Interventions In Long-term Care Research Articles

The Appropriateness of Canine-Assisted Interventions (CAIs) on the Health and Social Care of Older People Residing in Long Term Care: A Systematic Review

Executive Summary Background: Canine-assisted interventions are used frequently in long term care settings, even though their effectiveness has not been definitively proven. One concern commonly described in the literature is the risk of zoonotic infection or animal-related injury/allergy associated with this type of interaction. To date, no systematic review has been undertaken to determine the appropriateness of canine-assisted interventions in relation to these issues. Objective: The aim of the review was to synthesise the best available evidence on the appropriateness of canine-assisted interventions on the health and social care of the older population residing in long term care with regards to zoonotic infection or animal-related injury/allergy. Data Sources: A comprehensive search was undertaken on 32 electronic databases and two reputable websites from their inception to 2009. The search was restricted to English language and both published and unpublished studies and papers were considered. Review Methods: The review took an inclusive approach and considered quantitative and qualitative studies that focussed on zoonotic risk/exposure/infection or animal-related injury/allergy from canine-assisted interventions used in long term care settings. In the absence of research studies, text and opinion were also considered. Critical appraisal of papers was to be undertaken using the appropriate Joanna Briggs Institute critical appraisal instrument and data extraction was to be via the Joanna Briggs Institute data extraction forms, dependant on design. Results: There were no studies located the met the inclusion requirements of this review. There were also no text and opinion pieces that were specific to long term care, older people and canines. Conclusion: There is currently no evidence available to determine the appropriateness of canine-assisted interventions used for older people in long term care in regards to zoonotic risk/exposure/infection or animal-related injuries/allergies. There is a small body of literature available that focuses on health care but it is generalised and does not delineate between different age groups, settings or the animals used. Implications for Practice: No conclusive recommendations can be made regarding the use of canine-assisted interventions in long term care in the context of zoonotic infection and animal-related injuries/allergies. Text and opinion suggests that if a health care facility of any kind is planning to implement or is currently running this type of intervention (using any animal for people of any age group) the following should be considered: It should always be assumed that there is a risk of developing a zoonotic infection or an animal-related injury/allergy when involved in canine-assisted interventions Facilities undertaking canine-assisted interventions should develop their own infection control policy that includes a risk management strategy. They should also be aware of national and state health laws Prevention strategies should focus on hand washing, education and training, risk management and animal health/hygiene Any people who are involved in canine-assisted interventions (e.g. residents, family, staff, handlers) should be aware of these risks and educated on ways to minimise hazards Consent should always be obtained from people involved in canine-assisted interventions and the decision not to participate (regardless of reason) should be respected There are some people who should not participate in canine-assisted interventions due to their increased susceptibility of being injured or acquiring a zoonotic infection Implications for Research: Quantitative and qualitative research studies are urgently required to determine whether there is an increased risk of zoonotic infections or animalrelated injuries/allergies for those people involved in canine-assisted interventions undertaken in long term care. Those at risk need to be identified in a systematic way.

The Appropriateness of Canine-Assisted Interventions (CAIs) on the Health and Social Care of Older People Residing in Long Term Care: A Systematic Review.

Background: Canine-assisted interventions are used frequently in long term care settings, even though their effectiveness has not been definitively proven. One concern commonly described in the literature is the risk of zoonotic infection or animal-related injury/allergy associated with this type of interaction. To date, no systematic review has been undertaken to determine the appropriateness of canine-assisted interventions in relation to these issues. The aim of the review was to synthesise the best available evidence on the appropriateness of canine-assisted interventions on the health and social care of the older population residing in long term care with regards to zoonotic infection or animal-related injury/allergy. A comprehensive search was undertaken on 32 electronic databases and two reputable websites from their inception to 2009. The search was restricted to English language and both published and unpublished studies and papers were considered. The review took an inclusive approach and considered quantitative and qualitative studies that focussed on zoonotic risk/exposure/infection or animal-related injury/allergy from canine-assisted interventions used in long term care settings. In the absence of research studies, text and opinion were also considered. Critical appraisal of papers was to be undertaken using the appropriate Joanna Briggs Institute critical appraisal instrument and data extraction was to be via the Joanna Briggs Institute data extraction forms, dependant on design. There were no studies located the met the inclusion requirements of this review. There were also no text and opinion pieces that were specific to long term care, older people and canines. There is currently no evidence available to determine the appropriateness of canine-assisted interventions used for older people in long term care in regards to zoonotic risk/exposure/infection or animal-related injuries/allergies. There is a small body of literature available that focuses on health care but it is generalised and does not delineate between different age groups, settings or the animals used. No conclusive recommendations can be made regarding the use of canine-assisted interventions in long term care in the context of zoonotic infection and animal-related injuries/allergies. Text and opinion suggests that if a health care facility of any kind is planning to implement or is currently running this type of intervention (using any animal for people of any age group) the following should be considered:Implications for Research: Quantitative and qualitative research studies are urgently required to determine whether there is an increased risk of zoonotic infections or animalrelated injuries/allergies for those people involved in canine-assisted interventions undertaken in long term care. Those at risk need to be identified in a systematic way.

Data for improvement and clinical excellence: protocol for an audit with feedback intervention in long-term care

BackgroundThere is considerable evidence about the effectiveness of audit coupled with feedback, although few audit with feedback interventions have been conducted in long-term care (LTC) settings to date. In general, the effects have been found to be modest at best, although in settings where there has been little history of audit and feedback, the effects may be greater, at least initially. The primary purpose of the Data for Improvement and Clinical Excellence (DICE) Long-Term Care project is to assess the effects of an audit with feedback intervention delivered monthly over 13 months in four LTC facilities. The research questions we addressed are:1. What effects do feedback reports have on processes and outcomes over time?2. How do different provider groups in LTC and home care respond to feedback reports based on data targeted at improving quality of care?Methods/designThe research team conducting this study comprises researchers and decision makers in continuing care in the province of Alberta, Canada. The intervention consists of monthly feedback reports in nine LTC units in four facilities in Edmonton, Alberta. Data for the feedback reports comes from the Resident Assessment Instrument Minimum Data Set (RAI) version 2.0, a standardized instrument mandated for use in LTC facilities throughout Alberta. Feedback reports consist of one page, front and back, presenting both graphic and textual information. Reports are delivered to all staff working in the four LTC facilities. The primary evaluation uses a controlled interrupted time series design both adjusted and unadjusted for covariates. The concurrent process evaluation uses observation and self-report to assess uptake of the feedback reports. Following the project phase described in this protocol, a similar intervention will be conducted in home care settings in Alberta. Depending on project findings, if they are judged useful by decision makers participating in this research team, we plan dissemination and spread of the feedback report approach throughout Alberta.

Psychosocial interventions for dementia patients in long-term care

Psychosocial interventions in long-term care have the potential to improve the quality of care and quality of life of persons with dementia. Our aim is to explore the evidence and consensus on psychosocial interventions for persons with dementia in long-term care. This study comprises an appraisal of research reviews and of European, U.S. and Canadian dementia guidelines. Twenty-eight reviews related to long-term care psychosocial interventions were selected. Behavioral management techniques (such as behavior therapy), cognitive stimulation, and physical activities (such as walking) were shown positively to affect behavior or physical condition, or to reduce depression. There are many other promising interventions, but methodological weaknesses did not allow conclusions to be drawn. The consensus presented in the guidelines emphasized the importance of care tailored to the needs and capabilities of persons with dementia and consideration of the individual's life context. Long-term care offers the possibility for planned care through individualized care plans, and consideration of the needs of persons with dementia and the individual life context. While using recommendations based on evidence and consensus is important to shape future long-term care, further well-designed research is needed on psychosocial interventions in long-term care to strengthen the evidence base for such care.

The Pleasant Events Schedule – Nursing Home Version: A useful tool for behavioral interventions in long-term care

Objectives: Behavioral interventions for depression emphasize increasing engagement in pleasant events, requiring reliable and valid assessment of events. Versions of the Pleasant Events Schedule (PES) have been developed for this purpose. Although depression is prevalent in nursing homes, no PES version is yet available specifically for this setting, where access to pleasant events is circumscribed. Our goal was to develop and evaluate a nursing home version of the PES. Method: We developed the PES-NH on two samples of nursing home residents. We first sampled activity frequency and pleasantness for 10 residents of a large, urban facility. Using these pilot data and PES-Alzheimer's Disease items, we interviewed 37 more residents from the same facility, yielding a comprehensive list of events that residents find pleasant. From the second sample of 48 residents, we present normative and psychometric data on the new scale. Results: A 30-item inventory was able to cover the content of daily activities available in nursing homes. Scales derived from these items were internally consistent and reliable over time. Frequency of event participation was related to perceptions of quality of life, depression and positive affect independent of the overall tendency to rate events as pleasantness. Event participation was unrelated to negative affect, suggesting that activity engagement is linked to depression through its impact on positive affect. Conclusion: Data from this study provide base rate information for planning pleasant event interventions in nursing homes. The PES-NH is a useful and valid tool for implementing behavioral interventions for depression in these settings.

Hospital discharge planning and continuity of care for aged people in an Italian local health unit: does the care-home model reduce hospital readmission and mortality rates?

BackgroundHospital discharge planning is aimed to decrease length of stay in hospitals as well as to ensure continuity of health care after being discharged. Hospitalized patients in Turin, Italy, who are in need of medical, social and rehabilitative care are proposed as candidates to either discharge planning relying on a care-home model (DPCH) for a period of about 30 days, or routine discharge care. The aim of this study was to evaluate whether a hospital DPCH that was compared with routine care, improved patients' outcomes in terms of reduced hospital readmission and mortality rates in patients aged 64 years and older.MethodsIn a retrospective observational cohort study a sample of 380 subjects aged 64 years and over was examined. Participants were discharged from the hospital S.Giovanni Bosco in Turin, Italy from March 1st, 2005 to February 28th, 2006. Of these subjects, 107 received routine discharge care while 273 patients were referred to care-home (among them, 99 received a long-term care intervention (LTCI) afterwards while 174 did not). Data was gathered from various administrative and electronic databases. Cox regression models were used to evaluate factors associated with mortality and hospital readmission.ResultsWhen socio-demographic factors, underlying disease and disability were taken into account, DPCH decreased mortality rates only if it was followed by a LTCI: compared to routine care, the Hazard Ratio (HR) of death was 0.36 (95% Confidence Interval (CI): 0.20 – 0.66) and 1.15 (95%CI: 0.77 – 1.74) for DPCH followed by LTCI and DPCH not followed by LTCI, respectively. On the other hand, readmission rates did not significantly differ among DPCH and routine care, irrespective of the implementation of a LTCI: HRs of hospital readmission were 1.01 (95%CI: 0.48 – 2.24) and 1.18 (95%CI: 0.71 – 1.96), respectively.ConclusionThe use of DPCH after hospital discharge reduced mortality rates, but only when it was followed by a long-term health care plan, thus ensuring continuity of care for elderly participants.

Frequent Falls and Benefits of Interventions in Long-Term Care: Case and Literature Review

Falls occur commonly in elders, are a common problem in long-term care (LTC) and are associated with significant morbidity and mortality (25% fracture related mortality annually). This case highlights risk factors associated with falls and matching potential interventions with each risk factor. A review of the literature helps identify what interventions address these risks factors and demonstrated efficacy in reducing falls risk in the long term care (LTC) setting.

Improved Evaluation and Management of Cognitive Impairment: Results of a Comprehensive Intervention in Long-term Care

Although as many as 50% of patients in long-term care have dementia, it is often not diagnosed and therefore, undertreated. We determined whether an intervention could improve the diagnosis and management of patients with cognitive impairment (CI) in long-term care. The assessment phase consisted of a record review of 60 consecutively admitted patients to the San Francisco VA Nursing Home Care Unit (NHCU). Cognitive impairment was determined by admission MMSE < or = 24, indication of cognitive problem on MDS, or chart diagnosis of dementia. The evaluation consisted of a repeat chart review of 60 additional consecutively admitted patients. The intervention consisted of low-cost and easy-to-implement educational activities (training, focus groups), strategies to document cognitive status, and consultation with dementia experts. The 2 cohorts of 60 patients did not differ on demographics or on other characteristics (P > .25 for all). Prior to the intervention, of the 23 patients with CI, 52% had an identified etiology, 35% had a physician management plan, and 22% had a multidisciplinary care plan. Postintervention, of the 22 patients with CI, 91% had an identified etiology (P = .007), 86% had a physician plan (P = .001), and 59% had a multidisciplinary plan (P = .016). Initial results confirmed the underdiagnosis and undertreatment of CI in our long-term care facility. Our intervention with educational programs, increased documentation of cognitive status, and consultation resulted in increased identification of etiology and improved plans for management of patients with CI.

Use of standardized nursing diagnoses and interventions in long-term care.

1. Standardized language for patient assessment, nursing diagnoses and interventions provide a common language for professionals in long-term care. 2. A comprehensive Nursing Interventions Classification (NIC) was first published in 1992 by the Iowa Intervention Project and the North American Nursing Diagnosis Association offers a comprehensive list of nursing diagnoses. 3. Most frequently used nursing diagnoses were: Self Care Deficit: Bathing/Hygiene, Self Care Deficit: Dressing/Grooming, Impaired Physical Mobility, Altered Thought Process, and Potential for Injury.

Nurses' knowledge and beliefs about continence interventions in long-term care.

Incontinence in nursing homes is a prevalent condition requiring a programmatic approach due to its diverse aetiology. Awareness of antecedent factors, such as knowledge and beliefs about incontinence and its treatment by the individuals responsible for establishing and maintaining a continence programme, is important prior to implementation. A questionnaire was administered to licensed nurses who attended a workshop on urinary incontinence in nursing homes. One purpose of the questionnaire was to elicit information about beliefs regarding the effects of continence programmes on residents and staff and potential staff reaction to implementation of a continence programme in their facility. Responses by licensed practical nurses (LPNs) were compared to the responses of registered nurses (RNs). Attribution for causes of incontinence differed between LPNs and RNs. There were no significant differences in the report of current routine nursing care which included scheduled toileting, changing clothing when necessary, and use of adult briefs and underpads. Most nurses anticipated a favourable reaction by the staff to the implementation of a continence programme. However, at least 20% responded that the nursing staff would be apathetic or resistant to a programme. Administrative support was infrequently chosen as the most important factor in the implementation of a programme. The implications of these findings to continence programmes that are integrated into the organization and provide comprehensive services, including preventive interventions, are discussed.