Mapping implementation strategies of evidence-based interventions for three preselected phenomena in people with dementia : a scoping review

Background: Caring for people with dementia is complex, and there are various evidence-based interventions. However, a gap exists between the available interventions and how to implement them. The objectives of our review are to identify implementation strategies, implementation outcomes, and influencing factors for the implementation of evidence-based interventions that focus on three preselected phenomena in people with dementia: (A) behavior that challenges supporting a person with dementia in long-term care, (B) delirium in acute care, and (C) postacute care needs. Methods: We conducted a scoping review according to the description of the Joanna Briggs Institute. We searched MEDLINE, CINAHL, and PsycINFO. For the data analysis, we conducted deductive content analysis. For this analysis, we used the Expert Recommendations for Implementation Change (ERIC), implementation outcomes according to Proctor and colleagues, and the Consolidated Framework for Implementation Research (CFIR). Results: We identified 362 (A), 544 (B), and 714 records (C) on the three phenomena and included 7 (A), 3 (B), and 3 (C) studies. Among the studies, nine reported on the implementation strategies they used. Clusters with the most reported strategies were adapt and tailor to context and train and educate stakeholders. We identified one study that tested the effectiveness of the applied implementation strategy, while ten studies reported implementation outcomes (mostly fidelity). Regarding factors that influence implementation, all identified studies reported between 1 and 19 factors. The most reported factors were available resources and the adaptability of the intervention. To address dementia-specific influencing factors, we enhanced the CFIR construct of patient needs and resources to include family needs and resources. Conclusions: We found a high degree of homogeneity across the different dementia phenomena, the evidence-based interventions, and the care settings in terms of the implementation strategies used, implementation outcomes measured, and influencing factors identified. However, it remains unclear to what extent implementation strategies themselves are evidence-based and which intervention strategy can be used by practitioners when either the implementation outcomes are not adjusted to the implementation strategy and/or the effects of implementation strategies are mostly unknown. Future research needs to focus on investigating the effectiveness of implementation strategies for evidence-based interventions for dementia care

Additional file 1 of Counseling regarding the care of people with dementia with a focus on §7a SGB XI in Germany: a "gray-shaded" scoping review

Additional file 1

Structured Care Protocols to Reduce Behavior That Challenges in People With Dementia: A Systematic Review

Manietta C, Labonte V, Möhler R. Structured Care Protocols to Reduce Behavior That Challenges in People With Dementia: A Systematic Review. Journal of the American Medical Directors Association. 2021: S1525-8610(21)00932-4.OBJECTIVES: People with dementia often express behavior that challenges, such as agitation and aggression. Structured care protocols aim to identify common causes of behavior and facilitate the selection of appropriate treatments. The protocols comprise different steps including specific assessments and related nonpharmacologic and pharmacologic treatments. We aim to assess the effects of such protocols to reduce behavior that challenges.; DESIGN: Systematic review according to the methods of Cochrane and registered in PROSPERO (CRD42020155706).; SETTING AND PARTICIPANTS: People with dementia living in nursing homes.; METHODS: The systematic search (September 2020) included databases (MEDLINE, CINAHL, Cochrane Library) and other sources. Two reviewers independently performed the study selection, data extraction, and quality assessment for all included studies. A narrative synthesis was conducted owing to the small number of studies and the heterogeneity of instruments.; RESULTS: Four studies with 596 participants were included. Three studies compared a version of the Serial Trial Intervention, with control groups receiving education about behavior that challenges. One study compared 2 versions of the intervention. The methodologic quality was moderate. For behavior that challenges, there was little to no effect of structured care protocols (4 studies). Two studies found little to no effect on pain and quality of life. Structured care protocols may reduce discomfort (2 studies). None of the studies reported adverse effects. The certainty of evidence was low to moderate. Implementation fidelity of the structured care protocols was limited, although this was not assessed in all of the studies.; CONCLUSION AND IMPLICATIONS: Structured care protocols seem not to be more beneficial than education for reducing behavior that challenges or pain, but may reduce discomfort in people with dementia in nursing homes. Based on the small number of studies, the results should be interpreted with caution. Further research should focus on the feasibility and implementation of structured care protocols. Copyright © 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved

Implementation of interventions to maintain and promote the functional mobility of nursing home residents – a scoping review

Abstract Background To provide an overview of the available evidence on the implementation of direct and capacity-building interventions to promote and maintain the functional mobility of nursing home residents. Methods We conducted a scoping review following the methodological guidance for the conduct of scoping reviews as described by the Joanna Briggs Institute. We searched for studies in MEDLINE (via PubMed) and CINAHL (via EBSCO). We conducted a qualitative content analysis of the included studies with deductive categories based on the Consolidated Framework for Implementation Research (CFIR). Results Ultimately, we included 8 studies on direct interventions, 6 studies on capacity-building interventions, and 2 studies on both types of interventions in our review. Seven studies provided evidence on implementation strategies comprising discrete as well as multifaceted, multilevel strategies. Most of the studies did not systematically evaluate the strategies but remained at a descriptive level. All 16 studies provided evidence of influencing factors. We identified 32 of the 37 influencing factors of the CFIR. The five most frequent influencing factors were available resources (n = 14), access to knowledge and information (n = 12), patient needs and resources (n = 10), knowledge and beliefs about the intervention (n = 10) and compatibility (n = 9). Conclusions The available evidence on the implementation of functional mobility interventions in nursing homes is rather limited. This emphasizes the need for further research. Regarding implementation strategies, the systematic evaluation and further development of the reported promising approaches might be a starting point

Präferenzen von Menschen mit Pflegebedarf

<jats:title>Zusammenfassung</jats:title><jats:sec> <jats:title>Hintergrund</jats:title> <jats:p>Die Beachtung von Präferenzen des alltäglichen Lebens wird in der pflegerischen Versorgung mit einer Vielzahl von positiven Versorgungsergebnissen assoziiert. Derzeit ist unbekannt, ob in bundesdeutschen Pflegeeinrichtungen Präferenzen von Menschen mit Pflegebedarf systematisch erhoben werden, und inwiefern diese in der Pflegedokumentation auffindbar sind.</jats:p> </jats:sec><jats:sec> <jats:title>Ziel</jats:title> <jats:p>Das Ziel der Studie bestand darin zu untersuchen, welche und wie viele Präferenzen von Menschen mit Pflegebedarf in der Pflegedokumentation in verschiedenen pflegerischen Settings dokumentiert werden.</jats:p> </jats:sec><jats:sec> <jats:title>Methode</jats:title> <jats:p>Eine explorative Analyse von Pflegedokumentationen (<jats:italic>n</jats:italic> = 24) wurde in 4 Settings der pflegerischen Versorgung durchgeführt. Die erhobenen Daten wurden inhaltsanalytisch induktiv sowie quantitativ ausgewertet.</jats:p> </jats:sec><jats:sec> <jats:title>Ergebnis</jats:title> <jats:p>Es konnten 20 verschiedene Präferenzen identifiziert werden, die sich 5 Oberkategorien zuordnen ließen. Die Analyse zeigte in allen einbezogenen Settings, dass am häufigsten Präferenzen zu den Themen Pflege und Alltag in der Pflegedokumentation dokumentiert waren.</jats:p> </jats:sec><jats:sec> <jats:title>Schlussfolgerung</jats:title> <jats:p>Die Verschriftlichung von Präferenzen in der Pflegedokumentation ist in allen Settings unsystematisch, zugleich wird die Beachtung von Präferenzen des alltäglichen Lebens als relevant für die Pflege erachtet. Hier bietet die Verwendung eines Instruments zur systematischen Erfassung von Präferenzen die Möglichkeiten, einerseits die Sensibilisierung für dieses Thema zu stärken und andererseits die Zufriedenheit der Menschen mit Pflegebedarf zu steigern.</jats:p> </jats:sec&gt

Algorithm-based pain management for people with dementia in nursing homes

Manietta C, Labonte V, Thiesemann R, Sirsch EG, Möhler R. Algorithm-based pain management for people with dementia in nursing homes. Cochrane Database of Systematic Reviews. 2022;4: 4.BACKGROUND: People with dementia in nursing homes often experience pain, but often do not receive adequate pain therapy. The experience of pain has a significant impact on quality of life in people with dementia, and is associated with negative health outcomes. Untreated pain is also considered to be one of the causes of challenging behaviour, such as agitation or aggression, in this population. One approach to reducing pain in people with dementia in nursing homes is an algorithm-based pain management strategy, i.e. the use of a structured protocol that involves pain assessment and a series of predefined treatment steps consisting of various non-pharmacological and pharmacological pain management interventions.; OBJECTIVES: To assess the effects of algorithm-based pain management interventions to reduce pain and challenging behaviour in people with dementia living in nursing homes. To describe the components of the interventions and the content of the algorithms.; SEARCH METHODS: We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE, Embase, PsycINFO, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Web of Science Core Collection (ISI Web of Science), LILACS (Latin American and Caribbean Health Science Information database), ClinicalTrials.gov and the World Health Organization's meta-register the International Clinical Trials Registry Portal on 30 June 2021.; SELECTION CRITERIA: We included randomised controlled trials investigating the effects of algorithm-based pain management interventions for people with dementia living in nursing homes. All interventions had to include an initial pain assessment, a treatment algorithm (a treatment plan consisting of at least two different non-pharmacological or pharmacological treatment steps to reduce pain), and criteria to assess the success of each treatment step. The control groups could receive usual care or an active control intervention. Primary outcomes for this review were pain-related outcomes, e.g. the number of participants with pain (self- or proxy-rated), challenging behaviour (we used a broad definition that could also include agitation or behavioural and psychological symptoms assessed with any validated instrument), and serious adverse events.; DATA COLLECTION AND ANALYSIS: Two authors independently selected the articles for inclusion, extracted data and assessed the risk of bias of all included studies. We reported results narratively as there were too few studies for a meta-analysis. We used GRADE methods to rate the certainty of the results.; MAIN RESULTS: We included three cluster-randomised controlled trials with a total of 808 participants (mean age 82 to 89 years). In two studies, participants had severe cognitive impairment and in one study mild to moderate impairment. The algorithms used in the studies varied in the number of treatment steps. The comparator was pain education for nursing staff in two studies and usual care in one study. We judged the risk of detection bias to be high in one study. The risk of selection bias and performance bias was unclear in all studies. Self-rated pain (i.e. pain rated by participants themselves) was reported in two studies. In one study, all residents in the nursing homes were included, but fewer than half of the participants experienced pain at baseline, and the mean values of self-rated and proxy-rated pain at baseline and follow-up in both study groups were below the threshold of pain that may require treatment. We considered the evidence from this study to be very low-certainty and therefore are uncertain whether the algorithm-based pain management intervention had an effect on self-rated pain intensity compared with pain education (MD -0.27, 95% CI -0.49 to -0.05, 170 participants; Verbal Descriptor Scale, range 0 to 3). In the other study, all participants had mild to moderate pain at baseline. Here, we found low-certainty evidence that an algorithm-based pain management intervention may have little to no effect on self-rated pain intensity compared with pain education (MD 0.4, 95% CI -0.58 to 1.38, 246 participants; Iowa Pain Thermometer, range 0 to 12). Pain was rated by proxy in all three studies. Again, we considered the evidence from the study in which mean pain scores indicated no pain, or almost no pain, at baseline to be very low-certainty and were uncertain whether the algorithm-based pain management intervention had an effect on proxy-rated pain intensity compared with pain education. For participants with mild to moderate pain at baseline, we found low-certainty evidence that an algorithm-based pain management intervention may reduce proxy-rated pain intensity in comparison with usual care (MD -1.49, 95% CI -2.11 to -0.87, 1 study, 128 participants; Pain Assessment in Advanced Dementia Scale-Chinese version, range 0 to 10), but may not be more effective than pain education (MD -0.2, 95% CI -0.79 to 0.39, 1 study, 383 participants; Iowa Pain Thermometer, range 0 to 12). For challenging behaviour, we found very low-certainty evidence from one study in which mean pain scores indicated no pain, or almost no pain, at baseline. We were uncertain whether the algorithm-based pain management intervention had any more effect than education for nursing staff on challenging behaviour of participants (MD -0.21, 95% CI -1.88 to 1.46, 1 study, 170 participants; Cohen-Mansfield Agitation Inventory-Chinese version, range 7 to 203). None of the studies systematically assessed adverse effects or serious adverse effects and no study reported information about the occurrence of any adverse effect. None of the studies assessed any of the other outcomes of this review.; AUTHORS' CONCLUSIONS: There is no clear evidence for a benefit of an algorithm-based pain management intervention in comparison with pain education for reducing pain intensity or challenging behaviour in people with dementia in nursing homes. We found that the intervention may reduce proxy-rated pain compared with usual care. However, the certainty of evidence is low because of the small number of studies, small sample sizes, methodological limitations, and the clinical heterogeneity of the study populations (e.g. pain level and cognitive status). The results should be interpreted with caution. Future studies should also focus on the implementation of algorithms and their impact in clinical practice. Copyright © 2022 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd

Participatory development of a framework to actively involve people living with dementia and those from their social network, and healthcare professionals in conducting a systematic review: the DECIDE-SR protocol

Abstract Background Systematic reviews summarize and evaluate relevant studies to contribute to evidence-based practice. Internationally, researchers have reached a consensus that the active involvement of the public leads to better research. Despite this agreement, there are many reviews of research concerning healthcare interventions intended to promote the care of people living with dementia and those from their social network (e.g., close contacts, both family and non-family members) primarily involve only healthcare professionals and other experts. Due to the lack of a dementia-sensitive framework to actively involve people living with dementia and those from their social network, and healthcare professionals as co-researchers in systematic reviews, it is important to develop a framework to inform practice. Methods For this framework development process, we will recruit four people living with dementia and a total of four people from their social network, and three healthcare professionals working in acute or long-term care settings. We will conduct regular meetings with these groups of the public and healthcare professionals to include them in all stages of the systematic review. We will also identify and develop methods necessary to ensure meaningful involvement. The results will be documented and analyzed for the development of a framework. For the planning and preparation for these meetings, as well as the conduct of the meetings themselves, we will be guided by the principles of the INVOLVE approach. In addition, the ACTIVE framework will be used to guide the degree of involvement and the stage in the review process. Discussion We assume that our transparent approach to the development of a framework to support the active involvement of people living with dementia and those from their social network, and healthcare professionals in systematic reviews will serve as an impetus for and provide guidance to other researchers with the goal of increasing researchers’ focus on this topic and facilitating systematic reviews that apply participatory approaches. Trial registration: Trial registration is unnecessary as no intervention study will be conducted