Veronique Boscart

Background: People living with dementia face a risk of going missing, which can result in injury or death and distress for care partners. Although it is believed that alert systems can help locate missing persons and reduce risk through community engagement, little is known about implementation and user experiences. Objective: This study explored experiences with alert systems and related policies for missing persons with dementia, drawing on stories and insights from individuals who went missing, care partners, and those involved in search efforts. Methods: A multiple case study was conducted. Data were collected through interviews and focus groups with 40 individuals, including people with lived experience, first responders, service providers, policymakers from Canada, Scotland, and the United States and analyzed thematically. Results: Three key themes were identified: 1) implementing alert systems and policies, 2) experiences of going missing, and 3) factors that help or delay locating missing persons. Participants emphasized the importance of interest holder involvement, community buy-in, and legislative support for implementation. Challenges included sustainable funding and limited evaluation. The emotional impact of missing incidents highlighted the need for prompt police reporting, coordinated search efforts, tailored mobile alerts, and public education. Conclusion: According to participants, effective alert systems require geographic-specific mobile notifications and coordinated planning. Strong partnerships among first responders, health care and service providers, and community organizations, supported by training and public education, would improve preparedness and support for people living with dementia and their care partners.

Alert systems can engage the community to help locate missing persons with dementia. Evidence on the impact of implemented alert systems is minimal. Guided by three adapted Knowledge-to-Action Framework phases: identifying the problem, assessing barriers, and evaluating outcomes, this study aimed to examine understandings about alert systems and their implementation in Canada, Scotland, and the United States. A document review and interviews conducted with 40 interest holders (those with lived experience, first responders, service providers, and policymakers) underwent thematic analysis. Findings revealed variability in alert systems implementation and barriers at individual (limited understanding of alert systems, privacy concerns, alert fatigue) and organizational levels (sustainability, accessibility, privacy legislation). Participants recommended the following for successful implementation of alert systems: clear policy, collaboration, ongoing assessment, and a localized, opt-in system with accessibility, public education, and sustainable funding. This information indicates under what conditions alert systems for missing persons with dementia could be implemented.

Service providers have a unique understanding of older homeless adults’ challenges and service needs. However, research on the experiences of health care providers (HCPs) who work with this population is limited. We aimed to gain a better understanding of the experiences (roles, challenges, and rewards) of HCPs who work with older homeless adults (age 50 and over) in outreach settings. We conducted individual semi-structured interviews with 10 HCPs who worked in these roles. Four themes emerged: (a) the client–provider relationship as an essential building block to HCPs’ work; (b) progression of care that acknowledges the “whole person”; (c) collaboration as integral to providers’ work; and (d) the importance of system navigation. Providers found their work personally and professionally fulfilling but were frustrated by system-level challenges. Findings can be used to identify strategies on how to further support providers in their roles and enhance service provision for older homeless individuals.

Long-term care homes (LTCHs) were disproportionately affected by the coronavirus disease (COVID-19) pandemic, creating stressful circumstances for LTCH employees, residents, and their care partners. Team huddles may improve staff outcomes and enable a supportive climate. Nurse practitioners (NPs) have a multifaceted role in LTCHs, including facilitating implementation of new practices. Informed by a community-based participatory approach to research, this mixed-methods study aimed to develop and evaluate a toolkit for implementing NP-led huddles in an LTCH. The toolkit consists of two sections. Section one describes the huddles’ purpose and implementation strategies. Section two contains six scripts to guide huddle discussions. Acceptability of the intervention was evaluated using a quantitative measure (Treatment Acceptability Questionnaire) and through qualitative interviews with huddle participants. Descriptive statistics and manifest content analysis were used to analyse quantitative and qualitative data. The project team rated the toolkit as acceptable. Qualitative findings provided evidence on design quality, limitations, and recommendations for future huddles.

Background: Nursing home (NH) residents should have the opportunity to consider, discuss and document their healthcare wishes. However, such advance care planning (ACP) is frequently suboptimal. Objective: Assess a comprehensive, person-centred ACP approach. Design: Unblinded, cluster randomised trial. Setting: Fourteen control and 15 intervention NHs in three Canadian provinces, 2018–2020. Subjects: 713 residents (442 control, 271 intervention) aged ≥65 years, with elevated mortality risk. Methods: The intervention was a structured, $\sim$60-min discussion between a resident, substitute decision-maker (SDM) and nursing home staff to: (i) confirm SDMs’ identities and role; (ii) prepare SDMs for medical emergencies; (iii) explain residents’ clinical condition and prognosis; (iv) ascertain residents’ preferred philosophy to guide decision-making and (v) identify residents’ preferred options for specific medical emergencies. Control NHs continued their usual ACP processes. Co-primary outcomes were: (a) comprehensiveness of advance care planning, assessed using the Audit of Advance Care Planning, and (b) Comfort Assessment in Dying. Ten secondary outcomes were assessed. P-values were adjusted for all 12 outcomes using the false discovery rate method. Results: The intervention resulted in 5.21-fold higher odds of respondents rating ACP comprehensiveness as being better (95% confidence interval [CI] 3.53, 7.61). Comfort in dying did not differ (difference = −0.61; 95% CI −2.2, 1.0). Among the secondary outcomes, antimicrobial use was significantly lower in intervention homes (rate ratio = 0.79, 95% CI 0.66, 0.94). Conclusions: Superior comprehensiveness of the BABEL approach to ACP underscores the importance of allowing adequate time to address all important aspects of ACP and may reduce unwanted interventions towards the end of life.

Background: Making fun of growing older is considered socially acceptable, yet ageist humour reinforces negative stereotypes that growing old is linked with physical and mental deterioration, dependence, and less social value. Such stereotypes and discrimination affect the wellbeing of older people, the largest demographic of Canadians. While ageism extends throughout professions and social institutions, we expect nurses—the largest and most trusted group of healthcare professionals—to provide non-ageist care to older people. Unfortunately, nurses working with older people often embrace ageist beliefs and nursing education programs do not address sufficient anti-ageism content despite gerontological nursing standards and competencies.Methods: To raise awareness of ageism in Canada, this quasi-experimental study will be supported by partnerships between older Canadians, advocacy organizations, and academic gerontological experts which will serve as an advisory group. The study, guided by social learning theory, will unfold in two parts. In Phase 1, we will use student nurses as a test case to determine if negative stereotypes and ageist perceptions can be addressed through three innovative e-learning activities. The activities employ gamification, videos, and simulations to: (1) provide accurate general information about older people, (2) model management of responsive behaviours in older people with cognitive impairment, and (3) dispel negative stereotypes about older people as dependent and incontinent. In Phase 2, the test case findings will be shared with the advisory group to develop a range of knowledge mobilization strategies to dispel ageism among healthcare professionals and the public. We will implement key short term strategies.Discussion: Findings will generate knowledge on the effectiveness of the e-learning activities in improving student nurses’ perceptions about older people. The e-learning learning activities will help student nurses acquire much-needed gerontological knowledge and skills. The strength of this project is in its plan to engage a wide array of stakeholders who will mobilize the phase I findings and advocate for positive perspectives and accurate knowledge about aging—older Canadians, partner organizations (Canadian Gerontological Nurses Association, CanAge, AgeWell), and gerontological experts.

The COVID-19 pandemic has exposed persistent inequities in the long-term care sector and brought strict social/physical distancing distancing and public health quarantine guidelines that inadvertently put long-term care residents at risk for social isolation and loneliness. Virtual communication and technologies have come to the forefront as the primary mode for residents to maintain connections with their loved ones and the outside world; yet, many long-term care homes do not have the technological capabilities to support modern day technologies. There is an urgent need to replace antiquated technological infrastructures to enable person-centered care and prevent potentially irreversible cognitive and psychological declines by ensuring residents are able to maintain important relationships with their family and friends. To this end, we provide five technological recommendations to support the ethos of person-centered care in residential long-term care homes during the pandemic and in a post-COVID-19 pandemic world.