60 research outputs found
Technology to reduce social isolation and loneliness
Large numbers of individuals, many of them senior citizens, live in social isolation. This typically leads to loneliness, depression, and vulnerability, and subsequently to other negative health consequences. We report on research focused on understanding the communication needs of people in environments associated with social isolation and loneliness, and how technology facilitates social connection. Our work consists of successive iterations of field studies and technology prototype design, deployment, and analysis. Particular attention is paid to seniors in retirement communities and in long-term care settings (nursing homes). We present design implications for technology to enable seniors' social connections, the "InTouch" prototype that satisfies most of the implications, and a report on one older adult's experience of InTouch
Choosing Healthcare Options by Involving Canada's Elderly: a protocol for the CHOICE realist synthesis project on engaging older persons in healthcare decision-making
Introduction: While patient and citizen engagement has been recognised as a crucial element in healthcare reform, limited attention has been paid to how best to engage seniors-the fastest growing segment of the population and the largest users of the healthcare system. To improve the healthcare services for this population, seniors and their families need to be engaged as active partners in healthcare decision-making, research and planning. This synthesis aims to understand the underlying context and mechanisms needed to achieve meaningful engagement of older adults in healthcare decision-making, research and planning. Methods and analysis: The CHOICE Knowledge Synthesis Project: Choosing Healthcare Options by Involving Canada's Elderly aims to address this issue by synthesising current knowledge on patient, family, and caregiver engagement. A realist synthesis will support us to learn from other patient and citizen engagement initiatives, from previous research, and from seniors, families and caregivers themselves. The synthesis will guide development or adaptation of a framework, leading to the development of best practice guidelines and recommendations for engagement of older people and their families and caregivers in clinical decision-making, healthcare delivery, planning and research. Ethics and dissemination: The components of this protocol involving consultation with patients or caregivers have received ethics clearance from the University of Waterloo, Office of Research Ethics (ORE# 19094). After completion of the project, we will amalgamate the information collected into a knowledge synthesis report which will include best practice guidelines and recommendations for patient, family and caregiver engagement in clinical and health system planning and research contexts. Results: Will be further disseminated to citizens, clinicians, researchers and policymakers with the help of our partners.Technology Evaluation in the Elderly Network (TVN, grant # KS2013-08), which is funded by the Government of Canada's Networks of Centres of Excellence (NCE) Progra
Quality of Dementia Care in the Community: Identifying Key Quality Assurance Components
Background: Primary care-based memory clinics (PCMCs) have been established in several jurisdictions to improve the care for persons with Alzheimer’s disease and related dementias. We sought to identify key quality indicators (QIs), quality improvement mechanisms, and potential barriers and facilitators to the establishment of a quality assurance framework for PCMCs. Methods: We employed a Delphi approach to obtain consensus from PCMC clinicians and specialist physicians on QIs and quality improvement mechanisms. Thirty-eight candidate QIs and 19 potential quality improvement mechanisms were presented to participants in two rounds of electronic Delphi surveys. Written comments were collected and descriptively analyzed. Results:The response rate for the first and second rounds were 21.3% (n = 179) and 12.8% (n = 88), respectively. The majority of respondents were physicians. Fourteen QIs remained after the consensus process. Ten quality improvement mechanisms were selected with those characterized by specialist integration, such as case discussions and mentorships, being ranked highly. Written comments revealed three major themes related to potential barriers and facilitators to quality assurance: 1) perceived importance, 2) collaboration and role clarity, and 3) implementation process.Conclusion:We successfully utilized a consultative process among primary and specialty providers to identify core QIs and quality improvement mechanisms for PCMCs. Identified quality improvement mechanisms highlight desire for multi-modal education. System integration and closer integration between PCMCs and specialists were emphasized as essential for the provision of high-quality dementia care in community settings.Alzheimer Society of Canada, Canadian Institutes of Health Research (CIHR), Schlegel-University of Waterloo-Research Institute for Agin
Measuring the implementation of a group-based Lifestyle-integrated Functional Exercise (Mi-LiFE) intervention delivered in primary care for older adults aged 75 years or older: a pilot feasibility study protocol
Background Declines in function and quality of life, and an increased risk of cardiovascular events, falls, and fractures occur with aging and may be amenable to exercise intervention. Primary care is an ideal setting for identifying older adults in need of exercise intervention. However, a cost-effective, generalizable model of chronic disease management using exercise in a real-world setting remains elusive. Our objective is to measure the feasibility, potential effectiveness, and implementation of an evidence-based Lifestyle-integrated Functional strength and balance Exercise (LiFE) intervention adapted as a group-based format (Mi-LiFE) for primary care to promote increased physical activity levels in older adults aged 75 years or older. We hypothesize that the intervention will be feasible without modification if ≥30 individuals are recruited over 6 months, ≥75 % of our sample is retained, and ≥50 % of our sample complete exercises ≥3 days per week. Methods/design A pre-post pilot study design will be used to evaluate feasibility, potential effectiveness, and implementation outcomes over a 6-month period in physically inactive older adults ≥75 years recruited from a local family health team practice. The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework will be applied to evaluate the public health effects of the intervention including outcomes both at the individual and organizational levels. A physical therapist will teach participants how to integrate strength and balance activities into their daily lives over one individual and four group-based sessions, and two phone calls. Assessments will be completed at baseline and 6 months. Feasibility outcomes include recruitment over 6 months, retention at follow-up, and adherence measured by activity diaries. Change in patient-centered and implementation outcomes that will be evaluated include physical activity levels using accelerometers and International Physical Activity Questionnaire, physical performance using short physical performance battery, quality of life using EQ5D questionnaire, falls and harms using daily calendar diaries and self-report, fidelity using descriptive feedback, barriers and facilitators to implementation using thematic content analysis, and process outcomes. Discussion The feasibility and implementation of the Mi-LiFE intervention in primary care for older adults will be evaluated, as well as the effects of the intervention on secondary outcomes. If the intervention appears feasible, we will use the resultant information to design a larger trial.The Chronic Disease Prevention Initiative seed grant (https://uwaterloo.ca/propel/waterloo-chronic-disease-prevention-initiative) from the Propel Centre for Population Health Impact at the University of Waterloo funded the Mi-LiFE study
Making the Most of Mealtimes (M3): protocol of a multi-centre cross-sectional study of food intake and its determinants in older adults living in long term care homes
Background: Older adults living in long term care (LTC) homes are nutritionally vulnerable, often consuming insufficient energy, macro-and micronutrients to sustain their health and function. Multiple factors are proposed to influence food intake, yet our understanding of these diverse factors and their interactions are limited. The purpose of this paper is to fully describe the protocol used to examine determinants of food and fluid intake among older adults participating in the Making the Most of Mealtimes (M3) study. Methods: A conceptual framework that considers multi-level influences on mealtime experience, meal quality and meal access was used to design this multi-site cross-sectional study. Data were collected from 639 participants residing in 32 LTC homes in four Canadian provinces by trained researchers. Food intake was assessed with three-days of weighed food intake (main plate items), as well as estimations of side dishes, beverages and snacks and compared to the Dietary Reference Intake. Resident-level measures included: nutritional status, nutritional risk; disease conditions, medication, and diet prescriptions; oral health exam, signs of swallowing difficulty and olfactory ability; observed eating behaviours, type and number of staff assisting with eating; and food and foodservice satisfaction. Function, cognition, depression and pain were assessed using interRAI LTCF with selected items completed by researchers with care staff. Care staff completed a standardized person-directed care questionnaire. Researchers assessed dining rooms for physical and psychosocial aspects that could influence food intake. Management from each site completed a questionnaire that described the home, menu development, food production, out-sourcing of food, staffing levels, and staff training. Hierarchical regression models, accounting for clustering within province, home and dining room will be used to determine factors independently associated with energy and protein intake, as proxies for intake. Proportions of residents at risk of inadequate diets will also be determined. Discussion: This rigorous and comprehensive data collection in a large and diverse sample will provide, for the first time, the opportunity to consider important modifiable factors associated with poor food intake of residents in LTC. Identification of factors that are independently associated with food intake will help to develop effective interventions that support food intake.Canadian Institutes of Health Research (CIHR) , The PI is an endowed research chair with the Schlegel-University of Waterloo Research Institute for Aging; half of her salary is provided by this non-profit organizatio
Recommendations From the International Consortium on Professional Nursing Practice in Long-Term Care Homes
AbstractIn response to the International Association of Gerontology and Geriatrics' global agenda for clinical research and quality of care in long-term care homes (LTCHs), the International Consortium on Professional Nursing Practice in Long Term Care Homes (the Consortium) was formed to develop nursing leadership capacity and address the concerns regarding the current state of professional nursing practice in LTCHs. At its invitational, 2-day inaugural meeting, the Consortium brought together international nurse experts to explore the potential of registered nurses (RNs) who work as supervisors or charge nurses within the LTCHs and the value of their contribution in nursing homes, consider what RN competencies might be needed, discuss effective educational (curriculum and practice) experiences, health care policy, and human resources planning requirements, and to identify what sustainable nurse leadership strategies and models might enhance the effectiveness of RNs in improving resident, family, and staff outcomes. The Consortium made recommendations about the following priority issues for action: (1) define the competencies of RNs required to care for older adults in LTCHs; (2) create an LTCH environment in which the RN role is differentiated from other team members and RNs can practice to their full scope; and (3) prepare RN leaders to operate effectively in person-centered care LTCH environments. In addition to clear recommendations for practice, the Consortium identified several areas in which further research is needed. The Consortium advocated for a research agenda that emphasizes an international coordination of research efforts to explore similar issues, the pursuit of examining the impact of nursing and organizational models, and the showcasing of excellence in nursing practice in care homes, so that others might learn from what works. Several studies already under way are also described
Prevalence and Determinants of Poor Food Intake of Residents Living in Long-Term Care
The final publication is available at Elsevier via http://dx.doi.org/10.1016/j.jamda.2017.05.003 © 2017. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/Poor food intake is known to lead to malnutrition in long-term care homes (LTCH), yet multilevel determinants of food intake are not fully understood, hampering development of interventions that can maintain the nutritional status of residents. This study measures energy and protein intake of LTCH residents, describes prevalence of diverse covariates, and the association of covariates with food intake. Multisite cross-sectional study. Thirty-two nursing homes from 4 provinces in Canada. From a sample of 639 residents (20 randomly selected per home), 628 with complete data were included in analyses. Three days of weighed food intake (main plate, estimated beverages and side dishes, snacks) were completed to measure energy and protein intake. Health records were reviewed for diagnoses, medications, and diet prescription. Mini-Nutritional Assessment-SF was used to determine nutritional risk. Oral health and dysphagia risk were assessed with standardized protocols. The Edinburgh-Feeding Questionnaire (Ed-FED) was used to identify eating challenges; mealtime interactions with staff were assessed with the Mealtime Relational Care Checklist. Mealtime observations recorded duration of meals and assistance received. Dining environments were assessed for physical features using the Dining Environment Audit Protocol, and the Mealtime Scan was used to record mealtime experience and ambiance. Staff completed the Person Directed Care questionnaire, and managers completed a survey describing features of the home and food services. Hierarchical multivariate regression determined predictors of energy and protein intake adjusted for other covariates. Average age of participants was 86.3 ± 7.8 years and 69% were female. Median energy intake was 1571.9 ± 411.93 kcal and protein 58.4 ± 18.02 g/d. There was a significant interaction between being prescribed a pureed/liquidized diet and eating challenges for energy intake. Age, number of eating challenges, pureed/liquidized diet, and sometimes requiring eating assistance were negatively associated with energy and protein intake. Being male, a higher Mini-Nutritional Assessment–Short Form score, often requiring eating assistance, and being on a dementia care unit were positively associated with energy and protein intake. Energy intake alone was negatively associated with homelikeness scores but positively associated with person-centered care practices, whereas protein intake was positively associated with more dietitian time. This is the first study to consider resident, unit, staff, and home variables that are associated with food intake. Findings indicate that interventions focused on pureed food, restorative dining, eating assistance, and person-centered care practices may support improved food intake and should be the target for further research.Canadian Institutes for Health Research || 201403MOP-326892-NUT-CENA-2546
The Development of Nurse-patient Relationship Scales in Chronic Care
Quality of life and well-being of patients living in chronic care (CC) are determined to a considerable extent by the relationships these patients have with nursing personnel caring for them. Given the importance of these relationships, there is an absence of empirical research and measurement tools to assess these relationships from a patient’s perspective. The purpose of this study was to develop and test valid and reliable instruments to determine what qualities of the humanistic relationships between cognitively competent patients and nursing personnel in CC settings were most important to patients and what they experience most. A conceptual framework based on the Humanistic Nursing Theory by Paterson and Zderad (1976) served as a foundation to develop two scales; the Humanistic Relationship Importance Scale (HRIS) assessed what attributes of the relationship are most important, and the Humanistic Relationship Experience Scale (HRES) assessed what attributes of the relationship are experienced. Sixty-nine content relevant items based on six dimensions of the Paterson and Zderad theory were developed and tested for content validity resulting in the deletion of 20 items. Forty patients completed the now 49-item scales to establish their initial internal consistency reliability, test-retest reliability and construct validity. Another 25 items were deleted in the process. The 24-item scales were completed by 249 patients in five CC facilities and the results subjected to a
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principal axis analysis (PAA). An oblique rotation resulted in a five factor solution labeled: relational availability, promoting quality of daily life, recognizing and supporting choice, forming connections, and supporting human uniqueness. This was a simplification of the original six dimensions of the Paterson and Zderad theory. A PAA of the 24-item HRES resulted in a one factor solution labeled humanistic connection. Reliability testing of the factors resulted in the deletion of one more item and an HRIS with a Cronbach′s alpha of .87 indicating strong internal reliability and an HRES with a Cronbach′s alpha of .98 suggesting some redundancy of items. Relational availability was rated as the most important factor in the nurse-patient relationship although all factors were important to patients. The mean score of the HRES indicated that patients experience a moderate level of humanistic connection in terms of frequency and intensity with nurses who generally care for them. Findings of this study have contributed to a better understanding of the nurse-patient relationship, and support the care, research, and theoretical knowledge of nurses and patients in these environments.Ph
Psychometric Evaluation of the Team Member Perspectives of Person-Centered Care (TM-PCC) Survey for Long-Term Care Homes
Person-centered care (PCC) is fundamental for providing high-quality care in long-term care homes. This study aimed to evaluate the psychometric properties of an 11-item Team Member Perspectives of Person-Centered Care (TM-PCC) survey, adapted from White and colleagues (2008). In a cross-sectional study, 461 staff from four long-term care homes in Ontario, Canada, completed the TM-PCC. Construct validity and internal consistency of the TM-PCC were examined with a principal component analysis and Cronbach’s alpha coefficient. Findings revealed a three-component structure with factor 1, Supporting Social Relationships; factor 2, Familiarity with Residents’ Preferences; and factor 3, Meaningful Resident–Staff Relationships. The TM-PCC, as compared to the original survey, presented with less components (i.e., did not address Resident Autonomy, Personhood, Comfort, Work with Residents, Personal Environment, and Management Structure), yet included one new component (Meaningful Resident–Staff Relationships). The TM-PCC has a similar internal consistency (Cronbach’s alpha coefficient 0.82 vs. White et al. 0.74–0.91). The TM-PCC can be used to assess PCC from the staff’s perspective in long-term care homes
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