Montessori-based interventions (MBIs) were developed to promote guided participation in meaningful activities by people with dementia patients. In this study, we assessed nursing home volunteers’ fidelity to an MBI, relying primarily on a qualitative descriptive design. We completed a deductive content analysis of eight volunteer interviews using the Conceptual Framework for Intervention Fidelity. We also calculated average volunteer and resident scores on the Visiting Quality Questionnaire (VQQ), which assesses volunteers’ and residents’ perceptions of visits. We found good evidence that volunteers attended scheduled visits, made use of pre-designed activities, and attended to training recommendations. Most reported enjoying the visits (VQQ $ \overline{x} $ = 6.12, standard deviation [SD] = 0.75) and receiving a positive response from residents (VQQ $ \overline{x} $ = 5.46, SD = 0.88). Nevertheless, use of pre-designed activities and response to the MBI was lower for volunteers working with residents who had late-stage dementia. Therefore, overall, fidelity depended on the cognitive status of the resident.

Dementia, a term that describes a variety of brain conditions marked by gradual, persistent and progressive cognitive decline, affects a significant proportion of older adults. Older adults with dementia are sometimes perceived less favourably than those without dementia. Furthermore, compared to persons without dementia, those with dementia are often perceived by others as having reduced personhood. This study was aimed at investigating whether differences in attitudes towards dementia and personhood perceptions vary as a function of age group, care-giver status, attitudes towards ageing, dementia knowledge, gender and education. In total 196 younger, middle-aged and older adults were recruited. Findings revealed that being a care-giver as well as having less ageist attitudes were predictive of being more comfortable around persons with dementia, having more knowledge about dementia and ascribing greater personhood to people with dementia. Those with more dementia knowledge (prior to the study) were less comfortable around people with dementia. Finally, when controlling this prior dementia knowledge, older adults were more comfortable around people with dementia compared to younger and middle-aged adults. Gender and education were not associated with any of the variables under study. Findings contribute to a better understanding of the role of age- and care-giver-related factors in the determination of attitudes towards dementia.

The average expected lifespan in Canadian long-term care (LTC) homes is now less than two years post-admission, making LTC a palliative care setting. As little is known about the readiness of LTC staff in Canada to embrace a palliative care mandate, the main objective of this study was to assess qualities relevant to palliative care, including personal emotional wellbeing, palliative care self-efficacy and person-centred practices (e.g. knowing the person, comfort care). A convenience sample of 228 professional and non-professional staff (e.g. nurses and nursing assistants) across four Canadian LTC homes participated in a survey. Burnout, secondary traumatic stress and poor job satisfaction were well below accepted thresholds, e.g. burnout: mean = 20.49 (standard deviation (SD) = 5.39) for professionals; mean = 22.09 (SD = 4.98) for non-professionals; cut score = 42. Furthermore, only 0–1 per cent of each group showed a score above cut-off for any of these variables. Reported self-efficacy was moderate, e.g. efficacy in delivery: mean = 18.63 (SD = 6.29) for professionals; mean = 15.33 (SD = 7.52) for non-professionals; maximum = 32. The same was true of self-reported person-centred care, e.g. knowing the person; mean = 22.05 (SD = 6.55) for professionals; mean = 22.91 (SD = 6.16) for non-professionals; maximum = 35. t-Tests showed that non-professional staff reported relatively higher levels of burnout, while professional staff reported greater job satisfaction and self-efficacy (p < 0.05). There was no difference in secondary traumatic stress or person-centred care (p > 0.05). Overall, these results suggest that the emotional wellbeing of the Canadian LTC workforce is unlikely to impede effective palliative care. However, palliative care self-efficacy and person-centred care can be further cultivated in this context.

This study explored informal caregivers’ experiences of transitioning an older adult into long-term care (LTC). Qualitative description guided our analysis of semi-structured interviews with 13 informal caregivers of older adults from three LTC homes in southern Ontario. Our findings illustrate that caregivers experience chronic worry and burden before deciding on, or requiring to apply for, LTC. A sense of lack of control was a prominent theme, especially when caregivers were applying for LTC beds. Participants perceived pushing, pressure, and punishment from the health care system and felt relieved and fortunate after they accepted a bed offer. This tumultuous experience stimulated caregivers to anticipate future transitions. It is recommended that caregivers receive preparation and targeted support to manage transition experiences. Improved communication among health professionals is essential. Penalties for declining an offer for a bed in LTC should be re-examined in relation to its negative influence on caregivers’ experiences.

Translating existing internet-based cognitive-behavioural therapy (iCBT), along with the use of transdiagnostic and self-guided formats, may prove to be a cost-effective option of disseminating iCBT. Only recently have encouraging findings been reported for a self-guided delivery. This study assessed the feasibility of a French and self-guided version of an existing English iCBT course, called the Wellbeing Course, for the treatment of anxiety and depression. Existing ICBT programs have not yet been delivered in French, although this language is spoken worldwide. Thirty-one participants were included in a single group pre-post open trial with a 3-month follow-up. Feasibility outcomes were attrition, treatment adherence, acceptability, and preliminary efficacy. Primary outcome measures were the Patient Health Questionnaire 9-item (PHQ-9) and the Generalised Anxiety Disorder 7-item (GAD-7). Nearly 75% of the participants completed the program. Over 80% of the participants provided posttreatment and follow-up data. All study completers reported that they would recommend the Wellbeing Course to a friend having similar problems. Significant reductions in symptoms of anxiety and depression were found following treatment, consistent with earlier studies. These preliminary findings support the use of the assessed strategies to facilitate the cross-cultural dissemination of iCBT for a more universal access to quality psychological care.

Behaviours of concern (e.g. aggression) are often present in residents of long-term care (LTC) facilities diagnosed with dementia and may impact quality of life. Prior uncontrolled research has shown that an intervention involving sharing resident life histories may be effective in reducing aggressive behaviours and improving quality of life, perhaps by increasing staff empathy. We used a randomised controlled design, involving a considerably larger sample than previous investigations. We also examined staff perceptions of LTC resident personhood in relation to aggressive behaviour. Seventy-three residents were randomised to either a life history intervention (N = 38) or a control condition (N = 35). Ninety-nine nurses and care aides answered questionnaires about their own attitudes and the residents' behaviours and quality of life at baseline, post-intervention and at follow-up. Results of mixed-effects modelling indicated significant differences between groups in personhood perception and resident quality of life. Personhood perception mediated the relationship between the intervention and improved quality of life. We identified significant negative correlations between resident cognitive impairment and staff perceptions of resident personhood. Qualitative findings suggested that staff primarily changed their verbal interactions with residents following the intervention, which may be particularly helpful for residents with the most severe dementia. Our results indicate that LTC residents benefit when life histories are constructed with their families and shared with nursing staff.

Recently, the number of education programmes addressing person-centred approaches to long-term residential dementia care has increased, and nursing assistants (NAs) are often the target audience. The effectiveness of employee education programmes is actively debated, and our objective is to contribute to this discussion by exploring the knowledge NAs acquire through practice. We examined approaches to person-centred care generated during a series of interviews with NAs, and compared these to the content of five frameworks for person-centred dementia care. Our results suggest that although NAs acquire significant knowledge about person-centred dementia care during the course of their work, application of person-centred care strategies varies across NAs. We propose ways of enhancing NA education in order to address gaps in knowledge. We also recommend sustained attention to organisational factors that contribute to variability in practice.

Person-centred approaches in long-term care focus on providing holistic care to residents in order to improve quality of life, enhance resident wellbeing and autonomy, and mitigate behavioural and/or other symptoms. The results of research on person-centred approaches to care are mixed, with very few high-quality empirical studies examining resident outcomes specifically. The purpose of this investigation was to examine a person-centred care programme implemented in three Canadian long-term care facilities to determine its effect on resident outcomes, approach to care and maintenance of the programme three years after implementation. Using the Resident Assessment Instrument Minimum Data Set (RAI-MDS) scale scores and quality indicators, we retrospectively examined resident outcomes before, after and six months following the initiation of the programme using three additional facilities as control. We did not find any effects on resident outcomes. Focus group interviews with facility staff revealed no systematic differences between the programme and control facilities in their approach to care. All facilities supported aspects of a person-centred philosophy. Focus group interview data from the programme facilities indicated partial maintenance in two facilities and more complete maintenance in one facility. Although staff members supported the programme, implementation and maintenance proved difficult and effectiveness on resident outcomes was not indicated in this research. Additional controlled studies are needed.

Purpose: The study purposes were twofold: (1) to explore barriers to pain management and those associated with implementing a pain management program in long-term care (LTC); and (2) to develop an interprofessional approach to improve pain management in LTC.

Methods: A case study approach included both qualitative and quantitative components. We collected data at two LTC sites using seven focus groups for the licensed nurses, unregulated care providers and physicians, and 10 interviews with other health care provider groups, administration, and residents. We reviewed documents and administered a short survey to study participants to assess perceptions of barriers to pain management.

Results: The findings revealed barriers to effective LTC pain management at the resident/family, health care provider, and system levels. We then developed a six-tiered model with proposed interventions to address these barriers.

Conclusions: This model can guide the development of innovative approaches to improving pain management in LTC settings.

Background: Although psychosocial treatments for pain have been found to be effective in reducing self-reported pain, physician visits, and in improving mood, the research has largely focused on younger persons. As such, there is a paucity of related studies involving older adults. Method: We implemented and evaluated a 10-session psychosocial (i.e. cognitive behavioural orientation) pain management program that was specifically designed for older adults. The intervention was delivered either in the participants' homes or in bookable rooms in seniors' residence buildings. Ninety-five community dwelling seniors with at least one chronic pain condition were assigned to either a treatment or a wait-list control condition. An assessment battery was administered to treatment participants immediately before the program started, immediately post-treatment, and 3-months post-treatment. Comparable data were obtained from control group participants, although 3-month follow-up data were not available for the control group. Outcome variables included pain intensity, coping strategy usage, pain beliefs/appraisals, and perceived life stressors. Results: Although decreases in pain intensity were observed in both the treatment and wait-list control groups, the intervention was found to result in fewer maladaptive beliefs about pain and greater use of relaxation, which is considered to be an adaptive coping strategy. Conclusions: Although some treatment benefits were identified (e.g. change in pain-related beliefs), future research should test the effectiveness of a cognitive behavioural treatment program tailored for seniors with participants who are experiencing higher pain intensities than those reported by our sample (i.e. those who experience a higher level of pain at baseline may represent a more suitable sample for assessing the effectiveness of our intervention in reducing pain intensity).

This study presents the validation of the French Canadian version (PACLSAC-F) of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC). Unlike the published validation of the English version of the PACSLAC, which was validated retrospectively, the French version was validated prospectively. The PACSLAC-F was completed by nurses working in long-term care facilities after observing 86 seniors, with severe cognitive impairment, in calm, painful or distressing but non-painful situations. The test-retest and inter-observer reliability, the internal consistency, and the discriminent validity were found to be satisfactory. To evaluate the convergent validity with the DOLOPLUS-2 and the clinical relevance of the PACSLAC, it was also completed by nurses during their work shift, with 26 additional patients, for three days per week during a period of four weeks. These results encourage us to test the PACSLAC in a comprehensive program of pain management targeting this population.

Although the prevalence of acute pain does not increase as a result of aging, chronic pain problems tend to increase in late life. There is also limited evidence that there is a plateau or even a slight reduction in the frequency of chronic pain following the eighth decade of life. Many health conditions that affect older adults are associated with pain, and overall prevalence estimates for this population range from 25% to 65% for community-dwelling older persons, and up to 80% for seniors living in long-term care facilities. The wide variation in prevalence estimates is likely to be due to differences in survey methodologies and operational definitions of pain (e.g. ‘pain during the last week’ vs. ‘pain during the last month’). Nonetheless, a consensus view appears to converge on the conclusion that at least 50% of older persons suffer from at least one persistent or bothersome pain problem at any one point in time. Although many seniors with dementia have difficulty reporting pain due to cognitive impairment, in a large-scale investigation of nursing-home residents, it was shown that conditions that are likely to cause pain occur with equal frequency in residents with and without dementia.

Cataract surgery is one of the most frequent surgical procedures experienced by seniors. In Canada, substantial waiting lists for cataract surgery are common. This study systematically studied anxiety among older persons who were waiting for cataract surgery, and factors that may underlie anxiety in this population. Factors examined in relation to anxiety were age, sex, education, medical and ocular problems, previous cataract surgery, concern about wait, previous decisions to delay surgery, length of wait, visual functioning, visual acuity, worry about health, and coping strategies. A random sample (n = 50) of patients on a waiting list for cataract surgery took part in telephone interviews. Patients' ophthalmologists provided preoperative visual acuity. Over one-third of patients reported anxiety within the range reported for panic disorder patients and Beck Anxiety Inventory scores were well above reported norms for seniors. Increased anxiety was found among those with a general tendency to worry about their health, poorer visual functioning, and greater use of palliative coping strategies. The clinical implications of the findings are discussed. The results highlight the importance of assessing anxiety while elderly patients wait for surgery, designing interventions, and providing assistance to those patients found to have elevated levels of anxiety.

Palmore, Nowlin, and Wang (1985) posit a theoretical framework in which to predict the health status of older adults over time as a function of social, economic, physical and mental health variables. The current study provides the first independent, empirical test of this model based upon longitudinal data derived from a representative sample of older British Columbians. The results of this study support the basic structure of the Palmore model; however, various revisions were required to improve the fit of data. Findings indicate that demographic and socio-economic variables have a direct effect upon functional status at baseline. Results further suggest significant consistency in the functional status of older adults over a two-year interval. Directions for future research as well as limitations of the current study are discussed.