Long-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.

Vision and hearing impairments are highly prevalent in adults 65 years of age and older. There is a need to understand their association with multiple health-related outcomes. We analyzed data from the Resident Assessment Instrument for Home Care (RAI-HC). Home care clients were followed for up to 5 years and categorized into seven unique cohorts based on whether or not they developed new vision and/or hearing impairments. An absolute standardized difference (stdiff) of at least 0.2 was considered statistically meaningful. Most clients (at least 60%) were female and 34.9 per cent developed a new sensory impairment. Those with a new concurrent vison and hearing impairment were more likely than those with no sensory impairments to experience a deterioration in receptive communication (stdiff = 0.68) and in cognitive performance (stdiff = 0.49). After multivariate adjustment, they had a twofold increased odds (adjusted odds ratio [OR] = 2.1; 95% confidence interval [CI]:1,87, 2.35) of deterioration in cognitive performance. Changes in sensory functioning are common and have important effects on multiple health-related outcomes.

Older adult abuse (OAA), defined as abuse, neglect, or mistreatment of persons aged 65 years or older, is a globally pervasive concern, with severe consequences for its victims. While internationally reported rates of OAA are in the range of 5–20% per annum, New Zealand lacks the necessary data to quantify the issue. However, with a growing aging population, an increase in the prevalence of OAA is predicted. We investigated the extent of OAA in New Zealand, utilizing the mandatory interRAI-HC (International Resident Assessment Instrument-home care assessment) dataset, which included 18,884 interviewees from the Southern District Health Board between 2013 and 2019. Findings confirmed our hypothesis that the interRAI assessment is neither sufficiently sensitive nor specific capturing only 3% from a population of increased frailty and thus at higher risk of abuse. We characterized OAA victims as relatively younger males, depressed, and with impaired decision-making capacity. If the interRAIs were to serve as a preliminary screening tool for OAA in New Zealand, it would be germane to implement changes to improve its detection rate. Further studies are urgently called for to test changes in the interRAI that will aid in identifying often missed cases of OAA better and thus offer protection to this vulnerable population.

Falls in residential long-term care (LTC) facilities continue to be a leading cause of injury for residents and cost for the health care system. Interdisciplinary clinical teams are responsible for assessing risk levels for their residents and developing appropriate care plans and interventions in response. This study compares the predictive accuracy of three separate fall risk assessment tools: the interRAI Falls Clinical Assessment Protocol (CAP), derived from the LTC Facility (LTCF) or Minimum Data Set (MDS) 2.0 assessments; the Scott Fall Risk Screen; and a modified Fall Risk Tool that was implemented as part of a provincial Fall Reduction Strategy in Nova Scotia. To conduct this retrospective cohort study, secondary data were collected from 1,553 LTC residents with interRAI assessments completed between March 1, 2015 and September 29, 2016, across Nova Scotia and New Brunswick. For each resident, data were collected regarding the three fall risk assessments, along with fall incident data for use in sensitivity, specificity, and logistic regression analyses. This study found that although all three tools had limitations with sensitivity or specificity thresholds, the interRAI Falls CAP delivered the highest accuracy with a c-statistic of 0.673, compared with the Scott Fall Risk Screen at 0.529 and the modified Fall Risk Tool at 0.609. When diseases that have been established to be a risk factor for falls were added to the model, the overall accuracy of the interRAI Falls CAP combined with those covariates increased to 0.749. These results suggest that the best practice guidelines for fall risk assessment be revisited, and that the interRAI Falls CAP could potentially be updated to include certain diseases and controls for optimal predictive ability.

Outcomes of adverse events in home care are varied and multifactorial. This study tested a framework combining two health measures to identify home care recipients at higher risk of long-term care placement or death within one year. Both measures come from the Resident Assessment Instrument-Home Care (RAI-HC), a standardized comprehensive clinical assessment. Persons scoring high in the Method for Assigning Priority Levels (MAPLe) algorithm and Changes in Health, End-stage disease, Signs and Symptoms (CHESS) scale were at the greatest risk of placement or death and more than twice as likely to experience either outcome earlier than others. The target group was more likely to trigger mood, social relationship, and caregiver distress issues, suggesting mental health and psychosocial interventions might help in addition to medical care and/or personal support services. Home care agencies can use this framework to identify home care patients who may require a more intensive care coordinator approach.

Background: This study is part of the Innovations in Data, Evidence and Applications for Persons with Neurological Conditions project to understand the strengths, preferences, and needs of persons with neurological conditions living in Canada. Objective: To estimate the prevalence and describe the sociodemographic and clinical characteristics of persons with multiple sclerosis in Canadian home care, nursing home, Complex Continuing Care hospitals, and inpatient mental health care settings. Methods: Cross-sectional study of adults aged 18 years and older with multiple sclerosis (MS; n=11,250) across Canada from 1996 through 2011 using interRAI Resident Assessment Instrument (RAI) comprehensive health assessments (RAI Minimum Data Set 2.0, RAI-Home Care, RAI-Mental Health). Comparisons were made to adults with Alzheimer’s disease and related dementias (n=260,910), other neurological conditions (n=163,578) and non-neurological conditions (n=571,567). Results: The prevalence of MS was highest in Complex Continuing Care hospitals (4125 cases per 100,000 patients), followed by home care (2020 cases per 100,000 patients), nursing homes (1424 cases per 100,000 patients), and mental health settings (138 cases per 100,000 patients). Persons with MS experienced greater impairment in the completion of activities of daily living, pain, pressure ulcers, swallowing difficulty, depression, and anxiety compared with peers within care settings. There were also significant differences between settings, particularly the degree of physical and cognitive impairment experienced by persons with MS. Conclusions: Except for mental health care settings, the prevalence of MS in community, institutional and hospital-based care settings exceeded that of the general population. These data describing the sociodemographic and clinical characteristics of persons with MS may be used to inform clinical practice and policy decisions for persons with MS across the continuum of care.

Few studies have focused on falls among home care (HC) clients with neurological conditions. This study identified factors that increase risk of falling among HC clients with no recent history of falls, and explored whether risk profiles varied among those with dementia or parkinsonism compared to those without selected neurological conditions. A retrospective cohort design was used and analysis of data from community-based HC clients across Ontario was conducted on a sample of ambulatory clients with dementia, parkinsonism, or none of the selected neurological conditions. Data were obtained from the Resident Assessment Instrument for HC (RAI-HC) assessment. The outcome used in multivariable analyses was whether clients fell during follow-up. Unsteady gait was a strong predictor of falls across all three groups. Co-morbid parkinsonism most strongly predicted falls in the dementia group. Clients with borderline intact to mild cognitive impairment had higher odds of falling within the parkinsonism and comparison groups.

Quality of life (QoL) of long-term care (LTC) facility residents is an important outcome of care. This cross-sectional, descriptive study examined the self-reported QoL of LTC facility residents in Canada using the interRAI Self-Report Nursing Home Quality of Life Survey instrument. A secondary purpose was to test the instrument’s psychometric properties. Psychometric testing of the instrument supported its reliability and its convergent and content validity for assessing the residents’ QoL. Findings showed that residents rated positively several aspects of their life, such as having privacy during visits (76.9%) and staff’s being honest with them (73.6%). Residents gave lower ratings to other aspects such as autonomy, staff-resident bonding, and personal relationships. The findings point to gaps between facility philosophies of care and their translation into a care environment where care is truly resident-directed. Moreover, the findings have potential implications for resident care planning, facility programming, social policy development, and future research.

Institutionalization of the Elderly in Canada suggested that efforts to address the underlying causes of age-related declines in health might negate the need for nursing homes. However, the prevalence of chronic disease has increased, and conditions like dementia mean that nursing homes are likely to remain important features of the Canadian health care system. A fundamental problem limiting the ability to understand how nursing homes may change to better meet the needs of an aging population was the lack of person-level clinical information. The introduction of interRAI assessment instruments to most Canadian provinces/territories and the establishment of the national Continuing Care Reporting System represent important steps in our capacity to understand nursing home care in Canada. Evidence from eight provinces and territories shows that the needs of persons in long-term care are highly complex, resource allocations do not always correspond to needs, and quality varies substantially between and within provinces.

Background: This exploratory study examines factors associated with isolation from informal social ties among geriatric psychiatry inpatients. Specifically, it examines the associations of diagnoses, psychiatric history, and measures of current functioning with social isolation.

Methods: Analyses rely upon data derived from the Resident Assessment Instrument – Mental Health (RAI-MH), which is a patient focused, multidimensional, comprehensive assessment instrument designed to be a component of a larger, integrated health information system linking mental health with home care, long-term care, acute care, rehabilitation, and palliative care.

Results: Controlling for age, multivariate results show that being married or widowed was associated with a lower odds of being isolated. Mood disorders were also associated with a lower odds of isolation, while a history of a personality disorder and a personal biography of institutionalization were both clearly associated with an increased odds for isolation. Although significant bivariate predictors in the multivariate model, both schizophrenic and organic diagnoses failed to reach statistical significance. In addition, patients hospitalized at an earlier age and/or predicted to have a longer stay on the current admission were much less likely to have contact with informal supports. Of the study variables indexing functional status, only activities of daily living (ADLs) remained a significant predictor for isolation in the final multivariate model.

Conclusions: The analyses demonstrate the detrimental effects of an earlier life experience with mental illness. Having an earlier age of illness onset may lead to a potentially greater impairment in establishing and maintaining informal social ties throughout the life course into older age. These analyses reinforce the need for comprehensive assessment of patients on admission and over time.