LTC Residents Research Articles

2358 Evaluation of a novel screening protocol for respiratory viral infections in long-term care homes

Abstract Introduction Respiratory viral illnesses (RVI) pose a serious threat to LTC residents. Those with frailty often experience non-specific presentations causing delayed diagnosis and treatment of infection. To facilitate early RVI detection, a screening protocol was developed to evaluate changes in cognitive and functional status of LTC residents using the Single Question in Delirium (SQiD) with new Single Question in Functioning (SQiF) and Single Question in Reduced Mobility (SQiRM). This study aims to address: (i) If novel (SQiD/SQiF/SQiRM) screening was superior to public health in detecting COVID-19 in LTC, and; (ii) Did combining the novel and public health screening improve detection of COVID-19. Methods The novel screening protocol was integrated into daily screening for RVI at three LTC homes in Nova Scotia, Canada. Daily assessments were recorded in consenting residents. If any of the novel protocol was positive, the 4As Test (4AT) and Hierarchal Assessment of Balance and Mobility (HABAM) were evaluated and a positive 4AT and/or HABAM triggered an RVI swab for COVID-19. Area under the curve (AUC,) sensitivity and specificity analysis using PCR tests as the reference criterion was utilised. Between October 2021 to February 2024, 378 LTC residents consented to participate, resulting in 142 positive COVID-19 PCR tests. Preliminary results show public health screening had a sensitivity of 68.3%, specificity of 52.1% and AUC of 0.60. Novel protocol exhibited sensitivity of 12.0%, specificity of 85.2% and AUC of 0.49. Combining public health and novel screening yielded a sensitivity of 80.3%, specificity of 32.3% with a AUC of 0.59. Conclusions Preliminary results suggest that incorporating public health and novel protocol screening for daily RVI assessments in LTC is advantageous. Predictive accuracy is slightly less with combined screening, but sensitivity of the combined screening protocols remains high. Other information Ethical approval obtained from Nova Scotia Health Research Ethics Board # 1026558.

Oral Anticoagulant Use and Post-Fall Mortality in Long-Term Care Home Residents

ObjectivesLong-term care (LTC) residents are susceptible to falling and the risk of subsequent morbidity and mortality may be compounded with concurrent anticoagulation use. Uncertainty exists around the benefit and harm of anticoagulation use for residents with a high risk for falls because of concerns of major bleeding complications. We aimed to examine if anticoagulant use increases mortality risk among LTC residents who fall. DesignA retrospective cohort study. Setting and ParticipantsOlder adults (≥65 years) admitted to a LTC facility in Ontario, Canada between January 1, 2010, and December 1, 2019, who were transferred to emergency departments for fall-related injuries. MethodsThe exposure was the use of an oral anticoagulant (OAC). The primary outcome was mortality within 30 days of transfer. Secondary outcomes were major hemorrhage and care utilization. We used hierarchical logistic regression models to examine the association between the use of OAC and 30-day mortality. ResultsThere were 56,419 residents transferred to the hospital for a fall, of whom 9611 (17.0%) were on an OAC. At 30 days, 5794 (10.3%) of the cohort had died: 12.0% (1151) on an OAC and 9.90% (4643) not on an OAC (risk difference [RD], 2.1%; 95% CI, 1.40%–2.82%). There were 485 major hemorrhage cases: 1.3% (125) on an OAC and 0.8% (360) not on an OAC (RD, 0.5%; 95% CI, 0.26%–0.74%). Multivariable analysis found no significant association between OAC use and 30-day mortality (odds ratio [OR], 0.98; 95% CI, 0.90–1.06), but an increased risk of major hemorrhage (OR, 1.31; 95% CI, 1.04–1.66). Both groups had similar health system and neurosurgical care utilization. Conclusions and ImplicationsAmong LTC residents transferred to the emergency department for fall-related injuries, OACs did not increase the risk of post-fall mortality. OAC prescribing for frail older adults who experience falls should consider their individual risk profile.

Advanced practice nurses’ daily practices delivering primary care to residents in long-term care facilities: a qualitative study

BackgroundGlobally, there is a growing shortage of primary care professionals, including those who serve residents in long-term care facilities (LTCFs). In recent decades, numerous new care models have been implemented to improve these residents’ care. Many incorporate Advanced Practice Nurses (APNs) into interprofessional healthcare teams. In Switzerland, little is known about how these models function, and few facilities have integrated APNs. This study aims to explore the everyday practice of APNs employed at a medical centre in the Bernese Seeland region delivering care to LTC residents and collaborating with LTCFs staff.MethodsThis qualitative study uses the “Interpretive Description” methodology, which builds on existing knowledge and examines phenomena interpreted through a social constructivist approach. We conducted six semi-structured individual interviews, one semi-structured focus group interview, and an examination of secondary data. Our thematic analysis followed Braun and Clarke’s guidelines for data analysis.ResultsIn LTCFs, APNs perform tasks similar to those of primary care physicians, e.g., patient visits and therapy adjustments, within the limits set by their supervising physicians. In addition, they contribute significantly to facility-wide quality improvement. We identified three fundamental elements for successful collaboration between APNs and LTCF staff: 1) clarifying roles and responsibilities; 2) establishing well-defined communication methods and pathways; and 3) building and maintaining trust. Together with LTCF staff, APNs provide multidimensional, person-centred care that focuses on medical, social, and nursing issues with the goal of maintaining the residents’ best possible quality of life.ConclusionsOur results suggest that integrating APNs into the LTCF care system improves care quality for residents and increases staff members’ job satisfaction.

Enablers and Barriers for End-of-Life Symptom Management Medications in Long-Term Care Homes: A Qualitative Study

ObjectivesLong-term care (LTC) homes provide personal and medical care 24/7 to individuals unable to live at home due to illness or disability and are often the final place of care and death for their residents. Therefore, LTC homes are tasked with providing quality end-of-life care, often requiring injectable symptom management medications to relieve distressing symptoms (eg, pain). In this study, we aimed to understand the enablers and barriers to prescribing and administering end-of-life symptom management medications in LTC homes. DesignQualitative study. Setting and ParticipantsFrom February 2021 to December 2022, we conducted virtual semi-structured interviews with health care providers (physicians and nurses) who worked in Ontario LTC homes and family caregivers of residents who died in LTC. MethodsWe analyzed interview transcripts using thematic analysis. ResultsWe identified 4 themes related to factors that may impact the prescribing and administering of medications for end-of-life symptom management: (1) identifying the end-of-life period and symptoms, (2) communication among health care providers and between health care providers and family caregivers, (3) health care provider competency with end-of-life medications, and (4) resources for LTC staff to support medication prescribing and administrating. Conclusions and ImplicationsIn LTC, there are distinct challenges in the prescribing and administrating of end-of-life symptom management medications. Our findings can be used to inform interventions aimed at improving end-of-life care for LTC residents. However, these interventions require buy-in and investment from the provincial government and the LTC sector.

Examine the Impact of Intergenerational Volunteering on LTC Residents

Examine the Impact of Intergenerational Volunteering on LTC Residents

Factors associated with pressure ulcer and dehydration in long-term care settings in Ontario, Canada.

Pressure ulcers and dehydration are common conditions among residents of long-term care facilities that result in negative health effects. They have been associated with signs of neglect and increased 30-day mortality among LTC residents. However, they are both preventable and with proper care can be effectively managed and treated. We conducted a retrospective cohort study to examine factors associated with pressure ulcers and dehydration among long-term care residents in the province of Ontario, Canada. Results indicated that close to one-fifth of residents were dehydrated (17.3%) or had a pressure ulcer (18.9%) during the study period. Advanced age was significantly associated with the presence of pressure ulcers and dehydration for both men and women. However, men were more likely to present with a pressure ulcer while women were more likely to exhibit symptoms of dehydration. Study findings also demonstrate the presence of both conditions being higher in municipal and not-for-profit homes compared to for-profit homes. The significant differences observed in relation to home ownership which require further investigation to identify the most relevant factors in explaining these differences. Overall, pressure ulcers and dehydration are preventable conditions that warrant attention from policymakers to ensure quality of care and resident safety are prioritized.

Resident-, family-, and staff-identified goals for rehabilitation of long-term care residents with dementia: a qualitative study

BackgroundLong-term care (LTC) residents with dementia can benefit from rehabilitation to improve function and quality of life. However, specific goals for rehabilitation with this population are not always clear. The purpose of this study was to describe the goals for rehabilitation for LTC residents with dementia from the perspective of residents, family, and staff.MethodsThis was a phenomenological qualitative study. LTC residents with moderate to severe dementia, family members, and staff were recruited from two LTC homes in Halifax, Nova Scotia. Data were collected through semi-structured interviews and field notes from observations with residents while they were being active within the home. Data were analyzed via the principles of thematic content analysis, mapped onto the International Classification of Functioning, Disability, and Health (ICF) Model, and reported by the participant group (i.e., residents, family, or staff).ResultsThe 15 participants were three female residents aged 82 to 98 years, seven predominantly (86%) female family members aged 56 to 74 years, and five staff members (two females, three males, aged 22 to 55 years) who were physiotherapists, a physiotherapy assistant, a healthcare aide, and a registered licenced practical nurse. Most identified goals fell within the activities and participation constructs of the ICF model and focused on maintaining or improving function, mobility, and quality of life. Specific themes included preventing falls, walking or locomoting, stair climbing, maintaining activities of daily living, engaging in enjoyable exercise, maintaining independence and human connections, keeping busy, leaving the home for activities, and participating in group activities.ConclusionsRehabilitation goals for LTC residents living with dementia often focus on quality of life and functional activities and participation in LTC and family activities and events. Function and quality of life are interrelated, whereby functional goals influence quality of life. While some goals focus on improvement in function, maintenance or prevention of decline were also key elements. Future work should ensure rehabilitation interventions are developed relative to individually identified goals, and interventional success is measured in relation to the goal.

The impact of the COVID-19 pandemic on transfers between long-term care and emergency departments across Alberta

BackgroundLong-term care (LTC) was overwhelmingly impacted by COVID-19 and unnecessary transfer to emergency departments (ED) can have negative health outcomes. This study aimed to explore how the COVID-19 pandemic impacted LTC to ED transfers and hospitalizations, utilization of community paramedics and facilitated conversations between LTC and ED physicians during the first four waves of the pandemic in Alberta, Canada.MethodsIn this retrospective population-based study, administrative databases were linked to identify episodes of care for LTC residents who resided in facilities in Alberta, Canada. This study included data from January 1, 2018 to December 31, 2021 to capture outcomes prior to the onset of the pandemic and across the first four waves. Individuals were included if they visited an emergency department, received care from a community paramedic or whose care involved a facilitated conversation between LTC and ED physicians during this time period.ResultsTransfers to ED and hospitalizations from LTC have been gradually declining since 2018 with a sharp decline seen during wave 1 of the pandemic that was greatest in the lowest-priority triage classification (CTAS 5). Community paramedic visits were highest during the first two waves of the pandemic before declining in subsequent waves; facilitated calls between LTC and ED physicians increased during the waves.ConclusionsThere was a reduction in number of transfers from LTC to EDs and in hospitalizations during the first four waves of the pandemic. This was supported by increased conversations between LTC and ED physicians, but was not associated with increased community paramedic visits. Additional work is needed to explore how programs such as community paramedics and facilitated conversations between LTC and ED providers can help to reduce unnecessary transfers to hospital.

Acceptance of physical activity virtual reality games by residents of long-term care facilities: a scoping review

Purpose This scoping review aims to identify evidence on older adults’ acceptance of PA VR games in LTC facilities, describe research designs used, define key acceptance concepts, and identify knowledge gaps for future research. Materials and methods Following Arksey and O’Malley’s framework, data from published and unpublished articles (Jan 2000–May 2023) were collected. Twelve databases and additional sources were searched for studies on LTC residents (≥65 years), PA video games (including VR and console games), acceptance, and attitudes. Data extraction included article details, design, population, intervention, outcomes, and limitations. Results Five studies met inclusion criteria from 1628 initial titles. They assessed acceptance of PA VR games among older adults in LTC facilities, showing varying levels of acceptance. Most studies used analytical designs, including RCTs. Key concepts of VR acceptance were poorly defined, with only one study using a validated TAM questionnaire. Knowledge gaps highlight the need for further research to understand PA VR acceptance among older adults in LTC facilities. Conclusion Validated acceptance questionnaires are needed in study of VR acceptance by older adults. Use of qualitative and quantitative methods can enhance understanding of technology acceptance, alongside exploration of individual, environmental, and age-related factors. Detailed reporting of VR interventions is recommended to comprehend acceptance factors.

Appraisal of Provision Structures of Nursing Homes for Old Persons—Illustrated by Cross-Sectional Data for East Tyrol

(1) Background: In Austria, stationary long-term care facilities for old persons in need of care are increasingly at the centre of the discussion on sustainable long-term care for old persons. So far, there is a lack of research addressing problems of fit from a spatial planning perspective. This case study on East Tyrol aims to appraise provision structures of stationary long-term care for old persons focusing on nursing homes (LTC) with regard to any intra-regional disparities. (2) Methods: Catchments and Bradshaw’s taxonomy of social needs serve as the conceptual framework. Real-world data on residents and applicants up to a certain cut-off date in 2022 for four nursing homes are statistically analysed at different spatial reference levels. The GIS mapping of catchments focuses on the intra-regional level. The findings are discussed transdisciplinarily. (3) Results: Intra-regional disparities with regard to the level of provision are evident. There are: 1) LTC-specific differences related to catchments with regard to LTC residents and applicants and travel efforts for visitors; and 2) valley-related differences with regard to nursing home choice. Normatively determined catchments broadly match the actual catchments. (4) Conclusions: This study could serve as a starting point for discussing methodological limitations of waiting lists as a parameter for unmet demand. Shortcomings of provision in relation to (future) demand as well as the significance of longitudinal studies for assessing the stability of catchments and area-wide coverage become apparent.

Using telepresence robots as a tool for virtual research during the COVID‐19 pandemic

AbstractBackgroundLong‐term care (LTC) settings have been disproportionately affected by the COVID‐19 pandemic. It is necessary to investigate unmet needs and explore practical strategies for supporting LTC residents and staff. However, visitation restrictions and staff shortages have created barriers to conducting research in healthcare settings. Innovative methods and tools are needed for conducting research to support the research process. Telepresence robots enable virtual connections via videoconferencing and give a feeling of the person’s presence from a remote location. This study focuses on exploring the researchers’ experiences of using a telepresence robot as an interview tool.MethodWe interviewed a team of 10 researchers who used a telepresence robot to virtually conduct research during the COVID‐19 pandemic in British Columbia, Canada. The team includes academic researchers, graduate students and people living with dementia. Semi‐structured one‐to‐one interviews were conducted by Zoom virtual meetings. Thematic analysis was performed to identify themes.ResultAnalysis of the data produced five themes on benefits and challenges with respect to using a telepresence robot to conduct interviews with residents in LTC. Themes of benefits: (1) Use as a Research Enabler, (2) More accessible and engaged research process, and (3) Increased Environmental Inclusion and Engagement. Themes of challenges: (4) Lack of Infrastructure and Resources, and (5) Training and Technical Obstacles. Based on the results, we offer “ROBOT” – an acronym created for actionable recommendations that inspire and support others to use telepresence robots for research. These recommendations include Realign to adapt, Organize with champions, Blend strategies, Offer timely technical assistance, and Tailor training to individual needs.ConclusionThis study offers unique and practical insights into using telepresence robots as a safe and innovative tool for conducting research remotely. Our results demonstrate that people living with dementia can be engaged meaningfully in research during the pandemic. Future research should apply more creativity and flexibility in adopting technology to expand possibilities for involving people with dementia in research.

Meeting the Behavioral Health Needs of LTC Residents: Lessons Learned From the Pandemic

Meeting the Behavioral Health Needs of LTC Residents: Lessons Learned From the Pandemic

Using telepresence robots as a tool to engage patient and family partners in dementia research during COVID-19 pandemic: a qualitative participatory study

BackgroundLong-term care (LTC) settings have been disproportionately affected by the COVID-19 pandemic; it is important to address unmet needs and explore practical strategies for supporting LTC residents and staff. The involvement of patient partners and family community members in research planning, implementation and evaluation is the basis of Patient and Public Involvement approach and has been challenging during the COVID-19 pandemic, as visitation restrictions have created barriers to conducting research in healthcare settings. Innovative methods and tools are needed for conducting participatory research. This study investigated the use of telepresence as innovative tools for participatory research based on three projects conducted with patient and family partners during the COVID-19 pandemic.MethodsThe data source includes (a) team reflective discussions, (b) weekly meeting notes, (c) field notes, and (d) interviews with ten researchers. We applied purposive sampling to select ten researchers who used a telepresence robot to conduct research in British Columbia, Canada. Semi-structured one-to-one interviews were conducted via Zoom virtual meetings. Patient and family partners contributed to team analysis to identify themes.ResultsAnalysis of the data produced five themes: (1) Research Enabler, (2) User-Friendly Technology, (3) Increased Engagement, (4) Lack of Infrastructure and Resources, and (5) Training and Technical Obstacles. Based on the results, we propose “ROBOT”—an acronym for five actionable recommendations to support the use of telepresence robots for research. The ROBOT recommendations represent: Realign to adapt, Organize with champions, Blend strategies, Offer timely technical assistance, and Tailor training to individual needs.ConclusionsThis study offers practical insights into the use of telepresence robots as a safe and innovative tool for conducting remote research with people with dementia, even in times of restricted access, as with COVID-19. Future research should apply more creativity and flexibility in adopting technology to expand possibilities for involving people with dementia in research.

In older LTC residents, transitional care interventions vs. usual care reduce hospital readmissions.

Birtwell K, Planner C, Hodkinson A, et al. Transitional care interventions for older residents of long-term care facilities: a systematic review and meta-analysis. JAMA Netw Open. 2022;5:e2210192. 35507344.

Vaccine access shrinks disparities between long-term care and community rates of COVID-19 mortality.

This longitudinal secondary data analysis examines differences in COVID-19 incidence and mortality among long-term care facility (LTCF) residents with those living in the community in South Carolina (SC) throughout the pandemic, including the time of vaccine availability. Data came from the SC Department of Health and Environmental Control (SCDHEC). Descriptive statistics and trends for cases of infections and deaths were calculated. Cox proportional hazards were used to compare COVID-19 mortality in LTC residents to community dwelling older adults, controlling for age, gender, race, and pre-existing chronic health conditions. Until early January of 2021, significantly greater incidence rates of infection (116.2 per 10,000 per month) and hazard of death after infection (HR=1.83, 95% CI: 1.70-1.98) were experienced among LTC residents as compared to older adults in the community even after statewide mask mandates and visitation guidance. Since vaccine availability, COVID incidence rates among LTC residents fell by half (59.5 per 10,000 per month after vaccines), and the relative hazard of death compared to older adults in the community was diminished (HR=1.44, 95% CI:1.29-1.61). Reducing the gap between LTCF and community-wide infection and mortality rates suggests that vaccination against COVID-19 is correlated with reduced disease spread in the greater community and in LTCF. Results indicate that policies and regulations addressing LTC resident and staff vaccination may effectively protect the most vulnerable older adults and the workforce providing their care while mask mandates and visitation guidance do not.

Families as Valued Contributors to LTC Residents' Quality of Life: Policy Perspectives

Family members are essential contributors to Q0L of LTC residents. This paper analyzes how the system views family’s role in residents’ QoL and enables or inhibits family involvement. Our analysis of 21 policies that regulate LTC in four Canadian Provinces reveal differences in their portrayal of residents’ families. In many policies, family roles are characterized procedurally (task-oriented) or relationally (interactive) by policy type. Operational standards (regulatory policies) linked to licensing employ more formal terminology, while LTC program guidelines use facilitative language to engage families and build relationships through voluntary means. Specific examples of orientation and admission procedures, care protocols including use of restraints, right to live at risk, and end-of-life care are presented to reveal inter-provincial variations. We argue there are opportunities to further engage families within the current regulatory framework.

Ageism Predicts Prioritizing COVID-19 Vaccines for Older Adults and LTC Residents

Ageism and ageistic stereotypes regarding older adults have become widespread and influence many policies and practices. Benevolent ageism includes attitudes or behaviors that appear overtly positive but are actually patronizing (Cary et al., 2017). Hostile ageism, usually expressed through negative stereotypes, highlights older adults' poor physical and mental functioning (Cary et al., 2017). The aim of the current study was to examine the role of benevolent and hostile ageism on perceptions of vaccination priority during the COVID-19 pandemic. As part of a larger longitudinal study on perceptions of aging, measures of benevolent and hostile ageism were collected in January 2020, before the pandemic began in the US. In March 2021, the same participants were asked to identify top vaccine priorities by ranking groups (e.g., adults 65 and older, school teachers, etc.). Participants who put older adults in the lowest priority group expressed more benevolent ageism before the pandemic than those who put older adults in the top priority group, F(2, 88) = 3.93, p < .05. Participants who put older adults in the lowest priority group expressed more hostile ageism prior to the pandemic, compared to those who put older adults in the top priority group, F(2, 88) = -3.34, p < .05. Similar to Vale and colleague (2020) findings, our results suggest that ageism influences people's ideas about triage for the vaccine. Notably, neither form of ageism related to prioritization for other high-risk groups, including members of racial/ethnic minority groups or health care workers.

Ageism Predicts Prioritizing COVID-19 Vaccines for Older Adults and LTC Residents

Ageism is an insidious form of injustice that is internalized from an early age with accumulating negative health impacts across the lifespan. Internalized ageism is associated with numerous public health outcomes, including physical and mental health, functional impairment, cognition, cardiovascular stress, hospitalizations, and longevity. Research has begun to document how ageism negatively impacts health through psychological, behavioral, and physiological pathways. Yet, limited research has addressed interventions to reduce internalized ageism. This study integrates stereotype embodiment theory, theories of successful and productive aging, and recent scholarly literature to present a conceptual model with potential downstream, midstream, and upstream interventions at micro, meso, and macro levels. Micro interventions include: social, physical, and cognitive engagement, as well as stress management. Meso interventions include: education, intergenerational contact, and narrative reframing. Macro interventions include anti-ageism policy, such as amendments to the Age Discrimination in Employment Act (ADEA). The conceptual model is described in detail, and implications for practitioners are discussed. The need to examine how policy influences health through the three pathways in stereotype embodiment theory is discussed. This study provides a working model for scholars and practitioners to use when considering paths toward reducing internalized ageism and optimizing well-being for aging adults.

Caring for Persons With Dementia in Audiology

While hearing loss is highly prevalent among patients with dementia, it frequently goes unidentified and unmanaged. It has been a commonly-held belief that older adults with dementia are unable to benefit from hearing rehabilitation, but recent evidence shows that many individuals with dementia can successfully use amplification, helping to improve communication, social interaction and quality of life for these individuals and their caregivers. This presentation will describe how modifications to practice led to successful outcomes for the majority of patients of a geriatric audiology clinic with co-morbid hearing loss and cognitive impairment. In a study of hearing aid use in 67 patients with these comorbidities, over 90% used hearing aids successfully with measurable benefit for both patients and caregivers. Furthermore, we will discuss approaches to improving communication for LTC residents with dementia and hearing loss through the support of audiologists during remote visits with physicians and families during the pandemic.

The PREvention Program for Alzheimer\u2019s RElated Delirium (PREPARED) cluster randomized trial: a study protocol

BackgroundDelirium is a significant cause of morbidity and mortality among older people admitted to both acute and long-term care facilities (LTCFs). Multicomponent interventions have been shown to reduce delirium incidence in the acute care setting (30–73%) by acting on modifiable risk factors. Little work, however, has focused on using this approach to reduce delirium incidence in LTCFs.MethodsThe objective is to assess the effectiveness of the multicomponent PREPARED Trial intervention in reducing the following primary outcomes: incidence, severity, duration, and frequency of delirium episodes in cognitively impaired residents. This 4-year, parallel-design, cluster randomized study will involve nursing staff and residents in 45–50 LTCFs in Montreal, Canada. Participating public and private LTCFs (clusters) that provide 24-h nursing care will be assigned to either the PREPARED Trial intervention or the control (usual care) arm of the study using a covariate constrained randomization procedure. Approximately 400–600 LTC residents aged 65 and older with dementia and/or cognitive impairment will be enrolled in the study and followed for 18 weeks. Residents must be at risk of delirium, delirium-free at baseline and have resided at the facility for at least 2 weeks. Residents who are unable to communicate verbally, have a history of specific psychiatric conditions, or are receiving end-of-life care will be excluded. The PREPARED Trial intervention consists of four main components: a decision tree, an instruction manual, a training package, and a toolkit. Primary study outcomes will be assessed weekly. Functional autonomy and cognitive levels will be assessed at the beginning and end of follow-up, while information pertaining to modifiable delirium risk factors, medical consultations, and facility transfers will be collected retrospectively for the duration of the follow-up period. Primary outcomes will be reported at the level of intervention assignment. All researchers analyzing the data will be blinded to group allocation.DiscussionThis large-scale intervention study will contribute significantly to the development of evidence-based clinical guidelines for delirium prevention in this frail elderly population, as it will be the first to evaluate the efficacy of a multicomponent delirium prevention program translated into LTC clinical practice on a large scale.Trial registrationNCT03718156, ClinicalTrials.gov.