Collaborative Research Network in Long-Term Care

Introduction Since 1997, a group of researchers, clinicians and administrators from the Centre for Clinical Epidemiology and Community Studies at the Jewish General Hospital, Montreal, Quebec, and from the Maimonides Geriatric Centre, Montreal have worked together to promote the development of the Collaborative Research Network in Long-Term Care.

Goals of the Network:

• To elaborate and to complete research projects developed by Network members. Research projects may involve any medical and paramedical fields of geriatrics such as nursing, occupational therapy, physiotherapy, psychology, social work, etc., with an emphasis on an interdisciplinary approach.

• To collaborate with other research groups who also wish to develop projects involving a population living in long-term care facilities.

• To provide access to resource people (epidemiologists, statisticians) to facilitate the realization of projects.

• To improve the quality of care provided in long-term care facilities as a result of research efforts.

Funding:

The Maimonides Geriatric Centre Foundation provides financial support for the Network's activities. Funding to complete research projects is obtained from both governmental and non-governmental funding agencies and hospital foundations. The Network has the support of Dr. Howard Bergman, the Dr. Joseph Kaufmann Professor and Director, Director of the Division of Geriatric Medicine, McGill University and co-director of SOLIDAGE McGill/Université de Montréal Research Group on Integrated Services for Older Persons.

Research Projects

Completed studies

1. Use of conventional and atypical neuroleptics in long-term care facilities.
This study involved ten long-term care institutions in the Montreal area. Maimonides Geriatric Centre was one of these. Prevalence of neuroleptics use was 25.2%. Of these 25.5%, 62.1% were atypical neuroleptics. Almost 42% of the neuroleptic users had been using this drug for more than six months. Results highlighted need for improving neuroleptic prescribing patterns in long-term care facilities.

Publications:

• Monette J, Monette M, Champoux N, Galbaud du Fort G, Wolfson C , Le Cruguel JP. Usage des neuroleptiques conventionnels et atypiques parmi les personnes âgées institutionnalisées. Centre d’épidémiologie clinique et de recherche en santé publique. Hôpital général juif, Université McGill. Bibliothèque nationale du Canada, Bibliothèque nationale du Québec, 2002.
   
• Monette J, Monette M, Champoux N, Galbaud du Fort G, Wolfson C. Usage des neuroleptiques chez les personnes âgées hébergées : prévalence, efficacité et effets indésirables. La revue de Gériatrie 2003, 28(3): 259-68.
   
• Champoux N, Monette J, Monette M, Galbaud du Fort G, Wolfson C, Le Cruguel JP. Use of neuroleptics: study of institutionalized elderly in Montreal, Que. Can Fam Physician 2005; 51:696-97. (Awarded Best original research article by the Canadian Family Physician).

2. Prevalence of extrapyramidal signs among institutionalized elderly users of neuroleptics.
This study involved two institutions. The prevalence of extrapyramidal signs was determined using the Extrapyramidal Symptoms Rating Scale (ESRS). This study is the first validation study of the ESRS parkinsonism subscale done among the frail elderly population. With the experience acquired, an educational program was developed.

3. Improving the antiulcerative agents (AUA) prescribing pattern in long-term care.
This pilot-study involved all Maimonides Geriatric Centre physicians. The aim of this study was to assess the impact of an educational intervention to optimize the quality of AUA prescribing. Even if the mean prevalence of daily use of AUA remains higher than American studies (22%) during the program, the information recorded by the physicians regarding underlying reasons to AUA prescribing lead to a better understanding of their AUA prescribing habits among long-term care residents.

Publication:

• Monette J, Monette M, Frank H, Gore B. Optimisation de la qualité de la prescription des agents antiulcéreux en centre hospitalier de soins de longue durée. Centre d’épidémiologie clinique et de recherche en santé publique. Hôpital général juif, Université McGill. Bibliothèque nationale du Canada, Bibliothèque nationale du Québec, 2003.

4. Implementation of Practice Guidelines for urinary incontinence in long-term care setting.
The objective of this study was to develop guidelines to improve the management of elderly patients presenting with urinary incontinence. As a first step, a pilot-study was conducted to explore care provider's perceptions of urinary incontinence management strategies currently being used in long-term care settings. Four institutions participated, two academic and two non-academic. Maimonides Geriatric Centre was involved.

Publication:

• Tannenbaum C, Labrecque D, Lepage C. Understanding barriers to continence care in institutions. Canadian Journal on Aging-Revue Canadienne du vieillissement 2005; 24:151-9.

5. Enteral feeding in end-stage dementia: a comparison of religious and cultural differences.
This study involved six institutions: two in Israel, two in Toronto and two in Montreal. Maimonides Geriatric Centre was one of these institutions. Significant differences in tube-feeding prevalence were found between Canada (11%) and Israel (52.9%), with only 4.7% seen in non-Jewish Canadian institutions.

Publication:

• Clarfield AM, Monette J, Monette M, Bergman H, Ben-Israel Y, Caine Y, Charles J, Gordon M, Gore B. Enteral feeding in end-stage dementia: a comparison of religious, ethnic and national differences. J Gerontol A Biol Sci Med Sci 2006 ; 61: 621-7.

6. Optimization of the quality of antibiotics prescribing in long-term care facilities.
A pilot study was first conducted in three long-term care facilities (LTCF) to assess the effect of an educational intervention aimed at optimizing antibiotic prescribing. Maimonides geriatric Centre participated in the pilot study. The effect of this program was then assessed using a cluster randomized controlled study involving eight LTCF. The educational intervention was implemented in four LTCF. The other facilities were part of the control group.

Publication (pilot study):

• Monette J, Miller M, Laurier C, Boivin JF, Barraud L, LeCruguel JP, Monette M, Cotton-Montpetit M, Gore B. Interventions visant à optimiser la qualité de la prescription des antibiotiques en centre d’hébergement et de soins de longue durée. Centre d’épidémiologie clinique et de recherche en santé publique. Hôpital général juif, Université McGill. Bibliothèque nationale du Canada, Bibliothèque nationale du Québec, 2003.

Publication (cluster randomized controlled study):

• Monette J, Miller MA, Monette M, Laurier C, Boivin JF, Sourial N, LeCruguel JP, Vandal A, Cotton-Montpetit M. Effect of an educational intervention on optimizing antibiotic prescribing in long-term care facilities. J Am Geriatr Soc. 2007; 55 (8): 1231-5.

7. An out break of scabies at Maimonides Geriatric Centre
This study aimed to describe the scabies outbreak that was detected in August 2003 at the Maimonides Geriatric Centre. Underlying factors leading up to this outbreak were described as well as the control measures needed to stop it.

Publication:

• De Beer G, Monette J, Miller M, Tremblay L. An outbreak of scabies in a long term care facility: the role of mis-diagnosis and cost associated with control. Infect Control Hosp Epidemiol 2006; 27 (5) : 517-8.

8. Intervention program to improve the documentation of falls in Long-Term Care settings
This study aimed to describe the usual practices at Maimonides Geriatric Center and to determine whether the implementation of a flowchart system may improve the documentation of falls data. After the introduction of the flowchart system, documentation of risk factors and characteristics of fall episodes improved significantly and referrals to a geriatrician for falls evaluation significantly increased.

Publication :

• M Montero-Odasso, P Levinson, B Gore, L Tremblay, H Bergman. A flowchart system to improve fall data documentation in a long-term care institution. Journal of the American Medical Directors Association 2007; 8 (5): 300-6.

9. The use of cholinesterase inhibitors (ChE-I) in Long-Term Care settings.
The objective of this study was to evaluate the effectiveness of the Cholinesterase Inhibitors Committee at Maimonides Geriatric Centre. The Review Committee recommended discontinuation of ChE-I in 17 (32.7%) of the 52 patients assessed. The most common reasons for recommendation to discontinue ChE-I were insufficient benefit on cognition, activities of daily living, and behaviour.

Publication:

• Lee J, Monette J, Sourial N, Monette M, Bergman H. he Use of a Cholinesterase Inhibitor Review Committee in Long-Term Care. Journal of the American Medical Directors Association 2007; 8: 243-7.

10. Interdisciplinary educational program aiming to optimize the management of disruptive behaviors and antipsychotic prescribing in nursing home residents with dementia.
A pilot study was first conducted at Maimonides Geriatric Centre in 2004. Positive results led us to the implementation of the program (2006) in two long-term care facilities. This study design included a control group to allow for more accurate measurements and comparative evidence of the effect of the program on antipsychotic prescribing. This longitudinal study was completed in March 31, 2007. Documents developed in the context of this study are available HERE.

Publication (pilot study):

• Monette J, Champoux N, Monette M, Fournier L, Wolfson C, Galbaud du Fort G, Sourial N, Le Cruguel J-P, Gore Brian. Effect of an interdisciplinary educational program on antipsychotic prescribing among nursing home residents with dementia. Int J Geriatr Psychiatry 2008; 23:574-9.

Publication (longitudinal study):

• Monette J, Savoie ML, Champoux N, Monette M, Wolfson C, Fortin L, Sourial N, Fletcher J. An interdisciplinary educational program aiming to optimize antipsychotic prescribing in nursing home residents with dementia. Manuscript submitted.

11. Evaluation of an educational program about comfort care in advanced dementia: a collaborative quality improvement project with Maimonides Geriatric Centre.
The objective of this pilot study was to assess the impact of an educational program for nursing staff and physicians on comfort care and advanced dementia, in terms of family satisfaction with end-of-life care. The educational program included an educational session given several times to reach all targeted staff and the distribution of an informative booklet. This booklet could optionally be given to families. Results suggest that the program may have facilitated communication within the treating team and between team and family members. Replication of this intervention in a multi-centre nursing home population is needed to adequately assess its effectiveness.

Publication:

• Arcand M, Monette J, Monette M, Sourial N, Fournier L, Gore B, Bergman H. Educating Nursing Home Staff about the progression of dementia and the Comfort Care option: Impact on family satisfaction with end-of-life care. J Am Med Dir Assoc 2009 Jan; 10(1):50-5.

Ongoing studies

12. Delirium in long-term care settings: occurrence, modifiable risk factors and outcomes.
This study examines the prevalence and the effect of delirium on long-term care residents’ quality of life. The objective is to identify risk factors related to delirium. This multicentre study includes Maimonides Geriatric Centre.
Principal investigator: McCusker J
Co-Investigators: Berg k, Champoux N, Ciampi A, Cole M, Monette J, Voyer P.

13. Transmission of infections in healthcare settings: Risk in the elderly after a visit to the emergency room.
The objective of this study is to determine the risk of developing gastrointestinal and respiratory tract infections that could arise following a visit of long-term care residents to an emergency department. The study is equally aiming to identify the sources of these infections. This multicentre study includes Maimonides Geriatric Centre.
Principal investigator: C Quach-Thanh
Co- investigators: McGeer A, Simor A, Lévesque E, Dionne M.

Upcoming project

14. Evaluation of a nursing psycho-educational group intervention focused on communication for the family caregiver in early stage alzheimer disease.
The objective of this study is to develop and assess a nursing staff group intervention in order to generate evidence based data for nursing care.
Principal investigator: Kouri K
Co-investigators: Ducharme F, Bergman H.

Contacts