Neurodevelopmental disorders and neurodiversity: definition of terms from Scotland's National Autism Implementation Team.

Adults with neurodevelopmental disorders frequently present to, but fit uneasily into, adult mental health services. We offer definitions of important terms related to neurodevelopmental disorders through unifying research data, medical and other viewpoints. This may improve understanding, clinical practice and development of neurodevelopmental disorder pathways within adult mental health services.

Psychometric properties of the School Participation Questionnaire: Testing a measure of participation-related constructs.

AIM: To explore concurrent validity, convergent validity, interrater reliability, test-retest reliability, and Rasch model analysis of the School Participation Questionnaire (SPQ), a tool for teachers to assess personal and environmental determinants of school participation. METHOD: Teachers of children with additional support needs, including intellectual disability, autism, and learning difficulties completed measures. Data were collected using the SPQ and the Participation and Environment Measure for Children and Youth (PEM-CY). Test-retest and interrater reliability were assessed using intraclass correlation coefficients (ICCs). Internal consistency was assessed with Cronbach's alpha. Concurrent and convergent validity were explored via correlations with the PEM-CY. Further psychometrics were examined using a Rasch model. RESULTS: One hundred and eighty-seven children (136 [72.7%] male; mean age 9y [range 5y 6mo-12y 10mo, SD 2y]) were assessed by 67 teachers. Cronbach's alpha, test-retest, and interrater reliability were acceptable-excellent across each SPQ scale (alphas=0.89, 0.9, 0.94, 0.79; test-retest ICCs=0.64, 0.61, 0.78, 0.62; interrater ICCs=0.85, 0.71, 0.90, 0.81). Concurrent and convergent validity were confirmed with significant positive correlations between SPQ and PEM-CY. After Mokken and Rasch model analysis, person and item reliability were good, and unidimensionality was confirmed. Mean administration time was 8.2 minutes. INTERPRETATION: The results suggest that the SPQ is a rapid, reliable, and valid tool for assessment of participation-related indicators in schools.

Associations between Adolescent Psychosocial Factors and Disengagement from Education and Employment in Young Adulthood among Individuals with Common Mental Health Problems.

Transition to adulthood can be a challenging developmental task for adolescents with common mental health problems and is linked to adverse outcomes such as 'not in education, employment or training' (NEET). This study investigated longitudinal associations between adolescent psychosocial factors (e.g., self-esteem, aspirations, bullying, physical activity) and later NEET status among individuals with common mental health problems (i.e., depression and anxiety). A secondary data analysis of the Next Steps cohort study was completed using waves 2 and 8. Psychosocial factors, mental health, and background characteristics were captured when participants were aged 15-16 years (wave 2) while still in compulsory education. The 12-item General Health Questionnaire was used to identify adolescents with common mental health problems. The study population consisted of 2224 participants (females 66.8%) of which 1473 (66.2%) were aged 15 years and 751 (33.8%) were aged 16 years in wave 2. The outcome was NEET status at ages 25-26 years (wave 8). The results showed that after adjusting for background characteristics, adolescent self-esteem, locus of control, bullying, physical activity, job aspirations, and attitudes to school predicted NEET status. Educational aspirations, substance use, and behavioural problems were not significantly associated with NEET status. These findings provide new insights into the role of adolescent psychosocial factors in the context of education and employment outcomes for youth at risk and highlight the necessity of targeted mental health support to improve life chances.

The effectiveness and cost-effectiveness of assistive technology and telecare for independent living in dementia: a randomised controlled trial.

OBJECTIVES: The use of assistive technology and telecare (ATT) has been promoted to manage risks associated with independent living in people with dementia but with little evidence for effectiveness. METHODS: Participants were randomly assigned to receive an ATT assessment followed by installation of all appropriate ATT devices or limited control of appropriate ATT. The primary outcomes were time to institutionalisation and cost-effectiveness. Key secondary outcomes were number of incidents involving risks to safety, burden and stress in family caregivers and quality of life. RESULTS: Participants were assigned to receive full ATT (248 participants) or the limited control (247 participants). After adjusting for baseline imbalance of activities of daily living score, HR for median pre-institutionalisation survival was 0.84; 95% CI, 0.63 to 1.12; P = 0.20. There were no significant differences between arms in health and social care (mean -£909; 95% CI, -£5,336 to £3,345, P = 0.678) and societal costs (mean -£3,545; 95% CI, -£13,914 to £6,581, P = 0.499). ATT group members had reduced participant-rated quality-adjusted life years (QALYs) at 104 weeks (mean - 0.105; 95% CI, -0.204 to -0.007, P = 0.037) but did not differ in QALYs derived from proxy-reported EQ-5D. DISCUSSION: Fidelity of the intervention was low in terms of matching ATT assessment, recommendations and installation. This, however, reflects current practice within adult social care in England. CONCLUSIONS: Time living independently outside a care home was not significantly longer in participants who received full ATT and ATT was not cost-effective. Participants with full ATT attained fewer QALYs based on participant-reported EQ-5D than controls at 104 weeks.

Differences in assistive technology installed for people with dementia living at home who have wandering and safety risks.

BACKGROUND: Assistive Technology for people with dementia living at home is not meeting their care needs. Reasons for this may be due to limited understanding of variation in multiple characteristics of people with dementia including their safety and wandering risks, and how these affect their assistive technology requirements. This study therefore aimed to explore the possibility of grouping people with dementia according to data describing multiple person characteristics. Then to investigate the relationships between these groupings and installed Assistive Technology interventions. METHODS: Partitioning Around Medoids cluster analysis was used to determine participant groupings based upon secondary data which described the person characteristics of 451 people with dementia with Assistive Technology needs. Relationships between installed Assistive Technology and participant groupings were then examined. RESULTS: Two robust clustering solutions were identified within the person characteristics data. Relationships between the clustering solutions and installed Assistive Technology data indicate the utility of this method for exploring the impact of multiple characteristics on Assistive technology installations. Living situation and caregiver support influence installation of assistive technology more strongly than level of risk or cognitive impairment. People with dementia living alone received different AT from those living with others. CONCLUSIONS: Results suggest that caregiver support and the living situation of the person with dementia influence the type and frequency of installed Assistive Technology. Reasons for this include the needs of the caregiver themselves, the caregiver view of the participants' needs, caregiver response to alerts, and the caregiver contribution to the assistive technology assessment and selection process. Selection processes should be refined to account for the needs and views of both caregivers and people with dementia. This will require additional assessor training, and the development of validated assessments for people with dementia who have additional impairments. Policies should support the development of services which provide a wider range of AT to facilitate interventions which are focused on the needs of the person with dementia.

Participation as means for adaptation in dementia: a conceptual model.

OBJECTIVES: There are a number of conceptual models of dementia, capturing a range of biopsychosocial factors. Few integrate the lived experience of dementia. The aim of this study was to develop a conceptualisation grounded in the first-hand accounts of living with the condition and reflecting its complexity. METHOD: The study was conducted within an explanatory, critical realist paradigm. An overarching narrative approach, informed by a previously completed systematic review and metasynthesis of research on the lived experience of dementia and the assumptions of complexity theory, was used to guide data collection and analysis. Data were contributed by 31 adults, including 12 people living with dementia and 19 family caregivers. RESULTS: The experience of living with dementia was conceptualised as a process of adaptation through participation, emerging from ongoing, dynamic and nonlinear interactions between the adaptive capacity of a person with dementia and the adaptive capacity within the environment. The proposed conceptual model describes contexts and mechanisms which shape this capacity. It identifies a range of potential outcomes in dementia. These outcomes reflect interactions and the degree of match between the adaptive capacity of a person and the adaptive capacity within the environment. CONCLUSION: By recognising and exploring the potential for adaptation and enduring participation in dementia, findings of this research can support practitioners in facilitating positive outcomes for people affected by the condition.

Exploring the needs of people with dementia living at home reported by people with dementia and informal caregivers: a systematic review and Meta-analysis.

OBJECTIVES: To provide prevalence estimates of needs of people with dementia living at home, and to determine sources of variation associated with needs for this population. METHOD: A systematic review and meta-analysis was performed searching CINAHL, MEDLINE, PsycINFO and ASSIA databases. Following quality checks, random effects meta-analysis produced prevalence estimates for needs reported by people with dementia and by their informal caregivers. Fixed effects models were undertaken to compare caregiver and person with dementia reported needs. Heterogeneity was explored through sensitivity analysis. The study protocol was registered with Prospero #CRD42017074119. RESULTS: Six retrieved studies published between 2005 and 2017 including 1011 people with dementia and 1188 caregivers were included in the analysis. All data were collected using Camberwell Assessment of Need for the Elderly. Prevalence estimates are provided for 24 needs reported by participants in The Netherlands, United Kingdom, Poland, Ireland, Germany, Norway, Portugal, Italy and Sweden. Most prevalent needs reported by people with dementia were Memory 0.713 [95% CI 0.627, 0.791]; Food 0.706 [95% CI 0.547, 0.842]; Household activities 0.677 [95% CI 0.613, 0.738]; and Money 0.566 [95% CI 0.416, 0.711]. Caregivers reported greater prevalence than people with dementia did for 22 of 24 needs, although the priority ranking of needs was similar. Exploration of heterogeneity revealed that people with young onset dementia were the major source of variation for 24 out of 48 analyses. CONCLUSION: Increased understanding of prevalence of needs of people with dementia and associated heterogeneity can assist in planning services to meet those needs.

Community-based participation of children with and without disabilities.

AIM: To describe and compare the socio-demographic characteristics and community-based participation of children with and without disabilities. METHOD: This cross-sectional study reports data on 1073 children with disabilities (663 males, 410 females) and 11 122 children without disabilities (5617 males, 5505 females) aged 10 to 12 years from the fifth sweep of the Millennium Cohort Study. χ2 was used to explore differences between the two groups. Logistic regression models were used to assess the relationships between childhood disability (dependent variable) and socio-demographic characteristics. Logistic regression models were also used to examine the associations between childhood disability (dependent variable) and participation in community-based activities. RESULTS: Children with disabilities were more likely to be male, have psychosocial and behavioural problems, live in single-parent households, and have a parent with a longstanding illness. Patterns of community-based participation were similar between children with and without disabilities. However, the extent to which the two groups participated differed. Children with disabilities participated with lower frequency in unstructured physical activities (adjusted odds ratio [OR] 2.41; 95% confidence interval [CI]: 1.95-2.99), organized physical activities (adjusted OR 2.29; 95% CI: 1.83-2.86), religious gatherings (adjusted OR 2.08; 95% CI: 1.35-3.20), and getting together with friends (adjusted OR 3.31; 95% CI: 2.61-4.20). INTERPRETATION: Socio-demographic characteristics differed between children with and without disabilities. Children with disabilities had greater restriction in participation compared to peers without disabilities. Participation promoting interventions are required to support the participation of children with disabilities in social and physical activities. WHAT THIS PAPER ADDS: Patterns of community-based participation were similar between children with and without disabilities. Children with disabilities had lower frequency of participation in physical activities, religious gatherings, and getting together with friends.

An enhanced individual placement and support (IPS) intervention based on the Model of Human Occupation (MOHO); a prospective cohort study.

BACKGROUND: Employment is good for physical and mental health, however people with severe mental illness (SMI) are often excluded from employment. Standard Individual Placement and Support (IPS) is effective in supporting around 55% of people with SMI into employment or education. Current research considers enhancements to IPS to improve outcomes for those requiring more complex interventions. Clinicians need to better understand who will benefit from these enhanced IPS interventions. This study offers a new enhanced IPS intervention and an approach to predicting who may achieve successful outcomes. METHODS: This prospective cohort study included people with SMI who participated in an enhanced IPS service and had prolonged absence from employment. Secondary data analysis was conducted of data gathered in routine clinical practice. Univariate analysis coupled with previous research and clinical consultation was used to select variables to be included in the initial model, followed by a backward stepwise approach to model building for the final multiple logistic regression model with an outcome of successful or unsuccessful goal attainment (employment or education). RESULTS: Sixty-three percent of participants in the enhanced IPS successfully attained employment or education. Significant relationships from bivariate analyses were identified between outcomes (employment or education) and seven psychosocial variables. Adapting Routines to Minimise Difficulties, Work Related Goals, and Living in an Area of Lesser Deprivation were found to be significant in predicting employment or education in the final multiple logistic regression model R2 = 0.16 (Hosmer-Lemeshow), 0.19 (Cox-Snell), 0.26 (Nagelkerke). Model χ2(7) = 41.38 p < .001. CONCLUSION: An enhanced IPS service had a 63% rate success in achieving employment or education, higher than comparable studies and provides an alternative to IPS-Lite and IPS-standard for more complex populations. Motivational and habitual psychosocial variables are helpful in predicting who may benefit from an enhanced IPS intervention supporting people after prolonged absence from employment. TRIAL REGISTRATION: NCT04083404 Registered 05 September 2019 (retrospectively registered).

Quality of life outcomes for people with serious mental illness living in supported accommodation: systematic review and meta-analysis.

PURPOSE: To conduct a systematic review and meta-analysis of quality of life (QoL) outcomes for people with serious mental illness living in three types of supported accommodation. METHODS: Studies were identified that described QoL outcomes for people with serious mental illness living in supported accommodation in six electronic databases. We applied a random-effects model to derive the meta-analytic results. RESULTS: 13 studies from 7 countries were included, with 3276 participants receiving high support (457), supported housing (1576) and floating outreach (1243). QoL outcomes related to wellbeing, living conditions and social functioning were compared between different supported accommodation types. Living condition outcomes were better for people living in supported housing ([Formula: see text]= - 0.31; CI = [- 0.47; - 0.16]) and floating outreach ([Formula: see text]= - 0.95; CI = [- 1.30; - 0.61]) compared to high-support accommodation, with a medium effect size for living condition outcomes between supported housing and floating outreach ([Formula: see text]= - 0.40; CI = [- 0.82; 0.03]), indicating that living conditions are better for people living in floating outreach. Social functioning outcomes were significant for people living in supported housing compared to high support ([Formula: see text] = - 0.37; CI = [- 0.65; - 0.09]), with wellbeing outcomes not significant between the three types of supported accommodation. CONCLUSION: There is evidence that satisfaction with living conditions differs across supported accommodation types. The results suggest there is a need to focus on improving social functioning and wellbeing outcomes for people with serious mental illness across supported accommodation types.

Family factors associated with participation of children with disabilities: a systematic review.

AIM: The aim of this review was to synthesize empirical evidence of family factors associated with participation of children with disabilities aged 5 to 12 years to inform the development of family-centred participation-fostering interventions. METHOD: A systematic search was performed for articles published in English between 2001 and 2017 in MEDLINE, PsycINFO, CINAHL, Scopus, and ASSIA following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Quality of evidence was appraised using the Research Triangle Institute Item Bank. Family factors associated with participation were identified and assessed using a multistage 'semi-quantitative' approach. RESULTS: Thirty studies were included in the review. Four non-modifiable 'status' factors consistently associated with participation were parental ethnicity, parental education, family type, and family socio-economic status. Six modifiable 'process' factors with consistent associations with participation were parental mental and physical health functioning, parental self-efficacy beliefs, parental support, parental time, family preferences, and activity orientation. INTERPRETATION: Rehabilitation professionals should direct their focus towards modifiable family factors as primary targets for family-centred interventions. Strategies that can improve families' access to information, counselling, and community support services are likely to support children's participation by empowering families and optimizing their health and well-being. WHAT THIS PAPER ADDS: Non-modifiable 'status' and modifiable 'process' factors are important in participation of children with disabilities. Disadvantaged family circumstances shaped by status factors are associated with reduced participation. Key process factors for intervention are parental mental and physical health and parental self-efficacy beliefs. Other important process factors for intervention are parental support and time, family preferences, and activity orientation.

FACTORES FAMILIARES ASOCIADOS CON LA PARTICIPACIÓN DE NIÑOS CON DISCAPACIDAD: UN ESTUDIO SISTEMÁTICO: OBJETIVO: El objetivo de esta revisión fue sintetizar la evidencia empírica de los factores familiares asociados con la participación de niños con discapacidad entre los 5 y 12 años para informar el desarrollo de intervenciones que fomentan la participación centrada en la familia METODO: Una búsqueda sistemática fue realizada en artículos publicados en ingles entre 2001 y 2017 en MEDLINE, PsycINFO, CINAHL, Scopus, y ASSIA de acuerdo con los items reportados preferentes para guías de Búsqueda Sistemática y Meta-Análisis. La calidad de la evidencia fue evaluada utilizando el Banco de Items del Research Triangle Institute (RTI). Fueron identificados los factores familiares asociados con la participación y evaluados utilizando un enfoque semicuantitativo de varias etapas. RESULTADOS: Fueron incluidos 30 estudios en esta revisión. Cuatro factores no modificables de ¨estado¨ asociados sistemáticamente con la participación fueron la etnia de los padres, el nivel de educación de los padres, el tipo de familia, y el estatus socioeconómico de las familias. Seis factores de ¨proceso ¨modificables con asociaciones consistentes con la participación fueron el funcionamiento de salud física y mental de los padres, creencia de autoeficacia de los padres, soporte parenteral, tiempo de los padres, preferencias familiares, y orientación a la actividad. INTERPRETACION: Los profesionales de la rehabilitación deben dirigir su foco hacia los factores modificables como objetivo primario para las intervenciones centradas en la familia. Estrategias que puedan mejorar el acceso de las familias a la información , asesoramiento, y servicios de apoyo comunitario que apoyen la participación de los niños y empoderar a las familias y optimizar su salud y bienestar.

FATORES FAMILIARES ASSOCIADOS COM PARTICIPAÇÃO EM CRIANÇAS COM INCAPACIDADES: UMA REVISÃO SISTEMÁTICA: OBJETIVO: O objetivo desta revisão foi sintetizar a evidência empírica de fatores familiares associados com participação de crianças com incapacidades de 5 a 12 anos para informar o desenvolvimento de intevenções centradas na família que promovam a participação. MÉTODO: Uma busca sistemática foi realizada por artigos publicados em ingles entre 2001 e 2007 na Medline, PsycINFO, CINAHL, Scopus, e ASSIA seguindo as diretrizes para Itens preferidos a serem reportados em revisões sistemáticas. A qualidade da evidência foi avaliada usando o Banco de Itens Do Institututo do Triângulo das Pesquisas (ITR). Fatores familiares associados à participação foram identificados e avaliados usando uma abordagem semi-quantitativa multi-estágios. RESULTADOS: Trinta estudos foram incluídos na revisão. Quatro fatores com estado "não-modificável" consistentemente associados com participação foram etnia parental, educação parental, tipo de família e situação sócio-econômica da família. Seis fatores de "processo" modificáveis com associações consistentes com participação foram saúde e funcionamento mental e físico dos pais, auto-eficácia parental, apoio parental, tempo parental, preferências familiares e orientacões para atividades. INTERPRETAÇÃO: Profissionais de reabilitação devem direcionar o foco para fatores familiares potencialmente modificáveis como alvos primários para intervenções centradas na família. Estratégias que podem melhorar o acesso da família a informação, aconselhamento e serviços de suporte na comunidade têm probabilidade de apoiar a participação da criança por empoderar famílias e otimizar sua saúde e bem estar.

Family group conferencing in dementia care: an exploration of opportunities and challenges.

BACKGROUND: The Family Group Conference (FGC) is an approach to partnership working which brings together service users, their support network and care professionals in a family-led decision making forum. Evidence, though limited, indicates that that FGC can enhance outcomes for service providers and their users. This study aimed to evaluate the impact of the pilot FGC service, delivered to people with dementia and their families, in terms of the experience of care provision by families and care professionals involved in the project. METHODS: Focus group interviews were conducted with families and professionals participating in the pilot intervention. RESULTS: FGC was perceived as having the potential to positively impact service users, their families, service providers and the wider culture of care. However, despite an overall positive evaluation the participants identified a number of challenges related to service implementation. Both the opportunities and challenges identified in this study are discussed in the context of the existing international evidence base. CONCLUSIONS: This study contributes to a better understanding of the applicability of FGC as a strategy to support people with dementia and their families. Although promising in terms of potential outcomes for service users and providers, FGC presents challenges which need to be carefully managed in order to secure maximum benefit to all parties.

Scholarship of Practice in the Care of People with Dementia: Creating the Future Through Collaborative Efforts.

A scholarship of practice approach sets the stage for collaborative partnerships across academic and clinical practice settings that result in positive gains for all stakeholders. These gains include an enhanced ability to generate and apply relevant evidence in practice, disseminate knowledge and innovation, and ensure best practice is relevant to and effective for, people receiving services and their caregivers. This paper discusses national and international examples of collaborative, research-based practice initiatives that have implemented a scholarship of practice approach. The exemplars described here are framed within the Model of Human Occupation, which addresses the importance of volition, habits, roles, environment, and performance capacities in facilitating engagement in occupation for people with dementia. Research that focuses on how therapists adopt and use evidence in practice, as well as the opportunities and challenges for supporting therapists and their use of theory and evidence are discussed.

Service-related needs of older people with dementia: perspectives of service users and their unpaid carers.

BACKGROUND: Dementia is a major cause of disability among older people and constitutes one of the greatest challenges currently facing families and health and social care services in the developed world. In response to trends in dementia prevalence and the impact the condition has on peoples' lives, dementia care has been placed high on the public and political agenda in the United Kingdom. However, despite significant public resources being allocated to combat the impact of the disease, recent evidence indicates that numerous challenges in relation to service provision remain. This study aimed to develop a deeper understanding of the lived experience of people with dementia regarding their service-related needs. METHOD: The study made use of data gathered through individual semi-structured, narrative interviews conducted with persons with experience of dementia and their unpaid carers. RESULTS: Although participants were generally satisfied with the services they received, a number of unmet needs related to service provision were identified. In terms of diagnostic procedures the findings of this study indicate the need for early diagnosis delivered through a comprehensive assessment package. The participants also highlighted the need for well-coordinated post-diagnostic support, greater continuity of care concerning the personnel involved, and enhanced access to non-pharmacological interventions to support identity and social engagement. CONCLUSION: This study contributes to a better understanding of service-related needs of people with dementia in relation to diagnostic procedures and post-diagnostic support.

Readiness for employment: perceptions of mental health service users.

Work is good for both physical and mental health, and access to work is a basic human right. People with mental health conditions want to work and with the right support can work but are often excluded from the workplace. We explored factors influencing individual's perceptions of their readiness for employment. Participants' narratives focused particularly on personal causation and it's inter-reactions with other aspects of volition, habituation and the environment and highlight a number of key areas, which are discussed in relation to service provision. Sheltered workshops offer support and some structure and routine but may limit an individual's readiness for employment. Services should be evidence based and focused on real work opportunities which fit with individual's interests and values. Occupational therapy theory offers a unique and valuable perspective in understanding perceptions of readiness for employment and occupational therapists offer valid and useful assessments and interventions for vocational rehabilitation.

Vocational rehabilitation: facilitating evidence based practice through participatory action research.

BACKGROUND: Improving vocational rehabilitation in line with the current evidence base is an area of considerable interest. Aims To describe the strategies used by a multidisciplinary team in the initial stages of a participatory action research (PAR) approach to improving a vocational rehabilitation service. METHOD: A literature review and PAR process were completed. One hundred and fifteen participants engaged in multifaceted data collection and analysis, building consensus around key principles for a new vocational rehabilitation service. RESULTS: A synthesis of our literature review and PAR process was developed into a set of principles for practice which we plan to implement across the service. CONCLUSIONS: We have developed methodologies in interdisciplinary collaborations spanning statutory and non-statutory services. We have developed a set of principles for practice and detailed plans for implementation are being drawn up to inform provision in the future.

Establishing the measurement properties of the Residential Environment Impact Scale (Version 4.0).

BACKGROUND: Developed as an environment assessment informed by the Model of Human Occupation, the Residential Environment Impact Survey considered the physical, social and activity features of the environment, evaluating the impact of the environment on resident's quality of life. Clinicians reported that the Residential Environment Impact Survey was a useful tool; however, it had not been structured to be a measurement tool and did not have established psychometric properties. AIMS/OBJECTIVES: This study examines the psychometric properties of the restructured Residential Environment Impact Scale Version 4.0 (REIS), which measures the level of environment support provided to residents. MATERIAL AND METHODS: The REIS was completed across residential sites for people with complex mental health needs. A many facets Rasch analysis was conducted to establish the reliability and validity of the REIS. RESULTS: The REIS demonstrated reasonable psychometric properties, with items demonstrating internal scale validity and scale items following an expected pattern of increasingly challenging environment support. CONCLUSIONS AND SIGNIFICANCE: Initial evidence suggests that the REIS provides a valid and reliable measure of environment support, providing a detailed assessment of how physical, social and activity elements of the environment support or inhibit participation and can be applied across a range of living environments.

A Systematic Review and Correlational Meta-Analysis of Factors Associated With Resilience of Normally Aging, Community-Living Older Adults.

BACKGROUND AND OBJECTIVES: Global policy emphasizes the need to promote healthy aging through supporting inclusivity, safety, and functional independence. Research indicates that efforts to enhance resilience can contribute to meeting these objectives. We employed a meta-analytical approach to examine evidence on resilience in community-living older adults. RESEARCH DESIGN AND METHODS: We searched electronic databases until January 13, 2020 for observational studies investigating factors associated with resilience in this population. Articles had to provide quantitative data based on standardized assessment and include samples where mean participants' age and lower 95% confidence interval were more than 55 years. We included 49 studies reported in 43 articles and completed 38 independent meta-analyses, 27 for personal and 11 for contextual factors associated with resilience. RESULTS: A range of personal and contextual factors were significantly associated with resilience, with effects sizes predominantly small to moderate (0.1 < r < 0.49). Factors reflecting psychological and physical well-being and access to/quality of social support were associated with higher resilience. Factors indicative of poorer psychological well-being and social challenges were associated with lower resilience. Longitudinal evidence was limited. The level of between-study heterogeneity was substantial to considerable. Where relevant analysis was possible, the identified publication bias was also considerable. DISCUSSION AND IMPLICATIONS: The quality of the available evidence, as well as issues related to measurement of resilience, indicates the need for further work relative to its conceptualization and assessment. The presented findings have important clinical implications, particularly within the context of the coronavirus disease 2019 impact on resilience in older adults.

Key characteristics of knowledge transfer and exchange in healthcare: integrative literature review.

AIM: This paper presents the results of a review of literature relating to knowledge transfer and exchange in healthcare. BACKGROUND: Treatment, planning and policy decisions in contemporary nursing and healthcare should be based on sound evidence wherever possible, but research knowledge remains generally underused. Knowledge transfer and exchange initiatives aim to facilitate the accessibility, application and production of evidence and may provide solutions to this challenge. This review was conducted to help inform the design and implementation of knowledge transfer and exchange activities for a large healthcare organization. DATA SOURCES: Databases: ASSIA, Business Source Premier, CINAHL, PsychInfo, Medline and the Cochrane Database of Systematic Reviews. REVIEW METHODS: An integrative literature review was carried out including an extensive literature search. English language systematic reviews, literature reviews, primary quantitative and qualitative papers and grey literature of high relevance evaluating, describing or discussing knowledge transfer or exchange activities in healthcare were included for review (January 1990-September 2009). FINDINGS: Thirty-three papers were reviewed (four systematic reviews, nine literature reviews, one environmental scan, nine empirical studies and ten case studies). CONCLUSION: Robust research into knowledge transfer and exchange in healthcare is limited. Analysis of a wide range of evidence indicates a number of commonly featured characteristics but further evaluation of these activities would benefit their application in facilitating evidence-based practice in nursing.