Today s Meeting 10/20/

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1 Dissemination Event October 21, 2015 Supporting the Independence of Persons with Dementia in Newfoundland & Labrador Neena Chappell, Stephen Bornstein, Rosemarie Goodyear, Rob Kean, David Speed Welcome 2 Today s Meeting About CHRSP: Dr. Stephen Bornstein, Director NLCAHR Methods: Dr. David Speed, CHRSP Research Officer Results from report: Synthesis findings: Dr. Neena Chappell, Subject Expert Implications for decision makers: Dr. David Speed, CHRSP Research Officer Facilitated Discussion: All participants Moderated by Dr. Stephen Bornstein 3 1

2 1. Lorem ipsum dolor sit amet, consectetur adipiscing elit. 2. Phasellus vel augue sit amet dui adipiscing iaculis. 3. Morbi accumsan lectus sit amet risus luctus non dictum mauris placerat. 4. Praesent rhoncus sapien eget dolor posuere imperdiet. 5. Vestibulum interdum mi auctor tellus vulputate pharetra. 6. Fusce quis ligula metus, vel rutrum tortor. 7. Mauris tempor augue eget tortor sodales faucibus. 8. Nulla non turpis at erat lobortis fermentum. 9. Integer in lectus convallis neque tempor dapibus a vitae est. 10. Sed ac enim non erat feugiat placerat et pharetra neque. 11. Nam a eros sed enim feugiat malesuada quis eget mi. 12. Ut rutrum sem vitae libero ornare nec scelerisque tellus scelerisque. 13. Fusce gravida faucibus est, vel malesuada odio convallis eu. 14. Sed vehicula luctus lorem, eu molestie mauris ultricies sit amet. 15. Proin semper porta magna, in dictum leo tincidunt sit amet. 16. Proin aliquet orci fringilla magna facilisis non tincidunt nunc faucibus. 17. Pellentesque a odio sapien, eget commodo urna. 18. Vivamus nec enim at dolor rutrum lacinia id ut sapien. 19. Phasellus auctor auctor eros, a consectetur augue molestie ut. 20. Morbi suscipit mi sit amet urna commodo ac dapibus eros ullamcorper. 21. Ut eget neque risus, at faucibus lorem. 22. Sed sodales purus a lorem vulputate mollis at non nulla. 23. Suspendisse tempor velit sed mauris ullamcorper consectetur vulputate lorem vestibulum 24. Curabitur at lorem non nisi hendrerit scelerisque eget eu metus 25. Integer a dolor quis nisl iaculis placerat eget nec tortor 26. Nulla suscipit risus at nisi ornare eu malesuada diam gravida. 1. Lorem ipsum dolor sit amet, consectetur adipiscing elit. 2. Phasellus vel augue sit amet dui adipiscing iaculis. 3. Morbi accumsan lectus sit amet risus luctus non dictum mauris placerat. 4. Praesent rhoncus sapien eget dolor posuere imperdiet. 5. Vestibulum interdum mi auctor tellus vulputate pharetra. 6. Fusce quis ligula metus, vel rutrum tortor. 7. Mauris tempor augue eget tortor sodales faucibus. 8. Nulla non turpis at erat lobortis fermentum. 9. Integer in lectus convallis neque tempor dapibus a vitae est. 10. Sed ac enim non erat feugiat placerat et pharetra neque. 10/20/2015 What is CHRSP? Contextualized Health Research Synthesis Program CHRSP synthesizes the best available research evidence. CHRSP looks at local conditions to figure out what will work here. A program designed to support evidence based healthcare policy in Newfoundland & Labrador. 4 CHRSP produces two decision support products: Evidence in Context Reports o Detailed syntheses Rapid Evidence Reports o Brief overviews 5 4 CHRSP Topic Selection Health system partners & CHRSP Champions solicit CHRSP topic submissions from within their organizations Selecting the topic & research question CHRSP consolidates individual Health System Partner lists into a Long List Health System Partners CHRSP Project Team Long List CHRSP + Health System Partners arrive at a shortlist. Shortlist CHRSP Topic Submission Form From the shortlist, Health System Partners collaborate to identify the Research Questions that will form the basis of the next CHRSP projects. For Age Friendly Acute Care, the Original Research Question was: What are the barriers faced by the aging population in our acute care facilities and what are the best practices for ensuring that we have an age friendly acute care environment? Health & Community Services 6 2

3 Methods David Speed, CHRSP Research Officer 7 Report Authors Subject Expert Dr. Neena Chapell CHRSP Staff/Project Coordinator: Mr. Rob Kean Dr. Stephen Bornstein Dr. David Speed Health System Leader: Rosemarie Goodyear, CEO, Central Health 8 Project Team Dr. Neena Chappell Dr. Stephen Bornstein Rob Kean David Speed Rosemarie Goodyear Cathie Barker Pinsent Carla Butt Jennifer Fahey Valery Goulding Kelly Heisz Henry Kielley Renee Luedee Warren Melinda Noel Deborah Noseworthy Carla Wells Beverley Woodward External Reviewer: Dorothy Forbes 9 3

4 Research Question What interventions are most effective in preventing or delaying the admission of people with dementia to long-term care? 10 Evidence in Context Two components: Synthesis Secondary literature Recent primary literature Contextualization Key informant interviews 11 Evidence in Context Synthesis 27 systematic reviews January 2010 January 2015, AMSTAR 12 RCTs March 2014 March 2015, CRB Companion document:

5 Evidence in Context Synthesis Evidence Category PROMISING Criteria Evidence for the effectiveness of the intervention is provided in one or more high quality reviews (i.e., AMSTAR score 67%), encompassing 5 or more different primary studies SUGGESTIVE There is partial or qualified evidence to demonstrate the effectiveness of the intervention, derived from one or more moderate to high quality reviews (i.e., AMSTAR score >33%) encompassing more than one primary study INSUFFICIENT AT PRESENT Either there is no moderate to high quality review evidence to demonstrate the effectiveness of the intervention, or the combined reviews include only one primary study, or no primary studies on this intervention. 13 Results from the Report Dr. Neena Chappell, Subject Expert 14 General Observations Populations of interest included both caregivers of persons with dementia and persons with dementia Proximal vs. distal outcomes Studies addressing length of time until admission to LTC (a proximal outcome) were fairly rare Distal outcomes (ADL, functional decline, caregiver burden, etc.) were more common

6 Interventions with Promising Evidence Psychoeducational support interventions for caregivers 16 Interventions with Suggestive Evidence Case management Physical exercise Physical function, falls, and caregiver burden Interventions targeting ADL performance 17 Interventions with insufficient evidence Respite care Meditation Interventions that target urinary incontinence

7 Implications for Decision Makers Dr. David Speed, CHRSP Research Officer 19 Placing the findings in context for NL Population factors Aging population Outmigration Service landscape Home supports Day programs & NGOs Human resources Allied health (e.g., OTs & PTs) play substantive roles Implication #1: EARLY IDENTIFICATION & OUTREACH Persons with dementia in NL often attempt to access services when already in crisis. Decision makers should consider early identification and outreach to be strategic priorities

8 Implication #2 SUPPORT FOR SYSTEM NAVIGATION Persons with dementia and their families often struggle to navigate our provincial health system, identify and apply for available services, and access follow up care Building capacity in the area of system navigation should be considered. 22 Implication #3 HUMAN RESOURCES Chronic shortages of qualified, committed home support workers are an impediment to the Home Support Program s goal of supplementing family and support networks. Decision makers should consider recruitment and retention strategies for home support workers, especially in rural areas that have been affected by outmigration. 23 Implication #4 TRAINING FOR HOME SUPPORT WORKERS The lack of standardized dementia care training for people who provide home support can compromise the ability of such workers to meet their clients special care needs and manage the behavioural and psychological symptoms of the disease. Building capacity in homecare workers, specifically for dementia, should be considered

9 Implication #5 DAY PROGRAMS CAN HELP Expanding the number of dementiafriendly day programs would provide family caregivers with a source of support, and allow for persons with dementia to connect with health professionals and engage in the therapeutic activities. Community partnerships may be worth investigating 25 Implication #6 RESIDENTIAL CARE OPTIONS There is a need among persons with dementia living outside of LTC for a more affordable range of residential care options. Models to consider include Protective Community Residences in Corner Brook, Lewisporte, and Bonavista. 26 Implication #7 ALLIED HEALTH WORKERS Allied health workers are wellrespected and praised for their roles in supporting independence, but are often limited to delivering core services. Additional investment in these human resources may be needed to maximize the potential impact of community based Allied Health Workers

10 Questions/ Discussion