Resident-, family-, and staff-identified goals for rehabilitation of long-term care residents with dementia: a qualitative study.

BACKGROUND: Long-term care (LTC) residents with dementia can benefit from rehabilitation to improve function and quality of life. However, specific goals for rehabilitation with this population are not always clear. The purpose of this study was to describe the goals for rehabilitation for LTC residents with dementia from the perspective of residents, family, and staff. METHODS: This was a phenomenological qualitative study. LTC residents with moderate to severe dementia, family members, and staff were recruited from two LTC homes in Halifax, Nova Scotia. Data were collected through semi-structured interviews and field notes from observations with residents while they were being active within the home. Data were analyzed via the principles of thematic content analysis, mapped onto the International Classification of Functioning, Disability, and Health (ICF) Model, and reported by the participant group (i.e., residents, family, or staff). RESULTS: The 15 participants were three female residents aged 82 to 98 years, seven predominantly (86%) female family members aged 56 to 74 years, and five staff members (two females, three males, aged 22 to 55 years) who were physiotherapists, a physiotherapy assistant, a healthcare aide, and a registered licenced practical nurse. Most identified goals fell within the activities and participation constructs of the ICF model and focused on maintaining or improving function, mobility, and quality of life. Specific themes included preventing falls, walking or locomoting, stair climbing, maintaining activities of daily living, engaging in enjoyable exercise, maintaining independence and human connections, keeping busy, leaving the home for activities, and participating in group activities. CONCLUSIONS: Rehabilitation goals for LTC residents living with dementia often focus on quality of life and functional activities and participation in LTC and family activities and events. Function and quality of life are interrelated, whereby functional goals influence quality of life. While some goals focus on improvement in function, maintenance or prevention of decline were also key elements. Future work should ensure rehabilitation interventions are developed relative to individually identified goals, and interventional success is measured in relation to the goal.

An exploration of Canadian transitional care programs for older adults.

Transitional care programs are effective for improving patient outcomes upon discharge from acute care services and reducing the burden of healthcare costs; however, little is known about the types of transitional care programs for older adults across Canada. This exploratory study gathered an in-depth understanding of Canadian transitional care programs and described how each program functions to support older adults and family/friend caregivers. Nine key informants were interviewed about the development of transitional care programs within four Canadian provincial regions including Atlantic, Central, Prairie, and West Coast. Key facilitators and barriers influencing the development and long-term success of transitional care programs included program scope, program structure, continuity of care, funding, and health system infrastructure. Future research is required to identify how a broad range of transitional care programs operate and to disseminate knowledge with health leaders and decision-makers to ensure transitional care programs are embedded as essential health system services.

Dignity in Older Adults With Schizophrenia Residing in Assisted Living Facilities.

There is a lack of nursing literature on older adults' perceptions of dignity, specifically those of older adults with schizophrenia. With the aging population, mental health services and support for older adults with schizophrenia will become a greater priority. The purpose of the current descriptive phenomenological study was to describe the meaning of the lived experience of dignity for older adults with schizophrenia residing in assisted living facilities. A purposive sample of eight older adults with schizophrenia residing in assisted living facilities participated in semi-structured interviews following the descriptive phenomenological psychological method. Five intertwined constituents were identified: (1) dignity is an intrinsic or self-regarding experience; (2) dignity is an experience that is reciprocal, extrinsic, and regards others, and is embedded in social relationships; (3) dignity can be eroded by ageism, stigma, discrimination, and alienation; (4) dignity can be interrupted when positive and negative symptoms of schizophrenia are present and misunderstood by others; and (5) dignity can be enhanced when oneself and others embrace a recovery-focused relationship. Implications for mental health nursing are provided. [Journal of Psychosocial Nursing and Mental Health Services, 56(2), 20-28.].

Gerontology across the professions and the Atlantic: Development and evaluation of an interprofessional and international course on aging and health.

The need for interprofessional teamwork and the global challenges for health care systems of dramatically increasing numbers of older adults have received increased recognition in gerontological and geriatrics education. The authors report on the pilot development of a hybrid course on aging and health for graduate-level health professions students from Norway, Canada, and the United States. International faculty from partnering universities developed, taught, and evaluated the course. Course assignments included online forum postings, reflections, and a problem-based learning group assignment and presentation. Directed readings and discussion included topics related to health care systems and services in the three participating countries, teamwork, and patient-centered care. To evaluate the course, quantitative and qualitative data were collected and analyzed. Results indicate a significant impact on student learning outcomes, including understanding of issues in international aging and health, attitudes and skills in teamwork, and application to clinical practice. This course clearly established the importance of developing innovative interprofessional educational experiences that respond to the increasingly universal impacts of aging populations on health and social care systems around the world.

Insights Into Roles for Health-Care Professionals in Meeting the Needs of Older Adults and Unpaid Caregivers During Health-Care Transitions.

We provided insights from older adults, their unpaid caregivers, and health-care professionals into specific roles for professionals within the health system to better meet the needs of community-dwelling older adults and their unpaid caregivers experiencing transitions between health services. We used a qualitative approach to collect data within one Canadian province from older adults and unpaid caregivers of older adults who participated in focus groups ( n = 98) and professionals working in the health system who participated in an online survey ( n = 52). Questions included experiences with health service transitions, strengths, challenges, and suggestions to improve transitions. Thematic analysis resulted in identifying seven specific roles for professionals in supporting health-care transitions: information and education, planning for future health needs, supporting the acceptance of necessary care, facilitating access to the right services at the right time, facilitating communication between services, facilitating the discharge planning process and advocacy for older adults and unpaid caregivers. Our results based on evidence from older adults, unpaid caregivers, and health-care professionals will inform future research and further development of the instrumental and relational roles for professionals supporting older adults and their caregivers experiencing health-care transitions.

Strengthening resources for midlife and older rural women who experience intimate partner violence.

Little is known about midlife and older women who experience intimate partner violence living in rural places and their resource needs. Guided by a strengths perspective, we provided insights into resources that midlife and older women use, or would like to use, in their journey in leaving an abusive partner. Eight women who had left an abusive partner participated in a face-to-face interview. They drew on a wide variety of paid and unpaid resources, while each woman had a unique set of resources that contributed to her being able to make such a significant life transition. It is clear that we need to have a variety of formal and informal resources available to older women experiencing intimate partner violence (IPV) in rural places, and new forms of resources need to be developed. Our results also indicate that increased efforts are needed in improving both public and professional education regarding older rural women and IPV.

Piloting a Supplemental Assessment Tool with Younger Residents of Long-Term Care.

Background: Young adults living with disabilities may sometimes end up in long-term care facilities which may not always meet their needs. Our project set out to pilot a supplemental assessment tool, a questionnaire to be used upon admission of younger adults into long-term care. We wanted the opinions of both staff and younger residents on what modifications may be needed in the implementation processes to ensure effectiveness of the tool. Methods: This project followed a qualitative design, implementing a previously designed supplemental assessment tool with five staff members and seven younger residents of two long-term care homes in Halifax, Nova Scotia. Residents completed the questionnaire with members of staff involved in admissions. Each group participated in follow-up interviews regarding their thoughts on implementation of the tool. Responses were analyzed using the constructs of the Consolidated Framework in Implementation Research following direct content analysis methods. Results: Feedback from residents and staff suggested that the tool could not be used as a one-size-fits-all solution but that flexibility in the format, content, and structure of the tool would be beneficial to ensure its utility in a variety of settings. Issues raised by staff and residents included, but were not limited to, accessibility of the intervention, the availability of resources, the format of the intervention and topics covered within it, and ensuring that processes for implementation are clearly defined. Conclusions: Both staff and residents approved of the tool for use in the admissions process and agreed that it would enhance the admissions practices already in place.

A Review of Intimate Partner Violence Interventions Relevant to Women During the COVID-19 Pandemic.

Women have experienced increased rates of intimate partner violence (IPV) since the onset of the COVID-19 global pandemic, and at the same time requirements for physical distancing and/or remote delivery of services have created challenges in accessing services. We synthesized research evidence from 4 systematic reviews and 20 individual studies to address how IPV interventions can be adapted within the context of the pandemic. As many interventions have been delivered via various technologies, access to technology is of particular importance during the pandemic. Our results can inform the provision of services during the remainder of the COVID-19 pandemic including how to support women who have little access to in-person services.

Recent innovations in long-term care coverage and financing: a rapid scoping review.

OBJECTIVES: To identify, chart and analyse the literature on recent initiatives to improve long-term care (LTC) coverage, financial protection and financial sustainability for persons aged 60 and older. DESIGN: Rapid scoping review. DATA SOURCES: Four databases and four sources of grey literature were searched for reports published between 2017 and 2022. After using a supervised machine learning tool to rank titles and abstracts, two reviewers independently screened sources against inclusion criteria. ELIGIBILITY CRITERIA: Studies published from 2017-2022 in any language that captured recent LTC initiatives for people aged 60 and older, involved evaluation and directly addressed financing were included. DATA EXTRACTION AND ANALYSIS: Data were extracted using a form designed to answer the review questions and analysed using descriptive qualitative content analysis, with data categorised according to a prespecified framework to capture the outcomes of interest. RESULTS: Of 24 reports, 22 were published in peer-reviewed journals, and two were grey literature sources. Study designs included quasi-experimental study, policy analysis or comparison, qualitative description, comparative case study, cross-sectional study, systematic literature review, economic evaluation and survey. Studies addressed coverage based on the level of disability, income, rural/urban residence, employment and citizenship. Studies also addressed financial protection, including out-of-pocket (OOP) expenditures, copayments and risk of poverty related to costs of care. The reports addressed challenges to financial sustainability such as lack of service coordination and system integration, insufficient economic development and inadequate funding models. CONCLUSIONS: Initiatives where LTC insurance is mandatory and accompanied by commensurate funding are situated to facilitate ageing in place. Efforts to expand population coverage are common across the initiatives, with the potential for wider economic benefits. Initiatives that enable older people to access the services needed while avoiding OOP-induced poverty contribute to improved health and well-being. Preserving health in older people longer may alleviate downstream costs and contribute to financial sustainability.

The everyday experience of living with and managing a neurological condition (the LINC study): study design.

BACKGROUND: The impact of neurological conditions on individuals, families and society is increasing and having a significant economic impact in Canada. While some economic data is known, the human costs of living with a neurological condition are poorly understood and rarely factored into future burden analyses. The "Living with the Impact of a Neurological Condition (LINC)" study aims to fill this gap. It seeks to understand, for children and adults with neurological conditions, the supports and resources that make everyday life possible and meaningful. METHODS/DESIGN: The LINC study is a nested study using mixed methods. We are interested in the following outcomes specifically: health status; resource utilization; self-management strategies; and participation. Three studies captured data from multiple sources, in multiple ways and from multiple perspectives. Study One: a population-based survey of adults (n=1500), aged 17 and over and parents (n=200) of children aged 5 to 16 with a neurological condition. Study Two: a prospective cohort study of 140 adults and parents carried out using monthly telephone calls for 10 months; and Study Three: a multiple perspective case study (MPCS) of 12 adults and 6 parents of children with a neurological condition. For those individuals who participate in the MPCS, we will have data from all three studies giving us rich, in depth insights into their daily lives and how they cope with barriers to living in meaningful ways. DISCUSSION: The LINC study will collect, for the first time in Canada, data that reflects the impact of living with a neurological condition from the perspectives of the individuals themselves. A variety of tools will be used in a combination, which is unique and innovative. This study will highlight the commonalities of burden that Canadians living with neurological conditions experience as well as their strategies for managing everyday life.

Age and gender differences in emotional and informational social support insufficiency for older adults in Atlantic Canada.

It is well documented that nursing is concerned about the social support needs of older adults and the effects of those needs on health and well-being. Using survey data from the Atlantic Seniors Housing Research Alliance, the authors explore the emotional and informational social support needs of community-dwelling Canadians aged 65 and older living in the Atlantic provinces. The results indicate that these needs are not being met fully and that they increase with age. Also, men and women report different insufficiencies for specific needs; more men than women report having no support across all items. Nurses should be sensitive to specific age and gender support needs of older adults. They should also increase their social assessments and promote healthy social networks, especially for those 80 years and older. Further nursing research is recommended.

Transitional care programs in Canada for older adults transitioning from hospital to home: protocol for a systematic review of text and opinion.

OBJECTIVE: The objective of this systematic review is to identify what transitional care programs exist across Canada, including the characteristics and outcomes of these programs. INTRODUCTION: There is growing evidence of the benefits of transitional care programs to support older adults moving from hospital to home. However, there is limited literature identifying the types of transitional care programs that exist internationally and little evidence available within Canada. INCLUSION CRITERIA: Sources of gray literature published from 2016 that focus on older adults receiving services from transitional care programs to move from hospital to home in Canada will be considered for inclusion. Sources of gray literature will be excluded if interventions are targeted at adults younger than 65 years, Indigenous adults younger than 55 years, or if the primary discharge destination is not an independent community dwelling. Interventions designed for older adults waiting in hospital for long-term care placement will also be excluded from this review. METHODS: An initial limited search of Canadian national gray literature resources will be undertaken, followed by an advanced Google search of Canadian resources and news media reports. Lastly, an advanced search of Google for all 10 provinces and 3 territories will be undertaken to target examples of local transitional care programs that may not be found through a national search, such as local pilot projects, health region-specific programs, and provincial organizations. All identified sources will be retrieved and full text review of selected citations assessed in detail by 2 independent reviewers. Data about the characteristics and outcomes of transitional care programs and results will be extracted and synthesized, with a meta-aggregation approach for grading according to JBI ConQual method. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022298821.

With COVID Comes Complexity: Assessing the Implementation of Family Visitation Programs in Long-Term Care.

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) pandemic visitor restrictions to long-term care facilities have demonstrated that eliminating opportunities for family-resident contact has devastating consequences for residents' quality of life. Our study aimed to understand how public health directives to support family visitations during the pandemic were navigated, managed, and implemented by staff. RESEARCH DESIGN AND METHODS: Guided by the Consolidated Framework for Implementation Research, we conducted video/telephone interviews with 54 direct care and implementation staff in six long-term care homes in two Canadian provinces to assess implementation barriers and facilitators of visitation programs. Equity and inclusion issues were examined in the program's implementation. RESULTS: Despite similar public health directives, implementation varied by facility, largely influenced by the existing culture and processes of the facility and the staff understanding of the program; differences resulted in how designated family members were chosen and restrictions around visitations (e.g., scheduling and location). Facilitators of implementation were good communication networks, leadership, and intentional planning to develop the visitor designation processes. However, the lack of consultation with direct care staff led to logistical challenges around visitation and ignited conflict around visitation rules and procedures. DISCUSSION AND IMPLICATIONS: Insights into the complexities of implementing family visitation programs during a pandemic are discussed, and opportunities for improvement are identified. Our results reveal the importance of proactively including direct care staff and family in planning for future outbreaks.

Effectiveness of programs that offer individualized, multifactorial support to community-dwelling older people with ongoing health and social care needs: a systematic review protocol.

OBJECTIVE: The objective of this review is to assess the effectiveness of programs that offer individualized, multifactorial support to community-dwelling older people with ongoing health and social care needs and to report how these programs affect quality of life and health system outcomes. INTRODUCTION: As people age, they often have multiple chronic conditions and functional impairment, and as a result, they need support to live well. Nursing homes and other residential facilities provide care for people with such needs; however, they can be expensive and older people generally prefer to remain at home, in their community. There is growing interest in programs that offer individualized, multifactorial support in the community for people with complex health and social care needs. INCLUSION CRITERIA: This review will focus on the effectiveness of programs that offer individualized, multifactorial support in the community for people over the age of 60 who are identified as having ongoing health and social care needs. The review will assess quality of life and health system outcomes, such as hospital admission. METHODS: This review will be conducted in accordance with the JBI methodology for systematic reviews of effectiveness. Ten databases will be searched for published and unpublished studies. Titles, abstracts, and full-text studies will be screened by 2 or more independent reviewers and assessed for methodological validity using the standard JBI critical assessment tools. Relevant data will be extracted using the JBI data extraction tools. The data will then be synthesized and reported using measures of evidence certainty. REVIEW REGISTRATION: PROSPERO CRD42022324061.

The Delivery of Palliative and End-of-Life Care to Adolescents and Young Adults Living with Cancer: A Scoping Review.

The primary purpose of this scoping review was to provide an overview of the existing evidence on the delivery of palliative and end-of-life care to adolescents and young adults (AYAs) living with cancer, by identifying knowledge gaps and discussing the key characteristics and types of evidence in this field. This study employed a JBI scoping review design. CINAHL (EBSCO), Embase (Elsevier), MEDLINE (Ovid), APA PsycINFO (EBSCO), and Web of Science (Science Citation Index Expanded and Social Sciences Citation Index; Clarivate Analytics) databases were searched along with grey literature sources to February 2022 for related studies on the delivery of palliative and end-of-life care to AYAs. No search restrictions were applied. Two independent reviewers screened titles, abstracts, and full-text articles for eligibility, and they extracted data from studies that met the inclusion criteria. A total of 29,394 records were identified through our search strategy and 51 studies met the inclusion criteria of the study. The studies were published between 2004 and 2022, with the majority from North America (65%). The included studies involved patient, healthcare provider, caregiver, and public stakeholders. Their primary foci were often on end-of-life outcomes (41%) and/or advance care planning/end-of-life priorities and decision-making (35%). This review identified several evidence gaps within the field, including a focus primarily on patients who have died. Findings highlight the need for more collaborative research with AYAs on their experiences with palliative and end-of-life care, as well as their involvement as patient partners in research.

Interventions to Improve the Nursing Care of People with Dementia in Canadian Hospitals: An Environmental Scan.

As the number of people with dementia admitted to hospitals is expected to grow, now is the time to identify methods to improve nursing care of this population. We conducted an environmental scan to identify and describe interventions in Canadian hospitals to improve the nursing care of people with dementia, how they are being evaluated and what issues influence the success of interventions. Methods included a search of published and unpublished literature and key stakeholder interviews. Interventions are described under three categories: (1) interventions to improve nurses' knowledge, attitudes and skills; (2) interventions to address responsive behaviours; and (3) interventions to help nurses individualize care. The evaluation of interventions rarely included an evaluation of effectiveness and more often included a qualitative evaluation of nurses' experiences with interventions. We summarize the factors affecting the implementation of interventions following the Consolidated Framework for Implementation Research (Damschroder et al. 2009) and suggest strategies for supporting the success of interventions to improve patient care and the experiences of nurses working with people with dementia.

Factors Associated With Residents' Responsive Behaviors Toward Staff in Long-Term Care Homes: A Systematic Review.

BACKGROUND AND OBJECTIVES: When staff experience responsive behaviors from residents, this can lead to decreased quality of work life and lower quality of care in long-term care homes. We synthesized research on factors associated with resident responsive behaviors directed toward care staff and characteristics of interventions to reduce the behaviors. RESEARCH DESIGN AND METHODS: We conducted a mixed-methods systematic review with quantitative and qualitative research. We searched 12 bibliographic databases and "gray" literature, using 2 keywords (long-term care, responsive behaviors) and their synonyms. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. We developed a coding scheme using the ecological model as an organizing structure and prepared narrative summaries for each factor. RESULTS: From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training background (individual level), staff approaches to care (interpersonal level), leadership and staffing resources (institutional level), and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of behaviors, and quantitative findings on the impact of staff approaches to care on behaviors. Effects of interventions (n = 14) to reduce the behaviors were inconclusive. DISCUSSION AND IMPLICATIONS: We identified the need for an enhanced understanding of the interrelationships among factors associated with resident responsive behaviors toward staff and processes leading to the behaviors. To address these gaps and to inform theory-based effective interventions for preventing or mitigating responsive behaviors, we suggest intervention studies with systematic process evaluations.

A first voice perspective of people experiencing homelessness on preferences for the end-of-life and end-of-life care during the COVID-19 pandemic.

OBJECTIVE: People experiencing homelessness often encounter progressive illness(es) earlier and are at increased risk of mortality compared to the housed population. There are limited resources available to serve this population at the end-of-life (EOL). The purpose of this study was to gain insight into preferences for the EOL and end-of-life care for people experiencing homelessness. Utilizing an interpretive phenomenology methodology and the theoretical lens of critical social theory, we present results from 3 participants interviewed from August to October 2020, with current or previous experience of homelessness and a diagnosis of advanced disease/progressive life-threatening illness. RESULTS: A key finding focused on the existential struggle experienced by the participants in that they did not care if they lived or died. The participants described dying alone as a bad or undignified way to die and instead valued an EOL experience that was without suffering, surrounded by those who love them, and in a familiar place, wherever that may be. This study serves to highlight the need for improvements to meet the health care and social justice needs of people experiencing homelessness by ensuring equitable, humanistic health and end-of-life care, particularly during the context of the COVID-19 pandemic.

Nursing interventions to improve care of people with dementia in hospital: a mixed methods systematic review protocol.

OBJECTIVE: This review will focus on the effectiveness of, and experience with, nursing interventions to improve the care of people with dementia in hospital. INTRODUCTION: Acute care for people with dementia has been identified as an area for improvement. Admission to hospital can be upsetting and difficult for people with dementia and can be associated with negative outcomes. Nurses play a significant role in shaping the experience of hospitalization and are the focus of many related interventions. INCLUSION CRITERIA: This mixed methods review will examine literature on improving acute care for people with dementia. The quantitative component will consider studies that evaluate nursing interventions to improve care of people with dementia, comparing the intervention with usual care, other therapies, or no comparator. Outcomes will include behavioral, health, and health system indicators. The qualitative component will consider studies that explore the experience of nursing interventions from the perspective of people with dementia, their family- or friend-caregivers, and nurses. METHODS: This review will be conducted in accordance with JBI methodology for mixed methods systematic reviews. Twelve databases and gray literature sources will be searched for published and unpublished studies. Titles, abstracts, and full-text selections will be screened by two or more independent reviewers and assessed for methodological validity using the standard JBI critical assessment tools. This review will follow a convergent segregated approach to data synthesis and integration. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021230951.

Factors Associated with Falls in Canadian Long Term Care Homes: a Retrospective Cohort Study.

Background: Half of Canadians living in long-term care (LTC) homes will fall each year resulting in consequences to independence, quality of life, and health. The objective in this study was to analyze factors that contribute to, or are protective against, falls in Canadian LTC homes. Methods: We analyzed of a retrospective cohort of a stratified random sample of Canadian LTC homes in Western Canada from 2011-2017. We accessed variables from the RAI-MDS 2.0 to assess the association of the dependent variable "fall within the last 31-180 days" with multiple independent factors, using generalized estimating equation models. Results: A total of 28,878 LTC residents were analyzed. Factors found to increase the odds of falling were other fractures (OR 3.64 [95% confidence interval; CI 3.27, 4.05]), hip fractures (OR 3.58 [3.27, 3.93]), moderately impaired cognitive skills (OR 2.45 [2.28, 2.64]), partial support to balance standing (OR 2.44 [2.30, 2.57]), wandering (OR 2.31 [2.18, 2.44]). Conclusion: A range of factors identified were associated with falls for people living in LTC homes. Individual physical ability represented the largest group of independent factors contributing to falls. Residents who experience any fracture or an acute change in behaviour, mobility, or activities of daily living (ADL) should be considered at increased risk of falls.