Clinical Research Directory

A Path to Prevention of Elder Abuse in Long-term Care. Prevalence Study Among Staff in Long-term Care.

Globally, studies indicated that 16% of community dwelling older adults have been exposed to some form of abuse in the past 12 months. Furthermore, a global meta-analysis about AOP in long-term care facilities used staff as respondents and found that the pooled estimate of overall self-reported perpetration of staff to resident abuse during the past 12 months was 64.2% (95% CI 53.3-73.9%). Similar findings was also reported in a study from Norway in which the overall prevalence of observed staff-to-resident abuse was 76% and 60% of respondents report self-perpetration of abusive acts during the past 12 months. Resident-to-resident aggression was even more common, observed by 88% of respondents. This study is part of the Swedish national research program APPEAL (A Path to Prevention of Elder Abuse in Long-term care) with the long-term goal to co-create an intervention for abuse of older people (AOP) in nursing homes together with stakeholders, i.e., staff, managers, care recipients and relatives. Study design and data collection: A cross-sectional study design will be used with slightly different data collection modes. 1. Population sample. Statistics Sweden combine data from the Swedish Occupational Register with data about industry codes (SNI-codes) to make a national randomized sample of staff working in home care services (n=12000) and nursing homes (n=11000) in Sweden. Data will be collected through a digital survey. Data will be combined with available register data from Statistics Sweden, including for example sex, age, civil state and occupational related data. 2. Workplace sample. Sweden has 290 Municipalities. The Swedish Association of Local Authorities and Regions (SALAR) have an official categorization of the municipalities based on e.g., urban area size, proximity to a larger urban area, and commuting patterns. One municipality in each of the nine categories has been randomly selected for participation. In the randomization process, geographical location of the municipalities has been considered to assure national representativeness, meaning that in case several municipalities in the same geographical region were selected a new randomization was conducted. Staff in each selected municipalities will be invited to participate through managers in each organization. Data will be collected through a digital questionnaire. Organizations will be encouraged to set a side time at a staff meeting for completing the questionnaire. If this is not possible, a link to the questionnaire will be sent out by e-mail. Data will be collected anonymously. Material: The questionnaire used in the previously mentioned Norwegian study about AOP in long-term care facilities has been translated and culturally adapted. In addition, items about background characteristics of respondents as well as risk factors for AOP on both an individual and system level are included, e.g., workload and perceived support at the workplace and ageist attitudes. Analysis: Primary outcomes will be proportion of staff reporting different types of abuse (psychological, physical, sexual, financial abuse and neglect) in different relational contexts, i.e., self-perpetrated, staff-to-resident and relative-to resident abuse, and in long-term care facilities resident-to-resident abuse. Secondary outcome will be staff reported own exposure to different forms of abuse at the workplace, including by residents, co-workers, relatives and managers. Logistic regression analysis will be used to investigate associations between reporting different forms of abuse and potentially explanatory factors.

Training and Support Programme on Data-driven Quality Development for Swiss Long-Term Care Facilities (NIP-Q-UPGRADE Subaim 2.6)

Since 2019, long-term care facilities (LTCFs) in Switzerland have been required by the Federal Insurance Law (KVG, Art. 59a) to report data for the calculation and public reporting of medical quality indicators (MQIs) in four clinical domains: polypharmacy, pain, malnutrition, and physical restraints. This data serves both for monitoring care quality at the national level through public reporting and for internal quality development. Contextual analysis showed that various quality development methods are already known and used in Swiss LTCFs. However, significant challenges remain: limited resources, time constraints, and restricted access to MQI data hinder effective use. Facilities reported a greater need for support in using MQI data. They also expressed interest in peer networking, structured support for applying quality methods (such as Plan Do Check Act cycles (PDCA)), and practical tools such as training, best-practice examples, and additional resources. Residents and relatives also expressed a strong interest in being more involved in decision-making and care quality discussions. The overall aim of the current study is to test a quality development training programme that supports LTCFs in using MQI data for continuous data-driven care quality development. The study is structured into three thematic areas: 1. MQI Results Literacy - Supporting LTCFs in interpreting MQI reports and benchmarks. 2. Impactful Actions - Supporting LTCFs to translate MQI results into concrete quality development actions using PDCA cycles. 3. Sparking Culture - Integrating data-driven quality development into everyday practice and fostering a culture of continuous development, with a strong emphasis on strengthening the involvement of residents, relatives, and leadership. The study follows a train-the-trainer strategy. Trainers instructed by the NIP-Q-UPGRADE research team provide structured training and coaching to Quality Leaders and management representatives of LTCFs. Quality Leaders then support their co-workers in quality development. The training programme consists of online and in-person trainings, training materials, practical tools, a website, guided tasks for facilities, and an email helpdesk for ongoing support. Study outcomes: This sub-study of the NIP-Q-UPGRADE programme aims to assess the acceptability, feasibility, fidelity, and costs related to the training programme, both at the facility level and at the trainer level.