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The COVID-19 lockdown provided a unique opportunity to test the impacts of changes in travel patterns on air quality and the environment. Therefore, this study provides insights into the impacts of COVID-19 emergency public health “lockdown” measures upon traffic flow, active travel and gaseous pollutant concentrations (NO, NO2 and O3) in Oxford city centre during 2020 using time-series analysis and linear regression methods. Comparisons of traffic counts indicated pronounced changes in traffic volume associated with national lockdown periods. Car volume reduced by 77.5% (statistically significant) during the first national lockdown, with lesser changes in goods vehicles and public transport (bus) activity during the second lockdown. Cycle flow reduced substantively during the first lockdown only. These changes resulted in a reduction in nitric oxide (NO) and nitrogen dioxide (NO2) concentrations of 75.1% and 47.4%, respectively, at roadside, and 71.8% and 34.1% at urban background during the first lockdown period. In contrast ozone (O3) concentrations increased at the urban background site by 22.3% during the first lockdown period, with no significant changes in gaseous concentrations during the second lockdown at either roadside or urban background location. The diurnal pattern of peak mean NO and NO2 concentrations reduced in magnitude and was shifted approximately 2 h earlier in the morning and 2 h later in the evening (roadside) and 3 h earlier in the morning and 3 h later in the evening (urban background). Our findings provide an example of how gaseous air quality in urban environments could respond to future urban traffic restrictions, suggesting benefits from reductions in peak and daily NO2 exposures may be offset by health harms arising from increases in ground level O3 concentrations in the summer months.

Nursing homes (NHs) typically focus on health-related quality of life (HRQoL) among residents aged 65 and over despite approximately 7% of NH residents are younger (aged 18-64). Research suggests that the needs of younger NH residents are not being met and they may have low HRQoL. However, differences in HRQoL of younger and older NH residents may not be apparent in studies that use HRQoL measures designed for research with older NH residents. We hypothesized that the younger residents would have lower HRQoL mean scores than the older (aged ≥ 65) residents using a HRQoL measure based on the HRQoL score derived from Resident Assessment Instrument – Minimum Data Set 2.0 items. The measure uses items that emphasize physical aspects of quality of life rather than social aspects. In a sample of 21,129 residents from 94 NHs in Western Canada, we performed descriptive analyses, t-test, chi-square test, and an adjusted propensity score (PS) analysis through retrospective cohort study from years 2016 to 2017. The HRQoL index score ranged from -.351 to .996 (Mean= 0.693, SD=0.265). In the PS model, the adjusted mean score for younger was higher than for older adults with a mean difference at 0.061 (95% CI 0.031, 0.091) (p

Persons with newly diagnosed Alzheimer’s disease and related dementias (ADRD) and their care partners confront multiple challenges. These challenges have been even greater during the COVID-19 pandemic, where supportive resources often are limited or even discontinued. We conducted semi-structured interviews with 21 care partners of persons who were recently diagnosed with ADRD (2019-2020) to explore their lived experiences of adjusting to the new role. Directed and conventional content analyses were used and were informed by the life course theory. Care partners perceived difficulty in accessing medical and social services for their loved ones, particularly during the pandemic. Despite experiencing distress, some care partners chose not to seek help for fear of contracting COVID-19. This study provides insights on the unmet needs of care partners during a pandemic and highlights that effective, long-term strategies are needed to continue providing person-centered care to persons with ADRD and their families.

This paper examines the relationships between Direct Care Workers (DCW) and other nursing home (NH) staff. Specifically, we examine how trust, and the context in which trust exists, influences care practices and implementation of innovations in NHs. This secondary analysis of interviews and field observations from three separate NHs in different Canadian provinces shows differing levels of trust that between HCAs and other staff. We also analyze the organizational context can mediate trust in these relationships. Specifically, we analyzed trust DCWs have at the interpersonal, institutional, organizational levels and what ways they act as facilitators of programs aimed at improving care practices health outcomes of residents in NHs. Using the Alberta Context Tool’s dimensions of organizational context as a framework, this research shows how trust in the relationships between DCWs and other LTC staff influences caregiving practices and the uptake of new innovations.

The case studies were conducted as an early component of a pan-Canada project entitled Translating Research in Elder Care (TREC). This sub-project provided insights into the challenges and leadership of facilitating care model changes, care quality improvement, and quality of work enhancement of three long-term care (LTC) facilities in Canada. Through the lens of Adaptive Leadership Framework for Chronic Illness (ALFCI), leadership emerged as a critical element of their organizational context. Staff reported that contextual factors of high intensity of work and inadequate staff were barriers that added to the complexity of challenges facing them. Data collectors observed that frontline staff exhibited leadership behaviors in knowledge transmission, information sharing, teamwork, and person-centered strategies to address challenges. However, top-down facilitation can lead to misunderstanding and a lack of motivation from the frontline staff to follow the facilitation. The findings also suggested tailored facilitation about including frontline staff in formal interactions.

This paper reports on a project that brings together photovoltaics engineers with 4th-12th-grade teachers and students to test agrivoltaics applications using citizen science. A summer research experience for teachers (RET) program engaged teachers in building and programming a novel agrivoltaic school garden monitoring device facilitated by photovoltaics engineering researchers. The teachers and their students will design and install school gardens for their own community purposes and collect data on garden conditions with and without solar panels covering the crops. A set of curriculum materials are outlined to support implementation across multiple contexts.

Background Fidelity in complex behavioural interventions is underexplored. This study examines fidelity of the INFORM trial and explores the relationship between fidelity, study arm and the trial’s primary outcome – care aide involvement in formal team communications about resident care. We examined fidelity of intervention delivery, receipt, and enactment. The primary outcome in the INFORM study (care aide involvement in formal team communications about resident care) was also included as an outcome in this fidelity study.Methods A concurrent process evaluation of implementation fidelity was conducted in 33 nursing homes in Western Canada (Alberta and British Columbia). Study participants are from 106 clinical care units clustered in 33 nursing homes randomized to the Basic and Enhanced Assisted Feedback arms of the INFORM trial.Results Fidelity of the INFORM intervention was moderate to high, with fidelity delivery and receipt higher than fidelity enactment for both study arms. Higher enactment teams experienced a significantly larger improvement in formal team communications between baseline and follow-up than lower enactment teams ( F (1, 70) = 4.27, p = .042).Conclusions Overall fidelity enactment was associated with improvements in formal team communications, but study arm was not. This suggests that the intensity with which an intervention is offered and delivered may be less important than the intensity with which intervention participants enact the core components of an intervention. Greater attention to fidelity assessment and publication of fidelity results through studies such as this one is critical to improving the utility of published trials.

This study examined differences in the pathway to diagnosis of Alzheimer's disease and related dementias (ADRD) between Black and White older adults. Using electronic health records from a large health system, we included 2,085 non-Hispanic Black and 6,269 non-Hispanic White older adults with a final/primary diagnosis of ADRD between 2014 and 2020. Black older adults were more likely to receive the ADRD diagnosis from a primary care provider (35.4% vs. 29.8%), during a hospital admission (19.5% vs. 13.6%), or during an emergency department visit (4.2% vs. 2.0%); but were less likely to be diagnosed by an ADRD specialist (31.6% vs. 45.2%). Black older adults had nearly twice as many clinical encounters in the two years prior to the ADRD diagnosis than their White counterparts (43 vs. 26). Despite having more clinical encounters, Black older adults were more likely to be at a later stage when diagnosed than White older adults.

This presentation provides and overview of a mixed-methods stakeholder engaged study to develop a toolkit to encourage resident and family engagement in the safety of assisted living (AL). This study uses stakeholder-based data and stakeholder engaged processes to adapt existing tools and strategies from other settings to encourage resident and family engagement in the safety of AL. We will improve resident safety in AL by developing an evidence-based tool to implement these engagement tools/strategies in AL. The presentation will outline the theoretical base, the approach for this study, including efforts to recruit and retain stakeholders throughout the study, and stakeholder engaged process to develop the toolkit. The presentation will include challenges and strategies to encourage participation of AL staff, residents, and family caregivers in the study. The presentation will conclude with a discussion of implications for future design and research efforts aiming to impact AL care, policy, and research implementation.

Assisted living (AL), is a long-term care service that provides housing and care for over 800,000 older adults in 30,000 residences. AL culture and operations have been transforming to enhance resident personhood and increase autonomy, however, these practices are balanced with the need to minimize safety issues (e.g., medication errors, infections, falls, and in cases of dementia, elopement and injuries). In this stakeholder-based study, we are translating existing strategies for improving patient safety to AL residences and developing an evidence-based tool for implementing these engagement strategies in AL. This symposium presents the methods and findings from a federally-funded mixed methods study including qualitative interviews with 105 AL residents, staff and family caregivers, and a series of focus groups with an AL stakeholder group to develop a toolkit to improve resident and family engagement in AL safety. The first paper outlines our methodological approach, including our efforts to work with stakeholders throughout the research process. The second paper reports findings from a scoping review of existing tools to support resident and family engagement in the safety of AL. The third paper presents the findings from our interviews with AL residents, families and staff exploring their safety priorities, and how they differ across stakeholder groups. The fourth paper presents the findings from our qualitative interviews exploring the challenges and promising practice to resident and family engagement in AL safety during the COVID-19 pandemic. All four presentations in this symposium illustrate important issues for future practice, policy, and research.

This study aims to understand staff’s experiences of providing direct care for older residents with advanced dementia in long-term care facilities through the lens of Adaptive Leadership Framework for Chronic Illness (ALFCI). Semi-structured interviews were conducted with health care aides (N=35) from 2 government-owned and 2 private long-term care facilities in urban China. Directed and conventional content analysis were used, drawing upon core constructs of ALFCI. We found that health care aides are confronted with multiple challenges such as high intensity of work, stress from managing older residents’ behavioral and psychological symptoms of dementia (BPSD), a lack of access to on-the-job dementia-specific training, and a lack of support from nurses and managing team. Some of the health care aides demonstrated use of their strengths and doing adaptive work to improve work life and care for older residents by using communication cues, enhancing person-centeredness in their care, and facilitate peer interactions.

IntroductionOlder people with frailty (OPF) can experience reduced quality of care and adverse outcomes due to poorly coordinated and fragmented care, making this patient population a key target group for integrated care. This systematic review explores service user, carer and provider perspectives on integrated care for OPF, and factors perceived to facilitate and hinder implementation, to draw out implications for policy, practice and research.MethodsSystematic review and narrative synthesis of qualitative studies identified from MEDLINE, CINAHL, PsycINFO and Social Sciences Citation Index, hand-searching of reference lists and citation tracking of included studies, and review of experts' online profiles. Quality of included studies was appraised with The Critical Appraisal Skills Programme tool for qualitative research.ResultsEighteen studies were included in the synthesis. We identified four themes related to stakeholder perspectives on integrated care for OPF: different preferences for integrated care among service users, system and service organisation components, relational aspects of care and support, and stakeholder perceptions of outcomes. Service users and carers highlighted continuity of care with a professional they could trust, whereas providers emphasised improved coordination of care between providers in different care sectors as key strategies for integrated care. We identified three themes related to factors facilitating and hindering implementation: perceptions of the integrated care intervention and target population, service organisational factors and system level factors influencing implementation. Different stakeholder groups perceived the complexity of care needs of this patient population, difficulties with system navigation and access, and limited service user and carer involvement in care decisions as key factors hindering implementation. Providers mainly also highlighted other organisational and system factors perceived to facilitate and hinder implementation of integrated care for OPF.ConclusionsSimilarities and differences in lay and professional stakeholder perspectives on integrated care for OPF and factors perceived to facilitate and hinder implementation were evident. Findings highlight the importance of addressing organisational and system level components of integrated care and factors influencing implementation for OPF. Greater attention needs to be placed on collaboratively involving service users, carers and providers to improve the co-design and implementation of integrated care programmes for this patient population.