Interventions In Long-term Care Research Articles

Private Enterprises and Innovative Interventions in Long-Term Care for Older People: Insights into Residual Stereotypes of Greek Rural Areas

In many areas of rural Greece there exist remnants of traditional stereotypes that were socially constructed in closed societies where the institution of the patriarchal family previously reigned and are regenerated by the dominant culture. These stereotypes have shaped over time the perception that long-term care for older adults should be provided within the family structure and exclusively by family members. Notably, it was previously considered a disgrace in Greek rural society if children moved their parents to a residential or nursing home. Public or other care facilities for older people emerged just two decades ago, except a few led by the church. However, these attitudes have been softened in recent years. European and National funded programmes have shaped different notions towards long-term care in these areas. This was facilitated by the structural changes that occurred in the Greek countryside in combination with the existing low birth rate in these areas and the presence of concrete migratory flows. The present study explores the business environment that is being formed and its potential to unleash the productive forces that have pinned down the relevant residual stereotypes. It also examines the socio-economic impact of the above enterprises on rural areas. Qualitative interviews were conducted with eight entrepreneurs who have invested in rural long-term care settings for older persons and eight elected chairpersons of local councils. Our findings indicate that regardless of financial support towards private care entities for older people, in order for the services offered to take a more prominent social role, the development of local consensus and innovative interventions is required in tandem. If achieved, such care providers can contribute to the socio-economic development of rural areas. This study provides international literature with further evidence on the crucial role of such enterprises on supportiveness towards inhabitants’ quality of life improvement while results can be useful for Greek and European decision-making centers as well as potential rural entrepreneurs.

The impact of long-term care interventions on healthcare utilisation among older persons: a scoping review of reviews

BackgroundAs the ageing population grows, the demand for long-term care (LTC) services will rise, concurrently amplifying healthcare utilisation. This review aims to examine and consolidate information on LTC interventions that influence healthcare utilisation among older persons.MethodsA scoping review was performed through a systematic search in PubMed, EBSCO CINAHL, EBM Reviews - Cochrane Database of Systematic Reviews, Embase, APA PsycInfo, EBM Reviews - Health Technology Assessment, and EBM Reviews - NHS Economic Evaluation Database. Systematic reviews with meta-analyses published between 1 January 2010 and 2 June 2022 among older persons aged 60 and above were included. The characteristics of LTC interventions were mapped to the World Health Organization (WHO) Healthy Ageing Framework. The effect sizes of healthcare utilisations for LTC interventions were recalculated using a random-effects model. The methodological quality was assessed with the AMSTAR-2 checklist, while the quality of evidence for each association was evaluated using GRADE.ResultsThirty-seven meta-analyses were included. The most prominent domain of the healthy ageing framework was managing chronic conditions. One hundred twelve associations between various LTC interventions and healthcare utilisations were identified, with 22 associations impacting healthcare utilisation. Four interventions were supported by suggestive or convincing evidence. Preventive home visits were found to reduce hospital admission (OR: 0.73, 95% CI: 0.59, 0.91, p = 0.005), caregiver integration during discharge planning (OR: 0.68, 95% CI: 0.57, 0.81, p < 0.001), and continuity of care (OR: 0.76, 95% CI: 0.61, 0.95, p = 0.018) reduced hospital readmission, and perioperative geriatric interventions reduced the length of hospital stay (MD: -1.50, 95% CI: -2.24, -0.76, p < 0.001). None of the associations impacted emergency department visits, medication use, and primary care utilisations with convincing evidence. Most reviews received low methodological quality.ConclusionThe findings suggest that LTC interventions could benefit from transitioning to a community-based setting involving a multidisciplinary team, including carers. The spectrum of services should incorporate a comprehensive assessment to ensure continuous care.

Strategies for engaging older adults and informal caregivers in health policy development: A scoping review.

Care for older adults is high on the global policy agenda. Active involvement of older adults and their informal caregivers in policy-making can lead to cost-effective health and long-term care interventions. Yet, approaches for their involvement in health policy development have yet to be extensively explored. This review maps the literature on strategies for older adults (65+years) and informal caregivers' involvement in health policy development. As part of the European Union TRANS-SENIOR program, a scoping review was conducted using the Joanna Briggs Institute's methodology. Published and grey literature was searched, and eligible studies were screened. Data were extracted from included studies and analysed using the Multidimensional Framework for Patient and Family Engagement in Health and Healthcare. A total of 13 engagement strategies were identified from 11 publications meeting the inclusion criteria. They were categorized as "traditional", "deliberative" and "others", adopting the World Bank's categorization of engagement methods. Older adults and informal caregivers are often consulted to elicit opinions and identify priorities. However, their involvement in policy formulation, implementation and evaluation is unclear from the available literature. Findings indicate that older adults and their informal caregivers do not often have equal influence and shared leadership in policy-making. Although approaches for involving older adults and their informal caregivers' involvement were synthesized from literature, we found next to no information about their involvement in policy formulation, implementation and evaluation. Findings will guide future research in addressing identified gaps and guide policy-makers in identifying and incorporating engagement strategies to support evidence-informed policy-making processes that can improve health outcomes for older adults/informal caregivers.

Impact of a complex health services intervention in long-term care nursing homes on 3-year overall survival: results from the CoCare study

BackgroundThe Coordinated medical Care (CoCare) project aimed to improve the quality of medical care in nursing homes by optimizing collaboration between nurses and physicians. We analyze the impact of the CoCare intervention on overall survival.MethodsThe effect of time-varying treatment on 3-year overall survival was analyzed with treatment as time-varying covariate within the entire cohort. To reduce bias due to non-random assignment to treatment groups, regression adjustment was applied. Therefore, age, sex, and level of care were used as potential confounders.ResultsThe study population consisted of 8,893 nursing home residents (NHRs), of which 1,330 participated in the CoCare intervention. The three-year overall survival was 49.8% in the entire cohort. NHRs receiving the intervention were associated with a higher survival probability compared to NHRs of the control group. In a univariable cox model with time-dependent treatment, the intervention was associated with a hazard ratio of 0.70 [95%CI 0.56–0.87, p = 0.002]. After adjustment for age, sex and level of care, the hazard ratio increased to 0.82 but was still significant [95%CI 0.71–0.96, p = 0.011].ConclusionThe analysis shows that optimizing collaboration between nurses and physicians leads to better survival of NHRs in Germany. This adds to the already published favorable cost-benefit ratio of the CoCare intervention and shows that a routine implementation of optimized collaboration between nurses and physicians is highly recommended.

Analysing the Need for Long-Term Care: Potential of Data from Long-Term Care Assessments of the Bavarian Medical Service for Public Health Research and Practice

Despite demographic changes, there is still no systematic and comparable differentiation of nursing care reporting on a small-scale level in Germany, where outpatient long-term care is depicted. This article presents findings of care assessment data of the Medical Service of Bavaria and draws conclusions for future reporting on nursing. For the analysis, anonymised initial long-term care assessments of the Bavarian Medical Service of 2019 were evaluated exemplarily using descriptive methods. The study describes the characteristics of persons with a care level recommendation, the distribution of care level categories, medical diagnoses and degree of independence in the areas of life. The persons assessed were on average 80 years old. At the time of the initial assessment, the largest proportion of persons with an assigned care level lived in an outpatient setting. Care level (PG) 1 (slight impairment of independence or abilities) was assigned to 35.1% of the insured, PG 2 (considerable impairment) to 43.1%, PG 3 (severe impairment) to 16.6%, PG 4 and 5 (most severe impairment) were each rarely assigned at the time of the initial assessment (3.9% and 1.4%, respectively). Medical diagnoses were dominated by gait and mobility disorders, unspecified dementia, heart failure and senility. In particular, there were impairments in the areas of 'mobility' and 'organisation of everyday life and social contacts'. The data available from the German Medical Service may be highly relevant to health research and policy and may provide a basis for planning interventions in long-term care.

STRATEGIES FOR INVOLVING OLDER ADULTS AND INFORMAL CAREGIVERS IN HEALTH POLICY DEVELOPMENT: A SCOPING REVIEW

Abstract Encouraging the active involvement of older adults and informal caregivers in policymaking can lead to cost-effective health and long-term care interventions and enhance the creation of responsive policies. As part of the European Union TRANS-SENIOR program, a scoping review was conducted using the Joanna Briggs Institute’s methodology. Published and grey literature was searched. Studies were included if they described the use/evaluation of methods for engaging older adults (65 years and above) and informal caregivers in local, national, or regional health policy development. Analysis was guided by the Multidimensional Framework For Patient And Family Engagement In Health And Health Care. Thirteen engagement strategies were identified from 11 publications meeting the inclusion criteria. Adopting the World Bank’s categorization of citizen engagement methods, strategies were categorized as traditional, deliberative, and others. Older adults and informal caregivers are often consulted to elicit opinions for agenda/priority setting. However, their involvement in other stages of the policy cycle: health policy formulation, implementation, and evaluation, was unclear from the literature. The described engagement methods suggested that older adults and their informal caregivers do not often have shared equal power and shared responsibility in policymaking. Findings will guide policymakers in identifying and incorporating engagement strategies to support evidence-informed policymaking processes that can improve health outcomes for older adults/informal caregivers. Future research is needed on the evaluation of involvement methods.

Supporting the “hallway residents”: a qualitative descriptive study of staff perspectives on implementing the Namaste Care intervention in long-term care

BackgroundLong-term care (LTC) settings are becoming home to an increasing number of people living with advanced or late-stage dementia. Residents living with advanced dementia represent some of society’s most vulnerable and socially excluded populations and are thus at an increased risk of social isolation. A multisensory intervention tailored to this population, Namaste Care, has been developed to improve quality of life for residents living with advanced dementia in LTC homes. To date, limited research has explored the perspectives of staff in implementing the Namaste Care program with an emphasis on social inclusion of residents in Canadian LTC homes. This study aimed to describe the perspectives of LTC staff on the implementation facilitators and barriers of Namaste Care as a program to support the social inclusion of residents living with advanced dementia.MethodsUsing a qualitative descriptive design, semi-structured interviews (n = 12) and focus groups (n = 6) were conducted in two LTC homes in Southern Ontario, Canada, over a 6-month period. Convenience sampling was used to recruit LTC home staff from the two participating sites. Thematic analysis was used to analyze data.ResultsLTC staff (n = 46) emphasized the program’s ability to recognize the unique needs of residents with advanced dementia, and also stated its potential to facilitate meaningful connections between families and residents, as well as foster care partnerships between staff and families. Findings indicated staff also perceived numerous facilitators and barriers to Namaste Care. In particular, providing staff with dedicated time for Namaste Care and implementing volunteer and family participation in the program were seen as facilitators, whereas the initial perception of the need for extra staff to deliver Namaste Care and identifying times in the day where Namaste Care was feasible for residents, families, and staff, were seen as barriers.ConclusionsLTC staff recognized the need for formalized programs like Namaste Care to address the biopsychosocial needs of residents with advanced dementia and offer positive care partnership opportunities between staff and family members. Although staffing constraints remain the largest barrier to effective implementation, staff valued the program and made suggestions to build LTC home capacity for Namaste Care.

Evaluating the Association between the Implementation of the PoET Southwest Spread Project and Reductions in Acute Care Transfers from Long-Term Care: A Quasi-Experimental Matched Cohort Study Using Population-Level Health Administrative Data

ObjectivesTo measure changes in resident-level acute care transfer rates after the PoET Southwest Spread Project (PSSP), and to identify patient and long-term care (LTC) home characteristics associated with acute care transfers after program launch. DesignQuasi-experimental matched (1:1 ratio) cohort study design using linked population-based health administrative data. SettingSixty publicly funded LTC homes (PSSP = 30; control = 30) in Ontario, Canada, from November 2019 to December 2021. MethodsWe matched 30 PSSP homes to 30 control homes with similar characteristics and described incidence rates for resident-level acute care transfers during the 7-month post-implementation period. We used generalized linear mixed models to evaluate the association between PSSP implementation and acute care transfers during the post-implementation period. We adjusted resident-level characteristics (ie, age, sex, comorbidity status) and home-level characteristics (ie, rurality status, profit model, COVID-19 impact). We identified a decedent sub-cohort to measure transfer patterns during the last 2 months of life. ResultsA matched cohort of 8894 residents (PSSP = 4103; control = 4791) was captured. Incidence rates of transfers increased during the post-implementation period for both PSSP (78.8 to 80.9 transfers per 1000 person-months) and control residents (66.9 to 67.9 transfers per 1000 person-months). After adjusting for covariates of interest, PSSP exposure was associated with a reduction in acute care transfers during the post-implementation period after adjusting for covariates (incidence rate ratio, 0.73; 95% CI, 0.62–0.87; P = .0002). Older age and select health regions were associated with reduced transfers, whereas higher comorbidity status and higher COVID-19 outbreak days were associated with increases. Similar patterns persisted for transfers during the last 2 months of life. Conclusions and ImplicationsThis study systematically evaluated the impact of an ethics-based health care intervention in LTC using health care utilization databases. PoET implementation is associated with reduced acute care transfer rates, especially in the last 2 months of life in LTC.

Factors Associated With Resident Intake of Thickened Liquids in Long-Term Care

Purpose: Hydration is essential for health; however, long-term care (LTC) residents consume less fluid than is recommended, which may contribute to dehydration. Residents who drink thickened liquids likely consume even less than peers. Therefore, the aims of this study were to (a) determine if LTC residents who drink thickened liquids consume less fluid compared to those consuming thin liquids and (b) determine factors associated with fluid intake of residents who drink thickened liquids. Method: Participants who drank thickened liquids ( n = 68) were compared with participants who drank thin liquids ( n = 68). Fluid intake, cognition, diet prescription, and mealtime challenges were compared between groups. A stepwise multiple regression model assessed variables associated with fluid intake of residents who consumed thickened fluids. Results: All participants consumed less than recommended fluid volumes. No statistically significant difference was found in fluid intake between groups; however, the group consuming thickened liquids drank less than those consuming thin liquids. The thickened liquid group was also more likely to eat a modified diet, had higher levels of cognitive impairment, and had more mealtime challenges requiring more assistance. As age increased, thickened liquid intake decreased across study participants. Conclusion: These results highlight the need for interventions in LTC to support fluid intake in this vulnerable population.

449 Multidisciplinary deprescribing review for frail older adults in long-term care: Development of a theory informed implementation strategy using a Delphi survey and Roundtable discussion with stakeholders

Abstract Introduction Deprescribing, the systematic process of stopping or altering inappropriate medicines, has been suggested as a safe, effective and appropriate process to optimise prescribing for older adults (1). There is still a lack of understanding of how best to implement sustainable deprescribing in long-term care (LTC). Aim Design a theory-driven implementation strategy, based on consensus from healthcare professionals (HCPs), to facilitate their engagement with deprescribing for frail older adults in LTC. Methods This study consisted of three phases and was designed in conjunction with HCPs working in LTC. Firstly, barriers and enablers to deprescribing in LTC previously identified by the research team were mapped to behaviour change techniques (BCTs) (2). Secondly, a Delphi survey of HCPs (General Practitioners (GPs), Pharmacists, nurses, geriatricians and psychiatrists of old age) was conducted to select feasible BCTs to support deprescribing. HCPs were purposively sampled and recruited via email, divided into HCPs working in Ireland and internationally. Experts were identified from existing professional relationships, engagement with LTC or deprescribing research. Using the results from the Delphi process, the literature on deprescribing interventions and research team knowledge, the BCTs which could form components of an intervention in LTC were shortlisted based on was acceptability, effectiveness, affordability, safety and equity (APEASE). Finally, a roundtable discussion was held with a purposeful, convenience sample of GPs, Pharmacists and nurses working in LTC in Ireland, to prioritise the previously identified barriers/enablers and operationalise the proposed deprescribing strategies created from feasible BCTs and identify the most important strategy to facilitate deprescribing. Results Overall, 34 BCTs were mapped to previously identified barriers/enablers to deprescribing in LTC. For the Delphi survey, 33 HCPs were invited, 20 agreed and it was completed by 16 participants. The Delphi consisted of two rounds. Participants reached consensus that 26 of the BCTs could feasibly be implemented in LTC. Following the APEASE assessment, 21 BCTs were considered eligible for operationalisation. The roundtable discussion, consisting of eight HCPs, identified that lack of resources (time, staffing, technology), was the most important barrier to address. The agreed implementation strategy to enhance engagement with deprescribing processes was an education session prior to a multidisciplinary team (MDT) meeting, led by a nurse from the LTC setting. This was designed from 11 BCTs, including action planning, social support and environmental restructuring addressing the predominant barrier. Incorporating the MDT reduces the burden which would exist if the responsibility was placed on one HCP. Meeting at the LTC site addresses the insufficient technology, as patient information is available. Conclusion This study describes an implementation strategy design process following principles of behavioural and implementation science. Engaging targeted end users throughout the process allows for the creation of a strategy which is intended to address the main perceived barrier to deprescribing of insufficient resources. A limitation of this study is the specificity of the intervention for Irish LTC context, which may have different staffing and organisational structures compared to international healthcare systems.

Enablers and barriers to nurse-facilitated geriatric teleconsultations in nursing homes: a qualitative descriptive multi-site study

Nurses play a major role in facilitating teleconsultations in nursing homes with remote physicians. Currently, evidence explicating their role in teleconsultations is lacking. As telemedicine usage grows, understanding the factors that enable or impede nurses' role in teleconsultations allows for more support in the provision of patient care through this modality. This study sought to explore enablers and barriers nurses faced in facilitating geriatric teleconsultations in nursing homes. A qualitative descriptive study using semi-structured interviews was conducted in Singapore, from July to November 2021. Purposive sampling of nursing home nurses was undertaken. Data were inductively analysed using Braun and Clarke's thematic analysis approach. Twenty-two nursing home nurses participated in the study. Six key themes were identified as enablers and barriers in nurse-facilitated geriatrics teleconsultations. Enablers included nurses' acknowledgement of teleconsultations as needs-orientated service, close partnership with the hospital-based geriatric service for training and workflow support and nurses' sense of empowerment in teleconsultation involvement. Barriers that existed were the nurses' lack of confidence in physical assessment and communication competencies, role conflict due to nurses' perceived inability to meet physicians' expectations and limited scope of practice in performing teleconsultation-related tasks and the presence of technology-related challenges. The identification of enablers and barriers in teleconsultations for nursing home residents provides insights for future research and development in telemedicine-related implementation and educational interventions in long-term care. Developing strong partnerships between telemedicine providers and nursing homes, further enhancement of nurses' telemedicine competencies and optimising digital infrastructure are warranted.

Identification and Treatment of Agitation in Nursing Home Settings: Applying the IPA Algorithm

AbstractBackgroundWith an estimated prevalence of 55%, agitation is particularly common among nursing home residents. The recent International Psychogeriatric Association (IPA) agitation treatment algorithm describes steps for the identification and treatment of agitation across multiple care settings.MethodThis abstract describes the application of the IPA algorithm to the long‐term care (LTC) setting.ResultIn the IPA algorithm, nonpharmacologic care is considered first and continued for both treatment and prevention. In LTC residents, nonpharmacologic interventions are a key first step. For agitation in nursing home residents with dementia, the current evidence suggests that group activity based interventions (e.g., recreation therapy), resident interventions (e.g., massage and touch therapy, and music therapy) and multidisciplinary training and care (e.g., person‐centred care) are the most consistently effective nonpharmacologic treatments. There are several caveats that may impact efficacy of interventions. Feasibility and scalability considerations may impact implementation of nonpharmacologic interventions in long‐term care settings. Most interventions require training, implementation, or supervision by external specialized staff. Feasibility of interventions may also be limited by the capabilities of individuals with dementia; sensory impairments and physical disabilities may preclude some residents from participating in interventions such as music therapy or exercise. As such, interventions must be personalized. Data also show that nonpharmacologic interventions that modify the environment or stimulate the senses may be effective for different aspects of agitation in LTC residents with dementia. Pharmacologic care is personalized and guided by the major features of the agitation including when it occurs, severity and whether it represents a danger to self or others. Importantly, recent efforts have evaluated multi‐modal interventions in LTC. Taken in toto, literature to date provides evidence for use of the above mentioned nonpharmacological interventions for mild agitation in long‐term care facilities. Implementing these interventions requires assessment of medical and environmental causes for agitation, ongoing nonpharmacologic intervention and then pharmacologic interventions as necessary.ConclusionFuture studies should continue to investigate the long‐term effects of multi‐modal nonpharmacological interventions, alone and in combination with pharmacologic interventions in participants with severe agitation.

Family-oriented interventions in long-term care residential facilities for older people: A scoping review of the characteristics and outcomes.

Family-oriented interventions in long-term care (LTC) residential facilities are heterogenous in design, characteristics, and outcomes. To synthesize characteristics (e.g., type, provider, and duration) and outcomes of family-oriented interventions in LTC residential facilities. We followed the JBI methodology and searched seven databases for quantitative, qualitative, and mixed method studies that reported family-oriented interventions in LTC residential settings for older people; defined in this review as ≥60 years. Interventions that included residents, resident families, health professionals, or any combinations of these three were included if the study reported post-intervention assessment of at least one family-related outcome. Thirteen studies met the inclusion criteria. Interventions were found to be multifaceted, and education was the most common element. Nurses were the most common intervenors, and most interventions had more than one target (residents, resident families, or staff). Most outcomes were related to family involvement, satisfaction with care, quality of life, communication, symptom management, and shared decision making, and none of the studies reported a negative impact. Family-oriented interventions were associated with high care quality and better resident-staff-family partnership. Staff education and staff-family conversation are relatively cheap interventions to help family involvement, facilitate shared decision-making, and improve family satisfaction.

Availability and Uptake of Community-Based Rehabilitation and Inclusive Development Services for Children with Spina Bifida in Southwestern Uganda

Background: It is over a decade since services for children with Spina bifida were established in Uganda, which has increased the survival rate after Spina bifida repair through follow-ups. Such children have significant disability and other complications, which damage the central nervous system. The consequences of this are more profound in low-income countries if post-operative and long-term care interventions are not well adhered. This study explored the availability and uptake of community-based rehabilitation and inclusive development services to children with Spina bifida in Southwestern Uganda. Methods: A qualitative approach was adopted. The study considered a sample size of 110; 50 children (aged between 0 and 10 years) with Spina bifida were assessed on aspects QoL, while 50 parents and 10 professionals participated in the study. Interviews and children assessments were done at OURS and during home visits between January and April 2019. Results: Special services to children with Spina bifida were offered at one facility; OURS in the whole of Southwestern Uganda. Neuro surgeons and doctors from CURE hospital work with a team from MRRH and OURS. The findings indicated that improved health outcomes resulted from long-term rehabilitation services. These were friendly and free at OURS. Awareness about Spina bifida has been created in communities through Spina bifida associations. 82.3% of the assessed children of school-going age were not in school, some of them were had developed more health complications. Children with Spina bifida traveled long distances to access specialized services. Their peers socially excluded children. Specialized services were not offered at lower health units. Conclusion: This study concluded that such services could be extended to lower levels of healthcare delivery (at least Health Centre IV) in order to shorten the distance. The academic institutions could train more neuro surgeons and doctors and more funding should be availed through MoH.

A Recommended Package of Long-Term Care Services to Promote Healthy Ageing Based on a WHO Global Expert Consensus Study.

To reach consensus on a minimum list of long-term care (LTC) interventions to be included in a service package delivered through universal health coverage (UHC). A multistep expert consensus process. Multinational and multidisciplinary experts in LTC and ageing. The consensus process was composed of 3 stages: (1) a preconsultation round that built on an initial list of LTC interventions generated by a previous scoping review; (2) 2-round surveys to reach consensus on important, acceptable, and feasible interventions for LTC; (3) a panel meeting to finalize the consensus. The preconsultation round generated an initial list of 117 interventions. In round 1, 194 experts were contacted and 92 (47%) completed the survey. In round 2, the same experts contacted for round 1 were invited, and 115 (59%) completed the survey. Of the 115 respondents in round 2, 80 participated in round 1. Experts representing various disciplines (eg, geriatricians, family doctors, nurses, mental health, and rehabilitation professionals) participated in round 2, representing 42 countries. In round 1, 81 interventions achieved the predetermined threshold for importance, and in round 2, 41 interventions achieved the predetermined threshold for acceptability and feasibility. Nine conflicting interventions between rounds 1 and 2 were discussed in the panel meeting. The recommended list composed of 50 interventions were from 6 domains: unpaid and paid carers' support and training, person-centered assessment and care planning, prevention and management of intrinsic capacity decline, optimization of functional ability, interventions needing focused attention, and palliative care. An international discussion and consensus process generated a minimum list of LTC interventions to be included in a service package for UHC. This package will enable actions toward a more robust framework for integrated services for older people in need of LTC across the continuum of care.

Sustainability of INFORM: A Complex Team-Based Improvement Intervention in Long-Term Care

Improving Nursing Home Care Through Feedback On perfoRMance Data (INFORM) was a complex, theory-based, three-arm, parallel cluster-randomized trial. In 2015–2016, we successfully implemented two theory-based feedback strategies (compared to a standard approach to feedback) to increase nursing home (NH) care aides’ involvement in formal communications about resident care (formal interactions [FI], the primary outcome). Here, we report the extent to which FI was sustained 2.5 years following withdrawal of intervention supports. We also report on several determinants of sustainability. We analyzed data from 18 NHs (46 units, 529 care aides) in the control group, 19 NHs (60 units, 731 care aides) in the basic assisted feedback group (BAF), and 14 homes (41 units, 537 care aides) in the enhanced assisted feedback group (EAF). We assessed sustainability of FI, using repeated measures, hierarchical mixed models, adjusted for care aide, care unit and facility variables. In EAF, FI scores increased from T1 (baseline) to T2 (end of intervention) (1.30–1.42, p=0.010), remaining stable at T3 (long-term follow-up) (1.39 p=0.065). FI scores in BAF increased from T1 to T2 (1.33–1.44, p=0.003) and continued to increase at T3 (1.49, p<0.001). In the control group, FI did not change from T1 to T2 (1.25–1.24, p=0.909), but increased at T3 (1.38, p=0.003). Better culture, evaluation and fidelity enactment significantly increased FI at long-term follow-up. Theory-informed feedback provides long lasting benefits in care aides' involvement in FI. Greater intervention intensity neither implies greater effectiveness nor sustainability. Modifiable context elements and fidelity enactment may facilitate sustained improvement.

What Long-Term Care Interventions and Policy Measures Have Been Studied During the Covid-19 Pandemic? Findings from a Rapid Mapping Review of the Scientific Evidence Published During 2020

<strong>Context:</strong> Throughout the Covid-19 pandemic, long-term care researchers have aimed to generate evidence rapidly to inform the pandemic response. It is unclear which areas were prioritised during this period of rapid evidence generation. <strong>Objectives: </strong>We aimed to map the international scientific evidence on interventions and policy measures to mitigate the impacts of the Covid-19 pandemic on people who use and provide long-term care. <strong>Methods:</strong> We conducted a pragmatic, rapid mapping review of international evidence to identify the range of interventions, policies, and measures in long-term care studied during the Covid-19 pandemic and published throughout 2020. Studies were primarily identified from two academic databases (MEDLINE; Web of Science). <strong>Findings: </strong>We included 137 studies from 22 countries, mostly focusing on the United States, Europe, and Canada. Half of the studies focused on preventing or controlling Covid-19 infections. Other common types of interventions were measures to treat Covid-19 or improve access to general healthcare and studies of possible targets for policies and interventions, such as care home ownership. Only 13 studies covered home-based or community-based care. <strong>Limitations:</strong> This was a pragmatic review that aimed to map key areas of research in long-term care during the pandemic, rather than a systematic review of all available studies. <strong>Implications: </strong>During the first year of the Covid-19 pandemic, a substantial body of evidence on interventions to mitigate impacts of the pandemic in the long-term care sector emerged. However, reflecting the context and speed with which they were carried out, most studies did not apply an analytical lens and instead provided descriptive findings only. There were very few studies on home-based or community-based care settings. As countries assess the lessons that can be learnt from the pandemic and improve the preparedness of their long-term care systems for future pandemics and other shocks, it will be important to consider the importance of facilitating rapid generation of more robust evidence.

End-Of-Life Care Communication in Long-Term Care Among Nurses, Residents, and Families: A Critical Review of Qualitative Research.

RNs in long-term care (LTC) are a critical nexus for end-of-life (EOL) care communication with older adult residents and their families. A critical review of 17 qualitative research studies examined nurses' experience with EOL care in LTC. Findings indicate that time, preparation, advocacy, organizational resources, and a continuous, relational approach support EOL care communication. Regulatory burdens, understaffing, workflow demands, family and organizational dysfunction, anxiety, and depression impede EOL care communication. The current review revealed a gap in the literature describing LTC RNs' unique perspectives and knowledge regarding EOL care communication with residents and families. There is a current, pressing need to understand the facilitators LTC RNs use to overcome obstacles to effective EOL care communication. Future research could inform clinical practice guidelines and EOL care nursing education, enhancing LTC nurses' capacity to develop trust-based relationships and improving the efficacy of current EOL care communication interventions in LTC. [Journal of Gerontological Nursing, 47(7), 43-49.].

Probing pharmacists' interventions in Long-Term Care: a systematic review.

Long-Term Care (LTC) systems have experienced recent developments driven by changes in healthcare and demography (e.g. populationageing). As well, pharmacists are changing from traditional roles to more patient-oriented services. The present study aimed to identify and assess pharmacists' and/or pharmacy-based interventions in institutional LTC settings, also mapping relevant medications. The review was undertaken in general accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), using three main literature databases (PubMed, Scopus, and Web of Knowledge). A set of 16 keywords, divided into three domains (professional, type of care and type of setting), were combined into search equations. Selected studies were assessed through the Quality Assessment Tool for Quantitative Studies. Twenty-six studies met the inclusion criteria, out of 794 initial hits. Most studies (12) described pharmacist/pharmacy-driven interventions assessing Medication Management Reviews' impact in different endpoints or outcomes. Other studies (3) assessed pharmacists' interventions on specific medicationgroups. Good Administration Practices, new pharmaceutical care models, antibiotic stewardship programs, and studies assessing other pharmacists' interventions, such as pharmacy-managed informatics and education, were addressed by 11 other papers. Six studies were classified as Strong after quality assessment. LTC is a clinically complex type of care benefiting from interdisciplinary work. Despite the overall lower quality of the identified studies, pharmacists perform in a wide array of LTC areas. The broad implementation of pharmaceutical activities in institutional LTC settings opens opportunities to optimise medicines' use.

Impact of sensory interventions on the quality of life of long-term care residents: a scoping review

Introduction and purposeResidents in long-term care exhibit diminishing senses (hearing, sight, taste, smell or touch). The purpose of this study was to examine the available literature on the impact of...