychology and Center on Aging and Health, University of Regina, 3737 Wascana Parkway, Regina, Saskatchewan S4S 0A2 Canada
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Response to "Do Exercises Prevent Falls Among Older Adults: Where Are We Now? A Systematic Review". J Am Med Dir Assoc 2020; 22:474. [PMID: 33121869 DOI: 10.1016/j.jamda.2020.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/21/2022]
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Evaluating the Effect of COVID-19 Pandemic Lockdown on Long-Term Care Residents' Mental Health: A Data-Driven Approach in New Brunswick. J Am Med Dir Assoc 2020; 22:187-192. [PMID: 33232682 PMCID: PMC7587131 DOI: 10.1016/j.jamda.2020.10.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/06/2020] [Accepted: 10/20/2020] [Indexed: 01/29/2023]
Abstract
Long-term care (LTC) residents, isolated because of the COVID-19 pandemic, are at increased risk for negative mental health outcomes. The purpose of our article is to demonstrate how the interRAI LTC facility (LTCF) assessment can inform clinical care and evaluate the effect of strategies to mitigate worsening mental health outcomes during the COVID-19 pandemic. We present a supporting analysis of the effects of lockdown in homes without COVID-19 outbreaks on depression, delirium, and behavior problems in a network of 7 LTC homes in New Brunswick, Canada, where mitigative strategies were deployed to minimize poor mental health outcomes (eg, virtual visits and increased student volunteers). This network meets regularly to review performance on risk-adjusted quality of care indicators from the interRAI LTCF and share learning through a community of practice model. We included 4209 assessments from 765 LTC residents between January 2017 to June 2020 and modeled the change within and between residents for depression, delirium, and behavioral problems over time with longitudinal generalized estimating equations. Though the number of residents who had in-person visits with family decreased from 73.2% before to 17.9% during lockdown (chi square, P < .001), the number of residents experiencing delirium (4.5%-3.5%, P = .51) and behavioral problems (35.5%-30.2%, P = .19) did not change. The proportion of residents with indications of depression decreased from 19.9% before to 11.5% during lockdown (P < .002). The final multivariate models indicate that the effect of lockdown was not statistically significant on depression, delirium, or behavioral problems. Our analyses demonstrate that poor mental health outcomes associated with lockdown can be mitigated with thoughtful intervention and ongoing evaluation with clinical information systems. Policy makers can use outputs to guide resource deployment, and researchers can examine the data to identify better management strategies for when pandemic strikes again.
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The Seniors Quality Leap Initiative (SQLI): An International Collaborative to Improve Quality in Long-Term Care. J Am Med Dir Assoc 2020; 21:1931-1936. [PMID: 32921572 DOI: 10.1016/j.jamda.2020.07.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 06/19/2020] [Accepted: 07/17/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To describe an innovative Canadian and US community of practice that employs empirical evidence based on risk-adjusted indicators to guide collaborative initiatives to improve the quality of care in nursing homes. DESIGN Ongoing study of quality of care related to pain management in nursing home residents using clinical assessment records. SETTING and Participants: Nursing home residents in 14 organizations in Canada and the United States between 2014 and 2017. The most recent analytic samples for quality indicator calculation involve 11,123 unique residents in 68 homes associated with 12 different long-term care organizations. MEASURES Assessment data on pain and associated risk adjusters were obtained from the RAI/MDS 2.0 and MDS 3.0 assessments in Canadian and US nursing homes, respectively. RESULTS The Seniors Quality Leap Initiative has been functioning as an active community of practice for almost a decade with the aim of demonstrating leadership in the use of collaborative approaches to drive evidence-informed improvements in the quality of long-term care. Initiatives with a specific emphasis on improving care related to pain resulted in notable improvements in quality of clinical care in specific homes as well as within the network as a whole. CONCLUSIONS AND IMPLICATIONS The Seniors Quality Leap Initiative demonstrates that a partnership between organizations in 2 countries can foment quality transitions through a shared commitment to identifying needs; employing flexible, but practical initiatives; and evaluating the impact of those initiatives through a transparent reporting mechanism.
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Sutherland N. Structures, tensions, and processes shaping long-term care home staff's role in end of life decision-making for residents with dementia. J Aging Stud 2020; 54:100874. [PMID: 32972618 DOI: 10.1016/j.jaging.2020.100874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 12/27/2022]
Abstract
Although long-term care (LTC) home staff of nurses and personal support workers spend the most time providing direct care, their role in end of life decision-making for residents with dementia has largely been unacknowledged. Staff's perceptions of their role play a significant part in how they support people with dementia and family care partners. The purpose of this study was to examine LTC home staff's perspectives of their role in end of life decision-making for LTC home residents with dementia. For this interpretive descriptive study, 21 semi-structured interviews were conducted in two urban LTC homes with nine personal support worker (PSWs), eight registered practical nurses (RPNs), and four registered nurses (RNs). Additionally, a focus group was conducted, consisting of each a PSW, RPN, and RN. A voice-centred relational analysis was used to situate LTC home staff's perspectives within broader social contexts. Findings suggest that little has changed in LTC homes in the last 50 years. Rooted in dichotomies between medical and social care paradigms, ideologies of rationality and professionalism created tensions, hierarchical roles, and staff's minimal involvement in decision-making. A relational approach is needed to account for the interdependency of care and the relationships that LTC home staff have with residents, family care partners, and the sociopolitical environment.
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Affiliation(s)
- Nisha Sutherland
- Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada.
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Push and Pull Factors Surrounding Older Adults’ Relocation to Supportive Housing: A Scoping Review. Can J Aging 2020; 40:263-281. [DOI: 10.1017/s0714980820000045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
ABSTRACTSupportive housing, including retirement homes and assisted living, is increasingly touted as a suitable living option for Canadian older adults. This scoping review describes the nature and content of studies that explore underlying factors that motivate older adults to relocate to supportive housing. We conducted a search of PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Web of Science, and PsycINFO, which identified 34 articles for review. Articles reviewed employed a variety of methods and guiding theoretical frameworks, of which the push and pull framework appeared to be most common. This review suggests that health and functional deficits are important reasons for relocation to supportive housing for older adults. Further longitudinal data are required to more comprehensively describe medical and social determinants for relocation and its consequences, in order to better describe this growing population and better align policies with the needs of older adults contemplating or undergoing relocation.
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O'Neill D, Briggs R, Holmerová I, Samuelsson O, Gordon AL, Martin FC. COVID-19 highlights the need for universal adoption of standards of medical care for physicians in nursing homes in Europe. Eur Geriatr Med 2020; 11:645-650. [PMID: 32557250 PMCID: PMC7298916 DOI: 10.1007/s41999-020-00347-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/07/2020] [Indexed: 12/17/2022]
Abstract
The nursing home sector has seen a disproportionately high number of deaths as part of the COVID-19 pandemic. This reflects, in part, the frailty and vulnerability of older people living in care homes but has also, in part, been a consequence of the failure to include care homes in the systematic planning of a response to COVID, as well as a measure of neglect of standards and quality improvement in the sector. In response, the EUGMS published a set of medical standards of care developed in consultation with experts across its member national societies in 2015. The standards consisted of seven core principles of medical care for physicians working in nursing homes as a first step in developing a programme of clinical, academic and policy engagement in improving medical care for older people who are living and frequently also dying as residents in nursing homes. The gravity of the concerns arising for nursing home care from the COVID-19 pandemic, as well as emerging insights on care improvement in nursing homes indicate that an update of these medical standards is timely. This was performed by the writing group from the original 2015 guidelines and is intended as an interim measure pending a more formal review incorporating a systematic review of emerging literature and a Delphi process.
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Affiliation(s)
- Desmond O'Neill
- Centre for Ageing, Neuroscience and the Humanities, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, D24 NR0A, Ireland.
| | | | | | | | - Adam L Gordon
- Division of Medical Sciences and Graduate Entry Medicine, University of Nottingham, Nottingham, UK
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Geffen LN, Kelly G, Morris JN, Hogeveen S, Hirdes J. "Establishing the criterion validity of the interRAI Check-Up Self-Report instrument". BMC Geriatr 2020; 20:260. [PMID: 32727385 PMCID: PMC7391526 DOI: 10.1186/s12877-020-01659-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background Low and middle-income countries have growing older populations and could benefit from the use of multi-domain geriatric assessments in overcoming the challenge of providing quality health services to older persons. This paper reports on the outcomes of a study carried out in Cape Town, South Africa on the validity of the interRAI Check-Up Self-Report instrument, a multi-domain assessment instrument designed to screen older persons in primary health settings. This is the first criterion validity study of the instrument. The instrument is designed to identify specific health problems and needs, including psychosocial or cognition problems and issues related to functional decline. The interRAI Check-Up Self-Report is designed to be compatible with the clinician administered instruments in the interRAI suite of assessments, but the validity of the instrument against clinician ratings has not yet been established. We therefore sought to establish whether community health workers, rather than trained healthcare professionals could reliably administer the self-report instrument to older persons. Methods We evaluated the criterion validity of the self-report instrument through comparison to assessments completed by a clinician assessor. A total of 112 participants, aged 60 or older were recruited from 7 seniors clubs in Khayelitsha, Cape Town. Each participant was assessed by one of two previously untrained, non-healthcare personnel using the Check-Up Self-report version and again by a trained assessor using the clinician version of the interRAI Check-Up within 48 h. Our analyses focused on the degree of agreement between the self-reported and clinician-rated versions of the Check-Up based on the simple or weighted kappa values for the two types of ratings. Binary variables used simple kappas, and ordinal variables with three or more levels were examined using weighted kappas with Fleiss-Cohen weights. Results Based on Cohen’s Kappa values, we were able to establish that high levels of agreement existed between clinical assessors and lay interviewers, indicating that the instrument can be validly administered by community health workers without formal healthcare training. 13% of items had kappa values ranging between 0.10 and 0.39; 51% of items had kappa values between 0.4 and 0.69; and 36% of items had values of between 0.70 and 1.00. Conclusion Our findings indicate that there is potential for the Check-Up Self-Report instrument to be implemented in under-resourced health systems such as South Africa’s.
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Affiliation(s)
- Leon N Geffen
- Samson Institute for Ageing Research, University of Cape Town, Cape Town, South Africa
| | - Gabrielle Kelly
- Samson Institute for Ageing Research, 234 Upper Buitenkant Street, Cape Town, 8001, South Africa.
| | - John N Morris
- Marcus Institute for Aging Research, Boston, MA, USA
| | - Sophie Hogeveen
- Women's College Hospital Institute for Health System Solutions and Virtual Care; McMaster Institute for Research on Aging, Hamilton, Canada
| | - John Hirdes
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
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A Canadian Cohort Study to Evaluate the Outcomes Associated with a Multicenter Initiative to Reduce Antipsychotic Use in Long-Term Care Homes. J Am Med Dir Assoc 2020; 21:817-822. [PMID: 32493650 DOI: 10.1016/j.jamda.2020.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the impact of a multicenter intervention to reduce potentially inappropriate antipsychotic use in Canadian nursing homes at the individual and facility levels. DESIGN Longitudinal, population-based cohort study to evaluate the Canadian Foundation for Healthcare Improvement's Spreading Healthcare Innovations Initiative to reduce potentially inappropriate antipsychotic use in 6 provinces/territories. SETTING AND PARTICIPANTS Adults in nursing homes in 6 provinces/territories in Canada between 2014 and 2016. The sample involved 4927 residents in 45 intervention homes and 122,570 residents in 1193 control homes in the first quarter of the study. MEASURES Assessment data based on the Resident Assessment Instrument 2.0 were used in both settings to track antipsychotic use and to obtain risk-adjusters for a quality indicator on potentially inappropriate use. INTERVENTION Quality improvement teams in participating organizations were provided with education, training, and support to implement localized strategies intended to reduce antipsychotic medication use in residents without diagnosis of psychosis. RESULTS At the resident level, we found that the odds of remaining on potentially inappropriate antipsychotics were 0.75 in intervention compared with control homes after adjusting for age, sex, aggressive behavior, and cognition. These findings were evident within the pooled Canadian data as well as within provinces. At the facility level, the intervention homes had greater improvements in risk-adjusted quality indicator performance than the control homes, and this was true for the worst, median, and best-performing homes at baseline. There was no major change in the quality indicator for worsening of behavior symptoms. CONCLUSIONS/IMPLICATIONS The Canadian Foundation for Healthcare Improvement intervention was associated with a reduction in potentially inappropriate antipsychotic use at both the individual and facility levels of analysis. This improvement in performance was independent of secular trends toward reduced antipsychotic use in participating provinces. This suggests that substantial improvements in medication use may be achieved through targeted, collaborative quality improvement initiatives in long-term care.
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The Post-Acute Delayed Discharge Risk Scale: Derivation and Validation With Ontario Alternate Level of Care Patients in Ontario Complex Continuing Care Hospitals. J Am Med Dir Assoc 2020; 21:538-544.e1. [DOI: 10.1016/j.jamda.2019.12.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/12/2019] [Accepted: 12/30/2019] [Indexed: 11/20/2022]
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