Long-term Care Research Research Articles

Connecting Findings to Meaningful Change

There is a symbiotic relationship between qualitative research and knowledge mobilization. However, there is often a significant lag between the conduct of research and the findings reaching the public (including those it impacts and those with the power to make change). In designing my study on ethics and policy in long-term care (LTC) with the aim of improving quality care, I sought a method that would not only generate broad data but data on which stakeholders would be able to more readily act and thus promote meaningful and timely change. With this goal in mind, I adopted an empirical ethics approach with the aim of consensus building and used an innovative qualitative Delphi method to explore ethics and ethical reasoning in LTC and the interaction between frontline practice and organizational and public policy. While the Delphi method is starting to gain more recognition alongside more well-known qualitative methods, it has yet to be used in the exploration of empirical ethics and policy in LTC. The rich findings from this study suggest it has the potential of expanding the breadth of qualitative inquiry, as it draws on real-world practice and decision-making to promote consensus in areas of organizational, policy, and practice change. There is a need for further research using a modified qualitative Delphi method in empirical ethics and policy research in LTC, as well as other areas. However, the results of this study suggest the suitability and benefits of the approach for qualitative inquiry and propose researchers seeking to expand research findings, knowledge mobilization, and to connect findings to meaningful and practical change should consider adopting the Delphi method.

Factors associated with willingness to enter long-term care facilities among older adults in Chengdu, China.

ObjectiveTo describe Chinese older adults’ willingness to enter long-term care facilities and to examine individual factors associated with the willingness of using this growing model of long-term care in China.MethodsA cross-sectional study involving a random sample of 670 adults aged 60+ in the Hezuo community in Chengdu, China in 2016. Respondents were interviewed by trained staff on socio-demographics, health status, quality of life, social support, and willingness to enter long-term care facilities.ResultsOnly 11.9% of the respondents were willing to enter long-term care facilities for meeting their medical and social service needs. Multivariable logistic regression analysis showed that willingness to enter long-term care facilities was associated with higher household income (OR = 4.55, 95% CI:1.72–12.00), insurance of Urban Resident Basic Medical Insurance (OR = 4.80, 95% CI:1.17–19.67) and unemployment (OR = 0.48, 95% CI:0.24–0.99). Among those who were willing to enter long-term care facilities, an overwhelming majority (81.2%) would prefer going to a facility within 30-minute walking distance from their current residence, 82.5% indicated the need of nursing care, and 90.0% expected a partnership between the long-term care facility and a large hospital.ConclusionsA minority of older Chinese were willing to receive long-term care delivered at a facility within walking distance from their current residence. Recent policy aimed at increasing the supply of long-term care facilities may not be consistent with consumer preference for home and community-based care. Balancing investment between home and community-based care, and establishing long-term care insurance remain the top priorities for long-term care research and policy development in China.

Research hotspots and trend in chronic diseases′ long-term care based on knowledge map

Objective To analysis the development tendency and research focus of long-term care of chronic disease between China and abroad and guide the research and application of long-term care of chronic disease in China. Methods The PubMed database and China National Knowledge Infrastructure (CNKI) database were searched and co-word clustering analysis and multidimensional scaling analysis with Bicomb and SPSS 21.00 software were used. Results Foreign hot spots are summarized as follows: oxygen inhalation therapy; mental disorder patients; the needs and demands of long term care. And the following domestic hot spots: long term care for the aged; long term care insurance and social support. Conclusions Long-term care researches in China is still in the exploratory stage and combining with domestic and foreign research hot spots, proposal of long term care in China are summarized as follows: expand the study population of the domestic long-term care, such as the disabled and the mental disorder; enrich domestic long-term care research topics, such as long-term care model, caregivers, care quality, etc. Key words: Long-term care; Chronic diseases; Knowledge map; Multidimensional scaling analysis; Research focus

Evolution in Nursing Home Research: Forming Collaborative Groups

Evolution in Nursing Home Research: Forming Collaborative Groups

Research impact of systems-level long-term care research: a multiple case study

BackgroundTraditional reporting of research outcomes and impacts, which tends to focus on research product publications and grant success, does not capture the value, some contributions, or the complexity of research projects. The purpose of this study was to understand the contributions of five systems-level research projects as they were unfolding at the Bruyère Centre for Learning, Research and Innovation (CLRI) in long-term care (LTC) in Ottawa, Ontario, Canada. The research questions were, (1) How are partnerships with research end-users (policymakers, administrators and other public/private organisations) characterised? (2) How have interactions with the CLRI Management Committee and Steering Committee influenced the development of research products? (3) In what way have other activities, processes, unlinked actors or organisations been influenced by the research project activities?MethodsThe study was guided by Kok and Schuit’s concept of research impacts, using a multiple case study design. Data were collected through focus groups and interviews with research teams, a management and a steering committee, research user partners, and unlinked actors. Documents were collected and analysed for contextual background.ResultsCross-case analysis revealed four major themes: (1) Benefits and Perceived Tensions: Working with Partners; (2) Speaking with the LTC Community: Interactions with the CLRI Steering Committee; (3) The Knowledge Broker: Interactions with the Management Committee; and (4) All Forms of Research Contributions.ConclusionsMost contributions were focused on interactions with networks and stimulating important conversations in the province about LTC issues. These contributions were well-supported by the Steering and Management Committees’ research-to-action platform, which can be seen as a type of knowledge brokering model. It was also clear that researcher-user partnerships were beneficial and important.

The European general practice research network presents the translations of its comprehensive definition of multimorbidity in family medicine in ten European languages.

BackgroundMultimorbidity, according to the World Health Organization, exists when there are two or more chronic conditions in one patient. This definition seems inaccurate for the holistic approach to Family Medicine (FM) and long-term care. To avoid this pitfall the European General Practitioners Research Network (EGPRN) designed a comprehensive definition of multimorbidity using a systematic literature review.ObjectiveTo translate that English definition into European languages and to validate the semantic, conceptual and cultural homogeneity of the translations for further research.MethodForward translation of the EGPRN’s definition of multimorbidity followed by a Delphi consensus procedure assessment, a backward translation and a cultural check with all teams to ensure the homogeneity of the translations in their national context. Consensus was defined as 70% of the scores being higher than 6. Delphi rounds were repeated in each country until a consensus was reachedResults229 European medical expert FPs participated in the study. Ten consensual translations of the EGPRN comprehensive definition of multimorbidity were achieved.ConclusionA comprehensive definition of multimorbidity is now available in English and ten European languages for further collaborative research in FM and long-term care.

Beyond Neglect: Long-term Care Research in Low and Middle Income Countries

Long-term care (LTC) continues to be a neglected policy issue in most low and middle income countries. This paper assesses whether research on LTC contributes to or reinforces that neglect. This paper assesses the global geographical distribution of published research on LTC and relates this distribution to the demand for LTC. This is a systematic review of published research abstracted in PubMed and in relevant journals not routinely abstracted in PubMed. The keyword search term “long-term care policy” produced 4488 hits. These were personally screened by the author for relevance, according to the United Nations definition of LTC. A total of 1417 studies were identified as relevant. The validity of this approach was assessed by using the keyword search term “long-term care” (72,215 hits) for a selected set of countries. The study found an extreme bias towards more developed regions, which accounted for 37.5% of people aged 65 years and older in 2010, but accounted for 95.5% of relevant PubMed listings. Africa, Latin America and the Caribbean, and India stand out as particularly under-represented and account for 27.6% of people aged 65 years and older, but only account for 0.7% of relevant PubMed listings. There has been no previously published research on the geographical distribution of research on LTC. This study demonstrates an extreme degree of bias towards high income countries and away from low and middle income countries. These biases reflect and contribute to ongoing neglect by policymakers.

Making tradeoffs between the reasons to leave and reasons to stay employed in long-term care homes: Perspectives of licensed nursing staff

BackgroundTurnover of licensed nursing staff in long-term care (LTC) settings (e.g., nursing homes) is a mounting concern and is associated with poor quality of care and low staff morale. Retention and turnover research in LTC have focused primarily on direct care workers (i.e., nurse aides) leaving the issues largely unexplored for licensed nursing staff (i.e., registered nurses and licensed practical nurses). ObjectiveThe main objective of this study was to understand factors that influence nurses’ intentions to remain employed at their current job. DesignQualitative descriptive study. SettingsSeven nursing homes in Ontario, Canada. ParticipantsA convenience sample of forty-one licensed LTC nurses. MethodsData were collected through focus groups conducted at each of the participating nursing homes. Focus group discussions were transcribed verbatim. Directed content analysis was used to identify and develop themes. ResultsWork conditions were a salient element affecting nurses’ intention to stay and included impact of regulations on nurse role flexibility and professional judgment, an underfunded system contributing to insufficient resources and staffing, and a lack of supportive leadership. Factors promoting nurses’ willingness to stay included the development of meaningful relationships with residents and staff and opportunities for learning and professional development. Nurses also considered personal and life circumstances (e.g., marital status and seniority) when discussing intention to stay. ConclusionsNurses in this study weighed positive and negative work-related factors as well as personal circumstances to determine their intent to stay. Developing a more individualized approach to address attrition of licensed nurses in LTC may be the most successful strategy for improving retention of highly skilled staff in this sector.

French Geriatrician Says LTC Research Is Needed Worldwide

French Geriatrician Says LTC Research Is Needed Worldwide

Exercise Highlighted in Best Research of Past Year

San Antonio – A look back over the past year in long-term care research found two of the most influential papers to be about the benefits of exercise for elderly people in physical decline. The Hip Fracture Intervention Trial (HIPFIT) demonstrated the substantial value of high-intensity, progressive resistance training following hip fracture, JAMDA Editor in Chief Dr. John E. Morley said during the “Year in Review” session at AMDA Long Term Care – 2012. Session moderator Dr. Barbara Messinger-Rapport said that in an extensive review process, “we choose articles where the goal is improving care of frail elderly, and we look for those that focused on the population of older adults on a downward trajectory in the continuum of care.” Dr. Messinger-Rapport is director of the Center for Geriatric Medicine at the Cleveland Clinic. The HIPFIT paper, by Dr. Nalin A. Singh of Balmain Hospital, Sydney, Australia, and colleagues, was a clear standout, said Dr. Morley, a professor of gerontology and director of the division of geriatric medicine at Saint Louis University Medical School. “This article was chosen because it is most probably the single best article I have ever accepted as an editor of any of the journals I’ve edited,” he said. The randomized controlled study of 124 patients, published online in September 2011 and in print in January 2012, examined a high-intensity weightlifting exercise and targeted multidisciplinary intervention versus usual care after hip fracture. Initiated following completion of physical therapy, 6–8 weeks after a fracture, the highintensity exercise reduced mortality by 81% (age-adjusted odds ratio, 0.19) and nursing home admissions by 84% (age-adjusted OR, 0.16) compared with physical therapy alone ( J. Am. Med. Dir. Assoc. 2012;12:24-30). Basic activities of daily living also declined significantly less in the intervention group, and assistive device use was significantly lower at 12 months in that group. Given that there are 1.6 million fractures worldwide each year – and that, depending on age, mortality in these patients can be as high as 30%–50% – these findings have the potential to improve the lives of many patients, Dr. Morley said. Another paper that the group selected as one of the best of the year was the report of a randomized controlled clinical trial comparing the Seattle Protocol for Activity (SPA) in Older Adults with a health-educational program, a combination of SPA and health education, and routine medical care. SPA entails group exercise classes and assistance in setting weekly home exercise goals. In that study of 273 communitydwelling older adults, Linda Teri, PhD, of the University of Washington, Seattle, and her colleagues demonstrated that at 3 months, those in either group getting SPA exercised more and improved more in self-reported health, strength, and general well-being than those in the other groups. Combining SPA and health education did not significantly better results over SPA alone, Dr. Morley said. The benefits were maintained over 18 months of follow-up ( J. Am. Geriatr. Soc. 2011;59:1188-96). The findings of this straightforward study are interesting, he said, noting that while they don’t represent “superstar outcomes,” they do represent an inexpensive and effective means for providing immediate and long-term physical and affective benefits. “These are things you would like to see in a senior center and which are reasonable to offer to all people in a nursing home,” he said. Dr. Messinger-Rapport, a member of the editorial board of JAMDA, explained that a team of reviewers selected the top papers after carefully assessing the year’s LTC-research literature and rating each paper for how it specifically addressed geriatric problems and outcomes, demonstrated a harm or benefit of a practice, or explored a new intervention that improves either treatment for a disease or a care process. CfA

An interdisciplinary knowledge translation intervention in long-term care: study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial.

BackgroundKnowledge translation (KT) research in long-term care (LTC) is still in its early stages. This protocol describes the evaluation of a multifaceted, interdisciplinary KT intervention aimed at integrating evidence-based osteoporosis and fracture prevention strategies into LTC care processes.Methods and designThe Vitamin D and Osteoporosis Study (ViDOS) is underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. The primary objectives of this study are to assess the feasibility of delivering the KT intervention, and clinically, to increase the percent of LTC residents prescribed ≥800 IU of vitamin D daily. Eligibility criteria are LTC homes that are serviced by our partner pharmacy provider and have more than one prescribing physician. The target audience within each LTC home is the Professional Advisory Committee (PAC), an interdisciplinary team who meets quarterly. The key elements of the intervention are three interactive educational sessions led by an expert opinion leader, action planning using a quality improvement cycle, audit and feedback reports, nominated internal champions, and reminders/point-of-care tools. Control homes do not receive any intervention, however both intervention and control homes received educational materials as part of the Ontario Osteoporosis Strategy. Primary outcomes are feasibility measures (recruitment, retention, attendance at educational sessions, action plan items identified and initiated, internal champions identified, performance reports provided and reviewed), and vitamin D (≥800 IU/daily) prescribing at 6 and 12 months. Secondary outcomes include the proportion of residents prescribed calcium supplements and osteoporosis medications, and falls and fractures. Qualitative methods will examine the experience of the LTC team with the KT intervention. Homes are centrally randomized to intervention and control groups in blocks of variable size using a computer generated allocation sequence. Randomization is stratified by home size and profit/nonprofit status. Prescribing data retrieval and analysis are performed by blinded personnel.DiscussionOur study will contribute to an improved understanding of the feasibility and acceptability of a multifaceted intervention aimed at translating knowledge to LTC practitioners. Lessons learned from this study will be valuable in guiding future research and understanding the complexities of translating knowledge in LTC.Trial registrationClinicalTrials.gov NCT01398527.

Promoting Quality Improvement in Long-Term Care: A multi-site collaboration to improve outcomes with pneumonia, falls, bacteriuria and behavioural issues in dementia

The Bridges to Care for Long-Term Care research project aimed to facilitate improvements in outcomes for long-term care residents through the provision of knowledge-to-practice and quality improvement resources by trained facilitators. Point-of-care staff reported improved communication and collaboration, improved use of scope of practice and implementation of best practice knowledge. Overall, participating long-term care homes demonstrated an enhanced capacity for common care issues of the elderly (pneumonia, falls, bacteriuria and behavioural and psychological symptoms of dementia) and the ability to effectively engage in quality improvement processes with efficient and effective use of healthcare resources.

Responding to Poor-Quality Care During Research in Nursing Homes

For nurse researchers, responding appropriately to resident abuse is straightforward: The abuse must be reported. However, responding to care that is of poor quality-where care practices are problematic but do not meet the definition of reportable abuse-is not so straightforward. Decision making may be influenced by ethical and professional principles, as well as self-interest to complete a research project. The purpose of this article is to provoke a dialogue about a dilemma faced by many researchers conducting research in long-term care: responding to poor-quality care that does not meet the state's definition of resident abuse. We will accomplish this by providing a real-life situation faced by a novice researcher conducting her first funded research project, identifying some of the important considerations and possible responses by nurse researchers. Optimally, nurse researchers will develop a plan for responding to poor care before beginning the study.

Benefits and Challenges of Electronic Surveillance in Nursing Home Research

Cognitive impairment and frailty associated with dementia renders residents of long-term care (LTC) facilities particularly vulnerable to physical and emotional harm. Resident-to-resident violence affects not only the target of the aggression, but also the aggressor, as well as the formal and informal caregivers who must intervene. To date, little research has been conducted on resident-to-resident violence despite preliminary but emerging evidence that it is a common (and likely growing) problem in LTC settings. Exploration of this phenomenon presents multiple pragmatic and ethical challenges. This article presents a rationale for implementing newer technological methods to collect data in investigations of resident-to-resident violence associated with dementia. The advantages and disadvantages of electronic surveillance in LTC research and the ethical principles involved are discussed, and an argument is developed for using electronic surveillance in both the shared, as well as private, spaces of the facility.

Informed consent to research in long-term care settings.

Informed consent to nursing home research is a two-tiered process that begins with obtaining the consent of a long-term care community at the institutional level and progresses to the engagement of individuals in the consent process. Drawing on a review of the literature and the authors' research experiences and institutional review board service, this article describes the practical implications of nurse investigators' obligation to ensure informed consent among participants in long-term care research. Recommendations focus on applying a community consent model to long-term care research, promoting an evidence-based approach to the protection of residents with decisional impairment, and increasing investigators' attention to ethical issues involving long-term care staff.

Cognitive status and the psychological well-being of long-term care residents over time

The majority of research within long-term care (LTC) has emphasized the physical health of residents, has been cross-sectional in design and has focused almost exclusively on residents with dementia. Few longitudinal studies have followed participants over intervals longer than 1 year. In contrast, the current study set out to examine the experience of LTC residents with and without significant cognitive loss over a 2-year period comparing the psychological well-being of groups over time. Significant Group × Time interaction effects were observed between residents with and without significant cognitive loss in life satisfaction and depressive symptomatology. Results of this study underscore the need for longitudinal measurement in LTC research, the use of multivariate statistical procedures and the need to identify and meet the distinct needs of residents with and without significant cognitive loss.

Ethical Perspectives on Emerging Assistive Technologies: Insights from Focus Groups with Stakeholders in Long-Term Care Facilities

ASSISTIVE TECHNOLOGIES ARE RELATIVELY novel tools for research and daily care in long-term care (LTC) facilities that are faced with the burgeoning of the older adult population and dwindling staffing resources. The degree to which stakeholders in LTC facilities are receptive to the use of these technologies is poorly understood. Eighteen semi-structured focus groups and one interview were conducted with relevant groups of stakeholders at seven LTC facilities in southwestern Pennsylvania. Common themes identified across all focus groups centered on concerns for privacy, autonomy, cost, and safety associated with implementation of novel technologies. The relative importance of each theme varied by stakeholder group as well as the perceived severity of cognitive and/or physical disability. Our findings suggest that ethical issues are critical to acceptance of novel technologies by their end users, and that stakeholder groups are interdependent and require shared communication about the acceptance of these emerging technologies.

Medical Director, CPGs Spell QI Success

Medical Director, CPGs Spell QI Success

Quality Improvement Can Be Good Research

Quality Improvement Can Be Good Research

Your Medical Director Can Lead the QI Team

Your Medical Director Can Lead the QI Team