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Hodgson P, Cook G, Johnson A. The methodological challenges faced when conducting hydration research in UK care homes. Nurse Res 2024:e1923. [PMID: 38770593 DOI: 10.7748/nr.2024.e1923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND The evidence base for hydration practice in care homes is underdeveloped. High-quality research is therefore needed to determine what practices support older people with dementia in drinking sufficient fluid. However, methodological developments are needed to be able to do this. AIM To highlight the methodological issues researchers encountered during a feasibility cluster, randomised controlled trial of ThinkDrink, a hydration care guide for people with dementia living in UK care homes. DISCUSSION This is a challenging area because of the complexity of recruitment, participation and data collection in care homes. Researchers must pay extra attention to rigour and quality in the design of their studies. There may be multiple challenges, so various strategies may be required. CONCLUSION It is important that researchers continue to reflect on rigorous approaches to develop evidence in a crucial area of care, despite these challenges. IMPLICATIONS FOR PRACTICE Researchers working in complex environments face a variety of challenges to complete methodologically rigorous research. It is important for researchers to be critical of research processes and data, to mitigate and overcome these challenges.
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Affiliation(s)
- Philip Hodgson
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, England
| | - Glenda Cook
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, England
| | - Amy Johnson
- Department of Nursing Midwifery and Health, Northumbria University, Newcastle upon Tyne, England
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Ren LH, Wong KLY, Wong J, Kleiss S, Berndt A, Mann J, Hussein A, Hu G, Wong L, Khong R, Fu J, Ahmed N, Nolte J, Hung L. Working with a robot in hospital and long-term care homes: staff experience. BMC Nurs 2024; 23:317. [PMID: 38720346 PMCID: PMC11080152 DOI: 10.1186/s12912-024-01983-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/28/2024] [Indexed: 05/12/2024] Open
Abstract
Although there is a growing literature on the use of telepresence robots in institutional dementia care settings, limited research focused on the perspectives of frontline staff members who deliver dementia care. Our objective was to understand staff perspectives on using telepresence robots to support residents with dementia and their families. Guided by the Consolidated Framework for Implementation Research, we conducted four focus groups and 11 semi-structured interviews across four long-term care (LTC) homes and one hospital in Canada. We included 22 interdisciplinary staff members (e.g., registered nurses, social workers, occupational therapists, recreational therapists) to understand their experiences with telepresence robots. Thematic analysis identified three key themes: 1) Staff Training and Support; 2) Robot Features; 3) Environmental dynamics for Implementation. Our results underscore the imperative of structural support at micro-, meso- and macro-levels for staff in dementia care settings to effectively implement technology. This study contributes to future research and practice by elucidating factors facilitating staff involvement in technology research, integrating staff voices into technology implementation planning, and devising strategies to provide structural support to staff, care teams, and care homes.
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Affiliation(s)
- Lily Haopu Ren
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
| | - Karen Lok Yi Wong
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Joey Wong
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Sarah Kleiss
- Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Annette Berndt
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Jim Mann
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Ali Hussein
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Grace Hu
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Lily Wong
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Ruth Khong
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Jason Fu
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Nazia Ahmed
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Julia Nolte
- Department of Communication and Cognition, Tilburg University, Warandelaan 2, Tilburg, 5037 AB, The Netherlands
| | - Lillian Hung
- Innovation in Dementia and Aging Lab, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada.
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Weidner M, Towsley GL. Meaningful connections: An education program to enhance resident-certified nursing assistant relationships. GERONTOLOGY & GERIATRICS EDUCATION 2024; 45:259-275. [PMID: 36752118 DOI: 10.1080/02701960.2023.2174116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Close relationships between nursing home residents and Certified Nursing Assistants (CNAs) result in positive outcomes for both residents and staff, including increased well-being for residents. However, many resident-CNA relationships remain superficial, are focused primarily on physical care, and interpersonal skill training for CNAs is sparse. The purpose of this study was to develop an education program to foster CNAs' interpersonal skills and relationship development. We conducted a literature review on CNA interpersonal skill training and disseminated a survey to CNAs to inform the education program. Literature review findings revealed that CNAs value their relationships with residents and desire more interpersonal training, but this training is often limited. The survey, which was disseminated via social media and facility contact referrals, asked responding CNAs (n = 73) to evaluate their perceptions of empowerment, interpersonal skill competency, and learning preferences. We found that most CNAs feel confident in their interpersonal skills, but they lack training in boundary-setting and bereavement support. About one-third of respondents did not feel that their work was valued or their strengths recognized by their supervisors. Most respondents reported that they valued visual (85%), experiential (91%) learning. The final program, Meaningful Connections, includes nine modules covering topics such as person-centered caregiving, empathy, emotional intelligence, and boundary-setting. One supplementary module provides potential adaptations to the curriculum to customize the needs of each participant group. The results of this project suggest a need for more CNA relationship training and support, especially in the areas of boundary-setting and bereavement.
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Affiliation(s)
- Michelle Weidner
- University of Utah College of Nursing, Salt Lake City, UT, United States
| | - Gail L Towsley
- University of Utah College of Nursing, Salt Lake City, UT, United States
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Albanesi B, Conti A, Politano G, Dimonte V, Gianino MM, Campagna S. Emergency department visits by nursing home residents. A retrospective Italian study of administrative databases from 2015 to 2019. BMC Geriatr 2024; 24:295. [PMID: 38549053 PMCID: PMC10976813 DOI: 10.1186/s12877-024-04912-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/21/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Visits to Emergency Departments (ED) can be traumatic for Nursing Home (NH) residents. In Italy, the rate of ED visits by NH residents was recently calculated as 3.3%. The reduction of inappropriate ED visits represents a priority for National Healthcare Systems worldwide. Nevertheless, research on factors associated with ED visits is still under-studied in the Italian setting. This study has two main aims: (i) to describe the baseline characteristics of NH residents visiting ED at regional level; (ii) to assess the characteristics, trends, and factors associated with these visits. METHODS A retrospective study of administrative data for five years was performed in the Piedmont Region. Data from 24,208 NH residents were analysed. Data were obtained by merging two ministerial databases of residential care and ED use. Sociodemographic and clinical characteristics of the residents, trends, and rates of ED visits were collected. A Generalized Linear Model (GLM) regression was used to evaluate the factors associated with ED visits. RESULTS In 5 years, 12,672 residents made 24,609 ED visits. Aspecific symptoms (45%), dyspnea (17%) and trauma (16%) were the most frequent problems reported at ED. 51% of these visits were coded as non-critical, and 58% were discharged to the NH. The regression analysis showed an increased risk of ED visits for men (OR = 1.61, 95% CI 1.51-1.70) and for residents with a stay in NH longer than 400 days (OR = 2.19, 95% CI 2.08-2.31). CONCLUSIONS Our study indicates that more than half of NH residents' ED visits could potentially be prevented by treating residents in NH. Investments in the creation of a structured and effective network within primary care services, promoting the use of health technology and palliative care approaches, could reduce ED visits and help clinicians manage residents on-site and remotely.
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Affiliation(s)
- Beatrice Albanesi
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Alessio Conti
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy.
| | - Gianfranco Politano
- Department of Control and Computer Engineering, Politecnico di Torino, Turin, Italy
| | - Valerio Dimonte
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Maria Michela Gianino
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
| | - Sara Campagna
- Department of Sciences of Public Health and Pediatrics, University of Turin, Via Santena 5 bis, Turin, 10126, Italy
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Frampton K, Oppedijk L, Hadley R, Annett LE. Reduced Anxiety and Depression and Improved Mood in Older Adults Living in Care Homes After Participating in Chair Yoga. J Appl Gerontol 2024:7334648241241298. [PMID: 38522958 DOI: 10.1177/07334648241241298] [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: 03/26/2024] Open
Abstract
Providing opportunities for older adults to engage in physical and mental activity is important to support healthy aging. The present preliminary study investigated the feasibility of accessible chair yoga for older adults in care homes. Chair yoga participants (n = 17) were assessed before and after attending twice weekly chair yoga sessions for 8 weeks, while control participants (n = 16) underwent the assessments only. Participant ages ranged from 80 to 101 years and included those living with mild to severe dementia. Anxiety and depression measured by the Hospital Anxiety and Depression Scale (HADS), and negative affect measured by the Positive and Negative Affect Schedule (PANAS), improved in the chair yoga but not the control group. Balance confidence (Modified Falls Efficacy Scale) and Health-related Quality of Life (EQ-5D-3L) were unchanged. Chair yoga is a feasible activity for older care home residents, including those living with dementia, with the potential to improve mental well-being.
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Affiliation(s)
- Keeley Frampton
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
| | | | - Rebecca Hadley
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
| | - Lucy E Annett
- Department of Psychology, Sport and Geography, University of Hertfordshire, Hatfield, UK
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Portegijs S, van Beek APA, van Tuyl LHD, Wagner C. Implementing a new living concept for persons with dementia in long-term care: evaluation of a quality improvement process. BMC Health Serv Res 2024; 24:306. [PMID: 38454437 PMCID: PMC10921681 DOI: 10.1186/s12913-024-10765-y] [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: 08/10/2023] [Accepted: 02/21/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Improving quality of nursing home care for residents is a constant focus of stakeholders involved within quality improvement projects. Though, achieving change in long-term care is challenging. Process evaluations provide insight into the nature, exposure and experiences of stakeholders and influencing mechanisms for implementation. The aim of this study is to gain insight into the process and facilitating and hindering mechanisms of implementing a quality improvement project that seeks to create a dementia-friendly community with a nursing home at its core. METHODS For the process evaluation we planned a case study design with an ethnographic approach. Various research methods were used: qualitative observations, focus groups, interviews and questionnaires for various stakeholders and document review. Data collection and analyses in this study is based on the Consolidated Framework for Implementation Research. RESULTS Four main lessons were learned. Firstly, nursing staff are crucial to achieve more freedom for residents. Secondly, high-impact changes in daily care need strong and sustainable focus from the care organisation. Thirdly, dementia-friendly societies should be deployed from multiple actors, which entails long-term collaborations with external stakeholders. Fourthly, the transition to a dementia-friendly society requires meeting spaces for and a focus on both residents and people from the community. Consequently, local residents are shifting from external to internal stakeholders, extending beyond the regular involvement of informal carers and volunteers within the nursing home. CONCLUSIONS Nursing homes are part of the local community and provide opportunities to collaborate on a dementia-friendly society. However, the change that is required (promoting freedom, residents' autonomy and the redesign of care processes) is complex and influenced by various mechanisms. Understanding these mechanisms can benefit other care organisations that strive to implement a similar initiative.
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Affiliation(s)
- Suzanne Portegijs
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3513 CR, Utrecht, The Netherlands.
- Viva! Zorggroep, Care Organisation, Parlevinkerstraat 23, 1951 AR, Velsen-Noord, The Netherlands.
| | | | | | - Cordula Wagner
- Netherlands Institute for Health Services Research (Nivel), PO Box 1568, 3513 CR, Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute (APH), Amsterdam UMC, Vrije Universiteit Amsterdam, Van Der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
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Davis R, Sikorskii A. Recruitment of older adults from long-term care settings for a longitudinal clinical trial. Res Nurs Health 2024; 47:82-92. [PMID: 38095101 PMCID: PMC10843827 DOI: 10.1002/nur.22360] [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: 05/01/2023] [Revised: 10/19/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024]
Abstract
Recruitment of residents for research from long-term care settings is known to be difficult. The purpose of this study was to summarize the effectiveness and cost in terms of time and dollars of recruitment methods for a cluster-randomized controlled clinical trial conducted in long-term care settings. This study was a retrospective, exploratory, descriptive analysis of recruitment data. After recruitment of 15 independent and assisted living communities, residents at each site were recruited to participate in the study using combinations of 12 different recruitment methods. Recruitment methods, time spent screening, and enrollment data were collected. Recruitment data were analyzed at the levels of site, research staff member, and participant. Over the study period, 279 older adults were screened and 172 enrolled from the 15 sites. Many participants were cognitively impaired. Research staff spent 39-89 h recruiting at each site and utilized an average of four different recruitment methods per site. Introductions of participants by site contacts yielded the most consented participants compared to other recruitment methods. Sites that had a dedicated recruiter utilized more recruiting methods and enrolled more participants than those without a dedicated recruiter. The cost of recruiting averaged $1490 per site and $93-$258 per enrollee (mean $144, standard deviation $58), but was more costly in larger facilities. Recruitment of older adults from long-term care communities requires multiple methods of recruitment, skilled recruitment staff, and trust with the staff and potential participants.
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Affiliation(s)
- Rebecca Davis
- Grand Valley State University, Allendale, Michigan, USA
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McMichael D, Gillen P, McGeary C, Sartaj M, Patterson L. Investigating the impact of an online hydration intervention in care homes using the COM-B model: a mixed methods study. BMC Geriatr 2023; 23:822. [PMID: 38066418 PMCID: PMC10704796 DOI: 10.1186/s12877-023-04515-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is a serious threat to public health. To reduce antimicrobial resistance, interventions to reduce gram-negative infections, specifically urinary tract infections, are vital. Early evidence suggests increased fluid intake is linked with a reduction in UTIs and subsequently has potential to reduce antibiotic usage. Care homes have a high prevalence of UTIs and provide an opportunity in a closed setting to deliver an intervention focused on increasing fluid intake, where it is supported and monitored by health care workers. The study aimed to evaluate the impact and feasibility of an online staff focused intervention over a 30 day period to increase the hydration of care home residents with a view to reducing the burden of AMR in this setting. METHODS The study was a pre and post intervention with a sequential explanatory mixed methods design. The intervention was delivered online in 3 care homes, containing 3 main components underpinned by the COM-B model including hydration training, 7 structured drinks rounds and a hydration champion to change behaviour of care home staff. A pre and post questionnaire assessed the impact of the intervention on staff and data was collected on fluid intake, drinks rounds delivered to residents, UTIs, antibiotic used to treat UTIs, falls and hospitalisation. Descriptive statistics summarised and assessed the impact of the study. Focus groups with care home staff provided qualitative data which was thematically analysed. RESULTS Staff increased in self-perceived knowledge across the six components of hydration care. 59% of residents had an increase in median fluid intake post intervention. During the time of the intervention, a 13% decrease in UTIs and antibiotic usage to treat UTIs across the 3 care homes was recorded, however falls and hospitalisations increased. Themes arising from focus groups included the role of information for action, accessibility of online training, online training content. CONCLUSIONS This study demonstrates that a brief, low cost, online multi-component intervention focused on care home staff can increase the fluid intake of residents. A reduction in UTIs and antibiotic consumption was observed overall. Empowering care home staff could be a way of reducing the burden of infection in this setting.
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Affiliation(s)
- Danielle McMichael
- Public Health Agency, 12-22 Linenhall Street, Belfast, BT2 8BS, Northern Ireland.
| | - Patricia Gillen
- Ulster University, Shore Rd, Newtownabbey, BT37 0QB, Northern Ireland
- Health and Social Care Trust, Rosedale, 10 Moyallen Road, Gilford, BT63 5JX, Northern Ireland
| | - Caroline McGeary
- Public Health Agency, 12-22 Linenhall Street, Belfast, BT2 8BS, Northern Ireland
| | - Muhammad Sartaj
- Public Health Agency, 12-22 Linenhall Street, Belfast, BT2 8BS, Northern Ireland
| | - Lynsey Patterson
- Public Health Agency, 12-22 Linenhall Street, Belfast, BT2 8BS, Northern Ireland
- Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Queen's University Belfast, Belfast, BT12 6BA, Northern Ireland
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Lopez RP, Wei A, Locke JR, Plys E. Advanced-Comfort: Usability Testing of a Care Planning Intervention for Nursing Home Residents With Advanced Dementia. J Gerontol Nurs 2023; 49:15-23. [PMID: 37906044 DOI: 10.3928/00989134-20231010-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Many nursing home (NH) residents with advanced dementia receive burdensome interventions rather than interventions that promote comfort or quality of life. The purpose of the current study was to test the usability of a novel intervention, ADVANCED-Comfort, which aims to enhance the provision of personalized care for residents with advanced dementia. The intervention comprises structured care plan meetings between the NH team and proxies of residents with dementia (e.g., family members). Using the ADVANCED-Comfort workbook, proxies create individualized care plans addressing six domains adapted from the Age-Friendly Health System Framework. The purpose of this article is to describe the intervention and its theoretical underpinnings and report the usability of the intervention evaluated with surveys, observation, and exit interviews. The study demonstrated that proxies and NH staff found the intervention usable (acceptable, appropriate, and feasible). Based on these preliminary findings, additional testing of the ADVANCED-Comfort intervention is warranted. [Journal of Gerontological Nursing, 49(11), 15-23.].
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Nguyen QD, Forget MF, Zhang XS, Richer C, Podbielski R, Gaudreau P, Desmarais P. Systematic review of research barriers, facilitators, and stakeholders in long-term care and geriatric settings, and a conceptual mapping framework to build research capacity. BMC Geriatr 2023; 23:622. [PMID: 37794339 PMCID: PMC10552295 DOI: 10.1186/s12877-023-04318-x] [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: 12/22/2022] [Accepted: 09/14/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Older adults are underrepresented in research. Heterogeneity of research processes in this population, specifically in long-term care (LTC) and geriatric acute care (GAC), is not well described and may impede the design, planning, and conduct of research. In this study, we identified, quantified, and mapped stakeholders, research stages, and transversal themes of research processes, to develop a mapping framework to improve research capacity by better characterizing this heterogeneity. METHODS Multicomponent mixed methods study. An environmental scan was used to initiate a preliminary framework. We conducted a systematic literature search on processes, barriers, and methods for clinical research in GAC and LTC to extract and update stakeholders, research stages, and themes. Importance and interactions of elements were synthesized via heatmaps by number of articles, mentions, and content intersections. RESULTS For our initial framework and environmental scan, we surveyed 24 stakeholders. Of 9277 records, 68 articles were included in our systematic review and allowed us to identify 12 stakeholders, 13 research stages, 17 transversal themes (either barriers, facilitators, general themes, or recommendations), and 1868 intersections. Differences in relative importance between LTC and GAC emerged for stakeholders (staff, managers vs. caregivers, ethics committees), and for research stages (funding, facility recruitment vs. ethics, individual recruitment). Crucial themes according to specific stakeholders were collaboration for the research team; communication, trust, and human resources for managers; heterogeneity for patients and residents. A heatmap framework synthesizing vital stakeholders and themes per research stage was generated. CONCLUSIONS We identified and quantified the interactions between stakeholders, stages, and themes to characterize heterogeneity in LTC and GAC research. Our framework may serve as a blueprint to co-construct and improve each stage of the research process.
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Affiliation(s)
- Quoc Dinh Nguyen
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada.
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada.
- Department of Medicine, Université de Montréal, Montreal, Canada.
| | - Marie-France Forget
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Xi Sophie Zhang
- Department of General Medicine, Centre intégré de santé et de services sociaux du Centre- Sud-de-l'île-de-Montréal, Montreal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Catherine Richer
- Department of General Medicine, Centre intégré de santé et de services sociaux du Centre- Sud-de-l'île-de-Montréal, Montreal, Canada
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, Canada
| | - Renata Podbielski
- Direction of Teaching and the CHUM Académie, Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Pierrette Gaudreau
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
| | - Philippe Desmarais
- Division of Geriatrics, Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montreal, Canada
- Department of Medicine, Université de Montréal, Montreal, Canada
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Poupin P, Caille A, Gana W, Fougère B, Giraudeau B. Cluster randomized trials in nursing homes should better be planned as open-cohort than as closed-cohort. J Clin Epidemiol 2023; 161:1-7. [PMID: 37364621 DOI: 10.1016/j.jclinepi.2023.06.016] [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: 03/21/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVES Two designs are frequently used in cluster randomized trials in nursing homes: closed cohort and open cohort. The former design includes residents at the beginning of the trial and then follows them. In the latter design, participants are enrolled at the beginning of the trial or although it is ongoing; at dates of assessment, all residents present in the nursing home are assessed. The open-cohort design is much less used than the closed-cohort design, but it offers several advantages such as less exposure to individual attrition. Objective was to assess whether an open-cohort design could have been feasible in trials with a closed-cohort design. STUDY DESIGN AND SETTING Twenty-two closed-cohort trials in nursing homes. RESULTS An open-cohort design was considered a relevant alternative for 20 trials. For 16 trials, a resident newly admitted could not opt out of the intervention, and for all trials, the resident could benefit from an intervention effect if it existed. For two trials, newly admitted residents could not benefit from the intervention effect, if it existed. CONCLUSION The open-cohort design is well-adapted for most of the interventions assessed in nursing homes by means of a cluster randomized trial and should be considered more often.
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Affiliation(s)
- Pierre Poupin
- INSERM, SPHERE, U1246, Tours University, Nantes University, Tours, France; INSERM CIC 1415, Tours University Hospital, Tours, France.
| | - Agnès Caille
- INSERM, SPHERE, U1246, Tours University, Nantes University, Tours, France; INSERM CIC 1415, Tours University Hospital, Tours, France
| | - Wassim Gana
- Division of Geriatric Medicine, Tours University Medical Center, Tours, France
| | - Bertrand Fougère
- Division of Geriatric Medicine, Tours University Medical Center, Tours, France; Education, Ethics, Health (EA 7505), Tours University, Tours, France
| | - Bruno Giraudeau
- INSERM, SPHERE, U1246, Tours University, Nantes University, Tours, France; INSERM CIC 1415, Tours University Hospital, Tours, France
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Nocivelli B, Shepherd V, Hood K, Wallace C, Wood F. Identifying barriers and facilitators to the inclusion of older adults living in UK care homes in research: a scoping review. BMC Geriatr 2023; 23:446. [PMID: 37474927 PMCID: PMC10360346 DOI: 10.1186/s12877-023-04126-3] [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: 04/03/2023] [Accepted: 06/22/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND With an ageing population, older adults will have more complex health and social care needs and many of these older adults will be living in care homes. Despite the growth in care home populations, care home residents are often excluded from research that could potentially benefit their care. The purpose of this scoping review is to explore resident-related barriers and facilitators to including older people living in UK care homes in research and to identify potential approaches to modify such barriers. METHOD The 6-stage scoping review methodology framework proposed by Arksey and O'Malley guided this review. Five electronic databases (MedLine, PsychINFO, Scopus, Web of Science, CINAHL) and grey literature were searched. Identified articles went through two levels of screening, and those deemed relevant were collated, summarised and reported using a thematic analysis approach. RESULTS 90 reports were eligible for inclusion and were synthesised into 7 themes and related subthemes: (1) research design; (2) understanding and beliefs about research (resident and care home staff); (3) communication; (4) relationships; (5) eligibility criteria (resident and care home); (6) preference-based decisions; and (7) care home staff and environment. Given the complex interplay of the factors identified, both direct and indirect factors were included. CONCLUSIONS A number of recurring barriers and facilitators to the inclusion of care home residents in research are reported. However, isolating resident-related barriers was complex as both direct and indirect factors must be considered as influential. Understanding the barriers and facilitators to inclusion will enable these factors to be addressed and increase the evidence-base for care provided to older people living in care homes.
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Affiliation(s)
- Brittany Nocivelli
- Division of Population Medicine, PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, Wales.
| | - Victoria Shepherd
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales
| | - Kerenza Hood
- Centre for Trials Research, School of Medicine, Cardiff University, Cardiff, Wales
| | - Carolyn Wallace
- School of Care Sciences, University of South Wales, Newport, Wales
| | - Fiona Wood
- Division of Population Medicine, PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, Wales
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13
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Feehan O, Magee PJ, Pourshahidi LK, Armstrong DJ, McSorley EM. Vitamin D deficiency in nursing home residents: a systematic review. Nutr Rev 2023; 81:804-822. [PMID: 36367832 PMCID: PMC10251303 DOI: 10.1093/nutrit/nuac091] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
CONTEXT Vitamin D deficiency is a global public health issue, particularly in nursing home residents. OBJECTIVE This review critically summarizes the prevalence of vitamin D deficiency in nursing home residents worldwide. In addition, it outlines the effect of vitamin D intervention, alone or in combination with other nutrients or therapies, on improving vitamin D status and associated health outcomes in nursing home residents. DATA SOURCES, EXTRACTION, AND ANALYSIS Searches were conducted of electronic databases for articles published from 2010 to May 2021. After screening of the 366 papers initially identified, 58 articles were included. CONCLUSIONS A paucity of observational studies in nursing homes suggests a high prevalence of vitamin D deficiency ranging from 8% [25(OH)D <25 nmol/L], up to 94% [25(OH)D <50 nmol/L] in some cohorts where supplement use was low. Reported factors associated with deficiency and suboptimal vitamin D status include lack of sunlight exposure, poor dietary intake of vitamin D, limited vitamin D food fortification, frailty, poor renal function, and low use of vitamin D supplements. Residents who are severely deficient, deficient, or insufficient in vitamin D require remedial vitamin D supplementation prior to maintenance supplementation at doses >800 IU/day. High-dose vitamin D supplementation may reduce respiratory illness; however, supportive data are limited. Oral nutritional supplements, in combination with exercise, may benefit physical function and performance, whereas supplementation with vitamin D- and calcium-fortified foods has been associated with improved quality of life and reduced bone resorption. Globally, vitamin D deficiency is highly prevalent in nursing home residents. There is an urgent need for standardized dietary and supplementation guidelines to prevent deficiency in this vulnerable group.
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Affiliation(s)
- Orlagh Feehan
- are with the Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - Pamela J Magee
- are with the Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, Northern Ireland, United Kingdom
| | - L Kirsty Pourshahidi
- are with the Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, Northern Ireland, United Kingdom
- are with the Department of Rheumatology, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, United Kingdom
| | - David J Armstrong
- are with the Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, Northern Ireland, United Kingdom
- are with the Department of Rheumatology, Altnagelvin Hospital, Western Health and Social Care Trust, Londonderry, United Kingdom
| | - Emeir M McSorley
- are with the Nutrition Innovation Centre for Food and Health, Ulster University, Coleraine, Northern Ireland, United Kingdom
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14
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Dalgarno L, Birt L, Bond C, Blacklock J, Blyth A, Inch J, Notman F, Daffu-O’Reilly A, Spargo M, Watts L, Wright D, Poland F. Why the trial researcher matters: Day-to-day work viewed through the lens of normalization process theory. SSM. QUALITATIVE RESEARCH IN HEALTH 2023; 3:100254. [PMID: 37426703 PMCID: PMC10323713 DOI: 10.1016/j.ssmqr.2023.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 07/11/2023]
Abstract
Researchers working in the field, the places where research-relevant activity happens, are essential to recruitment and data collection in randomised controlled trials (RCTs). This study aimed to understand the nature of this often invisible work. Data were generated through an RCT of a pharmacist-led medication management service for older people in care homes. The study was conducted over three years and employed seven Research Associates (RA) working in Scotland, Northern Ireland, and England. Weekly research team meetings and Programme Management Group meetings naturally generated 129 sets of minutes. This documentary data was supplemented with two end-of-study RA debriefing meetings. Data were coded to sort the work being done in the field, then deductively explored through the lens of Normalization Process Theory to enable a greater understanding of the depth, breadth and complexity of work carried out by these trial delivery RAs. Results indicate RAs helped stakeholders and participants make sense of the research, they built relationships with participants to support retention, operationalised complex data collection procedures and reflected on their own work contexts to reach agreement on changes to trial procedures. The debrief discussions enabled RAs to explore and reflect on experiences from the field which had affected their day-to-day work. The learning from the challenges faced in facilitating care home research may be useful to inform future research team preparation for complex interventions. Scrutinising these data sources through the lens of NPT enabled us to identify RAs as linchpins in the successful conduct of a complex RCT study.
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Affiliation(s)
- Lindsay Dalgarno
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
- General Practice and Primary Care, University of Glasgow, Scotland, UK
| | - Linda Birt
- School Health Sciences, University of East Anglia, UK
- School of Healthcare, University of Leicester, UK
| | - Christine Bond
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
| | - Jeanette Blacklock
- School of Healthcare, University of Leicester, UK
- School of Pharmacy, University of East Anglia, UK
| | - Annie Blyth
- School of Pharmacy, University of East Anglia, UK
| | - Jacqueline Inch
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
| | - Frances Notman
- Institute of Applied Health Sciences, University of Aberdeen, Scotland, UK
| | | | | | - Laura Watts
- School of Pharmacy, University of East Anglia, UK
| | - David Wright
- School of Healthcare, University of Leicester, UK
| | - Fiona Poland
- School Health Sciences, University of East Anglia, UK
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15
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Rantz M, Ersek M. Care Delivery, Quality Measurement, and Quality Improvement in Nursing Homes: Issues and Recommendations from the National Academies' Report on the Quality of Care in Nursing Homes. J Am Geriatr Soc 2023; 71:329-334. [PMID: 36795629 DOI: 10.1111/jgs.18275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 02/17/2023]
Affiliation(s)
- Marilyn Rantz
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA
| | - Mary Ersek
- Center for Health Equity Research and Promotion, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute and School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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16
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Siegel EO, Kolanowski AM, Bowers BJ. A Fresh Look at the Nursing Home Workforce Crisis: Transforming Nursing Care Delivery Models. Res Gerontol Nurs 2023; 16:5-13. [PMID: 36692436 DOI: 10.3928/19404921-20230104-01] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The current State of the Science Commentary focuses on workforce challenges in the nursing home (NH) setting that lie within the purview of professional nursing-what professional nurses can do to promote high-quality person-centered care within a context of existing resources-individually and broadly across the collective profession. Historically, three models of care delivery have characterized the way in which nursing care is organized and delivered in different settings: primary nursing, functional nursing, and team nursing. Based on the existing evidence, we call for scientific leadership in the redesign, testing, and implementation of a nursing care delivery model that operationalizes relationship-centered team nursing. This integrative model incorporates successful evidence-based approaches that have the potential to improve quality of care, resident quality of life, and staff quality of work life: clear communication, staff empowerment, coaching styles of supervision, and family/care partner involvement in care processes. In addition to the needed evidence base for NH care delivery models, it is imperative that educational programs incorporate content and clinical experiences that will enable the future nursing workforce to fill the leadership gap in NH care delivery. [Research in Gerontological Nursing, 16(1), 5-13.].
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17
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Choi YR, Chang SO. Exploring interprofessional communication during nursing home emergencies using the SBAR framework. J Interprof Care 2023; 37:83-90. [PMID: 34757886 DOI: 10.1080/13561820.2021.1985985] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Communication breakdowns during emergencies threaten patient safety. In nursing homes (NHs) vulnerable residents may experience emergencies at any time. Concerns over clinical complexity and diverse communication styles among interprofessional practitioners heighten the need for standardized methods to improve practitioners' communication skills. This study explores communication structures among 32 practitioners in four NHs using in-depth interviews following a formalized Situation-Background-Assessment-Recommendation (SBAR) framework. Network analysis, a deductive approach to qualitative data analysis, and case analysis were performed for a comprehensive understanding of interprofessional communication in 48 emergency cases identified during interviews. Findings identified the flow of information, messaging, and management strategies that were expected of receivers during interprofessional communication. These results could help develop training regimens or guidelines to improve cooperative interprofessional communication, allowing practitioners to provide appropriate emergency care for NH residents.
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Affiliation(s)
- Young-Rim Choi
- College of Nursing, Korea University, Seoul, Republic of Korea
| | - Sung Ok Chang
- College of Nursing and BK21 FOUR R&E Center for Learning Health Systems, Korea University, Seoul, Republic of Korea
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18
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St Clair B, Jorgensen M, Nguyen A, Georgiou A. A Scoping Review of Adverse Incidents Research in Aged Care Homes: Learnings, Gaps, and Challenges. Gerontol Geriatr Med 2022; 8:23337214221144192. [PMID: 36568485 PMCID: PMC9772958 DOI: 10.1177/23337214221144192] [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: 09/23/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Adverse incidents are well studied within acute care settings, less so within aged care homes. The aim of this scoping review was to define the types of adverse incidents studied in aged care homes and highlight strengths, gaps, and challenges of this research. Methods: An expanded definition of adverse incidents including physical, social, and environmental impacts was used in a scoping review based on the PRISMA Extension for Scoping Reviews Checklist. MEDLINE, CINAHL, and EBSCOhost were searched for English language, peer-reviewed studies conducted in aged care home settings between 2000 and 2020. Forty six articles across 12 countries were identified, charted, and analyzed using descriptive statistics and narrative summary methods. Results: Quantitative studies (n = 42, 91%) dominated adverse incidents literature. The majority of studies focused on physical injuries (n = 29, 63%), with fewer examining personal/interpersonal (15%) and environmental factors (22%). Many studies did not describe the country's aged care system (n = 26, 56%). Only five studies (11%) included residents' voices. Discussion: This review highlights a need for greater focus on resident voices, qualitative research, and interpersonal/environmental perspectives in adverse event research in aged care homes. Addressing these gaps, future research may contribute to better understanding of adverse incidents within this setting.
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Affiliation(s)
- B. St Clair
- Macquarie University, Sydney, NSW, Australia,B. St Clair, Faculty of Medicine and Health Sciences, Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, NSW 2109, Australia.
| | | | - A. Nguyen
- Macquarie University, Sydney, NSW, Australia,UNSW Sydney, NSW, Australia
| | - A. Georgiou
- Macquarie University, Sydney, NSW, Australia
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19
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Providers' Perspectives on High-Quality Dementia Care in Long-Term Care. J Am Med Dir Assoc 2022; 23:2030.e1-2030.e8. [PMID: 36058295 DOI: 10.1016/j.jamda.2022.07.025] [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: 04/14/2022] [Revised: 07/20/2022] [Accepted: 07/24/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To understand dementia care providers' perspectives on high-quality care for persons living with dementia (PLWD) in long-term care (LTC). DESIGN A qualitative study using a directed content analysis approach. SETTING AND PARTICIPANTS Nine national LTC dementia care providers. METHODS We facilitated 5 listening sessions centered around dementia care philosophies, models, and practices. Two researchers first mapped qualitative data to the Holistic Approach to Transformational Change (HATCh) model for dementia care using a directed content analysis approach. They then identified themes and subthemes emerging from the data using a conventional analysis approach. They coded data iteratively and solicited input from 3 additional researchers to reach consensus where needed. Member checks were performed to ensure the trustworthiness of the data during 2 follow-up listening sessions. RESULTS The 9 participants described the importance of understanding the experiences of PLWDs in order to provide high-quality dementia care and to deliver such care with the residents and their preferences as the focus. They emphasized experiential education as essential for families and all staff, regardless of role. They noted the need to balance safety with resident choice, as well as the corresponding need for facility leadership and regulators to support such choices. The listening sessions revealed areas to foster person-centered care for PLWD, but also highlighted barriers to implementing this philosophy in LTC settings. CONCLUSIONS AND IMPLICATIONS Emergent themes included care practices that center on resident preferences and are supported by staff with the experiential education and communication skills necessary to relate to and support PLWD. These findings provide contextual information for researchers seeking to identify and test interventions that reflect LTC providers' priorities for PLWD and emphasize the need to align research priorities with provider priorities.
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20
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Kunasekaran M, Poulos CJ, Chughtai AA, Heslop DJ, MacIntyre CR. Factors associated with repeated influenza vaccine uptake among aged care staff in an Australian sample from 2017 to 2019. Vaccine 2022; 40:7238-7246. [PMID: 36328882 DOI: 10.1016/j.vaccine.2022.08.015] [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: 05/03/2022] [Revised: 07/13/2022] [Accepted: 08/08/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND/AIM Influenza vaccination is strongly recommended every year for aged care staff to protect themselves and minimise risk of transmission to residents. This study aimed to determine the factors associated with repeated annual influenza vaccine uptake among Australian aged care staff from 2017 to 2019. METHODS Demographic, medical and vaccination data collected from the staff, who participated in an observational study from nine aged care facilities under a single provider in Sydney Australia, were analysed retrospectively. Based on the pattern of repeated influenza vaccination from 2017 to 2019, three groups were identified: (1) unvaccinated all three years; (2) vaccinated occasionally(once or twice) over three years; and (3)vaccinated all threeyears. Multinomial logistic regression analysis was performed to better understand the factors associated with the pattern of repeated influenza vaccination. RESULTS From a total of 138 staff, between 2017 and 2019, 28.9 % (n = 40) never had a vaccination, while 44.2 % (n = 61) had vaccination occasionally and 26.8 % (n = 37) had vaccination all three years. In the multinomial logistic regression model, those who were<40 years old (OR = 0.57, 95 % CI: 0.19-0.90, p < 0.05) and those who were current smokers (OR = 0.20; 95 % CI: 0.03-0.76, p < 0.05) were less likely to have repeated vaccination for all three years compared to the unvaccinated group. Those who were<40 years old (OR = 0.61; 95 % CI: 0.22-0.68, p < 0.05) and those who were born overseas (OR = 0.50; 95 % CI:0.27-0.69, p < 0.05) were more likely to be vaccinated occasionally compared to the unvaccinated group. CONCLUSION The significant predictors of repeated vaccine uptake across the three-year study period among aged care staff were age, smoking status and country of birth (Other vs Australia). Targeted interventions towards the younger age group (<40 years old), smokers and those who were born overseas could improve repeated influenza vaccination uptake in the aged care workforce.
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Affiliation(s)
- Mohana Kunasekaran
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia.
| | - Christopher J Poulos
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia; HammondCare, Sydney, New South Wales, Australia
| | - Abrar A Chughtai
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - David J Heslop
- The University of New South Wales, School of Population Health, Sydney, New South Wales, Australia
| | - C Raina MacIntyre
- The University of New South Wales, Kirby Institute, Biosecurity Program, Sydney, New South Wales, Australia; College of Public Service and Community Solutions and College ofHealth Solutions, Arizona StateUniversity, Tempe, AZ, USA
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21
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Atchison K, Watt JA, Ewert D, Toohey AM, Ismail Z, Goodarzi Z. Non-pharmacologic and pharmacologic treatments for anxiety in long-term care: a systematic review and meta-analysis. Age Ageing 2022; 51:6691375. [PMID: 36057989 DOI: 10.1093/ageing/afac195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND older adults living in long-term care (LTC) commonly suffer from anxiety symptoms and disorders. We completed a systematic review and meta-analysis to identify efficacious treatments for anxiety symptoms for older adults living in LTC. METHODS we searched five electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials) to identify treatments for anxiety that have been trialled in LTC. Included studies had to be randomised trials, include residents of LTC, and measure anxiety symptoms as an outcome. RESULTS the electronic search returned 6,617 articles, 519 were reviewed in full text, and 80 were included in the descriptive synthesis. Limited studies were meta-analysed (n = 10) due to differences in described treatment and comparator conditions. Limited clinically relevant evidence supporting the use of pharmacologic treatments for symptoms of anxiety in LTC was identified. Of the treatments trialled, music compared with usual care (standardised mean difference, SMD: -0.82; 95% confidence interval (CI): -1.31, -0.34), music compared with social interaction (SMD: -0.41; 95% CI: -0.72, -0.10) and massage compared with usual care (SMD: -4.32; 95% CI: -7.44, -1.19) were found to improve anxiety symptoms, however, significant heterogeneity was detected in two comparisons. CONCLUSIONS a range of non-pharmacologic treatments that improved anxiety symptoms were identified for use in LTC. Although limited evidence exists to support the use of particular treatments, most non-pharmacologic treatments were low-risk interventions that may be readily implemented. Further research is required to assess the treatment effect on residents of LTC with anxiety disorders or clinically relevant symptoms at baseline.
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Affiliation(s)
- Kayla Atchison
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer A Watt
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Division of Geriatric Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Delaney Ewert
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Ann M Toohey
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.,Brenda Strafford Centre on Aging, Calgary, Alberta, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Zahra Goodarzi
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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22
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Physical Activity in People With Dementia Living in Long-Term Care Facilities and the Connection With Environmental Factors and Behavior. J Aging Phys Act 2022; 31:214-222. [PMID: 36041734 DOI: 10.1123/japa.2021-0459] [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: 11/18/2021] [Revised: 05/11/2022] [Accepted: 06/25/2022] [Indexed: 11/18/2022]
Abstract
This study is conducted in order to gain a better understanding of the relationship between physical activity and agitated behavior among older people with dementia, and physical activity and characteristics of long-term care wards. Data were collected among people with dementia living in long-term care facilities (N = 76) by conducting observations at the wards and distributing questionnaires among professional caregivers. The results show that participants are largely inactive (82.8%) and a significant relation was found between the degree of physical activity and characteristics of the ward such as "taking sufficient time," which relates to the time caregivers take when interacting with residents. This study supports the existing knowledge about the degree of physical activity among people with dementia in long-term care and adds information about the potential influence of organizational factors that could be valuable for daily practice.
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23
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Can alternative anatomical sites and environmental surveillance replace perianal screening for multidrug-resistant organisms in nursing homes? Infect Control Hosp Epidemiol 2022; 43:1063-1066. [PMID: 34016196 PMCID: PMC9190292 DOI: 10.1017/ice.2021.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Perianal screening can be intrusive. The sensitivities of multianatomical, nonperianal surveillance were 92.3% for methicillin-resistant Staphylococcus aureus (MRSA), 58.7% for vancomycin-resistant enterococci (VRE), and 54.9% for resistant Gram-negative bacilli (R-GNB). Sensitivities improved upon adding environmental surveillance (95.5%, 82.9%, and 67.9%, respectively). Multianatomical, nonperianal screening and room environment surveillance may replace perianal screening and reduce healthy participant bias in nursing homes.
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24
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Harrison SL, Lip GYH, Akbari A, Torabi F, Ritchie LA, Akpan A, Halcox J, Rodgers S, Hollinghurst J, Harris D, Lane DA. Stroke in Older Adults Living in Care Homes: Results From a National Data Linkage Study in Wales. J Am Med Dir Assoc 2022; 23:1548-1554.e11. [PMID: 35667411 DOI: 10.1016/j.jamda.2022.05.003] [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: 01/27/2022] [Revised: 04/21/2022] [Accepted: 05/02/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the proportion of older people moving to care homes with a recent stroke, incidence of stroke after moving to a care home, mortality following stroke, and secondary stroke prevention management in older care home residents. DESIGN Retrospective cohort study using population-scale individual-level linked data sources between 2003 and 2018 in the Secure Anonymized Information Linkage (SAIL) Databank. SETTING AND PARTICIPANTS People age ≥65 years residing in long-term care homes in Wales. METHODS Competing risk models and logistic regression models were used to examine the association between prior stroke, incident stroke, and mortality following stroke. RESULTS Of 86,602 individuals, 7.0% (n = 6055) experienced a stroke in the 12 months prior to care home entry. The incidence of stroke within 12 months after entry to a care home was 26.2 per 1000 person-years [95% confidence interval (CI) 25.0, 27.5]. Previous stroke was associated with higher risk of incident stroke after moving to a care home (subdistribution hazard ratio 1.83, 95% CI 1.57, 2.13) and 30-day mortality following stroke (odds ratio 2.18, 95% CI 1.59, 2.98). Severe frailty was not significantly associated with risk of stroke or 30-day mortality following stroke. Secondary stroke prevention included statins (50.5%), antiplatelets (61.2%), anticoagulants (52.4% of those with atrial fibrillation), and antihypertensives (92.1% of those with hypertension). CONCLUSIONS AND IMPLICATIONS At the time of care home entry, individuals with history of stroke in the previous 12 months are at a higher risk of incident stroke and mortality following an incident stroke. These individuals are frequently not prescribed medications for secondary stroke prevention. Further evidence is needed to determine the optimal care pathways for older people living in long-term care homes with history of stroke.
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Affiliation(s)
- Stephanie L Harrison
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom.
| | - Gregory Y H Lip
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Ashley Akbari
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales; Population Data Science, Administrative Data Research Wales, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Fatemeh Torabi
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Leona A Ritchie
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Asangaedem Akpan
- Musculoskeletal and Aging Science, Institute of Life Course and Medical Sciences, University of Liverpool, United Kingdom; Liverpool University Hospitals NHS FT, Liverpool, United Kingdom
| | - Julian Halcox
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Sarah Rodgers
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, United Kingdom
| | - Joe Hollinghurst
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales
| | - Daniel Harris
- Population Data Science, Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, Wales; Swansea Bay University Health Board, Swansea, Wales
| | - Deirdre A Lane
- Liverpool Center for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, United Kingdom; Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, United Kingdom; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Replacing Sedentary Behavior With Physical Activity of Different Intensities: Implications for Physical Function, Muscle Function, and Disability in Octogenarians Living in Long-Term Care Facilities. J Phys Act Health 2022; 19:329-338. [PMID: 35349980 DOI: 10.1123/jpah.2021-0186] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 11/21/2021] [Accepted: 02/14/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND We investigated the associations of replacing sedentary behavior (SB) with physical activity of different intensities on the physical function of octogenarians living in long-term care facilities. METHODS This pooled study recruited 427 older adults aged 80 years and older (69.1% female; body mass index: 27.53). For 345 participants who provided valid data, we assessed device-measured time spent in SB, light-intensity physical activity (LIPA), and moderate to vigorous physical activity (MVPA). We assessed lower limb physical function, strength, mobility, and disability. We used compositional data analysis to investigate the associations of replacing SB with physical activity on the outcomes. RESULTS Reallocation of SB to LIPA and MVPA was associated with a higher number of 30-second Chair Stand cycles (LIPA: +0.21, MVPA: +1.81; P < .001), greater peak force (LIPA: +11.96 N, MVPA: +27.68 N; P < .001), peak power (LIPA: +35.82 W, MVPA: +92.73 W; P < .001), peak velocity (LIPA: +0.03 m/s, MVPA: +0.12 m/s; P < .001), higher levels of grip strength (LIPA: +0.68 kg, MVPA: +2.49 kg; P < .001), and less time in the Time Up and Go (LIPA: -7.63 s, MVPA: -12.43 s; P < .001). CONCLUSIONS Replacing SB with LIPA or MVPA is associated with physical function and disability of older adults living in long-term care facilities.
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Latour K, De Lepeleire J, Catry B, Buntinx F. Nursing home residents with suspected urinary tract infections: a diagnostic accuracy study. BMC Geriatr 2022; 22:187. [PMID: 35255822 PMCID: PMC8903673 DOI: 10.1186/s12877-022-02866-2] [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: 06/30/2021] [Accepted: 02/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Urinary tract infections (UTIs) are one of the most common infections in nursing homes (NHs). A high error rate of a UTI diagnosis based solely on clinical criteria is to be expected in older persons as they often present infections in an atypical way. A study was set up to assess the diagnostic value of signs/symptoms and urine dipstick testing in identifying UTIs in NH residents and to explore whether C-reactive protein (CRP) measured by point-of-care testing (POCT) can help in the diagnosis. Methods During a three month prospective multicentre study, urine sampling for culture, POCT CRP and urinary dipstick testing were performed in each NH resident with a suspected UTI. UTIs were defined according to Stone et al., i.e. criteria based upon the presence of a set of signs/symptoms and a positive urine culture. Results Eleven NHs and 1 263 residents participated. Sixteen out of 137 recorded UTI suspicions were confirmed. Acute dysuria (positive likelihood ratio (LR +): 7.56, 95% confidence interval (CI): 3.94–14.5) and acute suprapubic pain (LR + : 11.4, 95% CI: 3.58–35.9) were found to be significant predictors. The combined nitrite and leucocyte esterase urine dipstick test (one or both positive) had a 96.0% negative predictive value (95% CI: 80.5–99.3%). The sensitivity of a positive CRP test (≥ 5 mg/L) was 60.0% (95% CI: 32.3–83.7%). Antimicrobials were prescribed in 60.2% of suspected but unconfirmed UTIs and in 92.3% of confirmed UTIs. Conclusions Using a stringent definition, only 11.7% of our suspicions were confirmed. Besides acute dysuria and suprapubic pain, we were not able to prove that any other clinical sign/symptom or POCT CPR adds useful information to the UTI diagnosis. We confirmed the findings of earlier research that urine dipstick tests are useful in ruling out UTIs and identified a potential overuse of antimicrobials in our NH population. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02866-2.
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Affiliation(s)
- Katrien Latour
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium. .,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.
| | - Jan De Lepeleire
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Boudewijn Catry
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Faculty of Medicine, Université Libre de Bruxelles, Brussels, Belgium
| | - Frank Buntinx
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Department of General Practice, Maastricht University, Maastricht, The Netherlands
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference. J Am Med Dir Assoc 2022; 23:323-327. [DOI: 10.1016/j.jamda.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 12/27/2022]
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic Trials and Improving Long-Term Care: Recommendations From a National Institutes of Health Conference. J Am Geriatr Soc 2022; 70:688-694. [PMID: 35195278 PMCID: PMC8915540 DOI: 10.1111/jgs.17697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Sheryl Zimmerman
- Cecil G. Sheps Center for Health Services Research and Schools of Social Work and Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Address correspondence to Sheryl Zimmerman, PhD, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King Jr Blvd, Campus Box 7590, Chapel Hill, NC 27599-7590, USA. (S. Zimmerman)
| | - Barbara Resnick
- University of Maryland School of Nursing, Baltimore, MD, USA
| | - Joseph Ouslander
- Department of Integrated Medical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Cari Levy
- Department of Veterans Affairs, Rocky Mountain Regional VA Medical Center, and University of Colorado, Aurora, CO, USA
| | - Joseph E. Gaugler
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Philip D. Sloane
- Cecil G. Sheps Center for Health Services Research and Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Vincent Mor
- Center of Innovation in Long-term Services and Supports, Providence VA Medical Center; Department of Health Services, Policy & Practice, Brown University School of Public Health, Providence, RI, USA
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Delude C, Abi‐Elias IH, Quinn CC, Adams AS, Magaziner JS, Ito K, Jain P, Gurwitz JH, Mazor KM. Stakeholders’ Views on Priorities Essential for Establishing a Supportive Environment for Clinical Trials in Nursing Homes. J Am Geriatr Soc 2022; 70:950-959. [PMID: 35188222 PMCID: PMC8986625 DOI: 10.1111/jgs.17710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND The U.S. clinical research enterprise in nursing homes was unprepared to mount clinical trials in nursing homes to address urgent questions relevant to prevention and treatment during the COVID-19 pandemic. We identify priorities essential for establishing a supportive environment for future clinical trials in nursing homes. METHODS Two cross-sectional online questionnaires were administered between January and February 2021. One was administered to nursing home providers, researchers, and policymakers; respondents rated the importance of attributes of researchers, facilities, leaders and staff for conducting clinical trials in nursing homes. Because importance may depend on trial type, respondents rated each attribute for efficacy trials (testing an intervention in ideal circumstances) and effectiveness trials (testing an intervention in "real world" circumstances). We calculated the attribute rating means and standard deviations, and used content analysis to characterize open-ended responses. The second questionnaire for resident family members and advocates included open-ended questions about nursing home research, and factors influencing willingness to participate. RESULTS The attributes rated as most essential for conducting efficacy and effectiveness trials in nursing homes are research team attributes, that is, that researchers recognize regulatory constraints; understand and adapt to nursing home workflow; and work collaboratively with nursing home leaders to identify priorities. Resident and facility diversity emerged as essential for effectiveness trials; important dimensions included resident race, ethnicity and income, as well as nursing home urban/rural location, quality ratings, geography, staffing ratios, size, and profit status. Caregivers and resident advocates stressed the importance of communication among participants, researchers, and nursing home leadership and staff at all stages of a trial. CONCLUSION Developing a robust U.S. clinical research enterprise capable of efficiently mounting future clinical trials in nursing homes will require a reimagining of the relationships that exist between researchers, facilities, nursing home leaders, and residents, with a research infrastructure specifically focused on supporting and fostering these connections.
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Affiliation(s)
| | | | | | | | | | - Kouta Ito
- Meyers Health Care Institute
- UMass Chan Medical School
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30
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Tropea J, Nestel D, Johnson C, Hayes BJ, Hutchinson AF, Brand C, Le BH, Blackberry I, Caplan GA, Bicknell R, Hepworth G, Lim WK. Evaluation of IMproving Palliative care Education and Training Using Simulation in Dementia (IMPETUS-D) a staff simulation training intervention to improve palliative care of people with advanced dementia living in nursing homes: a cluster randomised controlled trial. BMC Geriatr 2022; 22:127. [PMID: 35164695 PMCID: PMC8845393 DOI: 10.1186/s12877-022-02809-x] [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: 10/20/2021] [Accepted: 01/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background People with dementia have unique palliative and end-of-life needs. However, access to quality palliative and end-of-life care for people with dementia living in nursing homes is often suboptimal. There is a recognised need for nursing home staff training in dementia-specific palliative care to equip them with knowledge and skills to deliver high quality care. Objective The primary aim was to evaluate the effectiveness of a simulation training intervention (IMPETUS-D) aimed at nursing home staff on reducing unplanned transfers to hospital and/or deaths in hospital among residents living with dementia. Design Cluster randomised controlled trial of nursing homes with process evaluation conducted alongside. Subjects & setting One thousand three hundred four people with dementia living in 24 nursing homes (12 intervention/12 control) in three Australian cities, their families and direct care staff. Methods Randomisation was conducted at the level of the nursing home (cluster). The allocation sequence was generated by an independent statistician using a computer-generated allocation sequence. Staff from intervention nursing homes had access to the IMPETUS-D training intervention, and staff from control nursing homes had access to usual training opportunities. The predicted primary outcome measure was a 20% reduction in the proportion of people with dementia who had an unplanned transfer to hospital and/or death in hospital at 6-months follow-up in the intervention nursing homes compared to the control nursing homes. Results At 6-months follow-up, 128 (21.1%) people with dementia from the intervention group had an unplanned transfer or death in hospital compared to 132 (19.0%) residents from the control group; odds ratio 1.14 (95% CI, 0.82-1.59). There were suboptimal levels of staff participation in the training intervention and several barriers to participation identified. Conclusion This study of a dementia-specific palliative care staff training intervention found no difference in the proportion of residents with dementia who had an unplanned hospital transfer. Implementation of the intervention was challenging and likely did not achieve adequate staff coverage to improve staff practice or resident outcomes. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12618002012257. Registered 14 December 2018. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-022-02809-x.
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Affiliation(s)
- Joanne Tropea
- Department of Medicine and Aged Care, Royal Melbourne Hospital, 6 North Main building, 300 Grattan Street, Parkville, VIC, 3050, Australia. .,Department of Medicine - Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Debra Nestel
- School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia.,Austin Precinct, Department of Surgery, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Christina Johnson
- Monash Doctors Education, Monash Health, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Monash Medical Centre, 246 Clayton Rd, Clayton, VIC, 3168, Australia
| | - Barbara J Hayes
- Department of Cancer Services, Northern Health Bundoora, 1231 Plenty Road, Bundoora, VIC, 3083, Australia.,Northern Clinical School, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Anastasia F Hutchinson
- School of Nursing and Midwifery, Deakin University, 221 Burwood Hwy, Burwood, VIC, 3125, Australia
| | - Caroline Brand
- Department of Medicine - Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Brian H Le
- Department of Medicine - Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia.,Department of Palliative Care, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Irene Blackberry
- John Richards Centre for Rural Ageing Research, La Trobe Rural Health School, La Trobe University, Albury-Wodonga Campus, 133 McKoy Street, West Wodonga, VIC, 3690, Australia
| | - Gideon A Caplan
- Prince of Wales Hospital, 320-346 Barker Road, Randwick, NSW, 2031, Australia.,Prince of Wales Clinical School, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Ross Bicknell
- Department of Medicine and Aged Care, Royal Melbourne Hospital, 6 North Main building, 300 Grattan Street, Parkville, VIC, 3050, Australia
| | - Graham Hepworth
- Statistical Consulting Centre, University of Melbourne, Parkville, VIC, 3010, Australia
| | - Wen K Lim
- Department of Medicine and Aged Care, Royal Melbourne Hospital, 6 North Main building, 300 Grattan Street, Parkville, VIC, 3050, Australia.,Department of Medicine - Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia
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Kjörk EK, Gustavsson M, El-Manzalawy N, Sunnerhagen KS. Stroke-related health problems and associated actions identified with the post-stroke checklist among nursing home residents. BMC Cardiovasc Disord 2022; 22:50. [PMID: 35164696 PMCID: PMC8842537 DOI: 10.1186/s12872-022-02466-3] [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: 02/11/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the needs of permanent nursing home residents after a stroke; comprehensive descriptions of needs are rare. The Post-Stroke Checklist facilitates the identification of health problems. The study aimed to use the Post-Stroke Checklist to identify the extent of health problems, and how they were addressed, in nursing home residents that experienced strokes in Sweden. We also investigated the feasibility of the Checklist in a nursing home context. Methods This is a cross-sectional explorative study. Twenty nursing homes in two regions of Sweden participated. We included residents that had experienced a stroke within approximately 3 years and the responsible staff members were approached. Questionnaires were completed during face-to-face meetings with staff members (n = 45) knowledgeable about the residents. Data collection included the Post-Stroke Checklist, Barthel Index, modified Rankin Scale, resident and staff characteristics, and a satisfaction-questionnaire completed by staff. Results At the included nursing homes 1061 residents, 22% (n = 239) had a history of stroke, and 6% (n = 65) had experienced strokes during the last 3.5 years. Forty-nine residents were included (41% men, median age, 86 years, range 59–97). Among the health problems identified with the Checklist, activities of daily living (82%) were most common, and spasticity (41%) and pain (29%) were least common. Residents had extensive care needs, with a median of six health problems per resident. The total number of health problems addressed by previous actions i.e., referrals, as suggested in the Checklist, was 124, when recalled by staff. The median Barthel index score was 35. Lack of follow-up after stroke (e.g., by using a checklist) was reported in 17/20 nursing homes. The staff were satisfied with the Post-Stroke Checklist. Conclusions We found that more than 1/5 of residents had experienced a stroke; thus, the Post-Stroke Checklist was a useful tool in nursing homes. Half of the residents had more than six health problems, identified with the Post-Stroke Checklist. Extensive needs, combined with a lack of follow-up, indicated a risk of insufficient care. These findings suggested that nursing home routines could be improved with the Post-Stroke Checklist. Trial registration The project is registered in Research web, project number: 256021.
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Affiliation(s)
- Emma K Kjörk
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy at University of Gothenburg, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden.
| | - Martha Gustavsson
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy at University of Gothenburg, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden
| | - Nohad El-Manzalawy
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy at University of Gothenburg, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy at University of Gothenburg, Per Dubbsgatan 14, fl. 3, 413 45, Gothenburg, Sweden
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32
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Kutschar P, Osterbrink J, Weichbold M. Interviewer effects in a survey examining pain intensity and pain interference in nursing home residents. Age Ageing 2022; 51:6530460. [PMID: 35180286 PMCID: PMC8856601 DOI: 10.1093/ageing/afac008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction Face-to-face surveys are applied frequently when conducting research in older populations. Interviewers play a decisive role in data quality, may affect measurement and influence results. This study uses survey data about pain in nursing home residents and analyses, whether affiliation-of-interviewer (internal vs. external to nursing home) and gender-of-interviewer affect residents’ responses in terms of interviewer variance and systematically varying pain reports. Methods Overall, 258 nursing home residents with up to moderate cognitive impairment were examined by 61 interviewers about pain intensity and interference applying the Brief Pain Inventory. Interviewer variance was measured using intra-interviewer correlation coefficients (ρ). Two-factorial covariance analysis was applied to analyse whether pain intensity and interference scores differ by interviewer characteristics. Results Interviewer heterogeneity accounts for almost one quarter of total variance on average. Interviewer variance is higher for internal and male interviewers than for external and female interviewers. Covariance analyses show significant effects of interviewer characteristics on pain reports. Average pain intensity and interference scores vary considerably by interviewer gender and affiliation. Highest pain intensity was reported towards female internal and male external interviewers; highest pain interference was reported towards male external interviewers. Conclusion Residents’ answers substantially differ in relation to who is assessing pain. There is a risk of imprecise and biased survey estimates on sensitive topics like pain in nursing homes. Interviewer gender and affiliation seem to evoke gender-specific and status-related expectations and attributions which influence residents’ response process. Interviewer effects pose a considerable threat to survey data quality in institutionalised older populations.
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Affiliation(s)
- Patrick Kutschar
- Institute of Nursing Science and Practice, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Juergen Osterbrink
- Institute of Nursing Science and Practice, Paracelsus Medical University, A-5020 Salzburg, Austria
| | - Martin Weichbold
- Department of Sociology, Paris Lodron University Salzburg, A-5020 Salzburg, Austria
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33
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Zimmerman S, Resnick B, Ouslander J, Levy C, Gaugler JE, Sloane PD, Mor V. Pragmatic trials and improving long-term care: Recommendations from a national institutes of health conference. Geriatr Nurs 2022; 44:288-292. [DOI: 10.1016/j.gerinurse.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Terry C, Penland M, Garland D, Wang W, Burton T, Dark-Freudeman A. Adapting Mindfulness-Based Interventions for Residents of Long-Term Care Facilities. Gerontol Geriatr Med 2021; 7:23337214211057703. [PMID: 34869793 PMCID: PMC8637702 DOI: 10.1177/23337214211057703] [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: 06/18/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 02/04/2023] Open
Abstract
Mindfulness-based interventions (MBIs) have received increased clinical attention in
recent years. While some MBI research has focused on healthy older adults, research with
more emotionally and physically vulnerable populations, such as residents of long-term
care facilities (LTCFs), is lacking. The current paper presents quantitative and
qualitative results from a pilot study of an individual MBI designed for residents of
LTCFs. Participants included 8 residents from two skilled nursing facilities in the
southeastern United States. Data were collected between October 2016 through June 2017. A
modified MBI is proposed with specific adaptations for LTCF residents. Recommended
adaptations for LTCFs include a shift from a group to an individual format, individual
weekly instructor–participant meetings, removal of the yoga and full-day silent retreat
and shortening the duration of the formal practices. The current study found that these
adaptations result in an individual MBI that is accessible to most LTCF residents while
still providing the associated benefits of traditional group MBIs.
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Affiliation(s)
- Christian Terry
- Department of Psychology, University of North Carolina Wilmington, USA
| | - Michael Penland
- Department of Psychology, University of North Carolina Wilmington, USA
| | - Devon Garland
- Department of Psychology, University of North Carolina Wilmington, USA
| | - Wendy Wang
- Department of Psychology, University of North Carolina Wilmington, USA
| | - Taylor Burton
- Department of Psychology, University of North Carolina Wilmington, USA
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Jung HW, Lim WS, Cesari M, Auyeung TW, Kojima T, Ga H, Cameron ID, Lim JY. Challenges and Opportunities for Academic Journals to Serve the Older Population in Western Pacific Region. Ann Geriatr Med Res 2021; 25:231-236. [PMID: 34818700 PMCID: PMC8749032 DOI: 10.4235/agmr.21.0129] [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: 11/15/2021] [Accepted: 11/21/2021] [Indexed: 02/04/2023] Open
Abstract
Annals of Geriatric Medicine and Research held its inaugural international editorial board virtual meeting on September 16, 2021, to brainstorm ideas for sustainable growth. This special article summarizes the key concepts obtained from the webinar proceedings, with further development of ideas from ensuing discussions occurring after the meeting. From the initial discussion points provided by eight editorial board members, including six presenters, email discussions further enriched these ideas to construct the current special article. The key points discussed were: impactful research and impact factors, international and Asian perspectives, and challenges to sustainable growth. The editors noted the existing gap between the impact factor and research impact as a challenge for the growth paths of regional journals. However, they agreed that persevering with impactful research would ultimately translate into parallel and gradual gains in impact, which is, therefore, consistent with the organic growth of the journal. Acknowledging challenges in navigating between unique Asian perspectives and international outlooks, the editors encouraged academic journals to serve as bridges linking international evidence with the richness of local perspectives. For sustainable growth, the editors suggested that journals may be forged into the academic ecosystems of the region, diversify value streams, and establish themselves as reputable brands in disciplines. By combining these discussions, we proposed the “IMPACT” strategy for journals on the growth path in the region, which stands for IMmersive user experience encompassing authors, reviewers, and readers; Pasteur’s quadrant use-inspired research; Asia-Pacific context; Collaborative; and Translation to practice and policy.
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Affiliation(s)
- Hee-Won Jung
- Division of Geriatrics, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Wee Shiong Lim
- Department of Geriatric Medicine, Institute of Geriatrics and Active Ageing, Tan Tock Seng Hospital, Singapore
| | - Matteo Cesari
- Geriatric Unit, IRCCS Istituti Clinici Maugeri, University of Milan, Milan, Italy
| | - Tung Wai Auyeung
- Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hyuk Ga
- Institute of Geriatric Medicine, Incheon Eun-Hye Hospital, Incheon, Korea
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and University of Sydney, Kolling Institute, St Leonards, Australia
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University Bundang Hospital, Seongnam, Seoul National University College of Medicine, Seongnam, Korea.,Institute on Aging, Seoul National University, Seoul, Korea
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Knorr J, Tuttle JL, Sabo JA, East DH, Price KL, Shen L. Innovative clinical trial design and delivery: a phase 3 COVID-19 post-exposure prophylaxis study in skilled nursing and assisted living facilities (BLAZE-2). Trials 2021; 22:726. [PMID: 34674750 PMCID: PMC8529571 DOI: 10.1186/s13063-021-05699-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 09/29/2021] [Indexed: 02/01/2023] Open
Abstract
The efficient community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has resulted in the current pandemic of coronavirus disease-2019 (COVID-19), which in severe and critical cases results in progressive pulmonary infection, complicated by respiratory failure, with a high prevalence of acute respiratory distress syndrome. Of all age groups, older adults have the greatest risk of severe COVID-19 and the associated complications. Globally, there are many reports of the rapid spread of COVID-19 among residents of skilled nursing facilities, with high associated rates of morbidity and mortality. With over 1.3 million residents in nursing home care in the USA, there is an urgent need for therapeutic strategies to prevent COVID-19 in these populations. Lilly, in collaboration with the National Institute of Allergy and Infectious Diseases, conducted the BLAZE-2 trial to evaluate the efficacy and safety of the monoclonal antibody bamlanivimab (LY3819253) in preventing SARS-CoV-2 infection and COVID-19, defined as symptomatic infection, in skilled nursing and assisted living facilities. It is a phase 3 randomized, double-blind, placebo-controlled trial, where participants were randomized to bamlanivimab (4200 mg) or placebo and then followed up for 24 weeks. Conducting a trial in the midst of a pandemic in these facilities poses several challenges, including a vulnerable elderly population, travel restrictions, supply chain interruptions, and defining the target population. The operational challenges were addressed by the innovative use of mobile research units which are customized, equipped, and staffed to support BLAZE-2 randomization and participant dosing within the skilled nursing and assisted living facilities. Herein, we describe the design of the study, the analytics behind facility selection, and an innovative operational model.
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Affiliation(s)
- Jack Knorr
- Eli Lilly and Company, Indianapolis, IN, USA.
| | | | | | - Dawn H East
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | - Lei Shen
- Eli Lilly and Company, Indianapolis, IN, USA
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Saredakis D, Keage HA, Corlis M, Ghezzi ES, Loffler H, Loetscher T. The Effect of Reminiscence Therapy Using Virtual Reality on Apathy in Residential Aged Care: Multisite Nonrandomized Controlled Trial. J Med Internet Res 2021; 23:e29210. [PMID: 34542418 PMCID: PMC8491119 DOI: 10.2196/29210] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Background Apathy is a frequent and underrecognized neurological disorder symptom. Reduced goal-directed behavior caused by apathy is associated with poor outcomes for older adults in residential aged care. Recommended nonpharmacological treatments include person-centered therapy using information and communication technology. Virtual reality (VR) in the form of head-mounted displays (HMDs) is a fully immersive technology that provides access to a wide range of freely available content. The use of VR as a therapy tool has demonstrated promise in the treatment of posttraumatic stress disorder and anxiety. In addition, VR has been used to improve conditions including depression, anxiety, cognitive function, and balance in older adults with memory deficits, Alzheimer disease, and Parkinson disease. Research using VR for the symptoms of apathy in older adults living in residential aged care facilities is limited. Objective This study aims to examine whether using HMDs as a tool for reminiscence therapy improves the symptoms of apathy compared with using a laptop computer and physical items with older adults living in residential aged care. Methods In this multisite trial, 43 participants were allocated to one of three groups: reminiscence therapy intervention using VR in the form of HMDs, reminiscence therapy using a laptop computer supplemented by physical items if required (active control), and a usual care (passive control) group. The primary outcome was apathy, and the secondary outcomes included cognition and depression. The side effects of using HMDs were also measured in the VR group. Results Mixed model analyses revealed no significant group interaction over time in outcomes between the VR and laptop groups (estimate=−2.24, SE 1.89; t40=−1.18; P=.24). Pooled apathy scores in the two intervention groups compared with the passive control group also revealed no significant group interaction over time (estimate=−0.26, SE 1.66; t40=−0.16; P=.88). There were no significant secondary outcomes. Most participants in the VR group stated that they would prefer to watch content in VR than on a flat screen (Χ22=11.2; P=.004), side effects from HMD use were negligible to minimal according to the Simulator Sickness Questionnaire cutoff scores. Conclusions Although there were no significant results in outcome measures, this study found that participants engaged in the research and enjoyed the process of reminiscing using both forms of technology. It was found that VR can be implemented in an aged care setting with correct protocols in place. Providing residents in aged care with a choice of technology may assist in increasing participation in activities. We cannot dismiss the importance of immediate effects while the therapy was in progress, and this is an avenue for future research. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12619001510134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378564. International Registered Report Identifier (IRRID) RR2-DOI: 10.1136/bmjopen-2020-046030
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Affiliation(s)
- Dimitrios Saredakis
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
| | - Hannah Ad Keage
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
| | - Megan Corlis
- UniSA Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Erica S Ghezzi
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
| | - Helen Loffler
- Helping Hand Aged Care, Adelaide, South Australia, Australia
| | - Tobias Loetscher
- UniSA Justice & Society, University of South Australia, Adelaide, South Australia, Australia
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Gordon AL, Witham MD, Henderson EJ, Harwood RH, Masud T. Research into ageing and frailty. Future Healthc J 2021; 8:e237-e242. [PMID: 34286191 DOI: 10.7861/fhj.2021-0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Research into ageing covers opportunities and challenges posed by an older population, and research to understand the ageing processes across the lifespan. The evidence base for Comprehensive Geriatric Assessment (CGA) is well established and efforts should now shift to understanding how to implement its principles across different healthcare contexts. Research around syndromes common in older people has progressed with variable success; while effective therapies for falls and cognitive impairment have been identified, older people with advanced frailty have commonly been excluded from Parkinson's disease and continence research. Research to understand the mechanisms of ageing has potential to mitigate against or treat emerging sarcopenia and cognitive impairment, and thus modify frailty trajectories. Pharmacogenetics could individualise therapeutics to reduce polypharmacy. These issues can only be addressed with development of infrastructure, capacity and expertise in ageing research. Commonly used research methodologies must be adapted to take account of frailty, cognitive impairment and functional dependency.
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Affiliation(s)
- Adam L Gordon
- British Geriatrics Society, London, UK, University of Nottingham School of Medicine, Nottingham, UK, NIHR Applied Research Collaboration-East Midlands (ARC-EM), Nottingham, UK and University of Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - Miles D Witham
- British Geriatrics Society, London, UK, NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne, UK and The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - Emily J Henderson
- British Geriatrics Society, London, UK, Bristol Medical School, Bristol, UK and Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Rowan H Harwood
- British Geriatrics Society, London, UK, University of Nottingham School of Health Sciences, Nottingham, UK and Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tahir Masud
- British Geriatrics Society, London, UK, University of Nottingham School of Medicine, Nottingham, UK, Nottingham University Hospitals NHS Trust, Nottingham, UK and NIHR Nottingham Biomedical Research Centre, Nottingham, UK
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Garratt SM, Kosowicz L, Gilbert AS, Dow B, Ostaszkiewicz J. What is and what ought to be: A meta-synthesis of residential aged care staffs' perspectives on quality care. J Clin Nurs 2021; 30:3124-3138. [PMID: 34060164 DOI: 10.1111/jocn.15842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 02/22/2021] [Accepted: 04/14/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND As places of both residence and work, what constitutes "good quality care" in residential aged care requires consideration of staffs' perspectives. OBJECTIVE A meta-synthesis of the qualitative literature was conducted exploring residential aged care staff perspectives on "quality of care." METHODS Six electronic databases were searched for articles that met the screening inclusion criteria. This meta-synthesis was informed by the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, and included studies were critically appraised using JBI SUMARI. Two independent reviewers conducted thematic network mapping and analysis of included articles, with oversight from three additional reviewers. RESULTS Forty-seven articles were included, with findings summarised into four organising themes and nine basic themes. The four organising themes about quality care from staff perspectives include direct care, professional values and competence, the care environment and organisational/regulatory factors. CONCLUSION Staff describe a wide range of factors that they perceived to influence the quality of care. Some may feel motivated to leave employment in aged care, due to organisational pressures that make staff unable to uphold what they perceive as an acceptable standard of care. There is tension between professional values and organisation/regulatory factors-regulation should be enacted at a level that supports good practice and staff's moral integrity. RELEVANCE TO CLINICAL PRACTICE This review found that while person-centred care is now well established as the benchmark of quality care in residential aged care homes, achieving it in reality remains challenged by limitations on staff members' time, resources and sometimes their competencies and the regularity of their employment.
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Affiliation(s)
- Stephanie M Garratt
- National Ageing Research Institute, Parkville, Vic., Australia.,University of Auckland, Auckland, New Zealand
| | - Leona Kosowicz
- National Ageing Research Institute, Parkville, Vic., Australia
| | - Andrew S Gilbert
- National Ageing Research Institute, Parkville, Vic., Australia.,La Trobe University, Bundoora, Vic., Australia
| | - Briony Dow
- National Ageing Research Institute, Parkville, Vic., Australia.,Deakin University, Burwood, Vic., Australia.,University of Melbourne, Parkville, Vic., Australia
| | - Joan Ostaszkiewicz
- National Ageing Research Institute, Parkville, Vic., Australia.,Deakin University, Burwood, Vic., Australia
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Sluggett JK, Hughes GA, Ooi CE, Chen EYH, Corlis M, Hogan ME, Caporale T, Van Emden J, Bell JS. Process Evaluation of the SImplification of Medications Prescribed to Long-tErm Care Residents (SIMPLER) Cluster Randomized Controlled Trial: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115778. [PMID: 34072223 PMCID: PMC8199013 DOI: 10.3390/ijerph18115778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 02/01/2023]
Abstract
Complex medication regimens are highly prevalent, burdensome for residents and staff, and associated with poor health outcomes in residential aged care facilities (RACFs). The SIMPLER study was a non-blinded, matched-pair, cluster randomized controlled trial in eight Australian RACFs that investigated the one-off application of a structured 5-step implicit process to simplify medication regimens. The aim of this study was to explore the processes underpinning study implementation and uptake of the medication simplification intervention. A mixed methods process evaluation with an explanatory design was undertaken in parallel with the main outcome evaluation of the SIMPLER study and was guided by an established 8-domain framework. The qualitative component included a document analysis and semi-structured interviews with 25 stakeholders (residents, family, research nurses, pharmacists, RACF staff, and a general medical practitioner). Interviews were transcribed verbatim and reflexively thematically content analyzed. Descriptive statistics were used to summarize quantitative data extracted from key research documents. The SIMPLER recruitment rates at the eight RACFs ranged from 18.9% to 48.6% of eligible residents (38.4% overall). Participation decisions were influenced by altruism, opinions of trusted persons, willingness to change a medication regimen, and third-party hesitation regarding potential resident distress. Intervention delivery was generally consistent with the study protocol. Stakeholders perceived regimen simplification was beneficial and low risk if the simplification recommendations were individualized. Implementation of the simplification recommendations varied between the four intervention RACFs, with simplification implemented at 4-month follow-up for between 25% and 86% of residents for whom simplification was possible. Good working relationships between stakeholders and new remunerated models of medication management were perceived facilitators to wider implementation. In conclusion, the one-off implicit medication simplification intervention was feasible and generally delivered according to the protocol to a representative sample of residents. Despite variable implementation, recommendations to simplify complex regimens were valued by stakeholders, who also supported wider implementation of medication simplification in RACFs.
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Affiliation(s)
- Janet K. Sluggett
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
- Correspondence:
| | - Georgina A. Hughes
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia;
| | - Choon Ean Ooi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
| | - Esa Y. H. Chen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
| | - Megan Corlis
- UniSA Allied Health and Human Performance, University of South Australia, Adelaide, SA 5001, Australia;
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
| | - Michelle E. Hogan
- Helping Hand Aged Care, North Adelaide, SA 5006, Australia; (M.E.H.); (T.C.)
| | - Tessa Caporale
- Helping Hand Aged Care, North Adelaide, SA 5006, Australia; (M.E.H.); (T.C.)
| | - Jan Van Emden
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
- UniSA Clinical and Health Sciences, University of South Australia, Adelaide, SA 5001, Australia;
| | - J. Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC 3052, Australia; (C.E.O.); (E.Y.H.C.); (J.S.B.)
- NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, NSW 2077, Australia;
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
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Downs M, Blighe A, Carpenter R, Feast A, Froggatt K, Gordon S, Hunter R, Jones L, Lago N, McCormack B, Marston L, Nurock S, Panca M, Permain H, Powell C, Rait G, Robinson L, Woodward-Carlton B, Wood J, Young J, Sampson E. A complex intervention to reduce avoidable hospital admissions in nursing homes: a research programme including the BHiRCH-NH pilot cluster RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2021. [DOI: 10.3310/pgfar09020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
An unplanned hospital admission of a nursing home resident distresses the person, their family and nursing home staff, and is costly to the NHS. Improving health care in care homes, including early detection of residents’ health changes, may reduce hospital admissions. Previously, we identified four conditions associated with avoidable hospital admissions. We noted promising ‘within-home’ complex interventions including care pathways, knowledge and skills enhancement, and implementation support.
Objectives
Develop a complex intervention with implementation support [the Better Health in Residents in Care Homes with Nursing (BHiRCH-NH)] to improve early detection, assessment and treatment for the four conditions. Determine its impact on hospital admissions, test study procedures and acceptability of the intervention and implementation support, and indicate if a definitive trial was warranted.
Design
A Carer Reference Panel advised on the intervention, implementation support and study documentation, and engaged in data analysis and interpretation. In workstream 1, we developed a complex intervention to reduce rates of hospitalisation from nursing homes using mixed methods, including a rapid research review, semistructured interviews and consensus workshops. The complex intervention comprised care pathways, approaches to enhance staff knowledge and skills, implementation support and clarity regarding the role of family carers. In workstream 2, we tested the complex intervention and implementation support via two work packages. In work package 1, we conducted a feasibility study of the intervention, implementation support and study procedures in two nursing homes and refined the complex intervention to comprise the Stop and Watch Early Warning Tool (S&W), condition-specific care pathways and a structured framework for nurses to communicate with primary care. The final implementation support included identifying two Practice Development Champions (PDCs) in each intervention home, and supporting them with a training workshop, practice development support group, monthly coaching calls, handbooks and web-based resources. In work package 2, we undertook a cluster randomised controlled trial to pilot test the complex intervention for acceptability and a preliminary estimate of effect.
Setting
Fourteen nursing homes allocated to intervention and implementation support (n = 7) or treatment as usual (n = 7).
Participants
We recruited sufficient numbers of nursing homes (n = 14), staff (n = 148), family carers (n = 95) and residents (n = 245). Two nursing homes withdrew prior to the intervention starting.
Intervention
This ran from February to July 2018.
Data sources
Individual-level data on nursing home residents, their family carers and staff; system-level data using nursing home records; and process-level data comprising how the intervention was implemented. Data were collected on recruitment rates, consent and the numbers of family carers who wished to be involved in the residents’ care. Completeness of outcome measures and data collection and the return rate of questionnaires were assessed.
Results
The pilot trial showed no effects on hospitalisations or secondary outcomes. No home implemented the intervention tools as expected. Most staff endorsed the importance of early detection, assessment and treatment. Many reported that they ‘were already doing it’, using an early-warning tool; a detailed nursing assessment; or the situation, background, assessment, recommendation communication protocol. Three homes never used the S&W and four never used care pathways. Only 16 S&W forms and eight care pathways were completed. Care records revealed little use of the intervention principles. PDCs from five of six intervention homes attended the training workshop, following which they had variable engagement with implementation support. Progression criteria regarding recruitment and data collection were met: 70% of homes were retained, the proportion of missing data was < 20% and 80% of individual-level data were collected. Necessary rates of data collection, documentation completion and return over the 6-month study period were achieved. However, intervention tools were not fully adopted, suggesting they would not be sustainable outside the trial. Few hospitalisations for the four conditions suggest it an unsuitable primary outcome measure. Key cost components were estimated.
Limitations
The study homes may already have had effective approaches to early detection, assessment and treatment for acute health changes; consistent with government policy emphasising the need for enhanced health care in homes. Alternatively, the implementation support may not have been sufficiently potent.
Conclusion
A definitive trial is feasible, but the intervention is unlikely to be effective. Participant recruitment, retention, data collection and engagement with family carers can guide subsequent studies, including service evaluation and quality improvement methodologies.
Future work
Intervention research should be conducted in homes which need to enhance early detection, assessment and treatment. Interventions to reduce avoidable hospital admissions may be beneficial in residential care homes, as they are not required to employ nurses.
Trial registration
Current Controlled Trials ISRCTN74109734 and ISRCTN86811077.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 9, No. 2. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Murna Downs
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Alan Blighe
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Robin Carpenter
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Alexandra Feast
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sally Gordon
- National Institute for Health Research Clinical Research Network Yorkshire and Humber, York Teaching Hospital NHS Foundation Trust, York, UK
| | - Rachael Hunter
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Liz Jones
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Natalia Lago
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Brendan McCormack
- Division of Nursing and Division of Occupational Therapy and Arts Therapies, School of Health Sciences, Queen Margaret University, Edinburgh, UK
| | - Louise Marston
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | | | - Monica Panca
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Helen Permain
- Research Department, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Catherine Powell
- Centre for Applied Dementia Studies, University of Bradford, Bradford, UK
| | - Greta Rait
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - Louise Robinson
- Institute for Ageing and Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | | | - John Wood
- Department of Primary Care and Population Health and Priment Clinical Trials Unit, University College London, London, UK
| | - John Young
- Academic Unit of Elderly Care and Rehabilitation, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford, UK
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
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de Bruin ED, Baur H, Brülhart Y, Luijckx E, Hinrichs T, Rogan S. Combining Stochastic Resonance Vibration With Exergaming for Motor-Cognitive Training in Long-Term Care; A Sham-Control Randomized Controlled Pilot Trial. Front Med (Lausanne) 2020; 7:507155. [PMID: 33330519 PMCID: PMC7734185 DOI: 10.3389/fmed.2020.507155] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 11/09/2020] [Indexed: 01/06/2023] Open
Abstract
Purpose: Physical and mental functions allow classifying older adults as “Go-Go” (independent functioning); “Slow-Go” (in need of care with a slight handicap); and “No-Go” (in need of care with severe functional limitation). The latter group exhibits reduced exercise tolerance. More recently technology-based motor-cognitive types of training services emerged as a possible training service. This study examined the use of technology including stochastic resonance whole-body vibration and Exergame-dance training for motor-cognitive training in care home dwelling adults. Methods: Seventeen older adults (10 women, 7 men, age range: 79–98) were randomly assigned to the intervention (IG, n = 9) or the sham group (SG, n = 8). IG performed five sets of 1-min whole-body vibration with 1-min rest in between, three times a week for the first 4 weeks of the training period with varying frequency. From weeks five to eight the Exergame-dance training was conducted after the vibration sessions. SG performed a stochastic resonance whole-body vibration training with the same terms applied, however, with a fixed frequency of 1 Hz, Noise 1. From weeks five to eight a passive trampoline-programme of 5 min was applied following the vibration sessions. Primary outcome was the Short Physical Performance Battery (SPPB). Secondary outcomes were the Trail Making Test A and B (TMT A & B) and the Falls Efficacy Scale–International (FES-I). Outcomes were measured at baseline, after 4 and 8 weeks of intervention and at follow-up (4 weeks after the intervention). The non-parametric Puri and Sen rank-order test was applied, followed by an ANOVA for repeated measures to analyse main and interaction effects. Mann–Whitney U-Test was used to determine differences between the groups. Results: The post-hoc analysis showed significant effects on the SPPB total score with large effect sizes from baseline to 8 weeks (+72%, p = 0.005, η2 = 0.423). The TMT part B displayed significant improvements with large effect sizes from baseline to 8 weeks (+17.5%, p = 0.002, η2 = 0.779) and to follow-up (+21%, p = 0.001, η2 = 0.827). Conclusion: The technology based 8-week training programme consisting of a combination of stochastic resonance whole-body vibration and Exergame-dance training showed beneficial effects on both physical and cognitive performance in older care home dwelling adults.
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Affiliation(s)
- Eling D de Bruin
- Department of Health Sciences and Technology, Institute of Human Movement Sciences and Sport, ETH Zurich, Zurich, Switzerland.,Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Heiner Baur
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Yvonne Brülhart
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Eefje Luijckx
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Timo Hinrichs
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - Slavko Rogan
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Building relational research capacity in care homes in the COVID-19 era: applying recognition theory to the research agenda. QUALITY IN AGEING AND OLDER ADULTS 2020. [DOI: 10.1108/qaoa-09-2020-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Research can be an influential driver in raising care home standards and the well-being and human rights of residents. This paper aims to present a case for how a relational research capacity building programme could advance this agenda.
Design/methodology/approach
This study uses Axel Honneth’s Recognition Theory as a lens through which to explore organisational and institutional factors (such as research capacity and investment) that can either enable or limit “recognition” in the context of research in care homes. This paper draws on recent evidence from the COVID-19 pandemic in the UK and worldwide, to argue that such a relational capacity building agenda is even more pressing in the current context, and that it resonates with evidence from existing relational capacity building initiatives.
Findings
A lack of relevant research arguably contributed to the crisis experienced by the care home sector early in the pandemic, and there are only tentative signs that residents, care home providers and staff are now informing the COVID-19 research agenda. Evidence from pre COVID-19 and insights from Honneth’s Recognition Theory suggest that relational approaches to building research capacity within the care home sector can better generate evidence to inform practice.
Originality/value
This is a novel application of recognition theory to research in the care home sector. Drawing on theory, as well as evidence, has enabled the authors to provide a rationale as to why relationship-based research capacity building in care homes warrants further investment.
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Kirsch C, Doyle IM, Krause O, Junius-Walker U, Wiese B, Thürmann P, Sparenberg LC, Wollny A, Fuchs A, Wilm S, Joos S, Stolz R, Haumann H. „Lessons learned“ – Herausforderungen im Rekrutierungsprozess in der cluster-randomisierten Pflegeheimstudie „HIOPP-3 iTBX“. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 156-157:24-32. [DOI: 10.1016/j.zefq.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 02/01/2023]
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Neils-Strunjas J, Crandall KJ, Ding X, Gabbard A, Rassi S, Otto S. Facilitators and Barriers to Attendance in a Nursing Home Exercise Program. J Am Med Dir Assoc 2020; 22:803-808. [PMID: 33132017 DOI: 10.1016/j.jamda.2020.09.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/26/2020] [Accepted: 09/16/2020] [Indexed: 10/23/2022]
Abstract
Women and residents in Certified Nursing Homes (CNHs) with higher star ratings had better attendance in exercise and social engagement programming (ie, Bingocize) than men and residents in CNHs with lower ratings. OBJECTIVE The purpose of the current study was to determine whether resident factors and nursing home star ratings influenced attendance in Bingocize, a therapeutic exercise program that incorporates opportunities for social engagement in nursing homes. DESIGN This is a descriptive study of data collected across multiple nursing homes over 17 months. SETTING AND PARTICIPANTS Data were collected from residents in 25 certified nursing homes in the mid-southern United States. METHODS The program consisted of two 45-60-minute sessions each week. Bingocize attendance was recoded as number of sessions attended each month from September 2017 to February 2019 in 25 nursing homes. The impact of gender, age, cognitive functioning, and Nursing Home Star Ratings on adherence to the program based on percentage of Bingocize sessions attended was analyzed. RESULTS A total of 1165 residents of certified nursing homes were recruited and participated in Bingocize; 55% of participants attended Bingocize infrequently or had poor attendance, 21% of the participants had average attendance, and 24% had good attendance. The association between gender and level of attendance was significant (P = .045). The star rating of the nursing home also affected attendance. As star level of the nursing home increased, the percentage of good attendance increased (P < .001): 19.12% (1 star), 20.69% (2 stars), 23.57% (3 stars), 33.76% (4 stars), and 36.63% (5 stars). Neither age nor cognitive functioning [based on Brief Interview of Mental Status (BIMS)] had a significant impact on attendance. CONCLUSIONS AND IMPLICATIONS We examined adherence to an exercise program called Bingocize based on percentage of sessions attended in 25 nursing homes. Women and residents in nursing homes with higher star ratings were reported to have better attendance in Bingocize than men or residents in nursing homes with lower ratings, respectively. Residents of all ages and cognitive ability can successfully participate in the Bingocize program.
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Affiliation(s)
- Jean Neils-Strunjas
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA; Department of Communication Sciences and Disorders, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - K Jason Crandall
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA
| | - Xiuhua Ding
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA
| | - Annika Gabbard
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA
| | - Sepehr Rassi
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA
| | - Spencer Otto
- College of Health and Human Services, Western Kentucky University, Bowling Green, KY, USA
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Crayton E, Richardson M, Fuller C, Smith C, Liu S, Forbes G, Anderson N, Shallcross L, Michie S, Hayward A, Lorencatto F. Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review. BMC Geriatr 2020; 20:237. [PMID: 32646382 PMCID: PMC7350746 DOI: 10.1186/s12877-020-01564-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 04/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background Overuse of antibiotics has contributed to antimicrobial resistance; a growing public health threat. In long-term care facilities, levels of inappropriate prescribing are as high as 75%. Numerous interventions targeting long-term care facilities’ antimicrobial stewardship have been reported with varying, and largely unexplained, effects. Therefore, this review aimed to apply behavioural science frameworks to specify the component behaviour change techniques of stewardship interventions in long-term care facilities and identify those components associated with improved outcomes. Method A systematic review (CRD42018103803) was conducted through electronic database searches. Two behavioural science frameworks, the Behaviour Change Wheel and Behaviour Change Technique Taxonomy were used to classify intervention descriptions into intervention types and component behaviour change techniques used. Study design and outcome heterogeneity prevented meta-analysis and meta-regression. Interventions were categorised as ‘very promising’ (all outcomes statistically significant), ‘quite promising’ (some outcomes statistically significant), or ‘not promising’ (no outcomes statistically significant). ‘Promise ratios’ (PR) were calculated for identified intervention types and behaviour change techniques by dividing the number of (very or quite) promising interventions featuring the intervention type or behaviour change technique by the number of interventions featuring the intervention type or behaviour change technique that were not promising. Promising intervention types and behaviour change techniques were defined as those with a PR ≥ 2. Results Twenty studies (of19 interventions) were included. Seven interventions (37%) were ‘very promising’, eight ‘quite promising’ (42%) and four ‘not promising’ (21%). Most promising intervention types were ‘persuasion’ (n = 12; promise ratio (PR) = 5.0), ‘enablement’ (n = 16; PR = 4.33) and ‘education’ (n = 19; PR = 3.75). Most promising behaviour change techniques were ‘feedback on behaviour’ (n = 9; PR = 8.0) and ‘restructuring the social environment’ (e.g. staff role changes; n = 8; PR = 7.0). Conclusion Systematic identification of the active ingredients of antimicrobial stewardship in long-term care facilities was facilitated through the application of behavioural science frameworks. Incorporating environmental restructuring and performance feedback may be promising intervention strategies for antimicrobial stewardship interventions within long-term care facilities.
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Affiliation(s)
- Elise Crayton
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
| | - Michelle Richardson
- Institute of Education (IOE), University College London, London, WC1H 0NS, UK
| | - Chris Fuller
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Catherine Smith
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Sunny Liu
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Gillian Forbes
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Niall Anderson
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.,Health Protection Research Unit in Evaluation of Interventions, National Institute of Health Research (NIHR), London, BS8 2BN, UK
| | - Laura Shallcross
- Institute of Health Informatics, University College London, London, NW1 2DA, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.,Health Protection Research Unit in Evaluation of Interventions, National Institute of Health Research (NIHR), London, BS8 2BN, UK
| | - Andrew Hayward
- Institute of Epidemiology & Health, University College London, London, WC1E 7HB, UK
| | - Fabiana Lorencatto
- Department of Clinical, Educational and Health Psychology, Centre for Behaviour Change, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.,Health Protection Research Unit in Evaluation of Interventions, National Institute of Health Research (NIHR), London, BS8 2BN, UK
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Socially Assistive Robots, Older Adults and Research Ethics: The Case for Case-Based Ethics Training. Int J Soc Robot 2020. [DOI: 10.1007/s12369-020-00652-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Jain B, Syed S, Hafford-Letchfield T, O'Farrell-Pearce S. Dog-assisted interventions and outcomes for older adults in residential long-term care facilities: A systematic review and meta-analysis. Int J Older People Nurs 2020; 15:e12320. [PMID: 32394594 DOI: 10.1111/opn.12320] [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: 05/21/2019] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To comprehensively review studies on dog-assisted interventions (DAIs) among older people in residential long-term care facilities (RLTCFs) and to provide an overview of their interventions, outcomes and methodological quality. METHOD We searched 18 electronic databases to identify English articles (published January 2000-December 2019) reporting on well-defined DAIs targeting older adults (≥65 years) in RLTCF. Data were extracted by two independent reviewers. Descriptive statistics were produced for quantitative studies, with key themes identified among qualitative studies. Where possible, estimates were pooled from randomised controlled trials using random effects meta-analyses. RESULTS Forty-three relevant studies (39 quantitative; 4 qualitative) were identified. The majority of quantitative studies were assessed as low-quality according to the MMAT criteria (n = 26, 67%). Almost half of the quantitative studies (n = 18, 46%) found no significant changes over time or between groups across outcomes measured. The most salient intervention effects included improved social functioning (n = 10), reduced depressive symptoms (n = 6) and loneliness (n = 5). A random-effects meta-analysis revealed a medium effect in favour of DAT on reducing depressive or loneliness symptoms (pooled SMD: 0.66, 95%CI 0.21-1.11; I2 = 50.5; five trials), relative to treatment as usual. However, compared to treatment as usual, no overall effect of DAI on activities of daily living was detected (p = .737). Key themes from qualitative studies included (a) animals as effective transitional objects, (b) the therapeutic value of pets and (c) the significance of the care environment and stakeholders in facilitating DAI. IMPLICATIONS FOR PRACTICE The findings of this review indicate that while DAI has value for older people in RLTCF, challenges remain in accurately measuring its impact to provide a stronger evidence-base. Standardisation of DAI service design, delivery and evaluation is required for future research and practice in providing holistic care for older adults.
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Affiliation(s)
- Briony Jain
- Department of Mental Health and Social Work, Middlesex University, London, UK
| | - Shabeer Syed
- Department of Mental Health and Social Work, Middlesex University, London, UK
| | - Trish Hafford-Letchfield
- Department of Mental Health and Social Work, Middlesex University, London, UK.,School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
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Challenges of infection prevention and control in Scottish long-term care facilities. Infect Control Hosp Epidemiol 2020; 41:943-945. [PMID: 32317037 DOI: 10.1017/ice.2020.113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Residents living in long-term care facilities (LTCFs) are at high risk of contracting healthcare-associated infections (HAIs). The unique operational and cultural characteristics of LTCFs and the currently evolving models of healthcare delivery in Scotland create great challenges for infection prevention and control (IPC). Existing literature that discusses the challenges of infection control in LTCFs focuses on operational factors within a facility and does not explore the challenges associated with higher levels of management and the lack of evidence to support IPC practices in this setting.1-7 Here, we provide a broader view of challenges faced by LTCFs in the context of the current health and social care models in Scotland. Many of these challenges are also faced in the rest of the United Kingdom and internationally.
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Verbeek H, Zwakhalen SMG, Schols JMGA, Kempen GIJM, Hamers JPH. The Living Lab In Ageing and Long-Term Care: A Sustainable Model for Translational Research Improving Quality of Life, Quality of Care and Quality of Work. J Nutr Health Aging 2020; 24:43-47. [PMID: 31886807 PMCID: PMC6934630 DOI: 10.1007/s12603-019-1288-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 07/02/2019] [Indexed: 01/27/2023]
Abstract
There is a strong need in long-term care for scientific research, so older people and their families, health care professionals, policy makers, and educators can benefit from new advancements and best available evidence in every day care practice. This paper presents the model of a sustainable and successful interdisciplinary collaboration between scientists, care providers and educators in long-term care: the "Living Lab in Ageing and Long-Term Care" by Maastricht University in the Netherlands. Its mission is to contribute with scientific research to improving i) quality of life of older people and their families; ii) quality of care and iii) quality of work of those working in long-term care. Key working mechanisms are the Linking Pins and interdisciplinary partnership using a team science approach, with great scientific and societal impact. A blueprint for the model is discussed, describing its business model and challenges in getting the model operational and sustainable are discussed.
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Affiliation(s)
- H Verbeek
- Dr. Hilde Verbeek, Associate Professor, Department of Health Services Research, CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands,
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