Background Intergenerational programming has become a popular approach in the community and healthcare setting to integrate and enhance social engagement among seniors and youth. This systematic review aims to identify the length and type of social interaction where seniors achieve greater health benefits through intergenerational programming. This paper also intends to identify the appropriate age of the youth that would achieve a successful bond with the senior population. Prospective program directors will be able to use the insights towards the development of their own intergenerational programs.
Methods This systematic review uses a concurrent mixed methods design. The sample consisted of seven peer-reviewed journals: one systematic review, one randomized control trial, four cohort studies, and one case report study.
Results There is a total of 1,971 study participants included in this systematic review; 1,856 were ≥50 years of age and 155 between 5-16 years of age. The results from the seven studies provided three key insights for program directors. First, senior mentors who volunteer for ≥200 hours a year are 40% less likely to develop hypertension than non-volunteers. Second, seniors who volunteer as a ‘mentor’ receive the most benefit of social interaction when engaging in intergenerational programs. Third, the ideal age group of youths to engage in social interaction with seniors is middle adolescence; ages 13-16 years.
Conclusion The findings of this study have developed three insights for program directors that can be applied during the planning phase. These three insights will help to form a baseline for any intergenerational program directed at improving seniors' health.
Registered nurses are allowed to judge a person’s fitness to drive in certain provinces of Canada, such as Quebec, Ontario, British Columbia and Saskatchewan. However, the nurse’s role in road safety is little known, both among health professionals and within the nurse’s profession itself. The nursing profession has little presence in the scientific literature on road safety. A review of the literature in the Medline and CINAHL databases (key words: nurse, nurses, older, senior, elder, elderly, driver and driving) identified only three studies addressing this topic. The purpose of this presentation is to present the result of this literature review.
Thai family structure has become a small family because of the economic system transition. However, in Thai culture, the belief of gratitude and family expectations causes older adults to always rely on their children even though older adults do not live with their children, particularly in rural areas. These changes may lead to the conflict of beliefs between cultural beliefs and personal beliefs among family caregivers who have a wide range of responsibilities besides family obligations. A preliminary critical ethnography study aims to understand the meaning of family caregiving among Thai people. Semi-structured interviews were done in two family caregivers of disabled older adults providing care at home. The family caregiving was perceived and expressed as reflecting codes in five domains: domain one, caregiving activity (multi-caregiving tasks); domain two, skills (time management, observation, self-empowerment, and resilience); domain three, emotional experiences (attachment, appreciation, exhaustion, and self-esteem); domain four, caregivers' need (social supports); and domain five, values (family responsibility, family engagement, gratitude, no expectation of anything in return, caring out of love, and successful caregiving). The findings of this study suggest that family is still the priority of Thai children adults. The positive motivation from gratitude culture is the best way to promote for maintaining family caregivers' psychosocial well-being among Thais. Also, social supports are significant needs of family caregivers for preventing poor physical and psychosocial health from multi-caregiving tasks. However, the findings need further studies testing in other Asian cultures, which remain a family priority.
The lockdown in hospitals and care homes can generate anxiety and fear for families. People with dementia may refuse isolation procedures and resist care because they feel confused and overwhelmed. This knowledge translation study aimed to generate a greater understanding of technology adoption and develop strategies with stakeholders to support the use of iPads in engaging activities, especially to play family videos, for hospitalized older people with dementia. Three focus groups and three interviews were conducted with staff members and families to identify barriers and strategies of implementing iPads for virtual care in two large Canadian hospitals. Patients were observed and interviewed to explore their experiences. Thematic analysis identified three domains of barriers to implementing the iPad intervention: (a) lack familiarity with technology, (b) difficulties with operating the devices, (c) privacy and access issues. Based on the results, a toolkit was developed to disseminate the enabling strategies before the COVID-19 crisis. During the challenging time of the COVID-19 pandemic, the toolkit offered useful support for nurses to provide virtual care for family connections.
Purpose: Reminiscence therapy is a multi-sensory treatment that uses a combination of sight, touch, taste, smell and sound to help persons with dementia (PWD) remember events, people and places from their past lives. This project aims at developing an innovative, non-traditional framework prototype to improve the implementation of reminiscence therapy for PWD through customizable, immersive and interactive virtual reality (VR) experiences.
Methods We propose a framework for creating immersive and interactive virtual reminiscence experiences to facilitate the dementia care and management of behaviours and psychological symptoms of dementia (BPSD). The framework will support immersive VR using standalone VR head-mounted displays to provide users freedom of movement. At the same time, non-immersive VR will be developed using monitors, television, or projectors to visualize and engage with the content without the need of wearing any device. The evaluation of virtual reminiscence therapy will be conducted using data analytics and physiological measures including facial and eye tracking technology using video-recording to provide quantifiable metrics for evaluation of intervention. Clinical data on patients who have had the prototype intervention will be assessed to examine the relationship with decreasing agitation and other BPSD following intervention.
Study Implications The project expects to facilitate the complementary utilization of pharmacological and non-pharmacological interventions for dementia care. Enriching the traditional form of reminiscence therapy with VR can empower the caregivers to customize individualized virtual reminiscence experiences, which is expected to help PWD with maintaining and preserving their personal identity during disease progression and challenging circumstances associated with BPSD.
This presentation has a focus to explore health and healing experiences of Chinese older adults who have immigrated to live in Canada. The main purpose of this study is to explore what matters to older Chinese adults from two geographical and sociological cities in Western Canada. Topics include the concept of subjective well-being, quality of life, and life satisfaction amongst Chinese older adults. Recognizing that Canada’s population is projected to become significantly more ethically and culturally diverse by 2031 (Statistics Canada, 2018), there is a need to focus attention on diversity through country-of-origin. Older adults with Chinese decent may have needs that are different those born in Canada, supporting the contention that immigrant status is important in understanding health and wellness needs of older Chinese adults. The study uses a qualitative interpretive description design. The poster will discuss core theme and four categorical themes identified through the data analysis. Implications and recommendations for nurses working with Chinese Canadian elders will be shared. Looking forward to having discussions with you!
Background: Machine Learning (ML) algorithms are gaining popularity in health care to predict diseases, health outcomes, and prognosis due to the availability of big data. There is no prior study investigating the use of Machine learning to predict frailty in older adults. This scoping review aims to fill this gap by exploring the use of Machine Learning algorithms to detect frailty and its health outcomes.
Methods: Arksey and O’ Malley’s framework informed this study.
Results: A literature search in PubMed and Embase resulted in 558 studies, 13 were eligible for scoping review. Supervised (n=9) and unsupervised ML algorithms (n=4) were used to analyze data collected from nursing home residents (n=1), electronic databases (n=2), People Living With HIV [PLWH] (n=2), and community-dwelling older adults (n=8). Decision tree, Support Vector Machines, Bagging CART, Random forest, and Hierarchical Cluster Analysis were commonly used ML with accuracy ranging from 78 to 99%. Grip strength, gait speed, physical activity level, balance test, depression, socio-demographics, and cognitive function were predictors of frailty. Neuroimaging of cerebral blood flow was analyzed to predict physical frailty in PLWH. Frailty and other comorbidities predicted health outcomes such as immobility, hospitalization, ICU admission, and mortality.
Conclusion and Implications: ML shows potential in predicting frailty and health outcomes. Future ML research should test biomarkers to predict frailty in a diverse population. Improved ML algorithms could be incorporated into electronic health records to screen and manage frailty in older adults.
Within the care worlds of older adults, there are many care providers. All of these care providers are experts in their practice. The key to ensuring staff feel supported in their role as experts includes recognizing non-formal leadership positions integral to the team caring for a client. This recognition comes in formalized and expected interdisciplinary leadership communication as a central part of a client's everyday care. Participated in by all members of the immediate care-team, the client, and/or their advocate. An example in a longterm care setting would be the personal support worker, registered nurse or registered practical nurse, dietary and activation team members all being equals in providing leadership over their care area. In concert with the client and/or their advocate using the 3 min huddle to ensure every day starts with a clear care priority and all parties feel equally a part of the plan.
Interprofessional education (IPE) is a collaborative approach to education that brings together students across disciplines to interact prior to entering into their professions. The collective involvement of various healthcare professionals’ aids to consider and communicate unique disciplinary perspectives to deliver the highest level of quality care. The purpose of this study was to assess students’ readiness of health care students for interprofessional education.
The Readiness for Interprofessional Learning Scale (RIPLS), a 19-item validated assessment tool was distributed to multi-discipline students enrolled in the Fall semester. Categorical sample statistics were described, mean and standard deviation were obtained to assess the attitudes and perceptions of students’ readiness for interprofessional learning. A gerontological case study, embedded with elements unique to each discipline, was presented using a grand rounds format. The sample consisted of 43 nursing, social work, and speech pathology students from one University. Ninety percent of the students strongly agreed that shared learning with other healthcare students increased their ability to understand clinical problems. In addition, 86% of the students reported learning with healthcare students prior to qualifications would improve relationships after qualification.
The results suggest that IPE for students is an effective mechanism to identify and support student development of a professional identity that values the concepts of collaboration. IPE can lead to enhancements in healthcare such as improvements in quality of care and patient safety and has positive associations with improvements in clinical and patient outcomes. This program provided an innovative way to collaborate and instill cooperation across healthcare disciplines.
Personal expressions (responsive behaviours) in dementia are common and complex. To identify which non-pharmacological interventions may help reduce personal expressions, it is important to consider the multiple factors that contribute to these expressions. However, there is no consensus on how best to achieve this. The purpose of this scoping review is to explore approaches used to guide the understanding and management of personal expressions in persons with dementia in long-term care.
Following the Joanna Briggs Institute’s guidelines for scoping reviews, articles and grey literature from 2009 –2019 were reviewed using PubMed, Scopus, CINHAL, and PsychInfo databases. The review identified 3976 papers that were screened by two independent reviewers for relevancy. An additional 3 papers were identified from the grey literature and references. 28 papers were selected for charting.
Nineteen unique approaches to understanding personal expressions were identified, under two categories; Resident Focused and Care-Provider Focused approaches. Resident focused approaches guided care-providers in understanding resident experiences, through attending to expressions as communication of needs or through developing management strategies for behaviours. Care-provider focused approaches emphasized the role of the care-provider, including understanding interpersonal interactions and promoting the support of education/resource needs of staff. A comparison of components within the approaches is included.
Approaches offer guidance in the selection/integration of non-pharmacological interventions for personal expressions. Understanding the different components and what they offer can help develop better care practices. A comprehensive approach to understanding expressions can support residents and increase staff skill and confidence in responding to expressions.
Immigrants comprise a significant proportion of the older adult population in Canada. Yet, very little comparative research has focused on the health of immigrant and Canadian-born older persons.
This paper presents our analysis of the baseline data from the Canadian Longitudinal Study on Aging (CLSA) to explore the types of physical and mental health problems immigrant and Canadian-born older persons.
The sample included participants who were aged 55+ years and provided data about their country of birth: 18,245 Canadian-born and 4257 immigrants met these criteria. Data were analyzed using the chi-square test and the independent sample t-test.
In terms of physical health, immigrant and Canadian-born older persons did not differ in the prevalence of chronic illnesses, injury due to fall, or chronic pain. In terms of mental health, immigrant and non-immigrant older persons reported comparable levels of depressive symptoms but Canadian-born had higher prevalence of psychological distress, anxiety and mood disorders, and PTSD.
Conclusion: Immigrant and Canadian-born older persons participating in CLSA were comparable in terms of physical health problems but differed in the prevalence of most mental health problems. Subsequent CLSA datasets may allow for more nuanced between-group comparison of physical and mental health problems.
Keywords: Canada, Canadian-born, CLSA, immigrant, mental health, older adults, older persons, older immigrants, physical health
In the Central East Region of Ontario, Geriatric Assessment and Intervention Network (GAIN) teams were developed in response to a growing need for specialized frailty assessment and intervention services in the community. Nurse Practitioner (NP) led, interprofessional GAIN teams deliver comprehensive geriatric assessment (CGA) and interventions, which complement primary and specialist models of care. Since 2010, GAIN teams have supported the Region’s ~67,000 frail seniors, including diagnosing and managing dementia in the community. No systematic evaluation of community-based dementia care has been conducted to date. The purpose of this study was to describe dementia care management in GAIN Teams in Ontario. We conducted a retrospective chart review covering a 9-month study period (October 1, 2015 to July 1, 2016) at 10 GAIN sites. 300 charts of randomly selected patients age 75 and older, with dementia noted on the chart, who had a visit during the study period. Outcomes included proportion of new diagnoses made in GAIN, referrals to external specialists, number of patient contacts, quality of follow-up score, completion of an interprofessional CGA, and evidence of a Care Plan. GAIN teams are actively diagnosing (86%) and managing (8.4/10 quality score) persons with dementia in the community. This includes an interprofessional CGA (99%), and the development of a detailed care plan (69%). GAIN teams are able to closely follow their patients with dementia through frequent interactions (8 contacts over a 9-month period). The GAIN model can support the demand for diagnosis and management of dementia in the community.
With the dawning of the person-centred care movement within long-term care and dementia care, the facilitation of person-centred communication strategies and enhancement of relationships between care providers and residents has drawn increasing attention. One evident requisite in these transformative efforts is the ability to offer self-reflective learning opportunities for providers that impact their internal caregiver values and ultimately influence their outward person-centred behaviours.
The primary aim of this research was to pilot test the effectiveness of a novel communication intervention incorporating a video-feedback component on the person-centred dementia communication skills of health care aides. The secondary aim was to investigate the acceptability, utility and feasibility of the intervention in a residential long-term care setting.
A quasi-experimental single group pre-test/post-test design was used. Language-based and person-centred dementia communication skills were measured using video-recorded observations of usual care interactions. Outcomes of self-reflection, relationship closeness with the resident and confidence in interacting with residents with dementia were measured using self-report questionnaires. Focus groups and interviews with health care aides and nursing leadership were held to explore the feasibility of the intervention.
Eleven health care aide-resident dyads participated in the study. There was a significant increase in the use of language-based reciprocity and continuity skills, as well as language-based and person-centred statements overall. Reports of self-reflection at work, relationship closeness with the resident, and interaction comfort increased significantly. Participants indicated the intervention was highly acceptable and relevant. The key feasibility challenges included resistance to the video-recording component and time/resource challenges for implementation.
The interprofessional healthcare team on the Geriatric Dementia Unit at Ontario Shores Centre for Mental Health Sciences evaluated the use, impact and effectiveness of a relaxation chair as a non pharmacological intervention for patients with dementia who experience behavioural and psychological symptoms of dementia (BPSD). The relaxation chair is a fully automated chair that combines music, tactile stimulation and rocking motion to offer a unique and calming multi-sensory experience.
Patients were identified as candidates for this intervention through weekly rounds with interprofessional staff. An evaluation tool was developed and unit staff collected data at each instance of intervention delivery. Supplementary patient data was collected through chart review. In addition staff perception of the intervention was obtained through a focus group and completion of a questionnaire. Overall there was no significant improvement in patient’s length of sleep or NPI however improvements were seen in safety (harm to others). Staff identified challenges in utilizing the chair for person’s with severe dementia and the progressive recline chair feature was deemed disconcerting. The focus group identified subjectively that the chair seemed to provide more enjoyment to those with moderate dementia. A consideration for future investigation is whether the chair would be better suited in patients with mild to moderate cognitive impairment who are more functionally and cognitively able to remain in the chair.
Purpose Fall is a severe problem among person with Parkinson's disease (PD) and mild dementia. Recurrent falls may lead to decreased mobility, functional decline, depressive symptoms, and may decrease the quality of life (QoL), which are contributing factors to frailty. Tai Chi (TC) is an appropriate exercise among this population which helps to improve balance and reduce risk of fall. Considering challenges in performing exercises, virtual reality-based Tai Chi (VRTC) can be suitable due to its ease of use, safety, and participant improvement that can be measured in real-time compared to TC. This research aims to perceive the effect of VRTC exergame in reducing falls and improving frailty levels via Xbox 360 Kinect among PD with mild dementia in the Durham region.
Method This study will aim to conduct a mixed-method research. The quantitative part will examine (pre and post-intervention) the fall reduction in relation to patient’s balance, body strength, walking speed, daily living activities, confidence level and depressive status. Frailty level will be assessed based on the five criteria included in the Frailty Index. The patient’s perception of the impact of using VRTC exergame will be evaluated by qualitative descriptive research. The technology platform to be used is Xbox 360 Kinect.
Study Implications This research expects, VRTC can empower PD and mild dementia to reduce risk of fall by regaining balance and strength. It is expected to develop increased confidence level in their activities of daily living, improving QoL and frailty level thus contributing to successful aging.
The recent (2016) legalization of medical assistance in dying (MAiD) in Canada, challenges nurses to reflect on their potential roles, and the values they hold regarding providing care for patients who request MAiD at end of life. Nurses’ comfort levels regarding MAiD are seen to be multifactorial, influenced by age, gender, work experience, educational levels, and background personal beliefs such as religiosity (Terkamo-Moisio et al., 2017). As Canada’s population ages, nurses will increasingly be faced with caring for patients requesting MAiD. This calls on undergraduate nursing programmes to incorporate education that reflects current policy and prepares students to care well for patients who choose MAiD.
In this study, we explored i. the understanding and comfort levels of nursing students with respect to MAiD and, ii. how end of life education impacted nursing students’ understanding and comfort level with MAiD.
Forty third year BSN students were surveyed pre and post receiving education and participating in clinical experiences focused on end of life. In addition, six participants volunteered for individual interviews regarding their experiences. Three broad themes emerged from data analysis with student nurses’ understanding and comfort levels with MAiD being influenced by: their perception of the nurse’s role; their life experiences; and their education and knowledge levels. Students struggled with issues related to hope, professional standards, individual beliefs and values, limited experience, and instructor comfort levels. Study implications point to the need for more education and clarity in nursing education regarding MAiD.
Although there have been considerable public concerns about the impact of COVID-19 on residents living in long-term care homes, much less attention has focused on lessons learned from staff experiences during outbreaks. The outbreaks added significant additional stress to the nursing workforce, which has historically experienced high turnover, chronic staffing shortages, and increased burnout. We conducted focus groups (n=20) and individual interviews (n=10) to investigate critical challenges, experiences, and support needed for frontline staff in a long-term care home in British Columbia. A total of 30 staff in multiple disciplines participated in the study. They included Registered Nurses, Licenced Practical Nurses, care staff, recreational staff, and unit clerks. We applied qualitative thematic analysis and identified four themes: (a) I am proud, (b) we become stronger, (c) I am nervous (d) the vaccine helps. The frontline staff's voices provided a detailed description of their emotional experiences and positive stories about residents' care. In our late-breaker poster, lessons learned and implications for future research and practice will be explored and discussed.
Physical and emotional companionship in adults 65 years and older is not given much consideration in our society. In fact, much of the general population believe intimacy, it its many forms, no longer takes place in these 65 years of age and older. This narrative literature review aimed to gather data from the last ten years regarding companionship needs, including sexual behaviours, in older adults in long-term care facilities to dispel or confirm ageist myths. This review discovered barriers to meet companionship needs include partner availability, ageism, lack of privacy, physical limitations, caregiver attitudes, and long-term care facility culture. Long-term care facility staff acknowledge their lack of knowledge regarding companionship needs and support the idea of receiving training on the subject. From the results of this review, an educational fact sheet was created to provide caregivers, care recipients, and family members, accurate information on what companionship looks like during these later years, to better support the older adult.
Dementia is a progressive neurological condition that leads to decompensation in cognitive and functional abilities. With advancements in research, treatments, and diagnostic options, the ageing population is living longer, but require enhanced care needs and long-term care placements due to complex multi-morbidities. At least one behavioural and psychological symptom of dementia (BPSD) is accompanied in up to 97 percent of individuals diagnosed with Alzheimer’s dementia, and contributes to a diminished quality of life for the patient and enhanced distress for the nursing caregiver. The first-line traditional interventions are non-pharmacological but are often reported sub-therapeutic or ineffective. Pharmacological second line-treatments or usual care for these symptoms include individual use or combinations of typical and atypical antipsychotics, benzodiazepines, opioids, antidepressants, or anticonvulsants. Unfortunately, these therapeutic options are high-risk due to varying side and adverse effects, leading to increased cardiovascular events and higher mortality rates in this population. Cannabis provides an alternative therapeutic treatment option for BPSD. Researchers have primarily used synthetic cannabinoids in their intervention studies and have shown promise for reducing some effects of behavioural and psychological symptoms in individuals residing in long-term care facilities with dementia. To date, only one group of researchers has studied the effects of natural combination cannabidiol (CBD) with delta-9-tetrahydrocannabinol (THC) and showed potential positive outcomes in reducing BPSD. Throughout this presentation, I discuss the literature and methods for my thesis: A proposed randomised control trial to explore the effects of adding CBD/THC to usual care as compared to usual care alone on BPSD.
Introduction
Young carers are children, youth, and young adults under 25 who provide care to a loved one. In Canada, an estimated 1.25 million Canadian carers are between the ages of 15-24 and many others under 15. In Canada, less than 1% of young carers are being supported by formal services and supports. Without support, young carers have an increased likelihood of experiencing depression, anxiety, low self-esteem, peer rejection, loneliness, educational challenges, sleeping difficulty, and substance abuse.
Topic being addressed
This poster will discuss working with a community partner, Young Caregivers Association (YCA), to support young caregivers. YCA originated in 2003 and it was created as a special project of the Alzheimer Society of Niagara in response to the children and youth they identified as participating in the caregiving of a loved one with dementia. This poster will discuss how stakeholders were brought together and how this gave a voice to young carers by sharing stories and networking with key service providers, decision makers, and policy makers at knowledge sharing events.
Methods
Participatory action methods were used because they can create almost immediate and long-lasting impacts, especially for those populations from marginalized and vulnerable communities. It is also a powerful approach in bridging the gap between academia and service providers.
Outcomes
Community engagement and knowledge mobilization will be presented to help develop skills to create meaningful and lasting impacts. The poster will highlight the challenges related to recruitment and making an impact, as well as how the challenges were overcome.
Objectives: Older adults may have several age-related health problems that can affect daily life and self-management, which is important in maintaining well-being. Our objective was to find what self-management interventions can be used by older adults to address issues identified in a geriatric assessment and what is their effect on patient-centered outcomes such as patient knowledge and empowerment?
Methods: The following electronic databases were used: Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library on Sep 16, 2019.
Results: Among 17,789 abstracts reviewed, 32 studies were included (28 randomized controlled trials, 4 quasi-experimental studies). A total of 6,867 patients (mean age 65 to 78 years) were included. The most frequently reported outcomes were mobility/falls, quality of life, mood, and functional status. Most studies demonstrated positive effects on mobility/falls, pain, social supports, comorbidity, and medication management. Most studies were of moderate quality using the Cochrane Risk of Bias tool and the Downs and Black checklist for quasi-experimental studies. Many studies did not identify the primary outcome, did not report minimally important differences and employed multiple comparisons without control for family-wise error rate. Likewise, most studies did not calculate sample size. Although most geriatric domains were targeted in at least one study, no studies targeted nutrition or caregiver support. This is an important area for future research.
Conclusions: A variety of effective self-efficacy-targeted interventions exist for older adults to improve several important geriatric domains and related outcomes. However, long-term effects, validation, and scalability of these interventions remain largely unknown.
Background: Older adults have been hardest hit by the global pandemic and have been advised to limit social interaction and non-essential in-person interactions, raising the potential for secondary mental health impacts. Community-based groups are an important venue for socialization and wellbeing for seniors, but their services have been limited or closed due to the pandemic. We sought to document the efforts amongst community-based seniors groups to virtually meet the needs of older adults during the pandemic.
Methods: We conducted an environmental scan of community-based groups and organizations across the five geographically unique regions of British Columbia. We used snowball sampling approaches to identify relevant community groups and conducted key informant interviews. Data were thematically analyzed.
Findings: To date, we have interviewed 20 community seniors groups. Most had moved their services to a virtual format, some closed temporally to alter their services and came back using a virtual format, whereas a small number closed altogether due to limited capacity to move to a virtual format. The main barriers identified by agencies related to delivering, coordinating, and streamlining appropriate virtual content with limited budget/IT support. Participants reported that many older adults had limited capacity to use new technologies, and required IT support which they struggled to provide.
Conclusions: Many community organizations recognized the critical role they played for older adults and attempted to pivot resources online to meet those needs. However, barriers related to cost, time, and ultimately having seniors who were interested in a virtual delivery format were critical limitations.
Older adults from the LGBT community face barriers to quality healthcare, often resulting from healthcare providers misunderstanding the unique health needs of this population. Education is essential to support nurses to maintain culturally safe practice environments guidance, which includes guidance for both relating and communicating in a culturally humble way. Applying cultural humility principles during healthcare interactions is key to improving communication and strengthening the nurse-client relationship. In response to this need, a Sexual Orientation and Gender Identity (SOGI) Nursing toolkit was developed for healthcare providers. This toolkit provides relevant and authentic educational resources, including resources, bias testing, terminology guides, virtual simulation games (VSGs), and reflective questions all created to support the delivery of sexual orientation and gender identity education for nurses. A module within the toolkit includes Wolfgang's Story, which focuses on an older gay adult and a nurse's interaction during a healthcare encounter. This module explores the use of appropriate terminology, personal assumptions, biases, and key concepts related to heterosexism and grief. This virtual simulation game (VSG) identifies and prioritizes holistic nursing interventions to promote safety and improve client health, well-being, and recovery. This VSG and associated resources will encourage interprofessional dialogue, enhance understanding and support collaboration in older adult LGBT care through increasing awareness and culturally humble practice for this marginalized population.
Introduction: As part of an RNAO Advanced Clinical Practice Fellowship, the fellowship focused on the creation and implementation of a mentorship program model in a large long-term care (LTC) home. The project focused on implementing recommendations from the BPG "Developing and Sustaining Nursing Leadership". Supporting new nurses in a long-term care setting through a mentorship program is critically needed to promote a positive transition to practice, to enhance nursing leadership, increase retention rate and to foster a healthy work environment.
Methods: In order to inform the creation of the mentorship model, the Fellow conducted an environmental scan consisting of; 1) a review of the literature; 2) surveys and interviews of newly hired nurses; 3) interviews with managers and senior nurses; and 4) interviews with people leading existing mentorship programs. The pilot program model was trialed through Plan-Do-Study-Act cycles.
Results: A 6-week mentoring model was developed and implemented with 4 mentor-mentee dyads. The program elements included: mentoring tools (reflection tools, learning goals template, mentorship agreement form), processes (including mentor recruitment and training) and an evaluation strategy and sustainability plan.
Lessons learned: 1) Implementation of best practice guidelines enhanced the nursing leadership of staff nurses in a LTC setting; 2) mentorship promotes a supportive environment for newly hired nurses and promotes engagement of nursing staff. Organizational support is paramount to sustaining the delivery of the program.
Introduction: Delirium superimposed on dementia (DSD) is a highly prevalent, yet difficult to recognize problem in hospitals. DSD occurs when a person living with dementia (PLWD) also develops delirium. DSD is a highly distressing experience for caregivers.
Objective: This study aims to explore the experiences of caregivers of older persons with DSD in acute care hospitals; their role in the detection and management of DSD; and the type of support they require during this experience. Knowledge generated from this study can be used to identify strategies gerontological nurses can use to assist caregivers during their experience, and to improve the early detection and management of DSD, with the aim to improve health outcomes for both the hospitalized older person with DSD and the caregiver.
Methods: Thorne’s interpretive description method was used. In-person, semi-structured interviews were conducted with nine caregivers of older persons with DSD who were hospitalized in four medicine units. Interviews were transcribed and thematic analysis was conducted.
Results: The following themes related to caregivers’ experiences were identified: (a) caregivers found DSD to be an overwhelming experience, (b) caregivers were concerned about the quality of care that the older person received, (c) caregivers’ experiences were influenced by the nature of their relationship with the health care team, and (d) caregivers can play an important role in the detection and management of DSD.
Conclusion: Findings provide guidance on supporting and building collaborative relationships with caregivers. Recommendations on delivering caregiver-centred care to caregivers of older persons with DSD are outlined.
The media can be highly effective in swaying public perceptions about what is important and hence, influential in shaping health policy. During the COVID-19 pandemic, long-term care homes (LTCHs) were intensely scrutinized and represented in the Canadian media. This report provides an analysis of the representation of LTCHs, staff, and residents in the press during the early months of the COVID-19 pandemic in three widely circulating and influential Canadian newspapers. Eighty-three newspaper articles were identified through a keyword search of the Nexis Uni database and analysed using a qualitative approach based on Fairclough’s Critical Discourse Analysis (CDA) framework. A chronological analysis revealed conceptual themes that shifted over time from isolation and loneliness, to the neglect and abuse, and then to private versus not-for-profit funding of LTCHs. The textual analysis revealed three dominant discourses regarding LTCHs and the people who live and work there: 1) residents as vulnerable, fragile, elderly ‘others’, 2) staffing shortages exacerbated by COVID-19, and 3) rethinking LTC. A discourse practice and sociocultural practice analysis reveal the power of the media discourse in swaying public perceptions. The sociocultural practice level brings forth the ‘othering’ of LTCHs, staff and residents during the pandemic. The three discourses presented in the analysis support the call for a moral re-evaluation of LTCHs and the assumptions that influence their residents.
Introduction: The Lebed Method, a medically-based dance program marketed as Healthy-Steps, was developed fifty years ago as part of a postoperative regimen for patients with breast cancer surgery at Albert Einstein Hospital in the United States.
Problem: A clinical report was published in 1986, and the program was moved into practice without empirical evidence. It expanded to include a variety of conditions and now is practiced worldwide. The purpose of this study is to determine the therapeutic evidence of The Lebed Method
Methods: The Institute of Medicine framework for Systematic Literature Reviews was used for the data retrieval, abstraction, and analysis process. The Melnyk and Fineout-Overholt scale was used for level of evidence; 3-scale Jadad scoring method utilized for the quality and validity review. Studies were abstracted by 2 researchers for: General Information, Study Characteristics, Participant Characteristics, Intervention/ Setting, and Outcome/Data. Results were compared; decision determined by a third reviewer for discrepancies.
Outcomes: 7 studies met the inclusion criteria, published from 2005-2014; N=173; 83% female; 38-96 years old; 75% White. Overall positive findings include trends, clinical significance, effect size, and statistical significance for select measures of Quality of Life, range of motion, body image, perceived stress, depression, anxiety, balance, gait, nighttime restlessness, and pain. Level of evidence ratings and quality scores were moderate to high. This program appears to be safe adjunct therapy for multiple conditions. COVID-19 has paused face-to-face sessions, but virtual opportunities and video options have prevailed. Research is needed to establish dose efficacy.
In November 2011, Citizenship and Immigration Canada announced a new Super Visa program. The federal government claimed that Super Visa is a faster and convenient alternative for family reunification that helps to address the backlog of parent (permanent) immigration sponsorship applications. Little is known about how Super Visa shapes the experiences of immigrant families’ lives. Our study explored the experiences of Chinese immigrant families with Super Visa. A qualitative descriptive interpretive study was conducted that included semi-structured interviews with 19 immigrants and their (older) parents who had successfully obtained a Super Visa. Our study results show that the (older) parents provided considerable social, economic, instrumental, and emotional support to the immigrant families. For older parents, being able to support their (grand)children provided considerable satisfaction. While the Super Visa program is helpful for families whose regular visa applications were not successful, and for those who have temporary (grand)childcare or other family support needs, it is still a visitor visa and cannot meet the long-term needs and expectations of immigrant families, especially those from Global South. Their parents' temporary status in the country does not promote among immigrants a sense of belonging in Canada. The tightened immigration policy indicates that older immigrants tend to be framed negatively as a burden, and their contributions to immigrant families in Canada are devalued or even ignored by the government.
Introduction: Assisted Living Facility (ALF) is the largest growing model of care in the United States for older adults. The National Center for Assisted Living defines ALF as the long term care option that combines housing, supportive services, and personalized assistance with activities of daily living and health care. Most often self-pay, ALF administrators prioritize limited funds towards daily care needs to maximize residents’ length of stay.
Problem: Frailty associated with biological aging can be related to loss of leisure activity engagement. The benefits of engaging older adults in dance programs have steadily emerged. Although dance-based therapy has been therapeutically successful for older adults, no studies have been published to describe the engagement level of ALF residents while dancing.
Methods: This study measured the engagement benefit of 8 weeks of ballroom dancing sessions with ALF residents: N=15, age 76-94 years, F=17 (94.4%). An exploratory pretest/posttest longitudinal one group design used the Engagement in Meaningful Activities Survey. Seated and standing options were offered; sessions were taught by professional dancers.
Outcomes: The survey responses show that engagement scores increased from baseline to post-intervention: baseline 23-43 (median = 33), moderately engaged or lower (93%). Post intervention scores 14-46 (median = 42) moderately engaged or higher (92%). The results of this study appear that ballroom dancing may engage a group of ALF adults in a healthy activity.
Introduction:
The Canadian Nurses for Parkinson’s Disease (CNPD) network is a grassroots initiative that connects nurses in different practice settings including: hospitals, private nursing practice, private clinics and movement disorder clinics. This network aims to educate, research, advocate and champion best practices. Recently, the CNPD wrote an article in their newsletter reviewing best practices for neurogenic orthostatic hypotension (nOH). Many older adults living with Parkinson disease and multiple system atrophy develop neurogenic orthostatic hypotension due to disease and/or medications side effects.
Problem:
Given that the number of people and families living with Parkinsonisms is projected to rise in Canada and around the world, nurses need to be able to identify and be informed about best practices with regards to nOH.
Outcomes
The Canadian Nurses Network for Parkinson Disease learned of the development of clinical practice guidelines for the patient management of blood pressure for MSA, PD and other neurological disorders published in 2010, in the Canadian Journal of Neuroscience Nursing. Since these guidelines were published, a new validated orthostatic hypotension questionnaire was developed in 2011, and new drugs are coming to or on the market to treat nOH. The networks of nurses across nursing domains promote and share best practices for up-to-date evidence-based practice.
With the declaration of a state of emergency in Ontario in March 2020 due to COVID-19, new provincial guidelines for homecare services have been rapidly implemented for the health and safety of homecare workers, recipients, and caregivers. However, little is currently known regarding the impact of COVID-19 on homecare services as experienced by homecare recipients and their family/friend caregivers. As such, qualitative interviews were conducted from April-October 2020 to explore the impact of COVID-19 on homecare services for homecare recipients and their family/friend caregivers in SouthWestern Ontario. Based on a preliminary thematic analysis of interview transcripts, multiple themes have emerged related to homecare recipients’ and caregivers’ experiences of homecare services, including: 1) homecare recipients’ and caregivers’ hesitancy with in-person services provided by workers; 2) experiences of reduced homecare services due to restrictions and worker availability; 3) voluntary cancellation and/or suspension of homecare services; and, 4) notable changes with healthcare workers’ increased use of personal protective equipment during in-person care. As a result of the changes in the delivery of homecare services, caregivers also reported increasing caregiving responsibilities for patients, resulting in increased stress and burden. This analysis provides valuable insights regarding homecare recipients’ and caregivers’ experiences of homecare services during COVID-19. Furthermore, it contains significant implications for service providers in developing strategies to minimize potential disruption and promote the continuity of homecare services for homecare recipients and caregivers in need.
Background: Bathing can be frightening for people with dementia, and caregivers can be uncertain about approaching the bathing process, especially during behavioural escalation. Advanced Gerontological Education developed a Gentle Persuasive Approaches (GPA) Bathing eLearning curriculum to strengthen care providers’ knowledge, confidence, and skill to provide person-centred, evidence-informed bathing care.
Methods: Two GPA Bathing units were offered to Mississauga Halton LHIN Behavioural Supports Ontario staff in long-term or community care. Units were built upon best practice bathing competencies identified in the literature and included narrated video case scenarios. 36 participants completed the units and 24 submitted online evaluation responses. Pre- and post-GPA Bathing, participants completed a 20-item, 7-point Likert-type bathing self-efficacy measure. Additionally, pre-GPA Bathing, participants described past experiences, feelings, and approaches in bathing people with dementia and their learning goals. Post-GPA Bathing, participants reported bathing techniques they would use in the future and satisfaction with the units.
Results: Participants frequently encountered people with dementia who refused bathing or were extremely distressed by it. Even experienced participants reported feelings of fear, guilt, and incompetence in these interactions. They expressed a need for new and creative bathing strategies. After GPA Bathing, participants’ bathing self-efficacy scores significantly increased (p < .0001) relative to baseline. They reported plans to use specific tools and resources provided in the units to complete comprehensive bathing histories and assessments, and greater confidence in collaborating with families to create person-centred bathing plans.
Conclusion: GPA Bathing units provide caregiving staff with needed strategies and confidence to bathe people with dementia.
Older adults with severe and persistent mental illnesses are a vulnerable population. Often precariously housed, with little family support, these individuals are also less likely to receive services and appropriate medications for medical comorbidities. Traditional adult mental health models may struggle to support this aging cohort. In addition to these existing pressures, the COVID 19 pandemic has exacerbated these inequities. However, the same pandemic has also acted as a catalyst and accelerated the update of virtual care.
Many community practitioners have reached out across geographical regions and created new teams to support vulnerable patients. As we do so, we are learning the strengths and vulnerabilities of virtual care models which can help refine these new practices. An example of this is GeriMedRisk. It is a virtual clinical service that connects Ontario physicians, nurse practitioners or allied health professionals with geriatric specialists to optimize medications, physical and mental health conditions in older adults.
This poster will utilize a case based approach. It will highlight a rural geriatric nurse practitioner virtual care model. Discussion will focus on collaboration with family physician and utilization of GeriMedRisk with the aim to deprescribe in order to optimize function; minimize adverse effects and support aging in place. A summary of patient and caregiver perspectives about the experience as recipients of this innovative model of care will be provided.
Gerontological nurses ensure safe, client and family-centred care through comprehensive, best practices in pain and fall risk assessments. Pandemic related demands on nurses’ workload and time have increased exponentially, which may hinder their opportunity to seek educational resources that support point-of-care assessment best practices. A research team from a provincial university conducted a gap analysis study of student perspectives of best practice guideline implementation enablers and challenges. Study findings indicate that students require easy access to user friendly guidelines; and value clinical case studies to demonstrate implementation in practice. Therefore, with provincial funding support, the researchers recruited a group of students from across undergraduate and graduate programs as key informants to assist in the creation, development and user testing of a point-of-care mobile-friendly website, which informs implementation of key client and family-centred care, and pain and fall risk assessment best practice guideline recommendations. The team collaborated with the university’s Centre for Communication of Knowledge to co-create a responsive website (https://best-practice-guidelines-in-action.ca/) that is publicly available and free for all students and nurses to use. The mobile version of the website will be showcased in this poster presentation. Key features such as direct access to assessment instruments, with clear, implementation tips, case studies, and videos will be discussed/described. This presentation will introduce Gerontological nurses to a mobile learning resource that supports quality care and immediate uptake/implementation in practice.
Alberta has the highest worsening pain and worsening depressive mood average in Canada. In 2019, we set out to understand why and how we could improve.
We uncovered clues about the Depression Rating Scale, antidepressants, and polypharmacy.
We tested resources to improve comfort and well-being. Key concepts included common contributors to pain and mood distress, medication side-effects and deprescribing, interdisciplinary assessment, bundles of interventions, and evaluation of functional improvements.
Some things went well: individual residents demonstrated improved comfort e.g. no longer calling out 82 times per day, pain reduced from 10/10 to 4/10.
Some things could have gone better e.g. pandemic interruption.
We regrouped, adapted and innovated: Full-day in-person workshops were condensed to 30 minute e-learning modules. A three-step approach allows care teams to participate in the Pain & Mood Project according to capacity:
1. Three to five interdisciplinary team members access e-learning modules and improve comfort of 1-2 residents demonstrating distress (e.g. calling out, persistent anger).
2. All staff in a neighborhood or care community access e-Learning modules, and improve comfort of all residents.
3. Implementation of a unit quality improvement addresses common sources of distress such as immobility, social isolation, disrupted sleep and polypharmacy.
Our virtual platform is open access, building readiness for a national change movement!
Background: Most illness and death during COVID-19 occurred among older persons. The purpose of this study was to examine, from the perspectives of healthcare providers (HCPs) in a range of settings, how relational care of older persons changed during the pandemic and what innovative strategies HCPs used to overcome these changes.
Frameworks: The study was informed by a relational care framework, to clarify how multi-level interpersonal and structural factors shaped the relational care delivered by HCPs to older persons during the pandemic.
Methods: Qualitative, critical incident methodology guided data collection and analysis. Recruited through social media, HCP participants completed an 8-item demographic survey and a 9-item, open-ended critical incident (CI) questionnaire via a secure online platform (Opinio).
Results: 40 HCPs from various sectors submitted 2 detailed CIs, one satisfying and one dissatisfying. Participants reported relational care acts including comfort care, emotional validation, advocacy and creative means to maintain interpersonal connections between older people and their families. Participants modified relational care to address barriers such as restricted family presence, safety protocols, environmental insufficiencies and limited infrastructure supports. Participants applied alternative relational practices when safety policy impeded their ability to meet expected relational best practice standards. Creative strategies included providing window visits from ladders, virtual team consultations, large print picture boards, photographs, iPads, telephones, letter writing and brainstorming with peers and organizational leaders to bend the rules.
Conclusion: Despite COVID-19 pandemic conditions, HCPs across care settings found creative means to provide relational care, engaging families of older people in the process.
The aging population presents a new reality for Canadian oncology nursing practice. Age-related health, functional, social, psychological, and existential changes have an important impact on cancer care and treatment. Oncology nurses are well-positioned to identify and address the needs and concerns of older adults with cancer, but often lack the knowledge, resources, and support to do so.
In 2017, nurses within the Canadian Association of Nurses in Oncology (CANO) identified a need to develop a position statement concerning care of older adults with cancer. Between October 2018 and February 2020, we facilitated 13 roundtable sessions and circulated a bilingual online survey, receiving input from 170 nurses across 9 provinces. A draft position statement was presented in fall 2020, and feedback was integrated. The final statement was approved in March 2021. Findings also contributed to an international position statement.
This Canadian statement highlights the important contribution that oncology nurses can, and do, make in optimizing care of older Canadians with cancer and their caregivers. It provides a vision for quality care for older adults with cancer and their families, calling for engagement and specific action in clinical practice, leadership, education, policy, and research. With this statement, we invite collaboration with nurses in other areas of specialization to address the needs and concerns of this growing group of patients.
Canadian and international statements will be used to promote integration of existing evidence into practice and enable nurses to advocate for education, support, and resources in their care of older Canadians with cancer.
“Frailty” is a word we’ve all heard, but what it actually means and how it could, or should, impact our work with older adults isn’t always clear. To be ‘old’ doesn’t mean one is frail. Nor is frailty present simply due to the presence of disease. Frailty has been variously described as a phenotype, or a syndrome or a state, and there are multiple options available for assessment.
Alberta Health Services (AHS) Seniors Health Strategic Clinical Network (SCN) has an “Elder Friendly Care” (EFC) Quality Improvement initiative that teaches teams about frailty using the Edmonton Frail Scale, then supports teams to embed impactful strategies into routine care.
Frailty assessments are completed early in a patient’s admission and findings are used to prioritize interventions that address the person’s unique vulnerabilities. Interventions may address delirium risk, mobility, continence, sleep, nutrition/hydration, medications, responsive behaviours in dementia and restraint risk. There is strong evidence that adoption of such strategies contributes to reduced length of stay, ranging from 0.7 days to 7.3 days (Barnes 2012, Babine 2018, Sinha 2018). Analysis of data from AHS sites where select units participated in the EFC project showed patients aged 65 and over who stayed 50% or more of their hospital stay in an EFC unit had a mean decrease in LOS of 1.07 days.