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1.
Gerontologist ; 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-33659982

RESUMO

BACKGROUND AND OBJECTIVES: There is an urgency to respond to the long-standing deficiencies in health human resources in the long-term care (LTC) home sector, which have been laid bare by the Coronavirus Disease 2019 (COVID-19) pandemic. Nurse Practitioners (NPs) represent an efficient solution to human resource challenges. During the current pandemic, many Medical Directors in LTC homes worked virtually to reduce the risk of transmission. In contrast, NPs were present for in-person care. This study aims to understand the NPs' roles in optimizing resident care and supporting LTC staff during the pandemic. RESEARCH DESIGN AND METHODS: This exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes in Ontario, Canada was recruited. Data was generated using semi-structured interviews and examined using thematic analysis. RESULTS: Four categories relating to the NPs' practices and experiences during the pandemic were identified: a) containing the spread of COVID-19; b) stepping in where needed; c) supporting staff and families; and d) establishing links between fragmented systems of care by acting as a liaison. DISCUSSION AND IMPLICATIONS: The findings suggest that innovative models of care that include NPs in LTC homes are required moving forward. NPs embraced a multitude of roles in LTC homes, but the need to mitigate the spread of COVID-19 was central to how they prioritized their days. The pandemic clearly accentuated that NPs have a unique scope of practice, which positions them well to act as leaders and build capacity in LTC home.

2.
JBI Evid Synth ; 2021 Mar 11.
Artigo em Inglês | MEDLINE | ID: mdl-33720110

RESUMO

OBJECTIVE: This scoping review aims to compare strategies for measuring prescription medication switching with pharmacy claims data, with a focus on psychotropic vs non-psychotropic medications. INTRODUCTION: Medication switching (ie, the replacement of one medication for another) is common and occurs due to several factors (such as adverse effects to a specific medication). In pharmacoepidemiology studies that use pharmacy claims data, it is important to identify and account for switches; however, due to data limitations and lack of a methodological standard, this can be challenging. The aim of this scoping review is to describe how studies have previously measured medication switching with pharmacy claims data in order to create a repository of common strategies and highlight areas for future research. INCLUSION CRITERIA: This review will include studies that have used pharmacy claims data to measure medication switching as their primary independent or dependent variable. Studies conducted at the individual level (ie, not ecological), published between January 1, 1980, and October 31, 2020, and investigating orally administered, non-anti-infective medications will be considered. No age, population, or context restrictions are specified as inclusion criteria. METHODS: JBI methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews were used for this protocol. MEDLINE (PubMed), Embase (Ovid), Central (Cochrane Library), CINAHL (EBSCOhost), and Google Scholar will be searched with the assistance of a health sciences research librarian. Two reviewers will independently screen titles, abstracts, and full-text articles. Strategies for measuring medication switching will be narratively described and summarized overall and by broad medication class.

3.
J Med Internet Res ; 23(1): e22831, 2021 01 20.
Artigo em Inglês | MEDLINE | ID: mdl-33470949

RESUMO

BACKGROUND: As the aging population continues to grow, the number of adults living with dementia or other cognitive disabilities in residential long-term care homes is expected to increase. Technologies such as real-time locating systems (RTLS) are being investigated for their potential to improve the health and safety of residents and the quality of care and efficiency of long-term care facilities. OBJECTIVE: The aim of this study is to identify factors that affect the implementation, adoption, and use of RTLS for use with persons living with dementia or other cognitive disabilities in long-term care homes. METHODS: We conducted a systematic review of the peer-reviewed English language literature indexed in MEDLINE, Embase, PsycINFO, and CINAHL from inception up to and including May 5, 2020. Search strategies included keywords and subject headings related to cognitive disability, residential long-term care settings, and RTLS. Study characteristics, methodologies, and data were extracted and analyzed using constant comparative techniques. RESULTS: A total of 12 publications were included in the review. Most studies were conducted in the Netherlands (7/12, 58%) and used a descriptive qualitative study design. We identified 3 themes from our analysis of the studies: barriers to implementation, enablers of implementation, and agency and context. Barriers to implementation included lack of motivation for engagement; technology ecosystem and infrastructure challenges; and myths, stories, and shared understanding. Enablers of implementation included understanding local workflows, policies, and technologies; usability and user-centered design; communication with providers; and establishing policies, frameworks, governance, and evaluation. Agency and context were examined from the perspective of residents, family members, care providers, and the long-term care organizations. CONCLUSIONS: There is a striking lack of evidence to justify the use of RTLS to improve the lives of residents and care providers in long-term care settings. More research related to RTLS use with cognitively impaired residents is required; this research should include longitudinal evaluation of end-to-end implementations that are developed using scientific theory and rigorous analysis of the functionality, efficiency, and effectiveness of these systems. Future research is required on the ethics of monitoring residents using RTLS and its impact on the privacy of residents and health care workers.


Assuntos
Disfunção Cognitiva/terapia , Sistemas Computacionais/normas , Assistência de Longa Duração/normas , Análise de Dados , Humanos , Pesquisa Qualitativa
4.
J Am Med Dir Assoc ; 22(2): 228-237.e25, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33347846

RESUMO

OBJECTIVES: Good social connection is associated with better health and wellbeing. However, social connection has distinct considerations for people living in long-term care (LTC) homes. The objective of this scoping review was to summarize research literature linking social connection to mental health outcomes, specifically among LTC residents, as well as research to identify strategies to help build and maintain social connection in this population during COVID-19. DESIGN: Scoping review. SETTINGS AND PARTICIPANTS: Residents of LTC homes, care homes, and nursing homes. METHODS: We searched MEDLINE(R) ALL (Ovid), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (ProQuest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid), and AgeLine (EBSCO) for research that quantified an aspect of social connection among LTC residents; we limited searches to English-language articles published from database inception to search date (July 2019). For the current analysis, we included studies that reported (1) the association between social connection and a mental health outcome, (2) the association between a modifiable risk factor and social connection, or (3) intervention studies with social connection as an outcome. From studies in (2) and (3), we identified strategies that could be implemented and adapted by LTC residents, families and staff during COVID-19 and included the articles that informed these strategies. RESULTS: We included 133 studies in our review. We found 61 studies that tested the association between social connection and a mental health outcome. We highlighted 12 strategies, informed by 72 observational and intervention studies, that might help LTC residents, families, and staff build and maintain social connection for LTC residents. CONCLUSIONS AND IMPLICATIONS: Published research conducted among LTC residents has linked good social connection to better mental health outcomes. Observational and intervention studies provide some evidence on approaches to address social connection in this population. Although further research is needed, it does not obviate the need to act given the sudden and severe impact of COVID-19 on social connection in LTC residents.


Assuntos
/epidemiologia , Assistência de Longa Duração , Saúde Mental , Casas de Saúde , Isolamento Social/psicologia , Humanos , Pandemias
5.
Disabil Rehabil ; : 1-10, 2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33253597

RESUMO

PURPOSE: Rehabilitation clinicians need information about patient activities in the home/community to inform care. Despite active efforts to develop technologies that can meet this need, clinicians' perspectives regarding how information is collected and used in outpatient rehabilitation have not been comprehensively described. Therefore, we aimed to describe: (1) what data pertaining to a patient's health, function and activity in their home/community are currently collected in outpatient rehabilitation, (2) how these data can impact clinical decisions, and (3) what challenges clinicians encounter when they manage the care of outpatients based on this information. MATERIALS AND METHODS: Eight clinicians working in outpatient rehabilitation programs completed qualitative interviews that were analyzed using an inductive thematic analysis. RESULTS: Four themes were identified: "Nature of data about a patient's health, function and activity in the home/community and how it is collected by clinicians," "Value of data from the home/community," "Perceived drawbacks of current data collection methods," and "Improving data collection to understand patient trajectory." CONCLUSIONS: Clinicians described the importance of understanding patient activities in the home/community, but perspectives varied regarding the suitability of current methods. These perceptions may inform the design of solutions to bridge the gap between the clinic and the community in outpatient rehabilitation. Implications for rehabilitation Clinical decision-making in outpatient rehabilitation is guided by verbal and written reports about a patient's health and function in the community and adherence to treatment plans. Differing perceptions on the suitability of current data collection methods indicate that the development of new solutions, such as rehabilitation technologies, needs to carefully consider clinician workflows and what data are perceived as meaningful. Potentially impactful directions for new solutions include providing well validated data on adherence, movement quality, or longitudinal progression, presented in formats that match clinical decision criteria.

6.
Exp Gerontol ; 143: 111170, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33238173

RESUMO

Measures of gait center of pressure (COP) can be recorded using simple available technologies in clinical settings and thus can be used to characterize gait quality in older adults and its relationship to falls. The aim of this systematic review was to investigate the association between measures of gait COP and aging and falls. A comprehensive search of electronic databases including MEDLINE, Embase, Cochrane Central Register of Controlled Trials, CINAHL (EBSCO), Ageline (EBSCO) and Scopus was performed. The initial search yielded 2809 papers. After removing duplicates and applying study inclusion/exclusion criteria, 34 papers were included in the review. Gait COP has been examined during three tasks: normal walking, gait initiation, and obstacle negotiation. The majority of studies examined mean COP position and velocity as outcome measures. Overall, gait in older adults was characterized by more medial COP trajectory in normal walking and lower average anterior-posterior and medio-lateral COP displacements and velocity in both gait initiation and obstacle crossing. Moreover, findings suggest that Tai chi training can enhance older adults' balance control during gait initiation as demonstrated by greater COP backward, medial and forward shift in all three phases of gait initiation. These findings should be interpreted cautiously due to inadequacy of evidence as well as methodological limitations of the studies such as small sample size, limited numbers of 'fallers', lack of a control group, and lack of interpretation of COP outcomes with respect to fall risk. COP measures can be adopted to assess fall-related gait changes in older adults but more complex measures of COP that reveal the dynamic nature of COP behavior in step-to-step variations are needed to adequately characterize gait changes in older adults.

8.
J Am Med Dir Assoc ; 2020 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-32900610

RESUMO

OBJECTIVES: To develop a prognostic model to predict the probability of a short-term fall (within the next 7 to 30 days) in older adults with dementia. DESIGN: Prospective observational study. SETTING AND PARTICIPANTS: Fifty-one individuals with dementia at high risk of falls from a specialized dementia inpatient unit. METHODS: Clinical and demographic measures were collected and a vision-based markerless motion capture was used to record the natural gait of participants over a 2-week baseline. Falls were tracked throughout the length of stay. Cox proportional hazard regression analysis was used to build a prognostic model to determine fall-free survival probabilities at 7 days and at 30 days. The model's discriminative ability was also internally validated. RESULTS: Fall history and gait stability (estimated margin of stability) were statistically significant predictors of time to fall and included in the final prognostic model. The model's predicted survival probabilities were close to observed values at both 7 and 30 days. The area under the receiver operating curve was 0.80 at 7 days, and 0.67 at 30 days and the model had a discrimination performance (the Harrel concordance index) of 0.71. CONCLUSIONS AND IMPLICATIONS: Our short-term falls risk model had fair to good predictive and discrimination ability. Gait stability and recent fall history predicted an imminent fall in our population. This provides some preliminary evidence that the degree of gait instability may be measureable in natural everyday gait to allow dynamic falls risk monitoring. External validation of the model using a separate data set is needed to evaluate model's predictive performance.

9.
Aging Ment Health ; : 1-12, 2020 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-32691610

RESUMO

OBJECTIVE: Many people living in long-term care homes (LTCH) experience changes in behaviour termed the behavioural and psychological symptoms of dementia (BPSD). The valid and reliable assessment of BPSD is essential to guide treatment and monitor the effect of interventions. The aim of this study was to identify behavioural assessment tools implemented in LTCH and factors that impact on their use in clinical care. METHODS: We completed an online mixed-design survey of 300 randomly selected Canadian LTCH between September and November 2018. Respondents were asked to report tools used, reasons for use, methods of administration, training/supports available, confidence in use and challenges faced. Survey results were summarized descriptively and the correlation between implementation supports and confidence examined. Free-text responses were analysed qualitatively. RESULTS: Of 300 LTCH invited to participate, 103 completed the survey. Homes reported using a mean 2.2 ± 1.1 (range 0-7) different tools. The two most commonly used tools were the Dementia Observation System (DOS) and Cohen-Mansfield Agitation Inventory (CMAI). Overall confidence in most aspects of tool use was reported to be high, with workload identified as the greatest challenge. Training and supports correlated with confidence in tool use. Qualitative findings indicate tools provide valuable data to understand behaviours, facilitate team communication, target interventions and track outcomes. CONCLUSIONS: Behavioural assessment tools, in particular a direct observation tool, are widely used in clinical care in Canadian LTCH. Education, enhanced resources, leadership support and applications of technology represent opportunities to improve their use.

10.
Aging Ment Health ; : 1-10, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32677506

RESUMO

OBJECTIVE: Previous systematic reviews have examined depression screening in older adults with cognitive impairment (CI) in outpatient and inpatient clinics, nursing homes, and residential care. Despite an increasing number of older adults with CI receiving care in their homes, less is known about best depression screening practices in homecare. The objective of this review is to identify evidence-based practices for depression screening for individuals with CI receiving homecare by assessing tool performance and establishing the current evidence for screening practices in this setting. METHODS: This review is registered under PROSPERO (ID: CRD42018110243). A systematic search was conducted using MEDLINE, EMBASE, Health and Psychosocial Abstracts, PsycINFO and CINAHL. The following criteria were used: assessment of depression at home in older adults (>55 years) with CI, where performance outcomes of the depression screening tool were reported. RESULTS: Of 5,453 studies, only three met eligibility criteria. These studies evaluated the Patient Health Questionnaire (n = 236), the Geriatric Depression Scale (n = 79) and the Mental Health Index (n = 1,444) in older adults at home with and without CI. Psychometric evaluation demonstrated moderate performance in the subsamples of people with CI. CONCLUSION: At present, there is insufficient evidence to support best practices in screening for depression in people with CI in homecare.

11.
J Neuroeng Rehabil ; 17(1): 97, 2020 07 14.
Artigo em Inglês | MEDLINE | ID: mdl-32664973

RESUMO

BACKGROUND: Parkinsonism is common in people with dementia, and is associated with neurodegenerative and vascular changes in the brain, or with exposure to antipsychotic or other dopamine antagonist medications. The detection of parkinsonian changes to gait may provide an opportunity to intervene and address reversible causes. In this study, we investigate the use of a vision-based system as an unobtrusive means to assess severity of parkinsonism in gait. METHODS: Videos of walking bouts of natural gait were collected in a specialized dementia unit using a Microsoft Kinect sensor and onboard color camera, and were processed to extract sixteen 3D and eight 2D gait features. Univariate regression to gait quality, as rated on the Unified Parkinson's Disease Rating Scale (UPDRS) and Simpson-Angus Scale (SAS), was used to identify gait features significantly correlated to these clinical scores for inclusion in multivariate models. Multivariate ordinal logistic regression was subsequently performed and the relative contribution of each gait feature for regression to UPDRS-gait and SAS-gait scores was assessed. RESULTS: Four hundred one walking bouts from 14 older adults with dementia were included in the analysis. Multivariate ordinal logistic regression models incorporating selected 2D or 3D gait features attained similar accuracies: the UPDRS-gait regression models achieved accuracies of 61.4 and 62.1% for 2D and 3D features, respectively. Similarly, the SAS-gait models achieved accuracies of 47.4 and 48.5% with 2D or 3D gait features, respectively. CONCLUSIONS: Gait features extracted from both 2D and 3D videos are correlated to UPDRS-gait and SAS-gait scores of parkinsonism severity in gait. Vision-based systems have the potential to be used as tools for longitudinal monitoring of parkinsonism in residential settings.

12.
IEEE J Transl Eng Health Med ; 8: 2100609, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32537265

RESUMO

Fall risk is high for older adults with dementia. Gait impairment contributes to increased fall risk, and gait changes are common in people with dementia, although the reliable assessment of gait is challenging in this population. This study aimed to develop an automated approach to performing gait assessments based on gait data that is collected frequently and unobtrusively, and analysed using computer vision methods. Recent developments in computer vision have led to the availability of open source human pose estimation algorithms, which automatically estimate the joint locations of a person in an image. In this study, a pre-existing pose estimation model was applied to 1066 walking videos collected of 31 older adults with dementia as they walked naturally in a corridor on a specialized dementia unit over a two week period. Using the tracked pose information, gait features were extracted from video recordings of gait bouts and their association with clinical mobility assessment scores and future falls data was examined. A significant association was found between extracted gait features and a clinical mobility assessment and the number of future falls, providing concurrent and predictive validation of this approach.

13.
Am J Geriatr Psychiatry ; 28(8): 835-838, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32430111

RESUMO

Nursing homes are facing the rapid spread of COVID-19 among residents and staff and are at the centre of the public health emergency due to the COVID-19 pandemic. As policy changes and interventions designed to support nursing homes are put into place, there are barriers to implementing a fundamental, highly effective element of infection control, namely the isolation of suspected or confirmed cases. Many nursing home residents have dementia, associated with impairments in memory, language, insight, and judgment that impact their ability to understand and appreciate the necessity of isolation and to voluntarily comply with isolation procedures. While there is a clear ethical and legal basis for the involuntary confinement of people with dementia, the potential for unintended harm with these interventions is high, and there is little guidance for nursing homes on how to isolate safely, while maintaining the human dignity and personhood of the individual with dementia. In this commentary, we discuss strategies for effective, safe, and compassionate isolation care planning, and present a case vignette of a person with dementia who is placed in quarantine on a dementia unit.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Demência/terapia , Casas de Saúde/normas , Pandemias/prevenção & controle , Isolamento de Pacientes/métodos , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Quarentena/métodos , Idoso , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Demência/complicações , Feminino , Humanos , Tratamento Involuntário/ética , Tratamento Involuntário/métodos , Isolamento de Pacientes/ética , Pneumonia Viral/complicações , Pneumonia Viral/transmissão , Quarentena/ética
15.
J Am Med Dir Assoc ; 21(8): 1024-1035.e4, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31982358

RESUMO

OBJECTIVES: To determine the efficacy of fall intervention programs in nursing homes (NHs) and the generalizability of these interventions to people living with cognitive impairment and dementia. DESIGN: Systematic review and meta-analysis. SETTING AND PARTICIPANTS: NH residents (n = 30,057) living in NHs defined as residential facilities that provide 24-hours-a-day surveillance, personal care, and some clinical care for persons who are typically aged ≥65 years with multiple complex chronic health conditions. METHODS: Meta-analysis of falls prevention interventions on number of falls, fallers, and recurrent fallers. RESULTS: Thirty-six studies met inclusion criteria for the systematic review. Overall, fall prevention interventions reduced the number of falls [risk ratio (RR) = 0.73, 95% confidence interval (CI) = 0.60-0.88], fallers (RR = 0.80, 95% CI = 0.72-0.89), and recurrent fallers (RR = 0.70, 95% CI = 0.60-0.81). Subanalyses revealed that single interventions have a significant effect on reducing fallers (RR = 0.78, 95% CI = 0.69-0.89) and recurrent fallers (RR = 0.60, 95% CI = 0.52-0.70), whereas multiple interventions reduce fallers (RR = 0.69, 95% CI = 0.39-0.97) and multifactorial interventions reduce number of falls (RR = 0.65, 95% CI = 0.45-0.94). CONCLUSIONS AND IMPLICATIONS: Exercise as a single intervention reduced the number of fallers and recurrent fallers by 36% and 41%, respectively, in people living in NHs. Other effective interventions included staff education and multiple and multifactorial interventions. However, more research on exercise including people with cognitive impairment and dementia is needed to improve the generalizability of these interventions to the typical NH resident.

16.
Am J Geriatr Psychiatry ; 28(3): 285-287, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31786145
17.
J Am Med Dir Assoc ; 21(6): 793-798.e1, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31676326

RESUMO

OBJECTIVES: There are several mechanisms for monitoring the quality of care in long-term care (LTC), including the use of quality indicators derived from resident assessments and formal inspections. The LTC inspection process is time and resource-intensive, and there may be opportunities to better target inspections. In this study, we aimed to examine whether quality indicators could predict future inspection performance in LTC homes across Ontario, Canada. SETTING AND PARTICIPANTS: In total, 594 LTC homes across Ontario. METHODS: Using a database compiling detailed inspection reports for the period from 2017 to 2018, we classified each home into 1 of 3 categories (in good standing, needing improvement, needing significant improvement). Machine learning techniques were used to examine whether publicly available Resident Assessment Instrument‒Minimum Data Set quality indicators for the period 2016‒2017 could predict facility classification based on inspection results. RESULTS: After running a wide range of models, only a weak relationship was found between quality indicators and future inspection performance. The best-performing model was able to achieve a classification accuracy of 40.1%. Feature analysis was performed on the final model to identify which quality indicators were most indicative of predicted poor performance. Experiencing worsened pain, restraint use, and worsened pressure ulcers were correlated with homes predicted as needing significant improvement. Counterintuitively, improved physical functioning had an inverse relationship with homes predicted as being in good standing. CONCLUSIONS AND IMPLICATIONS: Most quality indicators are poor predictors of inspection performance. Further work is required to explore the limited relationship between these 2 measures of LTC quality, and to identify other quality measures that may be useful as predictors of facilities facing difficulty in meeting quality standards.

18.
J Gerontol A Biol Sci Med Sci ; 75(6): 1148-1153, 2020 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31428758

RESUMO

BACKGROUND: Gait impairments contribute to falls in people with dementia. In this study, we used a vision-based system to record episodes of walking over a 2-week period as participants moved naturally around their environment, and from these calculated spatiotemporal, stability, symmetry, and acceleration gait features. The aim of this study was to determine whether features of gait extracted from a vision-based system are associated with falls, and which of these features are most strongly associated with falling. METHODS: Fifty-two people with dementia admitted to a specialized dementia unit participated in this study. Thirty different features describing baseline gait were extracted from Kinect recordings of natural gait over a 2-week period. Baseline clinical and demographic measures were collected, and falls were tracked throughout the participants' admission. RESULTS: A total of 1,744 gait episodes were recorded (mean 33.5 ± 23.0 per participant) over a 2-week baseline period. There were a total of 78 falls during the study period (range 0-10). In single variable analyses, the estimated lateral margin of stability, step width, and step time variability were significantly associated with the number of falls during admission. In a multivariate model controlling for clinical and demographic variables, the estimated lateral margin of stability (p = .01) was remained associated with number of falls. CONCLUSIONS: Information about gait can be extracted from vision-based recordings of natural walking. In particular, the lateral margin of stability, a measure of lateral gait stability, is an important marker of short-term falls risk.

19.
BMJ Open ; 9(12): e033240, 2019 12 09.
Artigo em Inglês | MEDLINE | ID: mdl-31822544

RESUMO

INTRODUCTION: Social well-being is associated with better physical and mental health. It is also important for quality of life, including from the perspectives of those living in long-term care (LTC) homes. However, given the characteristics of the LTC home environment and the people who live there, the nature and influence of social integration and loneliness, and strategies to address them, may differ in this population compared with those living in the community. The objective of this scoping review is to provide an overview of the nature and extent of research on social integration and loneliness among LTC home residents, including a summary of how these concepts have been operationalised and any evidence from specific groups. METHODS AND ANALYSIS: This study protocol describes the methods of a scoping review of peer-reviewed literature related to social integration and loneliness among LTC home residents. A literature search was developed by an Information Specialist and will be conducted in MEDLINE(R) ALL (in Ovid, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE(R) Daily) and then translated into CINAHL (EBSCO), PsycINFO (Ovid), Scopus, Sociological Abstracts (Proquest), Embase and Embase Classic (Ovid), Emcare Nursing (Ovid) and AgeLine (EBSCO). Two reviewers will independently screen titles and abstracts of articles identified in the search. Two reviewers will then independently review full text articles for inclusion. Data extraction will also be carried out in duplicate. We will engage LTC home community members, including residents, family and staff, to refine the review questions, assist in interpreting the results and participate in knowledge translation. ETHICS AND DISSEMINATION: Ethics approval is not required. We will present findings at conferences and publish in a peer-reviewed journal. Ultimately, we hope to inform future observational and interventional research aimed at improving the health and quality of life of LTC home residents.

20.
CMAJ Open ; 7(3): E582-E589, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31551235

RESUMO

BACKGROUND: Opioids are an important pain therapy, but their use may be associated with adverse events in frail and cognitively impaired long-term care residents. The objective of this study was to investigate trends in opioid prescribing among Ontario long-term care residents over time, given the paucity of data for this setting. METHODS: We used linked clinical and health administrative databases to conduct a population-based, repeated cross-sectional study of opioid use among Ontario long-term care residents between Apr. 1, 2009, and Mar. 31, 2017. We identified prevalent opioid use by drug type, dosage and coprescription with benzodiazepines, and within certain vulnerable subgroups. We used log-binomial regression to quantify the percent change between 2009/10 and 2016/17. RESULTS: Among an average of 76 147 long-term care residents per year, the prevalence of opioid use increased from 15.8% in 2009/10 to 19.6% in 2016/17 (p < 0.001). Over the study period, the use of hydromorphone increased by 233.2%, whereas the use of all other opioid agents decreased. The use of high-dose opioids (> 90 mg of morphine equivalents) and the coprescription of opioids with benzodiazepines decreased significantly, by 17.7% (p < 0.001) and 23.8% (p < 0.001), respectively. Increases in opioid prevalence were more notable among frail residents (37.6% v. 18.8% among nonfrail residents, p < 0.001) and those with dementia (38.6% v. 21.6% among those without dementia, p < 0.001). INTERPRETATION: Within Ontario long-term care, trends suggest a shift toward increased use of hydromorphone but reduced prevalence of use of other opioid agents and potentially inappropriate opioid prescribing. Further investigation is needed on the impact of these trends on resident outcomes.

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