Glenise McKenzie

Translation of Two Evidence-Based Programs for Training Families to Improve Care of Persons With Dementia

The need for evidence-based non-pharmacological community programs to improve care of older adults with dementia is self-evident, considering the sheer numbers of affected individuals; the emotional, physical, and financial toll on affected individuals and their caregivers; the impact on our health care system; and the growing availability of evidence regarding the potential for psychosocial interventions to enhance care and decrease costs. To address this need, the Administration on Aging has begun funding translation of evidence-based programs into community settings. Two programs, Reducing Disability in Alzheimers Disease and STAR-Community Consultants (STAR-C), were selected by the Ohio Department of Aging (in collaboration with the Alzheimers Association Chapters in Ohio) and the Oregon Department of Health Services (in partnership with Area Agencies on Aging and the Oregon Chapter of the Alzheimers Association) to be implemented by their staff. Both programs are designed to improve care, enhance life quality, and reduce behavioral problems of persons with dementia and have demonstrated efficacy via randomized controlled trials. This article addresses the developmental and ongoing challenges encountered in the translation of these programs to inform other community-based organizations considering the translation of evidence-based programs and to assist researchers in making their work more germane to their community colleagues.

Improving Dementia Care in Assisted Living Residences: Addressing Staff Reactions to Training

More than 1 million older adults, many with significant cognitive impairment, receive care in assisted living residences (ALRs), and their numbers are increasing. Despite this, ALR staff are often inadequately trained to manage the complex emotional, behavioral, and functional impairments characteristic of these residents. Nurses are in a unique position to improve this situation by training and supervising ALR staff. To facilitate such training, an understanding of staff reactions to receiving training as well as a systematic yet flexible method for training is needed. This article provides information on one such program (STAR-Staff Training in Assisted-living Residences), discusses challenges that arose when offering this program across 3 states in 6 diverse ALRs (rural, urban, for-profit, and not-for-profit sites), and describes how these challenges were addressed. We illustrate how nurses can successfully train ALR staff to improve resident and staff outcomes and offer guidance for those interested in providing such training.

Staff training in assisted living: Evaluating treatment fidelity

OBJECTIVES To investigate a protocol for identifying and evaluating treatment fidelity in Staff Training in Assisted-living Residences (STAR), a structured but flexible program to train direct care staff to improve care of residents with dementia. DESIGN Multisite feasibility trial. SETTING Assisted living facilities (ALFs). PARTICIPANTS Forty-four direct care staff and 36 leadership staff. INTERVENTION STAR is a comprehensive, dementia-specific training program to teach direct care staff in ALFs to improve care and reduce affective and behavioral problems in residents with dementia. It is conducted on-site over 2 months through 2 half-day group workshops and four individualized sessions. MEASURES Treatment fidelity was assessed following the National Institute of Health Behavior Change Consortium model utilizing observations and self-report of trainers, direct care staff, and leadership. RESULTS Each key area of treatment fidelity was identified, measured, and yielded significant outcomes. For example, significant increases included direct care staff identifying activators, behaviors, and consequences (an essential component of training); understanding basics of dementia care; and applying STAR techniques. CONCLUSIONS Results support that STAR is ready to be translated and disseminated into practice. Because ALFs will continue to provide care for individuals with dementia, the need for effective, practical, and sustainable staff training programs is clear. STAR offers one such option. It is hoped that this report will encourage others to conduct comprehensive evaluations of the treatment fidelity of their programs and thereby increase the availability of such programs to enhance care.

Reactions of assisted living staff to behavioral and psychological symptoms of dementia.

This study investigates the experiences of unlicensed staff providing care for older adults with behavioral and psychological symptoms of dementia (BPSD). The purpose of this study was to describe the types and frequency of BPSD reported by unlicensed caregivers and to describe reactions and training of the caregivers who provide care to residents with BPSD. Data were derived from 87 staff-resident dyads in twelve assisted living facilities (ALFs). Types and frequency of BPSD and staff reaction to BPSD were collected using standardized measures. Demographic data included amount of staff training related to caring for someone with BPSD. Dementia related behaviors and psychological symptoms were prevalent in the ALF residents, with memory related symptoms being the most frequently reported. Symptoms of depression in the ALF residents were less frequent yet accounted for the highest level of staff reaction. Limited training related to caring for residents with cognitive impairment was reported by staff. Developing ALF staff skills in identifying and managing depression in older adults with dementia may serve a dual purpose of improving quality of life for residents and for ALF staff.

Falls prevention education: Interprofessional training to enhance collaborative practice

ABSTRACT The gap between the complex health care needs of older adults and the availability of geriatrics-trained health care professionals is widening. Interprofessional education offers an opportunity to engage multiple professions in interactive learning and clinically relevant problem solving to achieve high-quality patient-centered care. This article describes a project that engaged an interprofessional teaching team to support interprofessional practice teams to reduce falls in older adults via implementation of evidence-based practice guidelines. Ninety-five participants from 25 teams were trained on multiple strategies to decrease the risk of falls in older adults. The intervention facilitated increases in knowledge, confidence in skill performance, and team commitment to change practice patterns to support the health and safety of older adults. Findings suggest that community-based practices can successfully support the training of interprofessional teams and that training may lead to improved care processes and outcomes for older adults.

An Interprofessional Approach to Reducing the Risk of Falls Through Enhanced Collaborative Practice

Falls are the leading cause of accidental deaths in older adults and are a growing public health concern. The American Geriatrics Society (AGS) and British Geriatrics Society (BGS) published guidelines for falls screening and risk reduction, yet few primary care providers report following any guidelines for falls prevention. This article describes a project that engaged an interprofessional teaching team to support interprofessional clinical teams to reduce fall risk in older adults by implementing the AGS/BGS guidelines. Twenty‐five interprofessional clinical teams with representatives from medicine, nursing, pharmacy, and social work were recruited from ambulatory, long‐term care, hospital, and home health settings for a structured intervention: a 4‐hour training workshop plus coaching for implementation for 1 year. The workshop focused on evidence‐based strategies to decrease the risk of falls, including screening for falls; assessing gait, balance, orthostatic blood pressure, and other medical conditions; exercise including tai chi; vitamin D supplementation; medication review and reduction; and environmental assessment. Quantitative and qualitative data were collected using chart reviews, coaching plans and field notes, and postintervention structured interviews of participants. Site visits and coaching field notes confirmed uptake of the strategies. Chart reviews showed significant improvement in adoption of all falls prevention strategies except vitamin D supplementation. Long‐term care facilities were more likely to address environmental concerns and add tai chi classes, and ambulatory settings were more likely to initiate falls screening. The intervention demonstrated that interprofessional practice change to target falls prevention can be incorporated into primary care and long‐term care settings.

Plan of Action for Real-World Translation of LGBTQ Health and Aging Research

Despite accumulating evidence of health disparities, there exists limited translational research to enhance optimal health and aging of lesbian, gay, bisexual, transgender, and queer-identified * (LGBTQ) older adults. Based on the Health Equity Promotion Model that addresses the distinct needs and strengths of LGBTQ older adults, we underscore the important role of collaborations among researchers, practitioners, and communities to build community capacity. Given the rapidly shifting context, we advance principles to guide future work that will enhance translational research and the development of evidence-based practice so that LGBTQ older adults can reach their full health potential.

Escuchando a Nuestros Jóvenes: a latino youth photovoice project on teen pregnancy.

Half of Latina teens in the United States will become pregnant at least once by age 20 years. The purpose of this study was to explore a Pacific Northwest communitys strengths and weaknesses, through photovoice, as viewed by Latino youth to understand their concerns related to teen pregnancy. Participants were asked to take photographs of what they believe contributes to preventing or increasing the risk of teen pregnancy. There were 14 Latino youth, ages 15-20 years, who enrolled in the study, and 9 completed all aspects of the project including public dissemination. The themes were categorized as (a) risks for teens, (b) pressure, (c) education is key, (d) community resources, and (e) Latino values. Presentations to the community generated dialogue and problem solving and laid the groundwork for planning interventions.

TELE-STAR FOR CAREGIVERS: FIDELITY ASSESSMENT METHODS AND EARLY FINDINGS

approach to the intervention design combines advances from three fields: (a) the “task-sharing model” from global mental health research, in which trained community health workers, supervised by health professionals, deliver health care as a strategy to overcome the lack of adequately trained care specialists in LMICs; (b) evidence-based interventions developed in non-LMIC countries including exercise / activity programs used successfully with caregiver/ care recipient dyads in the US, and (c) the Getting-to-Outcomes (GTO) implementation support model. This is a promising approach for Thailand because it builds on prior, similar research in that country and potentially will help to improve efficient intervention implementation strategies. This work is innovative in that it will be the first government–university partnership to address growing needs for infrastructure to assist elderly persons with significant cognitive impairment in Thailand. We anticipate that this model, if successful, will be scaled-up in Thailand and exported to other Asian countries in the future. Results:Contextual data on policy environments, service settings, and financing mechanisms have been collected. These data are informative for addressing three basic challenges: How to tailor evidence-based exercise interventions to fit the local social and cultural context? How to build capacity at local service sites to enhance their readiness for new services? How to provide implementation support using a culturallyadapted GTO model? Conclusions: Contextual data are critical to inform the adaptation and implementation approaches for the randomized controlled trial to identify the most effective strategies for advancing and scaling up evidence-based dementia care services in a developing country.

Collaborative Falls Prevention: Interprofessional Team Formation, Implementation, and Evaluation

As health care rapidly evolves to promote person-centered care, evidence-based practice, and team-structured environments, nurses must lead interprofessional (IP) teams to collaborate for optimal health of the populations and more cost-effective health care. Four professions-nursing, medicine, social work, and pharmacy-formed a teaching team to address fall prevention among older adults in Oregon using an IP approach. The teaching team developed training sessions that included interactive, evidence-based sessions, followed by individualized team coaching. This article describes how the IP teaching team came together to use a unique cross-training approach to teach each other. They then taught and coached IP teams from a variety of community practice settings to foster their integration of team-based falls-prevention strategies into practice. After coaching 25 teams for a year each, the authors present the lessons learned from the teaching teams formation and experiences, as well as feedback from practice team participants that can provide direction for other IP teams. J Contin Educ Nurs. 2016;47(12):545-550.