Resident Assessment Instrument-Minimum Data Set Research Articles

Organizational Context and Facilitation Interactions on Delirium Risk in Long-Term Care: A Cross-Sectional Study

ObjectivesOrganizational context (eg, leadership) and facilitation (eg, coaching behaviors) are thought to interact and influence staff best practices in long-term care (LTC), including the management of delirium. Our objective was to assess if organizational context and facilitation—individually, and their interactions—were associated with delirium in LTC. DesignRetrospective cross-sectional analysis of secondary data. Setting and ParticipantsWe included 8755 residents from 281 care units in 86 LTC facilities in 3 Canadian provinces. MethodsDelirium (present/absent) was assessed using the Resident Assessment Instrument-Minimum Data Set 2.0 (RAI-MDS 2.0). The Alberta Context Tool (ACT) measured 10 modifiable features of care unit organizational context. We measured the care unit's total care hours per resident day and the proportion of care hours that care aides contributed (staffing mix). Facilitation included the facility manager's perception of RAI-MDS reports' adequacy and pharmacist availability. We included unit managers' change-oriented organizational citizenship behavior (OCB) and an item reflecting how often care aides recommended policy changes. Associations of organizational context, facilitation, and their interactions with delirium were analyzed using mixed-effects logistic regressions, controlling for covariates. ResultsDelirium symptoms were prevalent in 17.4% of residents (n = 1527). Manager-perceived adequacy of RAI-MDS reports was linked to reduced delirium symptoms [odds ratio (OR) = 0.63]. Higher care hours per resident day (OR = 1.2) and an available pharmacist in the facility (OR = 1.5) were associated with increased delirium symptoms. ACT elements showed no direct association with delirium. However, on care units with low social capital scores (context), increased unit managers' OCB decreased delirium symptoms. On care units with high vs low evaluation scores (context), increased staffing mix reduces delirium symptoms more substantially. Conclusions and ImplicationsUnit-level interactions between organizational context and facilitation call for targeted quality improvement interventions based on specific contextual factors, as effectiveness may vary across contexts.

Integration of a dental hygienist into the interprofessional long-term care team.

To address poor oral health of residents in long-term care homes (LTCH), this study explored the process of integrating an educational resource and a dental hygienist on the interprofessional care team. This convergent mixed-methods study took place at a 472-bed LTCH in Toronto, Canada from February to August 2018. Nurses employed at the LTCH participated in the study. During the study period, a dental hygienist was integrated into an interprofessional LTCH team. Nurses completed an online eLearning module about using the Oral Health Assessment Tool (OHAT) when referring residents' oral health concerns to a. Pre/post knowledge quizzes, module feedback and satisfaction surveys were administered. A retrospective chart review examined OHAT use and compared nurse and dental hygienist oral health assessments. Two cycles of semi-structured interviews with five nurses explored experiences with the eLearning module, OHAT and integration of the dental hygienist into the team. Nurses scored well on the knowledge quizzes and reported comfort in using the OHAT to refer oral concerns to a dental hygienist; however, actual use was minimal. oral health issues were under-reported by nurses on the Resident Assessment Instrument-Minimum Data Set (RAI-MDS); the dental hygienist reported significantly more debris, teeth lost and carious teeth (all P < 0.0001). Qualitative analysis indicated that the nurses valued dental hygienist integration into the team. Using knowledge mobilisation practices, a new oral health referral tool was developed. This study highlights the feasibility and desirability of an oral health eLearning module, practical assessment tools and participation of a dental hygienist on the LTCH interprofessional care team.

Long-term cognitive impairment after probable delirium in long-term care residents: A population-based retrospective cohort study.

The impact of delirium on cognition has not been well-studied in long-term care (LTC) residents. This study examined changes in cognition 1 year after a probable delirium episode among LTC residents, compared to LTC residents without probable delirium. We also evaluated whether the relationship between probable delirium and cognitive change differed according to a diagnosis of dementia. We conducted a population-based retrospective cohort study using linked health administrative data. The study population included adults aged 65+ residing in LTC in Ontario, Canada and assessed via the Resident Assessment Instrument-Minimum Dataset between January 1, 2016 and December 31, 2018. Probable delirium was ascertained via the delirium Clinical Assessment Protocol on the index assessment. Cognition was measured quarterly using the Cognitive Performance Scale (range 0-6, higher values indicate greater impairment). Cognitive decline up to 1 year after index was evaluated using multivariable proportional odds regression models. Of 92,005 LTC residents, 2816 (3.1%) had probable delirium at index. Residents with probable delirium had an increased odds of cognitive decline compared to those without probable delirium, with adjusted odds ratios of 1.64 (95% confidence interval [CI] 1.35-1.99), 1.56 (95% CI 1.34-1.85), 1.57 (95% CI 1.32-1.86) and 1.50 (95% CI 1.25-1.80) after 1-3, 4-6, 7-9, and 10-12 months of follow-up. Residents with probable delirium and a comorbid dementia diagnosis had the highest adjusted odds of cognitive decline (adjusted odds ratio 5.57, 95% CI 4.79-6.48) compared to those without probable delirium or dementia. Residents with probable delirium were also more likely to die within 1 year than those without probable delirium (52.5% vs. 23.4%). Probable delirium is associated with increased mortality and worsened cognition in LTC residents that is sustained months after the probable delirium episode. Efforts to prevent delirium in this population may help limit these adverse effects.

Potentially Inappropriate Prescribing in Long-Term Care and its Relationship With Probable Delirium

ObjectivesThis study examined potentially inappropriate prescribing (PIP) of medication and its association with probable delirium among long-term care (LTC) residents in Ontario, Canada. DesignPopulation-based cross-sectional study using provincial health administrative data, including LTC assessment data via the Resident Assessment Instrument–Minimum Dataset version 2.0 (RAI-MDS 2.0). Setting and ParticipantsLTC residents in Ontario between January 1, 2016, and December 31, 2019. MethodsWe used residents’ first RAI-MDS 2.0 assessment in the study period as the index assessment. Probable delirium was identified via the delirium Clinical Assessment Protocol. Medication use in the 2 weeks preceding assessment was captured using medication claims data. PIP was measured using the STOPP/START criteria and 2015 Beers criteria, with residents classified as having 0, 1, 2, or 3+ instances of PIP. Relationships between PIP and probable delirium was assessed via bivariate and multivariable logistic regression models. ResultsThe study population included 171,190 LTC residents (mean age 84.5 years, 66.8% female, 62.9% with dementia). More than half (51.8%) of residents had 1+ instances of PIP and 21% had 3+ instances of PIP according to the STOPP/START criteria; PIP prevalence was slightly lower when assessed using Beers criteria (36.5% with 1+, 11.1% with 3+). Overall, 3.7% of residents had probable delirium. The prevalence of probable delirium increased as the number of instances of PIP increased, with residents with 3+ instances of STOPP/START PIP being 1.66 times more likely (95% CI 1.56-1.77) to have probable delirium compared to those with no instances of PIP. Similar findings were observed when PIP was measured using the Beers criteria. Central nervous system (CNS)-related PIP criteria showed a stronger association with probable delirium than non–CNS-related PIP criteria. Conclusions and ImplicationsThis population-based study highlighted that PIP was highly prevalent in long-term care residents and was associated with an increased prevalence of probable delirium.

Nursing assistants' use of best practices and pain in older adults living in nursing homes.

Inadequate pain management persists in nursing homes. Nursing assistants provide the most direct care in nursing homes, and significantly improving the quality of care requires their adoption of best care practices informed by the best available evidence. We assessed the association between nursing assistants' use of best practices and residents' pain levels. We performed a cross-sectional analysis of data collected between September 2019 and February 2020 from a stratified random sample of 87 urban nursing homes in western Canada. We linked administrative data (the Resident Assessment Instrument-Minimum Data Set [RAI-MDS], 2.0) for 10,093 residents and survey data for 3547 nursing assistants (response rate: 74.2%) at the care unit level. Outcome of interest was residents' pain level, measured by the pain scale derived from RAI-MDS, 2.0. The exposure variable was nursing assistants' use of best practices, measured with validated self-report scales and aggregated to the unit level. Two-level random-intercept multinomial logistic regression accounted for the clustering effect of residents within care units. Covariates included resident demographics and clinical characteristics and characteristics of nursing assistants, unit, and nursing home. Of the residents, 3305 (30.3%) were identified as having pain. On resident care units with higher levels of best practice use among nursing assistants, residents had 32% higher odds of having mild pain (odds ratio, 1.32; 95% confidence interval, 1.01-1.71; p = 0.040), compared with residents on care units with lower levels of best practice use among nursing assistants. The care units did not differ in reported moderate or severe pain among residents. We observed that higher unit-level best practice use among nursing assistants was associated with mild resident pain. This association warrants further research to identify key individual and organizational factors that promote effective pain assessment and management.

Factors Associated With the Quality of Life of Nursing Home Residents During the COVID-19 Pandemic: A Cross-Sectional Study.

Quality of life (QoL) of nursing home (NH) residents is critical, yet understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, lack of access to geriatric professionals, and care aide burnout were associated with NH residents' QoL. Cross-sectional study (July to December 2021). We purposefully selected 9 NHs in Alberta, Canada, based on their COVID-19 exposure (no or minor/short outbreaks vs repeated or extensive outbreaks). We included data for 689 residents from 18 care units. We used the DEMQOL-CH to assess resident QoL through video-based care aide interviews. Independent variables included a COVID-19 outbreak in the NH in the past 2weeks (health authority records), care unit-levels of care aide burnout (9-item short-form Maslach Burnout Inventory), and resident access to geriatric professionals (validated facility survey). We ran mixed-effects regression models, adjusted for facility and care unit (validated surveys), and resident covariates (Resident Assessment Instrument-Minimum Data Set 2.0). Recent COVID-19 outbreaks (β= 0.189; 95% CI: 0.058-0.320), higher proportions of emotionally exhausted care aides on a care unit (β= 0.681; 95% CI: 0.246-1.115), and lack of access to geriatric professionals (β= 0.216; 95% CI: 0.003-0.428) were significantly associated with poorer resident QoL. Policies aimed at reducing infection outbreaks, better supporting staff, and increasing access to specialist providers may help to mitigate how COVID-19 has negatively affected NH resident QoL.

Examining the "Potentially Preventable Emergency Department Transfer" Indicator Among Nursing Home Residents.

To determine if nursing home (NH) resident characteristics associated with potentially preventable emergency department transfers (PPEDs) are similarly associated with non-potentially preventable emergency department transfers (non-PPEDs). We conducted a population-level retrospective cohort study using linked administrative data reported using the Resident Assessment Instrument-Minimum Data Set Version 2.0 and the National Ambulatory Care Reporting System for emergency department transfers. We assessed all NH residents transferred to the emergency department within 92days after admission. The cohort included 56,433 NH resident admissions assessment of which 3498 NH residents experienced PPEDs, and 9331 residents experienced non-PPEDs. We assessed Ontario NH residents admission assessments collected between January 1, 2017, and December 31, 2018. We used cumulative incidence functions and Cox regression to compare resident characteristics between residents experiencing PPEDs and non-PPEDs. PPEDs were defined based on the International Classification of Diseases, 10th Revision. Approximately 23% of residents experienced an emergency department transfer within 92days of NH admission. The cumulative incidence of PPEDs was 6.3% and non-PPEDs was 16.8%. After adjusting for clinically relevant features, 14 of 18 resident admission characteristics were associated with both types of transfers. Resident admission characteristics associated with a greater risk of PPEDs solely were pneumonia [hazard ratio (HR) 1.48; CI 1.25-1.70] and oxygen therapy (HR 1.88; CI 1.69-2.10). Resident admission characteristics associated with a greater risk of non-PPEDs solely are experiencing a change in mood (HR 1.09; CI 1.01-1.18) and delirium (HR 1.08; CI 1.04-1.13). PPEDs were associated with a similar cluster of NH resident characteristics as those transferred for non-ambulatory reasons, suggesting that the clinical distinction between PPEDs vs non-PPEDs within the NH might be unclear. These findings highlight that the PPED indicator could be revised to improve specificity.

A Cross-Sectional, Correlational Study Comparing Individual Characteristics of Younger and Older Nursing Home Residents using Western Canadian Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0.

To compare characteristics of nursing home (NH) residents by age categories in Western Canada. A cross-sectional, correlational analysis of secondary data. 89,231 residents living in Western Canada NHs in the provinces of Alberta, Manitoba, and British Columbia in 2016 and2017. Resident characteristics (age, sex, marital status, body mass index, medical diagnoses, cognitive function, physical function, depressive symptoms) came from the Resident Assessment Instrument-Minimum Data Set 2.0 and were analyzed using chi-square, analysis of variance, and post hoc pairwise tests. Human developmental stage age categories were used to create 5 age groups: 18-34, 35-50, 51-64, 65-80, and 81years and older. The demographics, medical diagnoses, cognitive function, and physical function characteristics of NH residents among 5 age groups differed considerably (all P &lt; .001). Residents aged 18-34years were predominately male, never married, with a higher incidence of paralysis and traumatic brain injury. Residents aged 35-50years had a higher incidence of stroke and multiple sclerosis, and residents aged 51-64years mainly were morbidly obese and more prone to depression. Residents aged 65-80years were predominately married and more prone to diabetes, and residents aged 81years and older were predominately widowed, with a higher incidence of dementia compared with others. Findings describe the uniqueness of younger NH age groups and indicate that the youngest NH residents often have the severe disability and a modest support system (as defined by partnered status) compared to older residents in NHs. Future studies must analyze longitudinal data that track the growth of, and changes in, residents' health and functional status.

Using routinely collected data to develop and evaluate a clinical tool for early identification of palliative care needs in long-term care: The RESPECT Project.

ObjectivesPrognostication tools reporting personalized mortality risk and survival can improve advance care planning and discussions about end-of-life care. We developed, validated, and implemented a mortality risk algorithm for older adults with diverse care needs in long-term care (LTC) homes, called the Risk Evaluation for Support: Predictions for Elder-Life in the Community Tool for LTC (RESPECT-LTC). ApproachRESPECT-LTC was developed using routinely-collected health information on residents in LTC homes in Ontario, Canada. Model development used a cohort of LTC residents aged 50 years or older with at least 1 Resident Assessment Instrument—Minimum Data Set (RAI-MDS) record between January 2010 and December 2016. The primary outcome was mortality 6 months after a RAI-MDS assessment. We used proportional hazards regression with robust standard errors to account for clustering by the individual. We validated this algorithm, temporally, in a cohort of LTC residents who were assessed between January and December 2017. We constructed 37 risk bins based on incremental increases in estimated median survival of ~3 weeks among residents at high risk of death and 3 months among residents with lower mortality risk. We implemented and are evaluating the use of RESPECT-LTC for early identification of palliative care needs in LTC homes across Ontario. ResultsDevelopment and validation cohorts included 2,228,176 and 328,204 RAI-MDS assessments, respectively. Mean predicted 6-month mortality risk ranged from 1.38% (95% CI 0.63%-1.61%) in the lowest to 91.97% (95% CI 81.47%-99.9%) in the highest risk group. Estimated median survival spanned from 42 days (15 to 128 d at the 25th and 75th percentiles) in the highest risk group to over 8 years (2,066 to 3,428 d) in the lowest risk group. The algorithm had a c-statistic of 0.730 (95% CI 0.726–0.736) in our validation cohort. ConclusionRESPECT-LTC makes use of routinely-collected information to improve the identification of palliative and end-of-life care needs in LTC. Ongoing evaluation will assess its impact on referrals to palliative care, hospitalization at the end of life, and location of death.

Potentially inappropriate prescribing in long-term care residents and its association with probable delirium.

Objective: Medications can increase the risk of delirium due to drug toxicities, polypharmacy, and drug interactions. This study examined potentially inappropriate prescribing (PIP) of medication and its association with probable delirium among long-term care residents. Approach: We conducted a cross-sectional study of long-term care residents in Ontario, Canada between January 1, 2016 and December 31, 2019. Routinely collected long-term care resident assessment data from the Resident Assessment Instrument – Minimum Dataset (RAI-MDS) was linked to prescription claims data to ascertain probable delirium and medication use in the two weeks preceding the index assessment. PIP was measured via the STOPP/START criteria and Beers criteria, with residents classified as having 0, 1, 2, or 3+ PIPs. Associations between PIP and probable delirium was assessed via bivariate and multivariable logistic regression models. ResultsThe study population included 171,190 long-term care residents. The mean age was 84.5 years, 66.8% were female, and 62.9% had dementia. Probable delirium was documented on 3.7% of resident assessments. Over half (51.8%) of residents had 1+ PIP and 21% had 3+ PIPs according to the STOPP/START criteria. The odds of probable delirium increased as the number of PIPs increased. Probable delirium was 1.86 times more likely (95% confidence interval 1.74-1.98) in residents with 3+ PIPs compared to those with no PIPs after confounder adjustment. Similar findings were observed when PIP was evaluated using the Beers criteria. ConclusionThis population-based study highlighted that potentially inappropriate medication prescribing was highly prevalent and was significantly associated with the increased likelihood of probable delirium among long-term care residents.

Nursing Home Resident Admission Characteristics and Potentially Preventable Emergency Department Transfers

To determine which nursing home (NH) resident-level admission characteristics are associated with potentially preventable emergency department (PPED) transfers. We conducted a population-level retrospective cohort study on NH resident data collected using the Resident Assessment Instrument-Minimum Data Set Version 2.0 and linked to the National Ambulatory Care Reporting System for ED transfers. We used all NH resident admission assessments from January 1, 2017, to December 31, 2018, in Ontario. The cohort included the admission assessment of 56,433 NH residents. PPED transfers were defined based on the International Classification of Disease, Version 10 (Canadian) We used logistic regression with 10-fold cross-validation and computed average marginal effects to identify the association between resident characteristics at NH admission and PPED transfers within 92days after admission. Overall, 6.2% of residents had at least 1 PPED transfer within 92days of NH admission. After adjustment, variables that had a prevalence of 10% or more that were associated with a 1% or more absolute increase in the risk of a PPED transfer included polypharmacy [of cohort (OC) 84.4%, risk difference (RD) 2.0%], congestive heart failure (OC 29.0%, RD 3.0%), and renal failure (OC 11.6%, RD 1.2%). Female sex (OC 63.2%, RD -1.3%), a do not hospitalize directive (OC 24.4%, RD -2.6%), change in mood (OC 66.9%, RD -1.2%), and Alzheimer's or dementia (OC 62.1%, RD -1.2%) were more than 10% prevalent and associated with a 1% or more absolute decrease in the risk of a PPED. Though many routinely collected resident characteristics were associated with a PPED transfer, the absence of sufficiently discriminating characteristics suggests that emergency department visits by NH residents are multifactorial and difficult to predict. Future studies should assess the clinical utility of risk factor identification to prevent transfers.

The impact of Neighbourhood Team Development on resident quality of life in long-term care

AbstractLong-term care (LTC) residents often experience poor quality of life (QOL). Culture change has been proposed as an approach to improve resident centredness in care, thereby aiming to enhance residents' QOL. This article reports on one of the findings of the implementation of an organisational culture change approach, Neighbourhood Team Development (NTD). A retrospective cohort design was used to explore resident QOL scores. The sample included 232 residents across six Ontario LTC homes. Quantitative data were collected through the Resident Assessment Instrument–Minimum Data Set 2.0 (RAI-MDS 2.0) and the interRAI Self-Report QOL Survey for Long Term Care Facilities (SQOL-LTCF). Results demonstrated that culture change interventions, such as NTD, improve residents' QOL scores (+3.5 points, p = 0.0034). This article also adds to knowledge on the use of the SQOL-LTCF as a standardised assessment tool to measure QOL in LTC, and provides rationale to include resident QOL as a key outcome measure in quality improvement initiatives and care modelling in LTC homes.

Exploring Behaviours Related to Pain Indication for Residents in Long-Term Care with Dementia

Aim: The aim of this article is to explore the behaviours related to pain for residents of long-term care with dementia.&#x0D; Background: Nurse practitioners caring for residents with dementia face the complex task of assessing and managing pain. Residents in long-term care who live with dementia may express pain differently than those without cognitive or communication impairments. Responsive behaviours that may occur in advancing dementia may also be indicators of pain. Tools that consider behaviours related to pain for cognitively impaired residents such as the PACSLAC, should be considered.&#x0D; Methods: This secondary analysis is a retrospective population-based descriptive study of Resident Assessment Instrument-Minimum Data Set version 2.0 assessments conducted in long-term care homes across Ontario.&#x0D; Findings: Results show that, in many circumstances when a resident with dementia exhibits responsive behaviors that may be related to both dementia and pain, no pain is reported. These items include wandering, resisting care, and repetitive verbalizations. The findings suggest that pain may not be identified or treated in people with dementia.&#x0D; Conclusions: Nurse practitioners must provide an individualized approach in order to accurately assess and treat pain for residents with dementia. By acknowledging deficits and improving practice guidelines, the hope is to improve pain management and quality of life for residents with dementia and pain.

Cognitive decline, sensory impairment, and the use of audio-visual aids by long-term care facility residents

BackgroundHearing and vision impairments and the use of audio-visual aids are associated with cognitive decline in community-dwelling older people, but effects in long-term care facilities (LFCF) are unclear. We hypothesize that visual and hearing impairment are associated with cognitive decline and these relationships are mediated by using visual and hearing aids.MethodsSecondary data analysis of a longitudinal study was conducted in the 7 government-subsidized LTCF operated by one of the largest non-governmental organizations in Hong Kong using data between 2005 and 2016. Eligible residents were ≥ 60 years of age without severe cognitive impairment at baseline who had stayed in the facilities for more than 3 years. All variables were measured by using the Minimum Data Set-Resident Assessment Instrument Version 2.0, Hong Kong version. The outcome was cognitive decline. Predictors were visual and hearing impairments. Mediators were the use of visual and hearing aids. General linear models were employed to test the hypotheses.ResultsResults for 2,233 residents were analyzed, with a mean age of 82.1 ± 8.2 years and a mean follow-up period of 4.4 ± 0.8 years. Results showed that those who had visual impairment (p = 0.004) and hearing impairments (p = 0.022) had a higher risk of cognitive decline. Using hearing aids (coefficient = 0.0186, p < 0.05) positively mediates the effect of hearing impairment on cognitive decline. Using visual aids (coefficient = -0.0881, p < 0.05) negatively mediates the effects of visual impairment on cognitive decline.ConclusionIn LTCF, hearing and visual impairments are associated with a higher risk of cognitive decline. Hearing aids often-users were associated with a higher risk of cognitive decline. LTCF residents with visual impairment did not use visual aids. Use of visual aids demonstrated potential effects in slowing cognitive decline. A future study with a larger and more diverse sample with attention to quality of devices is proposed to confirm its effects.

Virtual Reality for Veteran Relaxation: Can VR Therapy Help Veterans Living With Dementia Who Exhibit Responsive Behaviors?

Virtual Reality for Veteran Relaxation: Can VR Therapy Help Veterans Living With Dementia Who Exhibit Responsive Behaviors?

SCOPE: safer care for older persons (in residential) environments\u2014a pilot study to enhance care aide-led quality improvement in nursing homes

BackgroundNursing home residents require daily support. While care aides provide most of this support they are rarely empowered to lead quality improvement (QI) initiatives. Researchers have shown that care aide-led teams can successfully participate in a QI intervention called Safer Care for Older Persons in Residential Care Environments (SCOPE). In preparation for a large-scale study, we conducted a 1-year pilot to evaluate how well coaching strategies helped teams to enact this intervention. Secondarily, we measured if improvements in team cohesion and communication, and resident quality of care, occurred.MethodsThis study was conducted using a prospective single-arm study design, on 7 nursing homes in Winnipeg Manitoba belonging to the Translating Research in Elder Care research program. One QI team was selected per site, led by care aides who partnered with other front-line staff. Each team received facilitated coaching to enact SCOPE during three learning sessions, and additional support from quality advisors between these sessions. Researchers developed a rubric to evaluate how well teams enacted their interventions (i.e., created actionable aim statements, implemented interventions using plan-do-study-act cycles, and used measurement to guide decision-making). Team cohesion and communication were measured using surveys, and changes in unit-level quality indicators were measured using Resident Assessment Instrument-Minimum Data Set data.ResultsMost teams successfully enacted their interventions. Five of 7 teams created adequate-to-excellent aim statements. While 6 of 7 teams successfully implemented plan-do-study-act cycles, only 2 reported spreading their change ideas to other residents and staff on their unit. Three of 7 teams explicitly stated how measurement was used to guide intervention decisions. Teams scored high in cohesion and communication at baseline, and hence improved minimally. Indicators of resident quality care improved in 4 nursing home units; teams at 3 of these sites were scored as ‘excellent’ in two or more enactment areas, versus 1 of the 3 remaining teams.ConclusionsOur coaching strategies helped most care aide-led teams to enact SCOPE. Coaching modifications are needed to help teams more effectively use measurement. Refinements to our evaluation rubric are also recommended.

Probable Delirium and Associated Patient Characteristics in Long-Term Care and Complex Continuing Care: A Population-Based Observational Study.

To estimate the prevalence of probable delirium in long-term care (LTC) and complex continuing care (CCC) settings and to describe the resident characteristics associated with probable delirium. Population-based cross-sectional study using routinely collected administrative health data. All LTC and CCC residents in Ontario, Canada, assessed with the Resident Assessment Instrument-Minimum Dataset (RAI-MDS) assessment between July 1, 2016, and December 31, 2016 (LTC n=86,454, CCC n=10,217). Probable delirium was identified via the delirium Clinical Assessment Protocol on the RAI-MDS assessment, which is triggered when individuals display at least 1 of 6 delirium symptoms that are of recent onset and different from their usual functioning. RAI-MDS assessments were linked to demographic and health services utilization databases to ascertain resident demographics and health status. Multivariable logistic regression was used to identify characteristics associated with probable delirium, with adjusted odds ratios (ORs) and 95% confidence intervals (CIs) reported. Delirium was probable in 3.6% of LTC residents and 16.5% of CCC patients. LTC patients displayed fewer delirium symptoms than CCC patients. The most common delirium symptom in LTC was periods of lethargy (44.6% of delirium cases); in CCC, it was mental function varying over the course of the day (63.5% of delirium cases). The odds of probable delirium varied across individual demographics and health characteristics, with increased health instability having the strongest association with theoutcome in both care settings (LTC: OR 30.4, 95% CI 26.2-35.3; CCC: OR 21.0, 95% CI 16.7-26.5 for highvs low instability). There were differences in the presentation and burden of delirium symptoms between LTC and CCC, potentially reflecting differences in delirium severity or symptom identification. Several risk factors for probable delirium in LTC and CCC were identified that may be amenable to interventions to prevent this highly distressing condition.

Excess Mortality in Long-Term Care Residents With and Without Personal Contact With Family or Friends During the COVID-19 Pandemic

Excess Mortality in Long-Term Care Residents With and Without Personal Contact With Family or Friends During the COVID-19 Pandemic

Comprehensive geriatric assessments for long‐term and home care settings and digital platforms available to support their applicability: A systematic review

AbstractBackgroundIntegrated care delivery is regarded as the most effective way of care provisioning to tackle challenges of dementia care, such as uncoordinated care, risk of hospitalizations, care planning and unmet needs. As Comprehensive Geriatric Assessments (CGAs) incorporate the key principles of integrated care, implementing CGAs in care practice might be highly relevant. However, this implementation should be supported by Digital Health Interventions in order to reach the full CGA capacity.Aims: To present the state‐of‐the‐art evidence on available CGAs for long‐term and home care, and digital platforms supporting the administration of CGAs.MethodsTwo search strategies were conducted in PubMed, CINAHL, and Web of Science. One focused on the validity and reliability of available CGAs for long‐term and home care settings, and the second search comprised digital platforms that support CGAs. Studies in English and Spanish and published up to July 30, 2020 were considered.ResultsA total of 73 studies reporting on the validity/reliability of 14 different CGAs, and five papers describing four digital platforms supporting CGAs were identified. Most of the CGAs covered a wide range of domains, evidence for good to excellent validity and reliability was reported for various instruments. Digital platforms showed some limitations and barriers regarding their usability and feasibility.ConclusionForemost, strong evidence of good to excellent validity and reliability was found for the Resident Assessment Instrument‐Minimum Data Set (RAI‐MDS) and subsequent updated instruments, similar results have been reported for multiple countries. For this reason, we recommend the use of its latest versions for long‐term care facilities and home care, the interRAI LTCF and interRAI HC. Regarding the digital platforms supporting CGAs, the inclusion of safe data storage, automatic notifications for assessment completion, individualized profile reports, automatic calculation of final outcomes, and facilitation of multidisciplinary assessments, were identified as key features to enhance their implementation. This project is part of the Marie Skłodowska Curie Actions Innovative Training Network H2020‐MSCA‐ITN, under grant agreement number 813196.

409 - Psychometric features of Comprehensive Geriatric Assessments (CGAs) in long-term and community care settings: A Systematic Review

Background:Comprehensive Geriatric Assessments (CGAs) incorporate the key principles of integrated care delivery, which is regarded as the most effective approach of care provisioning to face challenges of dementia care, such as uncoordinated care, risk of hospitalizations, care planning and unmet needs. For this reason, implementing CGAs in care practice might be highly relevant, however, to do so, we must consider their psychometric characteristics.Research Objective:To provide insight into the content and the reliability and validity of CGAs used in long-term care and home care settings.Method:A search strategy was conducted in PubMed, CINAHL, and Web of Science, targeting studies that have focused on the validity and reliability of available CGAs for long-term and home care settings. Studies in English and Spanish and published up to July 13, 2021, were considered.Preliminary results of the ongoing study:A total of 72 studies reporting on the validity/reliability of 13 different CGAs were identified. For long-term care facilities, five CGAs were reported; for home care, eight assessment tools were targeted. Most of the CGAs covered a wide range of domains, such as Physical Health, Functional, Mental Health, and Social Status. Evidence for good to excellent validity and reliability was reported for various instruments.Conclusion:Resident Assessment Instrument-Minimum Data Set (RAI-MDS) and subsequent updated instruments reported strong evidence of good to excellent validity and reliability for multiple countries. For this reason, interRAI LTCF and interRAI HC are recommended to be use for long-term and home care facilities, as they are the latest versions of the RAI-MDS.This project is part of the Marie Skłodowska Curie Actions Innovative Training Network H2020-MSCA-ITN, under grant agreement number 813196