scholarly journals Development and Evaluation of Clinical Practice Guideline for Delirium in Long-Term Care

2020 ◽  
Vol 17 (21) ◽  
pp. 8255
Author(s):  
Eunhye Jeong ◽  
Jinkyung Park ◽  
Sung Ok Chang
Keyword(s):  
Clinical Practice ◽  
Development Process ◽  
Healthcare Professionals ◽  
Long Term Care ◽  
Structured Interviews ◽  
Term Care ◽  
Barriers To Implementation ◽  
Selection For ◽  
Search Quality

Delirium is highly prevalent and leads to several bad outcomes for older long-term care (LTC) residents. For a more successful translation of delirium knowledge, Clinical Practice Guidelines (CPGs) tailored to LTC should be developed and applied based on the understanding of the barriers to implementation. This study was conducted to develop a CPG for delirium in LTC and to determine the barriers perceived by healthcare professionals related to the implementation of the CPG. We followed a structured, evidence- and theory-based procedure during the development process. After a systematic search, quality appraisal, and selection for eligible up-to-date CPGs for delirium, the recommendations applicable to the LTC were drafted, evaluated, and confirmed by an external group of experts. To evaluate the barriers to guideline uptake from the users’ perspectives, semi-structured interviews were conducted which resulted in four major themes: (1) a lack of resources, (2) a tendency to follow mindlines rather than guidelines, (3) passive attitudes, and (4) misunderstanding delirium care in LTC. To minimize adverse prognoses through prompt delirium care, the implementation of a CPG with an approach that comprehensively considers various barriers at the system, practice, healthcare professional, and patients/family levels is necessary.

scholarly journals Evaluating the integration of palliative care in national health systems: an indicator rating process with EAPC task force members to measure advanced palliative care development

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Natalia Arias-Casais ◽  
Eduardo Garralda ◽  
Miguel Antonio Sánchez-Cárdenas ◽  
John Y. Rhee ◽  
Carlos Centeno
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Long Term Care ◽  
Task Force ◽  
National Level ◽  
Structured Interviews ◽  
Term Care ◽  
Care Facilities ◽  
Rating Process

Abstract Background Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology. Aim To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above. Methods A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy. Results The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines. Conclusion Meaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.

Frailty Status and Cognitive Function Should Guide Prescribing in Long-term Care Facilities

2021 ◽  
Vol 36 (10) ◽  
pp. 469-473
Author(s):  
Shin J. Liau ◽  
J. Simon Bell
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Long Term Care ◽  
Adverse Drug Events ◽  
Cognitive Status ◽  
Term Care ◽  
Care Facilities ◽  
Disease Specific

Frailty, dementia and complex multimorbidity are highly prevalent among residents of long-term care facilities (LTCFs). Prescribing for residents of LTCFs is often informed by disease-specific clinical practice guidelines based on research conducted among younger and more robust adults. However, frailty and cognitive impairment may modify medication benefits and risks. Residents with frailty and advanced dementia may be at increased susceptibility to adverse drug events (ADEs) and often have a lower likelihood of achieving long-term therapeutic benefit from chronic preventative medications. For this reason, there is a strong rationale for deprescribing, particularlyamong residents with high medication burdens, swallowing difficulties or limited dexterity. Conversely, frailty and dementia have also been associated with under-prescribing of clinically indicated medications. Unnecessarily withholding treatment based on assumed risk may deprive vulnerable population groups from receiving evidence-based care. There is a need for specific evidence regarding medication benefits and risks in LTCF residents with frailty and dementia. Observational studies conducted using routinely collected health data may complement evidence from randomized controlled trials that often exclude people living with dementia, frailty and in LTCFs. Balancing over- and under-prescribing requires consideration of each resident’s frailty and cognitive status, therapeutic goals, time-to-benefit, potential ADEs, and individual values or preferences. Incorporating frailty screening into medication review may also provide better alignment of medication regimens to changing goals of care. Timely identification of frail residents as part of treatment decision-making may assist with targeting interventions to minimize and monitor for ADEs. Shifting away from rigid application of conventional disease-specific clinical practice guidelines may provide an individualized and more holistic assessment of medication benefits and risks in the LTCF setting.

Long-term care placement: The transitional support needs and preferences of spousal dementia caregivers

Dementia ◽  
2021 ◽  
pp. 147130122110564
Author(s):  
Deborah Brooks ◽  
Elizabeth Beattie ◽  
Elaine Fielding ◽  
Katy Wyles ◽  
Helen Edwards
Keyword(s):  
Long Term Care ◽  
Intervention Development ◽  
Care Facility ◽  
Spousal Caregivers ◽  
Support Needs ◽  
Structured Interviews ◽  
Term Care ◽  
Long Term Care Facility ◽  
Facility Staff

Background and objectives Many spousal caregivers experience stress, depression, loneliness, guilt and grief when placing a partner with dementia into long-term care. However, there is little research about their transitional support experiences, needs and preferences. This study aimed to gain a deeper understanding of these issues from spousal caregiver and long-term care facility staff perspectives, to inform subsequent support and intervention development. Research design and methods Semi-structured interviews and small group discussions were held separately with spousal caregivers ( n = 9) and care facility staff ( n = 11). Criterion and variation sampling aimed to ensure a range of experiences and perspectives. The ‘Framework’ approach was utilised for data analysis. Interpretation was with respect to underpinning models of stress-grief process in dementia caregiving. Findings A range of informational, psychoeducational and psychosocial supports were identified to help spousal caregivers cope better with the stressors and losses experienced throughout the transition from home to long-term care. Improved education about disease progression, information relating to long-term care provision, peer support and dementia-specific grief counselling were deemed important. Opportunities for better support within care facilities were also identified. Support should be tailored to individual needs and preferences. Discussion and implications The findings suggest a supportive care framework be developed, encompassing the trajectory from assessment for and admission into long-term care to end-of-life and post-bereavement support. Spousal caregivers should have their support needs assessed by trained health or social care professionals and be offered a range of support options as appropriate.

scholarly journals EVACUATING OR SHELTERING IN PLACE DURING A DISASTER: HOW ASSISTED LIVING ADMINISTRATORS MAKE THE DECISION

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S699-S699
Author(s):  
Lindsay J Peterson ◽  
Kathryn Hyer ◽  
David Dosa ◽  
Joseph June ◽  
Debra J Dobbs ◽  
...  
Keyword(s):  
Assisted Living ◽  
Long Term Care ◽  
Lessons Learned ◽  
Structured Interviews ◽  
Term Care ◽  
Nursing Home Administrators ◽  
Axial Coding ◽  
Storm Characteristics ◽  
Hurricane Irma

Abstract The decision to evacuate or shelter in place during a natural disaster such as a hurricane is complicated and poses risks to long-term care residents. While research has documented the difficulty of the evacuation decision for nursing home administrators, little is known about how assisted living residence (ALR) administrators make this decision. This is a concern given the physical and cognitive impairment level of many ALR residents, the increasing number of ALRs in the U.S., and the frequency of natural disasters. The purpose of this paper was to explore the factors that influenced whether assisted living administrators evacuated their ALRs for Hurricane Irma, a large hurricane that made landfall on Florida’s Southwest coast in September, 2017. This qualitative study used semi-structured interviews and focus groups with ALR owners or administrative staff (N=60) with questions including how they prepared for Hurricane Irma, their experiences during the hurricane, including whether they evacuated or sheltered in place, and lessons learned. The sample includes small (< 25 beds) and large ALRs in the multiple Florida counties affected by the hurricane. A content analysis approach was used. Atlas.ti version 7 was used for initial and axial coding. Prevalent themes included “emergency management planning”, “logistics”, “pressure”, “storm characteristics,” and “staffing”. The results of this study have implications for long-term care policy and training, potentially leading to changes in how ALR leaders prepare for and respond to disasters to improve the safety of residents.

Dietetic Students’ Experiences: Providing Meal Assistance in Long-term Care Facilities

2013 ◽  
Vol 74 (2) ◽  
pp. 88-91 ◽  
Author(s):  
Nicole Osinga ◽  
Heather Keller
Keyword(s):  
Long Term Care ◽  
Care Home ◽  
Structured Interviews ◽  
Term Care ◽  
Face To Face ◽  
Qualitative Thematic Analysis ◽  
Care Facilities ◽  
Role Learning ◽  
Dietetic Students

Purpose: This qualitative study involved describing the experiences of dietetic students who provided meal help to older adults. Of interest were benefits and challenges, and how training could be enhanced. Methods: Individual, face-to-face, semi-structured interviews were conducted with nine undergraduate dietetic students. In the preceding year, these students had volunteered as meal helpers in a long-term care home. Interviews were digitally recorded and transcribed verbatim. Qualitative thematic analysis was used to analyze the transcripts. Results: All participating students were female and from one undergraduate program. Three main themes emerged: growing into the role, learning outside the classroom, and providing quality assistance. Conclusions: This study provides an understanding of how meal helping can be a valuable experience for emerging dietitians. It also gives insights into training and the development of the meal helper role.

Dementia in rural settings: examining the experiences of former partners in care

2017 ◽  
Vol 39 (2) ◽  
pp. 340-357 ◽  
Author(s):  
RACHEL V. HERRON ◽  
MARK W. ROSENBERG
Keyword(s):  
Long Term Care ◽  
Structured Interviews ◽  
Northern Ontario ◽  
Term Care ◽  
Home Support ◽  
People With Dementia ◽  
Rural Settings ◽  
Informal Carers ◽  
Person With Dementia

ABSTRACTInformal carers, also referred to as partners in care, provide the bulk of care to people living with dementia across a range of community settings; however, the changing experiences and contexts of providing informal care for people with dementia in rural settings are under-studied. Drawing on 27 semi-structured interviews with former partners in care in Southwestern and Northern Ontario, Canada, we examine experiences of providing and accessing care over the course of the condition and across various settings. Our findings illustrate the challenges associated with navigating the system of care, finding people who understand dementia in the surrounding community, negotiating hours of home support, facing resistance to respite from the person with dementia, and feeling pressured into long-term care. We argue that partners' time, bodies and choices are spatially constrained within rural and small-town settings and the current systems of home, community and long-term care.

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