Please select the eligibility criteria that correspond to the clinical trial below.
Title: Outcomes of Nursing Management Practice in Nursing Homes
Brief Summary: Clinical trials have identified interventions that reduce adverse outcomes such as falls in nursing home (NH) residents but attempts to translate these into practice quality improvement (QI) techniques have not been successful. Using a complexity science framework, our previous study showed that low connection, information flow, and cognitive diversity among NH staff explains quality of care for complex problems such as falls. Our pilot of "Connect," a multi-component intervention that encourages staff to engage in network-building and use simple strategies to make new connections with others, enhance information flow, and use cognitive diversity, suggests that staff can improve the density and quality of their interactions. This 5-year study uses a prospective, cluster-randomized, outcome assessment blinded design, with NHs (n=16) randomized to either Connect and a falls QI program (Connect + Falls) or QI alone (Falls). About 800 residents and 576 staff will participate. Specific aims are to, in nursing homes: 1) Compare the impact of the Connect intervention plus a falls reduction QI intervention (Connect+Falls) to a falls reduction QI intervention (Falls) on fall risk reduction indicators (orthostatic blood pressure, sensory impairment, footwear appropriateness, gait; assistive device; toileting needs, environment, and psychotropic medication); 2) Compare the impact of Connect+Falls to Falls alone on fall rates and injurious falls, and determine whether these are mediated by the change in fall risk reduction indicators; 3) Compare the impact of Connect+Falls to Falls alone on complexity science measures (communication, participation in decision making, local interactions, safety climate, staff perceptions of quality) and determine whether these mediate the impact on fall risk reduction indicators and fall rates and injurious falls. Cross-sectional observations of complexity science measures are taken at baseline, at 3 months, at 6 months, and at 9 months. Resident fall risk reduction indicators, fall rates, and injurious falls are measured for the 6 months prior to the first intervention and the 6 months after the final intervention is completed. Analysis will use a 3-level mixed model to account for the complex nesting of patients and staff within nursing homes, and to control for covariates associated with fall risk, including baseline facility fall rates and staff turnover rates.


Options:
A: Inclusion Criteria:

* LTC homes in Ontario that are serviced by MPGI
B: Inclusion Criteria:

* Residents of both sex, aged 60 years or over
* Residents living in a nursing home participating in the study
* Residents living in the nursing home for 30 days or more
* Residents without diagnosed and documented dementia, identified as follows:

  * residents not identified by the French Healthcare system as suffering from dementia (ALD 15)
  * residents not benefiting from a specific care program or a specialized follow-up for dementia
  * residents for whom there is no appropriate investigation for dementia diagnosis in medical records
  * residents not taking specific drugs for dementia (Cholinesterase inhibitors and/or Memantine)
* Residents and their GP having received information about the study
* Residents and their GP having expressed their agreement to participate in the study

Exclusion Criteria:

* Residents aged less than 60 years
* Residents not living in a nursing home participating in study
* Residents living in nursing home for less than 30 days
* Residents with diagnosed and documented dementia, identified as follows:

  * residents Identified by the French Healthcare system as suffering from dementia (ALD 15)
  * residents benefiting from specific care programme or specialized follow-up for dementia
  * residents for whom there is appropriate investigation for dementia diagnosis in medical records
  * residents taking specific drugs for dementia (Cholinesterase inhibitors and/or Memantine)
* Residents and/or their GP who received no information about the study
* Residents and/or their GP having expressed their opposition to participate in the study
C: Inclusion Criteria:

* Eligible residents will be long-term care residents at least 65 years of age who have resided in the NH at least 6 months and are likely to survive at least 6 months. Residents must be potentially at risk for falls, which we define as ambulatory or transfer-independent as recorded on the Minimum Data Set.

Exclusion Criteria:

* None.
D: Inclusion Criteria:

* patient aged 65 or more, with a dementia diagnosed by a specialist or the general practitioner;
* patient presenting with a disruptive NPS as defined in French Haute Autorité de Santé (HAS) recommendations (2009), that requires a specialist consultation based on the LTCF staff judgment;
* informed and written consent by the patient or the legal representative or the reliable person when appropriate;
* general practitioner agreement.

Exclusion Criteria:

* patient's life expectancy less than 6 months;
* Non agreement of study participation of patients or legal representative or the reliable person when appropriate.

Answer: C