Characteristics Associated with Relationship-Centred and Task-Focused Mealtime Practices in Older Adult Care Settings.

Purpose: To assess care home and staff characteristics associated with task-focused (TF) and relationship-centred care (RCC) mealtime practices prior to the COVID-19 pandemic.Methods: Staff working in Canadian and American care homes were invited to complete a 23-item online survey assessing their perceptions of mealtime care, with one item assessing 26 potential care practices from the Mealtime Relational Care Checklist (relationship-centred = 15; task-focused = 11) reported to occur in the home prior to the pandemic. Multivariate linear regression evaluated staff and care home characteristics associated with mealtime practices.Results: Six hundred and eighty-six respondents completed all questions used in this analysis. Mean TF and RCC mealtime practices were 4.89 ± 1.99 and 9.69 ± 2.96, respectively. Staff age was associated with TF and RCC practices with those 40-55 years reporting fewer TF and those 18-39 years reporting fewer RCC practices. Those providing direct care were more likely to report TF practices. Dissatisfaction with mealtimes was associated with more TF and fewer RCC practices. Homes that were not making changes to promote RCC pre-pandemic had more TF and fewer RCC practices. Newer care homes were associated with more RCC, while small homes (≤49 beds) had more TF practices.Conclusions: Mealtime practices are associated with staff and home factors. These factors should be considered in efforts to improve RCC practices in Canadian homes.

"Nobody but a family member can do it quite the same way": Understanding the meaning of mealtimes to residents and families in long-term care homes during the pandemic.

BACKGROUND AND OBJECTIVES: Meals in long term care (LTC) are essential to residents not only for nutrition and their physical well-being, but also for their social interactions supporting resident quality of life. This study aims to understand the mealtime experiences of residents and family care partners during the COVID-19 pandemic when restrictions were put in place in LTC and retirement homes. RESEARCH DESIGN AND METHODS: Interpretive description analysis of qualitative interviews in LTC and retirement homes, with 17 family care partners and 4 residents. Convenience and snowball sampling used to recruit participants for telephone interviews. RESULTS: Three themes were generated. Compromised mealtimes mean compromising community - meals were seen by participants as a key social and community-building event of the home; they reported this loss of community with pandemic restrictions. Participants noted that Family care partners are indispensable at meals for social, psychological and physical support. The dangers of eating alone spoke to the social isolation reported by participants that occurred during the pandemic and the risks they described of eating alone. DISCUSSION AND IMPLICATIONS: This study confirms the importance of mealtimes in LTC and retirement homes to community building and extends our understanding of the importance of family inclusion at meals and why eating alone, as happened during COVID-19, was so detrimental to residents. Effort needs to be made to value this communal activity for the well-being of residents.

Weight Loss and Weight Gain: Multi-Level Determinants Associated with Resident 3-Month Weight Change in Long-Term Care.

This study examined factors associated with weight change in 535 residents in 32 long term care homes where 3-month weight records were available. Trained researchers and standardized measures (e.g., nutrition status, food intake, home characteristics) were used to collect data; weight change was defined as ±2.5%. Just over 25% of the sample lost and 21% gained weight. Weight stability was compared to loss or gain. Weight loss was associated with being male, malnourished (MNA-SF or BMI <25), energy and protein intake and oral nutritional supplement use, while weight gain was associated with being female, and a physically (e.g., less noise) and socially supportive dining room. Weight stability was associated with better cognition. A high proportion of residents had a significant weight change in 3 months. Modifiable factors associated with weight stability or gain suggest focusing interventions that promote food intake and improve the mealtime environment.

The experiences of nurse educators in establishing a teaching practice in the care of older persons: A focused ethnography study.

BACKGROUND: Gerontological nursing is not a career choice for most new graduates. Nurse educators, who influence students' career decisions, lack expertise in older person care. The academic culture may affect educators developing gerontological expertise. PURPOSE: The study explored the culture of a Canadian pre-licensure nursing education program in relation to educators' expertise in gerontological nursing. METHODS: In a focused ethnography, 22 nurse educators/researchers/administrators participated in interviews and/or observations conducted from March 2018 to December 2018. Content analysis of interview transcripts and fieldnotes occurred concurrently with data collection. RESULTS: Themes characterizing the culture were: Structure and Hierarchy, Losing Gerontology, Teaching Challenges, and Valuing Older Persons and Their Care. Participants felt: a hierarchy limited gerontologists' support for undergraduate educators and the curriculum; the integrated curriculum reduced the focus on gerontology; limited professional development opportunities and excessive workload constrained building gerontology expertise; and valuing older persons and their care influenced access to gerontology resources. CONCLUSIONS: The culture of a pre-licensure nursing program impacted educators building expertise in older person care. More research is needed to overcome barriers that constrain educators' proficiency in gerontological nursing. Increasing the number of educators adept in gerontology will develop nurse graduates with an appreciation for working with older persons.

Feasibility and Acceptability Testing of Evidence-Based Hydration Strategies for Residential Care.

The current study examined stakeholder perspectives on the perceived effectiveness, feasibility, and acceptability of 20 evidence-based strategies appropriate for residential care via an online survey (N = 162). Most participants worked in long-term care (83%), were direct care providers (62%), worked in food/nutrition roles (55%), and identified as female (94%). Strategies that were rated as effective, feasible, and likely to be used in the future were social drinking events, increased drink options at meals, and pre-thickened drinks. Participants also listed their top strategies for inclusion in a multicomponent intervention. Responses to open-ended questions provided insight on implementation, compliance, and budget constraints. Participant perspectives provide insight into developing a multicomponent intervention. Strategies prioritized for such an intervention include: staff education, social drinking opportunities, drinks trolley, volunteer support, improved beverage availability, hydration reminders, offering preferred beverages, and prompting residents to drink using various cues. [Research in Gerontological Nursing, 15(1), 27-38.].

Construct Validity of the Health Utilities Index Mark 2 and Mark 3 to Measure Health-Related Quality of Life of Residents in Long-Term Care Facilities.

BACKGROUND AND PURPOSE: The purpose is to evaluate the construct validity of two generic health measures, the Health Utilities Index Mark 2 (HUI2) and Mark 3 (HUI3) in residents of long-term care (LTC) facilities, using a convergent/divergent validity approach, with the Functional Independence Measure (FIM), Quality of Life-Alzheimer's Disease (QOL-AD) and Resident Assessment Instrument (RAI) 2.0 as comparators. METHODS: Health status of 130 residents with dementia residing in one of seven LTC facilities was evaluated by their Healthcare Aides who were their primary care assistants. A priori hypotheses on the magnitude and direction of the correlations were formulated by two clinician/researchers and a researcher familiar with the measures and this population. Predicted and observed correlations were compared. RESULTS: Mean overall HUI2 (0.48, SD 0.16) and HUI3 scores (0.31, SD 0.27) were indicative of severe disability. Of the 208 a priori hypotheses, 39.9% (n = 83) matched the observed correlations, 29.8% were underestimated and 19.7% were overestimated by one category. CONCLUSIONS: Findings support the use of the HUI2 and HUI3 in measuring health-related quality of life in dementia-related research to complement disease-specific measures.

Stakeholder Engagement in Practice Change: Enabling Person-Centred Mealtime Experiences in Residential Care Homes.

Person-centred care is recognized as best practice in dementia care. The purpose of this study was to evaluate the effectiveness of a stakeholder engagement practice change initiative aimed at increasing the provision of person-centred mealtimes in a residential care home (RCH). A single-group, time series design was used to assess the impact of the practice change initiative on mealtime environment across four time periods (pre-intervention, 1-month, 3-month, and 6-month follow-up). Statistically significant improvements were noted in all mealtime environment scales by 6 months, including the physical environment (z = -3.06, p = 0.013), social environment (z = -3.69, p = 0.001), relationship and person-centred scale (z = -3.51, p = 0.003), and overall environment scale (z = -3.60, p = 0.002). This practice change initiative, which focused on enhancing stakeholder engagement, provided a feasible method for increasing the practice of person-centred care during mealtimes in an RCH through the application of supportive leadership, collaborative decision making, and staff engagement.

Making the Most of Mealtimes (M3): Association Between Relationship-Centered Care Practices, and Number of Staff and Residents at Mealtimes in Canadian Long-Term Care Homes.

OBJECTIVES: To determine if (1) number of staff or residents, when considering home-level factors and presence of family/volunteers, are associated with relationship-centered care practices at mealtimes in general and dementia care units in long-term care (LTC); and (2) the association between number of staff and relationship-centered care is moderated by number of residents and family/volunteers, profit status or chain affiliation. DESIGN: Secondary analysis of the Making the Most of Mealtimes (M3) cross-sectional multisite study. SETTING AND PARTICIPANTS: Thirty-two Canadian LTC homes (Alberta, Manitoba, Ontario, and New Brunswick) and 639 residents were recruited. Eighty-two units were included, with 58 being general and 24 being dementia care units. METHODS: Trained research coordinators completed the Mealtime Scan (MTS) for LTC at 4 to 6 mealtimes in each unit to determine number of staff, residents, and family or volunteers present. Relationship-centered care was assessed using the Mealtime Relational Care Checklist. The director of care or food services manager completed a home survey describing home sector and chain affiliation. Multivariable analyses were stratified by type of unit. RESULTS: In general care units, the number of residents was negatively (P = .009), and number of staff positively (P < .001) associated with relationship-centered care (F9,48 = 5.48, P < .001). For dementia care units, the associations were nonsignificant (F5,18 = 2.74, P = .05). The association between staffing and relationship-centered care was not moderated by any variables in either general or dementia care units. CONCLUSION AND IMPLICATIONS: Number of staff in general care units may increase relationship-centered care at mealtimes in LTC. Number of residents or staff did not significantly affect relationship-centered care in dementia care units, suggesting that other factors such as additional training may better explain relationship-centered care in these units. Mandating minimum staffing and additional training at the federal level should be considered to ensure that staff have the capacity to deliver relationship-centered care at mealtimes, which is considered a best practice.

Hungry for more: Low resident social engagement is indirectly associated with poor energy intake and mealtime experience in long-term care homes.

Mealtimes in long-term care (LTC) homes provide social engagement and nutritional intake to residents. Psychosocial challenges may detract from the mealtime experience, resulting in low food intake and increased risk of malnutrition. This study explores the independent effects of psychosocial factors on energy intake among LTC residents. Secondary data (Making the Most of Mealtimes [M3]) from residents in 32 Canadian LTC homes were analyzed. Data included 3-day weighed food intake, mealtime care actions taken by staff, loss of appetite, eating challenges, and other resident characteristics. Psychosocial factors (i.e., social engagement, depression, and aggressive behaviours) were measured using standardized scales. The independent effects of psychosocial factors on energy intake were tested using bivariate and linear regression analyses adjusted for loss of appetite, eating challenges, and demographic characteristics. The final sample included 604 residents (mean age = 86.8 ± 7.8 years; 31.8% male). Of the three psychosocial factors, only social engagement was associated with energy intake. Low social engagement was associated with cognitive and functional challenges, malnutrition risk, more task-focused mealtime actions by staff, and lower energy intake. Simple regression analysis revealed that individuals with low social engagement ate 59.6 kcal less per day (95% CI = -111.2, -8.0). This significant association remained when adjusting for loss of appetite, but was no longer significant when adjusting for eating challenges. Low social engagement occurs concurrently with physical and functional challenges among LTC residents, affecting both the nutritional and social aspects of mealtimes. Emphasis on socializing during mealtimes, especially for those with eating challenges (e.g., requiring assistance), may contribute to improved resident appetite and quality of life.

Family member eating assistance and food intake in long-term care: A secondary data analysis of the M3 Study.

AIM: To determine if protein and energy intake is significantly associated with a family member providing eating assistance to residents in long-term care homes as compared with staff providing this assistance, when adjusting for other covariates. BACKGROUND: Who provides eating support has the potential to improve resident food intake. Little is known about family eating assistance and if this is associated with resident food intake in long-term care. DESIGN: Cross-sectional, secondary data analysis. METHODS: Between October and January 2016, multilevel data were collected from 32 long-term care homes across four Canadian provinces. Data included 3-day weighed/observed food intake, mealtime observations, physical dining room assessments, health record review, and staff report of care needs. Residents where family provided eating assistance were compared with residents who received staff-only assistance. Regression analysis determined the association of energy and protein intake with family eating assistance versus staff assistance while adjusting for covariates. RESULTS: Of those residents who required any physical eating assistance (N = 147), 38% (N = 56) had family assistance during at least one of nine meals observed. Residents who received family assistance (N = 56) and those who did not (N = 91) were statistically different in several of their physiological eating abilities. When adjusting for covariates, family assistance was associated with significantly higher consumption of protein and energy intake. CONCLUSION: Energy and protein intake is significantly higher when family provides eating assistance. Family are encouraged to provide this direct care if it is required. IMPACT: Residents who struggle with independent eating can benefit from dedicated support during mealtimes. Findings from this study provide empirical evidence that family eating assistance is associated with improved resident food intake and provides strong justification to encourage families to be active partners in the care and well-being of their relatives. Home administrators and nursing staff should support the specialized care that families can provide at mealtimes.

Effectiveness of reminders to sustain practice change among direct care providers in residential care facilities: a cluster randomized controlled trial.

BACKGROUND: The study purpose was to compare the effectiveness of monthly or quarterly peer reminder knowledge translation interventions, with monthly or quarterly paper-based reminders, to sustain a mobility innovation, the sit-to-stand activity. METHOD: A cluster RCT using a stratified 2 × 2 factorial design was conducted in 24 Canadian residential care facilities with 416 residents and 54 peer reminder care aides. The 1-year intervention included two intensities of reminders (high: socially based peer reminders delivered by volunteer care aides to other care aides; low: paper-based reminders posted in residents' rooms), at two frequencies (monthly; every 3 months). Intervention fidelity was assessed using questionnaires and observations. Monthly sustainability rate of the sit-to-stand activity was calculated as the percentage of opportunities that residents successfully completed the activity in 30 days. Residents' sustainability rates were analyzed using a linear mixed model that mirrored the clustered repeated-measures factorial trial design. The model included a random intercept to account for clustering within sites. An unstructured covariance structure characterized the interdependence of repeated measures over time. RESULTS: Twenty-four sites were randomized. One site was excluded because of falsifying data, leaving 23 sites and 349 residents for intention-to-treat analysis. Paper reminders were implemented with high fidelity across all arms (91.5% per protocol), while the peer reminders were implemented with moderate fidelity in the monthly group (81.0% per protocol) and poor fidelity in the quarterly group (51.7% per protocol). At month 1, mean sustainability ranged from 40.7 to 47.2 per 100 opportunities, across the four intervention arms (p = 0.43). Mean rate of sustainability in the high intensity, high frequency group diverged after randomization, yielding statistically significant differences among the groups at 4 months which persisted for the remainder of the trial. After 12 months, the mean sustainability in the high intensity, high frequency group was approximately twice that of the other three groups combined (64.1 versus 37.8 per 100 opportunities, p < 0.001). CONCLUSIONS: A monthly peer reminder intervention was more effective than a quarterly peer reminder intervention, a monthly paper-based reminder intervention, and a quarterly paper-based reminder intervention, in supporting care aides to sustain a mobility innovation in residential care facilities over 1 year. TRIAL REGISTRATION: ClinicalTrials.gov , NCT01746459. Registered 11 December 2012: https://clinicaltrials.gov/ct2/show/NCT01746459 .

Sit-to-stand activity to improve mobility in older people: A scoping review.

AIMS AND OBJECTIVES: To identify the current state of knowledge about the use of the sit-to-stand intervention with older people and to identify implications for further research. BACKGROUND: Many older people experience mobility challenges which can negatively affect their well-being. Physical activities are vital to improving or maintaining mobility. Although there is evidence that mobility challenged older people benefit from the sit-to-stand intervention, there is a need to systematically examine the state of knowledge about this intervention. DESIGN: Scoping review using Arksey and O'Malley's methodological framework. METHODS: A systematic search of three databases was completed. Abstracts were evaluated for relevance using predetermined inclusion criteria. Studies that met the inclusion criteria had data extracted and were appraised for internal and external validity. Narrative synthesis was based on methods described by Popay and colleagues. RESULTS: Of 3,041 papers, six studies met the inclusion criteria. Publications provided a range of sit-to-stand interventions with durations varying from four weeks to six months. The frequency of each intervention fluctuated from three to seven times/week with a duration of 15-45 min. Different professionals prompted the activity. Three themes were identified the following: (a) sit-to-stand activity as an intervention; (b) generalisability of findings; and (c) sustainability. CONCLUSIONS: Most of the studies reviewed indicated improvements in performance of the sit-to-stand activity and in motor function. However, issues with studies rigour do not allow us to make generalisations. Further research is needed to confirm the effectiveness of the intervention. IMPLICATIONS FOR PRACTICE: Healthcare providers are expected to offer evidence-based patient care. This review details current knowledge about the sit-to-stand intervention with older people.

Strategies to facilitate shared decision-making in long-term care.

AIM: The aim of this study was to explore shared decision-making among residents, their families and staff to determine relevant strategies to support shared decision-making in long-term care (LTC). BACKGROUND: Meaningful engagement of long-term care home (LTCH) residents and their families in care decisions is key in the provision of quality of care. Shared decision-making is an interprofessional approach to increasing resident and family engagement in care decisions which can lead to higher quality decisions, more relevant care interventions and greater resident, family, and staff satisfaction. Despite these advantages, shared decision-making has not been widely implemented in practice in LTC. METHODS: The study took place in one LTCH in Toronto, Ontario, Canada. A qualitative descriptive design was used to explore how residents, family members and staff described how they collaborate when making decisions concerning resident care, and their perceptions of facilitators and challenges to a collaborative approach to decision-making. Individual interviews were conducted with nine participants: residents, families and staff. Data were analysed using content and thematic analysis. FINDINGS: Four main themes that described resident, family and staff perspectives of shared decision-making were as follows: (a) oral communication pathways for information sharing; (b) supporting resident decision-making autonomy; (c) relational aspects of care facilitate shared decision-making; and (d) lack of effective communication creates barriers to shared decision-making. CONCLUSION: As the demand for LTC continues to increase, it is crucial that healthcare providers engage in collaborative, relational practices that foster high-quality resident care. While a relational approach to care can facilitate shared decision-making, there are opportunities to further cultivate shared decision-making in LTCHs through more effective communication and collaboration. IMPLICATIONS FOR PRACTICE: Understanding how information is shared and decisions are made can facilitate shared decision-making in LTCHs. The strategies identified from this study could be further co-developed and implemented in LTCHs.

The association of eating challenges with energy intake is moderated by the mealtime environment in residential care homes.

OBJECTIVES: Given the increased risk of malnutrition in residential care homes, we studied how specific aspects of the mealtime environment are associated with residents' eating challenges and energy intake in general and dementia care units of these homes. DESIGN: Cross-sectional study. PARTICIPANTS: 624 residents and 82 dining rooms. SETTING: 32 residential care homes across Canada. MEASUREMENTS: Eating challenges were measured using the Edinburgh Feeding Evaluation in Dementia Questionnaire (Ed-FED-q). Energy intake was estimated over nine meals. Physical, social, person-centered, functional, and homelike aspects of the mealtime environment were scored using standardized, valid measures. Effects of interactions between dining environment scores and eating challenges on daily energy intake were assessed using linear regression. RESULTS: More eating challenges were associated with decreased energy intake on the general (ß = -36.5, 95% confidence interval [CI] = -47.8, -25.2) and dementia care units (ß = -19.9, 95% CI = -34.6, -5.2). Among residents living on general care units, the functional (ß = 48.5, 95% CI = 1.8, 95.2) and physical (ß = 56.9, 95% CI = 7.2, 106.7) environment scores were positively and directly associated with energy intake; the social and person-centered aspects of the mealtime environment moderated the relationship between eating challenges and energy intake. CONCLUSIONS: Resident eating challenges were significantly associated with energy intake on both dementia care and general care units; however on general care units, when adjusting for eating challenges, the functional and physical aspects of the environment also had a direct effect on energy intake. Furthermore, the social and person-centered aspects of the dining environment on general care units moderated the relationship between eating challenges and energy intake. Dementia care unit environments had no measurable effect on the association between resident eating challenges and energy intake.

Factors affecting undergraduate nurse educators' knowledge, skills or attitudes about older persons and their care: An integrative review.

BACKGROUND: Nurses are increasingly expected to provide care for older persons; however, there are too few nurse educators with expertise in older person care to ensure students graduate with the requisite competencies. METHODS: An integrative review, using Whittemore and Knafl's framework, was undertaken to identify and synthesise evidence about factors affecting nurse educators' knowledge, skills or attitudes about older persons and their care. RESULTS: Forty-four articles met the inclusion criteria. All but three papers originated in the USA. Content analysis yielded three central themes: external-level factors, employer-level factors and individual-level factors. Findings demonstrated that external funding from philanthropic organisations and government agencies supported many of the national, regional and site-specific initiatives, which were, in many cases, underpinned by professional regulatory frameworks. Negative attitudes of administrators and reduced budgets of educational institutions impeded the availability of such initiatives. Negative attitudes of individual educators towards older person care and the specialty of gerontology constrained their pursuit of such learning, as did their lack of awareness of current gerontology resources. CONCLUSIONS: The lack of educators with gerontology knowledge, skills and requisite attitudes requires a focused effort from external and professional bodies, and from educational institutions to ensure the resources are available to enhance educator expertise in gerontology. Rigorous study addressing the factors influencing educators' knowledge, skills or attitudes towards older persons and their care is required. IMPLICATIONS FOR PRACTICE: Addressing the lack of nurse educator expertise in gerontology could help to ensure new nurses have the required competencies to provide quality older person care.

Prevalence of Malnutrition or Risk in Residents in Long Term Care: Comparison of Four Tools.

The ideal tool for determination of malnutrition risk or malnutrition in long term care (LTC) is elusive. This study compares prevalence, association with resident risk factors and sensitivity (SE) and specificity (SP) of malnutrition or risk categorization in 638 residents from 32 LTC homes in Canada using four tools: the Mini-Nutritional Assessment Short Form (MNA-SF); Patient-Generated Subjective Global Assessment (PG-SGA) Global Category Rating and the Pt-Global webtool; and the interRAI Long Term Care Facility undernutrition trigger. Prevalence was most common with MNA-SF (53.7%) and lowest with InterRAI (28.9%), while the PG-SGA Global Category Rating (44%) was higher than the Pt-Global webtool (33.4%). Tools were consistently associated with resident covariates with few exceptions. The PG-SGA Global Category Rating demonstrated the best sensitivity and specificity when compared to all other tools. Further work to determine the predictive validity of this tool in LTC residents is required.

Resident and Staff Mealtime Actions and Energy Intake of Long-Term Care Residents With Cognitive Impairment: Analysis of the Making the Most of Mealtimes Study.

Long-term care (LTC) residents with cognitive impairment (CI) are at increased risk of malnutrition, often explained by mealtime actions (e.g., resident eating challenges, staff actions with eating assistance). The purpose of the current study was to examine the association between mealtime actions and energy intake of LTC residents with CI. Participants with CI (N = 353) from 32 LTC in four provinces were included. Mealtime actions were assessed using the Relational Behavioural Scale, Edinburgh Feeding Evaluation in Dementia (Ed-FED), nine additional eating challenges, and the Mealtime Relational Care Checklist. Several eating challenges (e.g., refusal to eat, turning head away) were associated with poor energy intake. Adjusting for age and sex, partial eating assistance and total Ed-FED score were associated with poor intake, whereas dysphagia risk and often receiving assistance were associated with better intake. Interventions to support eating independence and address residents' eating challenges in LTC are needed to improve their intakes. [Journal of Gerontological Nursing, 45(8), 32-42.].

Examining the Impact of Knowledge Translation Interventions on Uptake of Evidence-Based Practices by Care Aides in Continuing Care.

BACKGROUND: Dissemination of evidence-based practices has been a long-standing challenge for healthcare providers and policy makers. Research has increasingly focused on effective knowledge translation (KT) in healthcare settings. AIMS: This study examined the effectiveness of two KT interventions, informal walkabouts and documentation information sessions, in supporting care aide adoption of new evidence-based practices in continuing care. METHODS: The Sustaining Transfers through Affordable Research Translation (START) study examined sustainability of a new practice, the sit-to-stand activity completed with residents in 23 continuing care facilities in Alberta, Canada. At each facility, two informal walkabouts and two documentation information sessions were conducted with care aides during the first 4 months. To assess their effect, uptake of the sit-to-stand activity was compared 4 days prior to and 4 days after each intervention, as well as the entire first and fourth months of the study were compared. Data were analyzed using mixed linear regression models created to estimate the changes in uptake. RESULTS: Data were collected from 227 residents. After controlling for age, sex, dementia, and mobility, a 5.3% (p = .09) increase in uptake of the mobility activity was observed during the day shift and 6.1% (p = .007) increase in uptake of the mobility activity during the evening shift. Site size had a significant effect on the outcome with medium-sized facilities showing a 12.6% (SE = .07) increase over small sites and a 18.2% (SE = .05) increase over large sites. These results suggest that repeated KT interventions and sufficient time are key variables in the successful implementation of new practices. LINKING EVIDENCE TO ACTION: Consideration of time, repetition, and facility-specific variables such as size may generate simple, cost-effective KT interventions in healthcare settings.

Diet quality is associated with malnutrition and low calf circumference in Canadian long-term care residents.

BACKGROUND: Older adults living in long-term care (LTC) are nutritionally vulnerable. The purpose of this study was to determine diet quality of Canadian LTC residents and its association with malnutrition and low calf circumference. METHODS: A cross-sectional study was undertaken in 32 LTC homes across four Canadian provinces. Nutrient adequacy ratios (NARs) were calculated for seventeen nutrients; mean adequacy ratio (MAR) was calculated to describe overall diet quality. Malnutrition risk was assessed with the Mini Nutritional Assessment-Short Form (MNA-SF) and diagnosis of protein/energy malnutrition with the Patient-Generated Subjective Global Assessment (PG-SGA). Calf circumference (CC) was also assessed. Linear and logistic regressions for these outcomes with diet quality as the predictor were conducted adjusting for covariates. RESULTS: Average MNA-SF score was 10.7 ± 2.5. Residents (43.5%) had mild/moderate to severe malnutrition based on the PG-SGA and 32.6% had a CC of < 31 cm. Mean MAR score was 0.79 ± 0.09 with significant differences between those requiring eating assistance (0.77 ± 0.11) and those that did not require assistance (0.80 ± 0.07) (p < .05). MAR score was significantly associated with malnutrition in fully adjusted models: MNA-SF scores [ß = 5.34, 95% Confidence interval (CI) (2.81, 7.85)] and PG-SGA [Odds ratio (OR) = 0.49, 95% CI (0.38, 0.64)]. Those who had better diet quality were more likely to be well nourished or not at risk. Although several individual nutrients were associated with low CC (< 31 cm), there was no association between overall diet quality (MAR) and low CC. CONCLUSIONS: Diet quality is associated with malnutrition and individual nutrients (NARs) with a low CC. In addition to calories and protein, nutrient dense diets that promote adequate micronutrient intake are required in LTC.

The Changing Landscape of Continuing Care in Alberta: Staff and Resident Characteristics in Supportive Living and Long-Term Care.

With provincial policy changing institutional care provision for older adults who are unable to safely remain at home, supportive living represents a new middle-ground to provide care for older adults. We compared characteristics of supportive living staff and residents to those in long-term care (LTC), using facility and staff surveys, as well as administrative Resident Assessment Instrument (RAI) data, to describe differences and similarities between facility types. Data analysis included t-tests, chi-square tests, ridit analyses and odds ratios. Participants from 15 supportive living facilities were compared to participants from eight LTC homes. Supportive living healthcare aides were younger, worked fewer years and were more likely to work full time than LTC healthcare aides. LTC residents were more likely than supportive living residents to have: cognitive impairment, medical instability, and activities of daily living dependence. This knowledge, which situates supportive living in the new care continuum, is useful for policy makers and administrators deciding on interventions and clinical guidelines for care groups.