Recruitment and Retention Challenges in a Technology-Based Study with Older Adults Discharged from a Geriatric Rehabilitation Unit.

PURPOSE: Technology has the potential to offer support to older adults after being discharged from geriatric rehabilitation. This article highlights recruitment and retention challenges in a study examining an interactive voice response telephone system designed to monitor and support older adults and their informal caregivers following discharge from a geriatric rehabilitation unit. METHODS: A prospective longitudinal study was planned to examine the feasibility of an interactive voice telephone system in facilitating the transition from rehabilitation to home for older adults and their family caregivers. Patient participants were required to make daily calls into the system. Using standardized instruments, data was to be collected at baseline and during home visits. FINDINGS: Older adults and their caregivers may not be willing to learn how to use new technology at the time of hospital discharge. Poor recruitment and retention rates prevented analysis of findings. CONCLUSIONS AND CLINICAL RELEVANCY: The importance of recruitment and retention in any study should never be underestimated. Target users of any intervention need to be included in both the design of the intervention and the study examining its benefit. Identifying the issues associated with introducing technology with a group of older rehabilitation patients should assist others who are interested in exploring the role of technology in facilitating hospital discharge.

Measuring repeatability of compositional diet estimates: An example using quantitative fatty acid signature analysis.

By measuring the temporal consistency, or repeatability, in the diets of predators, we can gain a better understanding of the degree of individual specialization in resource utilization and implications for predator-prey interactions, population dynamics, and food web structure. To measure repeatability, we require repeated diet estimates of individuals over time, such as those derived from quantitative fatty acid signature analysis (QFASA), a popular diet estimation technique. However, diet estimates are often lengthy compositional vectors with many zeros, as some prey will not be consumed by all individuals, precluding the use of previously proposed measures of repeatability. In this paper, we propose a novel approach for inferring repeatability for multivariate data and, in particular, compositional diet estimates. We extend the commonly used measure of repeatability for univariate data to the multivariate compositional setting by utilizing the mean squares obtained from a nonparametric multivariate analysis of variance, and an appropriate choice of statistical distance. Our measure and its extension are compatible with both balanced and unbalanced data sets. Associated confidence intervals via nonparametric bootstrapping are also developed for the case of QFASA diet estimates that incorporate both sampling error and measurement error, where the latter error arises because the diets of predators are estimated. Simulation study results suggest that for practical levels of repeatability, our methods yield confidence intervals with the desired coverage probability even when the sample size relative to the dimension of the data (i.e., number of prey species eaten) is small. We tested our methods using QFASA diet estimates for free-ranging Northwest Atlantic grey seals. Given the importance of understanding how predator diets vary over time and space, our method may find broad application to other compositional diet estimates, including those derived from the stomach or fecal contents, and stable isotope analyses.

Fatty acid-based diet estimates suggest ringed seal remain the main prey of southern Beaufort Sea polar bears despite recent use of onshore food resources.

Polar bears (Ursus maritimus) from the southern Beaufort Sea (SB) subpopulation have traditionally fed predominantly upon ice-seals; however, as the proportion of the subpopulation using onshore habitat has recently increased, foraging on land-based resources, including remains of subsistence-harvested bowhead whales (Balaena mysticetus) and colonial nesting seabirds has been observed. Adipose tissue samples were collected from this subpopulation during the springs of 2013-2016 and analyzed for fatty acid signatures. Diet estimates were generated for the proportional consumption of ringed seal (Pusa hispida), bearded seal (Erignathus barbatus), and beluga whale (Delphinapterus leucas), relative to onshore foods, including bowhead whale remains and seabird, as represented by black guillemot (Cepphus grylle mandtii) nestlings and eggs. Quantitative fatty acid signature analysis (QFASA) estimated that the ice-obligate prey, ringed seal, remained the predominant prey species of SB polar bears (46.4 ± 1.8%), with much lower consumption of bearded seal (19.6 ± 2.0%), seabird (17.0 ± 1.2%), bowhead whale (15.0 ± 1.4%), and hardly any beluga whale (2.0 ± 0.5%). Adult and subadult females appeared to depend more on the traditional ringed seal prey than adult and subadult males. Diet estimates of SB polar bears showed significant interannual variability for all prey (F 12, 456 = 3.17, p < .001). Longer-term estimates suggested that both types of onshore prey, bowhead whale remains and seabird, have represented a moderate proportion of the food resources used by SB polar bears since at least the start of the 21st Century.

Changes in nursing students' knowledge, attitudes and interest in caring for older adults: A longitudinal cohort study.

Nursing education programs have a responsibility to prepare future nurses to care for the growing number of older adults who will be accessing health care services. Preparation involves ensuring students have the knowledge, skills and desire to provide quality care to older adults. A longitudinal cohort study was conducted to collect data on students' knowledge of, attitudes towards, and interest in working with older adults during each year of an undergraduate nursing program. Data were collected using the Kogan Attitudes Towards Older People Scale, Palmore's Fact on Aging Quiz and a demographic instrument designed specifically for this study. Results showed slight improvements in students' overall attitudes towards older adults at the completion of their nursing degree. Increases in knowledge were seen in 12 of 24 areas measured. Gerontology as a preferred career choice was highest immediately following a clinical placement focusing on caring for older adults. Integrating gerontological clinical experiences into a beginning fundamental nursing course does not necessarily improve students' learning in the area of caring for older adults. Nursing programs have a responsibility to design, monitor and update curricula to ensure students are being adequately prepared to care for older adults.

Predictors of Success in the NCLEX-RN for Canadian Graduates.

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) has been the nursing licensure exam in most Canadian jurisdictions since 2015. Nursing faculty across the country have invested considerable effort into understanding the NCLEX-RN, so they could help to prepare students to be successful in the exam. A retrospective study was conducted at one Canadian university to identify predictors of success on the NCLEX-RN. Findings revealed that the strongest predictors of success were a grade point average of >3.5 and a course grade in the community development course. The strong predictive value of the community development course was unexpected, and this suggests that content specifically related to acute care may not play as heavy a role in the NCLEX-RN outcome as previously expected. It is possible that students' higher levels of cognitive abilities, such as application, analysis and synthesis of nursing knowledge, play a larger role in the exam outcome than content-specific knowledge.

The Untold Story of Being Designated an Alternate Level of Care Patient.

INTRODUCTION: Much of the research and policy reports on Alternate Level of Care (ALC) in Canada have focused on the impact ALC has on acute care services. To date, the experiences and opinions of those who must wait in hospital for alternate services have been largely absent from discussions. METHOD: A qualitative study was conducted with patients and families designated as ALC in one urban and two rural hospitals in Atlantic Canada. Data were analyzed using content analysis. RESULTS: Three themes emerged from the data: a perception of normalcy, being old but not sick and anticipating relocation to another facility. CONCLUSIONS: ALC is an important issue for patients and their families. Policy directives aimed at addressing the causes and impacts of ALC, identification and provision of appropriate supportive care in the community and sensitivity to the impact of ALC for individuals designated as ALC are needed.

How registered nurses, licensed practical nurses and resident aides spend time in nursing homes: An observational study.

BACKGROUND: Calls for improved conditions in nursing homes have pointed to the importance of optimizing the levels and skills of care providers. Understanding the work of care providers will help to determine if staff are being used to their full potential and if opportunities exist for improved efficiencies. OBJECTIVES: To explore the activities of care providers in different nursing homes and to identify if variations exist within and across homes and shifts. METHODS: A multi-centre cross-sectional observational work flow study was conducted in seven different nursing homes sites in one Canadian province. Data were collected by a research assistant who conducted 368 h of observation. The research assistant collected data by following an identical route in each site and recording observations on staff activities. RESULTS: Findings indicate staff activities vary across roles, sites and shifts. Licensed practical nurses (nursing assistants) have the greatest variation in their role while registered nurses have the least amount of variability. In some sites both registered nurses and licensed practical nurses perform activities that may be safely delegated to others. Care providers spend as much as 53.7% of their time engaged in non-value added activities. CONCLUSIONS: There may be opportunities for registered nurses and licensed practical nurses to delegate some of their activities to non-regulated workers. The time care providers spend in non-value activities suggest there may be opportunities to improve efficiencies within the nursing home setting.

Corrigendum: Comparison of the SIMARD MD to clinical impression in assessing fitness to drive in patients with cognitive impairment.

[This corrects the article on p. 63 in vol. 17, PMID: 24883164.].

Alternate level of care patients in hospitals: what does dementia have to do with this?

BACKGROUND: Patients in acute care hospitals no longer in need of acute care are called Alternate Level of Care (ALC) patients. This is growing and common all across Canada. A better understanding of this patient population would help to address this problem. METHODS: A chart review was conducted in two hospitals in New Brunswick. All patients designated as ALC on July 1, 2009 had their charts reviewed. RESULTS: Thirty-three per cent of the hospital beds were occupied with ALC patients; 63% had a diagnosis of dementia. The mean length of stay was 379.6 days. Eighty-six per cent were awaiting a long-term care bed in the community. Most patients experienced functional decline during their hospitalization. One year prior to admission, 61% had not been admitted to hospital and 59.2% had had at least one visit to the emergency room. CONCLUSIONS: The majority of the ALC patients in hospital have a diagnosis of dementia and have been waiting in hospital for over one year for a long-term care bed in the community. Many participants were recipients of maximum home care in the community, suggesting home maker services alone may not be adequate for some community-dwelling older adults. Early diagnosis of dementia, coupled with appropriate care in the community, may help to curtail the number of patients with dementia who end up in hospital as ALC patients.

Comparison of the SIMARD MD to Clinical Impression in Assessing Fitness to Drive in Patients with Cognitive Impairment.

BACKGROUND: The assessment of fitness to drive in patients with cognitive impairment is complex. The SIMARD MD was developed to assist with assessing fitness to drive. This study compares the clinical decision made by a geriatrician regarding driving with the SIMARD MD score. METHODS: Patients with a diagnosis of mild dementia or mild cognitive impairment, who had a SIMARD MD test, were included in the sample. A retrospective chart review was completed to gather diagnosis, driving status, and cognitive and functional information. RESULTS: Sixty-three patients were identified and 57 met the inclusion criteria. The mean age was 77.1 years (SD 8.9). The most common diagnosis was Alzheimer's disease in 22 (38.6%) patients. The mean MMSE score was 24.9 (SD 3.34) and the mean MoCA was 19.9 (SD 3.58). The mean SIMARD MD score was 37.2 (SD 19.54). Twenty-four patients had a SIMARD MD score ≤ 30, twenty-eight between 31-70, and five scored > 70. The SIMARD MD scores did not differ significantly compared to the clinical decision (ANOVA p value = 0.14). CONCLUSIONS: There was no association between the SIMARD MD scores and the geriatricians' clinical decision regarding fitness to drive in persons with mild dementia or mild cognitive impairment.

Pregnancy and childbirth during family medicine residency training.

BACKGROUND AND OBJECTIVES: Family medicine residency programs are training more women; pregnancy and childbirth during residency have become more common. The purpose of this study was to examine childbirth during residency from the perspectives of the new mother, her female colleagues who did not give birth during training, and program directors. METHODS: We surveyed female residents and program directors of 457 family medicine residency programs in the United States by mail. Questions were primarily quantitative with Likert and yes/no responses. We analyzed data using Statit-EQC. RESULTS: Response rates were 40% (program directors), 25% (birthing residents), and 13% (non-birthing female residents), regionally reflecting program density. According to program directors, 52% of the residents were female, 17% of these had given birth and returned to work, and 75% of those who gave birth planned to extend their residency. The average time off for maternity leave was 6.5 weeks while the optimum time off was thought to be significantly greater (7-12 weeks). Higher satisfaction of birthing residents was associated with greater satisfaction with childcare. Lower satisfaction was associated with earlier termination of breast-feeding due to demands of residency. A smaller percentage of birthing residents plan to work full-time after graduation than non-birthing residents. CONCLUSIONS: Perceptions that the newborns' needs are met influence the satisfaction and self-ranked performance of birthing residents. Programs with a higher percentage of women accommodate more time off after delivery. Childbirth during residency may influence future work plans.

The health status and unique health challenges of rural older adults in California.

Despite living in the countryside where open space is plentiful and there is often significant agricultural production, rural older adults have higher rates of overweight/obesity, physical inactivity and food insecurity than older adults living in suburban areas. All three conditions are risk factors for heart disease, diabetes and repeated falls. This policy brief examines the health of rural elders and, by contrast, their urban counterparts, and finds that both groups are more likely to be unhealthy than suburban older adults. Yet rural elders, because of their geographical isolation and lack of proximity to health care providers, experience unique environmental and other risk factors that require context-specific solutions to these health issues. In both policies and programs that impact health, policymakers need to take into account the distinctive environmental and social context of older adults living in California's countryside.