Inappropriate medication use in long-term care facility residents with advanced Alzheimer’s disease and other dementias

Les personnes atteintes de démence sévère, résidant dans un centre d’hébergement et de soins de longue durée (CHSLD) et approchant la fin de leur vie, ne reçoivent pas systématiquement des soins palliatifs, malgré que ce niveau de soins soit le plus approprié. La plupart de ces personnes reçoivent également un grand nombre de médicaments dont les effets indésirables peuvent contribuer à des souffrances évitables. Une approche axée sur les soins palliatifs serait possiblement associée à une réduction de la charge médicamenteuse et, du même coup, à une prescription plus appropriée. Les objectifs de ce projet de recherche étaient de décrire l’usage des médicaments chez les résidents atteints de démence sévère en CHSLD, de comparer leur usage de médicaments à des critères de pertinence et d’évaluer si la mise en œuvre d’une approche axée sur les soins palliatifs était associée aux médicaments prescrits. Cette étude décrit l’usage des médicaments chez 215 sujets atteints de démence sévère et en fin de vie qui ont participé à une étude d’intervention quasi expérimentale menée dans quatre CHSLD du Québec sur la mise en œuvre d’une approche axée sur les soins palliatifs. L’utilisation des médicaments a été comparée à trois listes de critères pertinents publiés, soit ceux de Holmes, Rancourt et Kröger, en utilisant des statistiques descriptives. Les analyses sur l’usage de 412 médicaments différents chez 120 sujets du groupe expérimental et 95 sujets du groupe témoin ont montré que cette approche axée sur les soins palliatifs n’est pas associée à une prescription plus appropriée des médicaments chez ces personnes particulièrement vulnérables.

Perceived learning needs in staff development of some care providers in five long-term care settings in Southern Ontario /

This exploratory descriptive study described what 20 care providers in 5 long-term care facilities perceived to aid or hinder their learning in a work-sponsored learning experience. A Critical Incident Technique (Woolsey, 1986) was the catalyst for the interviews with the culturally and professionally diverse participants. Through data analysis, as described by Moustakas (1994), I found that (a) humour, (b) the learning environment, (c) specific characteristics of the presenter such as moderate pacing, speaking slowly and with simple words, (d) decision-making authority, (e) relevance to practice, and (f) practical applications best met the study participants' learning needs. Conversely, other factors could hinder learning based on the participants' perceptions. These were: (a) other presenter characteristics such as a program that was delivered quickly or spoken at a level above the participants' comprehension, (b) no perceived relevance to practice, (c), other environmental situations, and (d) the timing of the learning session. One of my intentions was to identify the emic view among cultural groups and professional/vocational affiliations. A surprising finding of this study was that neither impacted noticeably on the perceived learning needs of the participants. Further research with a revised research design to facilitate inclusion of more diverse participants will aid in determining if the lack of a difference was unique to this sample or more generalizable on a case-to-case transfer basis to the study population.

Study protocol for the translating research in elder care (TREC): Building context through case studies in long-term care project (project two)

Background: The organizational context in which healthcare is delivered is thought to play an important role in mediating the use of knowledge in practice. Additionally, a number of potentially modifiable contextual factors have been shown to make an organizational context more amenable to change. However, understanding of how these factors operate to influence organizational context and knowledge use remains limited. In particular, research to understand knowledge translation in the long-term care setting is scarce. Further research is therefore required to provide robust explanations of the characteristics of organizational context in relation to knowledge use.
Aim: To develop a robust explanation of the way organizational context mediates the use of knowledge in practice in long-term care facilities.
Design: This is longitudinal, in-depth qualitative case study research using exploratory and interpretive methods to explore the role of organizational context in influencing knowledge translation. The study will be conducted in two phases. In phase one, comprehensive case studies will be conducted in three facilities. Following data analysis and proposition development, phase two will continue with focused case studies to elaborate emerging themes and theory. Study sites will be purposively selected. In both phases, data will be collected using a variety of approaches, including non-participant observation, key informant interviews, family perspectives, focus groups, and documentary evidence (including, but not limited to, policies, notices, and photographs of physical resources). Data analysis will comprise an iterative process of identifying convergent evidence within each case study and then examining and comparing the evidence across multiple case studies to draw conclusions from the study as a whole. Additionally, findings that emerge through this project will be compared and considered alongside those that are emerging from project one. In this way, pattern matching based on explanation building will be used to frame the analysis and develop an explanation of organizational context and knowledge use over time. An improved understanding of the contextual factors that mediate knowledge use will inform future development and testing of interventions to enhance knowledge use, with the ultimate aim of improving the outcomes for residents in long-term care settings.

Understanding feedback report uptake: process evaluation findings from a 13-month feedback intervention in long-term care settings

BACKGROUND: Long-term care settings provide care to a large proportion of predominantly older, highly disabled adults across the United States and Canada. Managing and improving quality of care is challenging, in part because staffing is highly dependent on relatively non-professional health care aides and resources are limited. Feedback interventions in these settings are relatively rare, and there has been little published information about the process of feedback intervention. Our objectives were to describe the key components of uptake of the feedback reports, as well as other indicators of participant response to the intervention. METHODS: We conducted this project in nine long-term care units in four facilities in Edmonton, Canada. We used mixed methods, including observations during a 13-month feedback report intervention with nine post-feedback survey cycles, to conduct a process evaluation of a feedback report intervention in these units. We included all facility-based direct care providers (staff) in the feedback report distribution and survey administration. We conducted descriptive analyses of the data from observations and surveys, presenting this in tabular and graphic form. We constructed a short scale to measure uptake of the feedback reports. Our analysis evaluated feedback report uptake by provider type over the 13 months of the intervention. RESULTS: We received a total of 1,080 survey responses over the period of the intervention, which varied by type of provider, facility, and survey month. Total number of reports distributed ranged from 103 in cycle 12 to 229 in cycle 3, although the method of delivery varied widely across the period, from 12% to 65% delivered directly to individuals and 15% to 84% left for later distribution. The key elements of feedback uptake, including receiving, reading, understanding, discussing, and reporting a perception that the reports were useful, varied by survey cycle and provider type, as well as by facility. Uptake, as we measured it, was consistently high overall, but varied widely by provider type and time period. CONCLUSIONS: We report detailed process data describing the aspects of uptake of a feedback report during an intensive, longitudinal feedback intervention in long-term care facilities. Uptake is a complex process for which we used multiple measures. We demonstrate the feasibility of conducting a complex longitudinal feedback intervention in relatively resource-poor long-term care facilities to a wider range of provider types than have been included in prior feedback interventions.

Effects of a dog walking program with older adults in long-term care

The purpose of this study was to determine if walking a dog would increase motivation to adhere to a walking program and result in an increase in walking endurance and mobility among institutionalized elderly. An experimental pre and post test two group randomly assigned study design was utilized. Thirty subjects, 20 females and 10 males with an average age of 72, were enrolled from three long-term care facilities. The walking program was 3 times a week for 6 weeks. The experimental group walked with a certified therapy dog and the handler. The control group walked with only the handler. The Outcome Expectations for Exercise Scale (OEES) was used to measure the perceived benefits of exercise. The 2-minute walk test and the 30 second chair stand test were administered before and after the walking program. The OEES scores did not significantly predict adherence to the program. The pre- and post-chair stand test and the 2-minute walk test did not show statistical significant differences between groups. All of the participants did show an increase (7 minutes) in walking time during the 6 week period (p=0.048). The mean pre and post walk test scores for participants with stroke/arthritis were significantly less than those without stroke/arthritis (p=0.013). The experimental group had 12 subjects with stroke/arthritis compared with 6 in the control group. The walk test means in feet walked were 362.44 ± 130.36 (control) vs. 201.27 ± 106.25 (experimental), p=0.001. The results indicate walking practice has the potential to increase walking time and endurance. Because residents of long-term care facilities were not allowed outside the facilities without accompaniment, the presence of the dog handler was key to their walking. Analysis of conversations during the walks indicated that for participants who walked with dogs, the dogs did serve as motivation for continuing in the program. ^

1996 state data book on long term care program and market characteristics /

"This research was funded by the U.S. Health Care Financing Administration and the U.S. Department of Housing and Urban Development."

Annual report on long term care.

Description based on: 1984.

Illinois Department of Public Health long-term care facility profiles.

Title from caption.

Long-term care annual report to the General Assembly.

Title from cover.

Long-term care facility survey, Illinois, 1984/85 /

"June, 1986."

The long term care constellation : recommendations of the Community-Based Long Term Care Reform Task Force to Governor Jim Edgar.

January 1996.

Choosing long-term care : a guide for people with Medicare /

"Publication no. CMS-02223"

Long-Term Care Facility Disaster Preparedness, June 19, 2014

Long-term care facilities have very difficult decisions to make in terms of evacuating residents/tenants or providing “shelter in place”. Long-term care facilities need to be actively involved with the Emergency Management Teams at the county level and work with them to develop effective disaster preparedness plans. When it comes to disaster preparedness it is important to write a plan, exercise the plan, revise the plan, re-exercise the plan and identify the best practices.

Office of the State Long-Term Care Ombudsman, March 26,2015

Exclamation of what the duties are of a Long-Term Care Ombudsman and why to call. Residents of long-term care facilities are entitled to many rights.

The Illinois long-term care and chronic disease facilities plan [Chapter 3B] /

"Approved and adopted by the Illinois Health Facilities Planning Board"--T.p.