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Developing and implementing a research agenda can be challenging, but identifying the ultimate destination and defining the intermediate steps along the path are critical. The purpose of this session is to help early-career researchers (including graduate students, postdocs, junior faculty, and those considering transitioning into academics) identify key considerations and strategies for the development and implementation of their own research agenda. The speakers will discuss identifying research topics, designing a strong research program, and building evidence of effectiveness around the agenda. The speakers represent a range of settings and experiences, allowing attendees to appreciate the diversity of types of research agenda that exist within the profession. Attendees will leave the session with specific tools and resources to help them begin to develop a research agenda that will be appropriate for a range of settings.

This research estimates the life expectancy of members of the Church of Jesus Christ of Latter-day Saints (LDS) in Utah. We create gender-specific life tables for four groups: total Utah, active LDS, less-active LDS, and non-LDS. Male life tables are based on data from 1991-1995; female life tables are based on data from 1994-1998. Life expectancy at birth is 75 years for all utah males, 79.8 years for active LDS Utah males, 71.6 years for less active LDS Utah males, and 71.5 years for non-LDS Utah males. Female life expectancy at birth is 80.4 years for all Utah females, 83.9 years for active LDS Utah females, 77.7 years for less-active LDS Utah females, and 77.4 years for non-LDS utah females. Results from this research can be useful to health policy makers and in the allocation of health resources. If it is indeed true that a large portion of the life expectancy gains in the active LDS group is attributable to adherence to a health code, then this information can be used when designing and evaluating health intervention programs.

Introduction: The purpose of this study is to examine how nursing home (NH) characteristics, specifically racial composition of nursing homes residents, influences the use of physical restraints. As the population ages and becomes more diverse, it is essential to mitigate/eliminate racial/ethnic disparities in quality care. Methods: This is cross-sectional study using a 2010 national data set from Brown University Center for Gerontology and Healthcare Research. This study employs Donabedian's Structure-Process-Outcome (SPO) conceptual framework. Statistical analysis includes univariate, bivariate, and a logistic regression model. It is hypothesized that nursing homes with higher proportions of black residents, more Medicaid residents, and for-profit ownership status will be associated with higher prevalence of physical restraint use. Results: Findings show that nursing homes with high proportions of blacks have a lower likelihood of high physical restraint use. Nursing homes with a higher proportion of Medicaid-reliant residents have a higher likelihood of restraint use, as does for-profit nursing homes. Discussion: The findings indicate that there are no racial/ethnic disparities present in the use of physical restraints in nursing homes. There is indication of socio-economic disparities, since nursing homes with higher Medicaid-reliant residents are associated with greater restraint. There are policy implications associated with these findings, including raising Medicaid per diem or implementing a quality performance payment incentive. Further research will be needed to determine ways to reduce racial/ethnic disparities in nursing homes. This research, adds to the nursing home literature focused on socio-economic disparities.

Background: A rural level 1 trauma center underwent a consolidation to level III status in a new trauma network system. A dedicated group of midlevel practitioners emphasizing early mobilization, a geriatric care model, and fall prevention replaced surgical residents in the level 3 center. We hypothesized that outcomes of elderly fall-related injuries may be enhanced with midlevel providers using a geriatric-focused care model. Methods: An IRB-approved trauma registry review of patients over 65 years of age with a fall-related injury admitted to a rural trauma center 1 year prior to and 1 year following a trauma center consolidation from level 1 to level III designation evaluated demographics, anticoagulant use, comorbidities, and clinical outcomes. Statistical analysis included t-test and regression analysis. Results: 327 patients injured by falls were seen over a 2-year study period. The number of patients admitted with a fall-related injury and the injury severity were similar over the study period. Increasing age and anticoagulant use increased length of stay and mortality (both with P <.05). Mortality rates and patient level of independence on discharge were improved in the later period involving midlevel practitioners (both with P <.05). Discussion: Trauma centers and trauma system networks face increasing challenges to provide resources and providers of care for patients injured by falls, especially for the growing elderly population. Midlevel providers focusing on geriatric clinical issues and goals may enhance care and outcomes of elderly fall-related injuries.

An integral concern across care settings is the prompt intervention for patients suffering with pain. Long-term care (LTC) settings present with unique challenges to assess and manage pain in resident populations. Pain assessment is especially challenging, because residents have varying degrees of cognition to communicate their pain, and clinician/staff knowledge of pain symptoms may be lacking. The purpose of this research was to improve the measurement of pain and outcomes of care for the elderly residing in skilled nursing care, especially those with cognitive-impairment. The specific aims of this study were to: 1) Determine the magnitude of the relationship between pain behaviors and a measurement model hypothesized for pain; 2) Test the construct validity of a pain measurement model; 3) Examine the concomitance of pain and cognition in a three-year longitudinal analysis. The research questions answered: 1) Is there a difference in the prevalence of pain in cognitively intact versus cognitively-impaired residents; 2) Can a theoretically derived model of pain aid in detecting pain across all cognitive levels; and 3) Do pain and cognitive status concomitantly correlate? The goal was to examine the covariance model of concomitance of pain and cognition to more accurately construct theoretical models of pain to then include additional resident care factors in future research. Traditional self-reports of pain are often under-assessed and under-treated in the cognitively-impaired (CI) elderly resident. Having additional measures to detect pain beyond self-reports of pain intensity and frequency increases the likelihood of detecting pain in populations with complex symptom presentation. Data collected from skilled nursing facilities offer exceptional opportunities to study resident demographics, characteristics, symptoms, medication use, quality indicators, and care outcomes. The Minimum Data Set-Resident Assessment Instrument (MDS-RAI) 2.0, a nationally required resident assessment tool, must be completed on every resident in a Medicare LTC facility within 14 days of admission, quarterly, annually and with significant changes in resident status. Because the MDS is widely used and recognized in LTC settings, core items from MDS [i.e., pain frequency (J2a) and pain intensity (J2b)] along with additional MDS items hypothesized to signify pain were analyzed in the pilot measurement model. Ten core items from MDS were used: 1) Inappropriate behavior frequency (E4da); 2) Repetitive physical movements; 3) Repetitive verbalizations (E1c); 4) Sad facial expressions (E1l); 5) Crying (E1m); 6) Change in mood (E3); 7) Negative statements (E1a); 8) Pain frequency (J2a); 9) Pain intensity (J2b); and 10) Cumulative pain sites scores. All indicators of pain were significant at the <.01 level. A longitudinal cohort design was used to answer if a concomitance exists between pain and cognition. Data were collected from MDS annual assessments from 2001, 2002 and 2003 for residents across the United States. The sample consisted of 56,494 residents age 65 years and older with an average age of 83 [plus or minus] 8.2 years. Descriptive statistics, ANOVA and a covariance model were used to evaluate cognition and pain at the three time intervals. ANOVA indicated a significant effect (<.01) for pain and cognition with protected t-tests indicating scores decreased significantly over time with resident measures of pain and cognition. Results from this study suggest that: 1) Using only pain intensity and frequency, pain prevalence was found in 30% of the pilot population, while 47.7% of cognitively intact residents had documented pain and only 18.2% of the severely CI had documented pain, supporting previous research that pain is potentially under-reported in the CI; 2) Parsimonious measurements models of pain should include dimensions beyond self-reports of pain (i.e., cognitive, affective, behavioral and inferred pain indicators); 3) Model fit was improved by using specific MDS items in the pain construct; 4) Longitudinal analysis revealed relative stability for pain and cognition measures over time (e.g., larger stability or consistency was found in cognitive measures than the measures of pain over the three-year period); 5) Crossed-legged effects between pain and cognition were not consistent; 6) A concomitant relationship was not found between pain and cognition. The relationship was significant (<.01), but associations were weak (r=0.03 to 0. 08). Pain or cognition should not be used as a predictor of the other in theoretical models for similar populations. The MDS is a reliable instrument to follow resident attributes, quality of care, and patient outcomes over time. The development of more accurate assessments of pain may improve resident care outcomes. Ineffectively intervening on the pain cycle is posited to cause secondary unmet needs that affect the resident's quality of life. Findings support the importance of improving clinical outcomes in the management of pain in the elderly residing in long-term care. Deficits in the treatment of pain highlight the impetus to support health policy change that includes pain treatment as a top health priority and a quality indicator for federally funded programs supporting eldercare.

Bakgrund: Antalet äldre i världen ökar ständigt. Åtta procent av Sveriges befolkning, som är 65 år och äldre, har någon form av kognitiv svikt. Med åldern ökar risken för mild kognitiv svikt, vilket påverkar alla områden i människans liv. Mild kognitiv svikt är ett tillstånd som kan leda till mer omfattande kognitiv nedsättning om det inte åtgärdas i ett tidigt skede. Det är därför viktigt att tidigt upptäcka och åtgärda de första symtomen på mild kognitiv svikt.  Syfte: Syftet med studien var att undersöka vilka interventioner som kan förbättra livskvaliteten hos äldre personer med mild kognitiv svikt. Metod: Systematisk blandad litteratur översikt (Systematic mixed studie review) med narrativ sammanfattning (narrativ summary) enligt Ryan (2013) valdes som studiedesign. Artiklar söktes systematiskt i databaserna Cinahl, PubMed och PsycINFO. Följande kategorier fastställdes vid analysen: fysisk aktivitet, kognitiv stimulans, kombinerade fysiska och kognitionsstimulerande interventioner och estetiska aktiviteter. Resultat: Studiens resultat baserades på en analys av elva kvantitativa och tre kvalitativa studier som omfattade äldre personer i ålder 65+ med MCI. Dessa artiklar publicerades mellan åren 2019 och 2023 och omfattade länderna Italien (1), Kanada (1), Kina (6), Mexiko (1), Nederländerna (1), Sverige (1), Tyskland (1) och USA (2). Interventioner som inkluderades i studien omfattade: fysiska aktiviteter som Tai Chi, måttlig aerob träning och squaredans; interventioner för kognitiv stimulans med hjälp av modern teknink; fysiska aktiviteter kombinerade med kognitiv träning; samt estetiska aktiviteter som stråkkonst, akvarell och akrylmålning. Interventionerna visade varierande grad av påverkan på livskvalitet för äldre personer med MCI, men samtliga visade positiv effekt på livskvaliteten. Slutsatser: Det finns evidens som tyder på att användandet av moderna teknologier kan förbättra äldre personernas med MCI livskvalitet. Interventioner som mindfulness, reminiscens, estetiska och fysiska aktiviteter kan också ge en positiv effekt på livskvalitet hos äldre personer med MCI. / Background: The number of elderly people in the world is constantly increasing. Eight percent of Sweden's population, who are 65 years and older, have some form of cognitive impairment. With age, the risk of mild cognitive impairment increases, which affects all areas of a person's life. Mild cognitive impairment is a condition that can lead to more extensive cognitive impairment if not addressed in its early stages. It is therefore important to detect and address the first symptoms of mild cognitive impairment at an early stage.  Aim: The aim of this study was to investigate which interventions can improve the quality of life in older people with mild cognitive impairment. Method: Systematic mixed study review with narrative summary according to Ryan (2013) was chosen as the study design. Articles were systematically searched in the databases Cinahl, PubMed and PsycINFO. The following categories were established in the analysis: physical activity, cognitive stimulation, combined physical and cognition-stimulating interventions, and aesthetic activities. Results: The results of the study were based on an analysis of eleven quantitative and three qualitative studies that included older people aged 65+ with MCI. These articles were published between the years 2019 and 2023 and covered the countries Italy (1), Canada (1), China (6), Mexico (1), the Netherlands (1), Sweden (1) Germany (1), and the United States (2). Interventions in the study included: physical activities such as Tai Chi, moderate aerobic, and square dancing; interventions for cognitive stimulation using modern technology; physical activities combined with cognitive training; as well as aesthetic activities such as string art, watercolor, and acrylic painting. The interventions showed varying degrees of impact on quality of life for older people with MCI, but all showed a positive effect on quality of life.  Conclusions: There is evidence to suggest that the use of modern technologies can improve the quality of life of older people with MCI. Interventions such as mindfulness, reminiscence, aesthetic and physical activities can also have a positive effect on quality of life in older people with MCI.

Bakgrund: Patienter inom äldreomsorgen är i behov av vård och omsorg i allt större utsträckning. I takt med en globalt åldrande befolkning ökar även handhavandet av kliniska insatser som sjuksköterskan blir alltmer pressad till att delegera ut till omsorgspersonal. Det är väl känt att arbetsbelastningen är hög inom äldreomsorg och det innebär avsevärda svårigheter att uppfylla de samhälleliga krav och förväntningar som efterfrågas. Sjuksköterskor och omsorgspersonal besitter ett stort ansvar i att säkerställa den omvårdnad patienter är berättigade till och samtidigt upprätthålla god vårdkvalitet och beakta patientsäkerhet. Utan en fullgod teamsamverkan uppstår hög risk att våra äldre patienter faller mellan stolarna. Dagens delegeringsarbete innefattar stort risktagande då all omsorgspersonal inte anses besitta lämplig kompetens, trots detta delegeras allt fler kliniska insatser inom äldreomsorgen enbart för att sjuksköterskan ska få ihop arbetsdagen och dess kamp mot klockan. Syfte: Syftet med studien var att beskriva sjuksköterskors upplevelser av utmaningar gällande teamsamverkan inom äldreomsorgens delegeringsarbete. Metod: Studien genomfördes som en allmän litteraturöversikt med användning av kvalitativa artiklar och kvalitativa delar av artiklar med mixad metod. En deduktiv ansats tillämpades. Resultat: Studiens analys presenterades i form av fyra bestämda kategorier: Bristande kompetens påverkar systemteorins balans; Bristande kommunikation och interaktion inom vårdteamet; Tids- och resursbrist hämmar adaption; Hanteringsprocessens utfall när organisationens teamsamverkan brister. Slutsats: Flera faktorer pekar på att vårdteamets brist på tid och resurser är det primära problemet. Det faktum att det råder uttalad brist på kommunikation och kompetens är sekundär problematik inom såväl organisation som upprätthållning av bärande lagstiftning.

Introduktion: Fysisk träning är en viktig del av dagens rehabiliterings-paradigmer. Träning leder inte bara till bättre hälsa och förebyggande av sjukdomar; träning ökar dessutom psykiskt välmående. Med stöd av forskning har träningsprinciper tagits fram av fysiologer som beskriver hur fysisk träning kan ske på ett optimalt sätt med snabbast möjliga progression beroende på patientens mål. Användandet av träningsprinciper av fysioterapeuter som ordinerar träning till patienter kräver eftertänksamhet och individanpassning. Dagens forskning visar att följsamheten gällande användning av träningsprinciper ibland är bristfällig i hur användandet rapporteras och tillämpas både i Sverige och internationellt. Syfte: Syftet var att kartlägga i vilken utsträckning fysioterapeuter använder sig av vedertagna träningsprinciper i sitt arbete. Syftet är också att undersöka om det föreligger skillnad mellan fysioterapeuter i primärvård respektive geriatrik, samt undersöka sambandet mellan användandet av träningsprinciper och antal år i yrket. Metod: Fysioterapeuter som ordinerat träning det senaste året inbjöds via utvalda Facebookgrupper att besvara en egenkonstruerad enkät om användandet av träningsprinciper. Resultat: Åttioen svar erhölls. Genomsnittligt skattade studiedeltagarna högt gällande användandet av träningsprinciper. Primärvård skattade aningen högre på samtliga principer med en signifikant skillnad för överbelastningsprincipen (p=0.009). Förindividualiseringsprincipen fanns en liten negativ korrelation (p=0.045) där ökande arbetslivserfarenhet korrelerade med minskat användande av principen. Konklusion: Studiedeltagarna skattade sin användning av träningsprinciper på medelhög nivå. Det föreligger en liten skillnad mellan grupperna där primärvård har högre följsamhet. Erfarenhet korrelerar aningen negativt med användandet av träningsprinciper. Vidareforskning behövs. / Introduction: Physical exercise is an important part of today’s rehabilitation measures. Exercise doesn’t only improve health and prevent diseases; exercise also increases psychological wellbeing and self-efficacy. Training principles have been developed by physiologists with the support of science describing how exercise should be administered by physiotherapists for optimal results and optimal progression. Usage of principles when administering exercise demands thoughtfulness and customization to the patient’s needs. Research shows that adherence to training principles is lacking both in how it’s reported and used both in Sweden and internationally. Purpose: The purpose was to examine to what extent physical therapists use established training principles in their work. The secondary purpose was to examine if there’s a difference in usage between primary care and geriatrics, and the connection regarding work experience and adherence to the principles. Method: Respondents prescribing exercise the past year were invited from chosen Facebook groups to answer a survey with self-constructed questions regarding the usage of principles. Results: eightyone responses were submitted. Respondents estimated a high adherence to the principles with primary care adhering slightly more with a significant difference for the overload principles (p=0.009). Regarding the individualisation principle there was a slight negative correlation (p=0.045) concerning more work experience and adherence to the principles. Conclusion: Participants rated their usage of training principles at a medium-high level. A small difference was observed between groups where primary care adhere to principles better. More experience correlated slightly negatively with usage of training principles. More research is needed.

Problem/Purpose: Antibiotic associated diarrhea (AAD) and clostridium-difficile diarrhea (CDAD) are the most common forms of infectious diarrhea in long-term care facilities. The purpose of this study was to determine the effectiveness of probiotics in preventing AAD and CDAD in the long term care geriatric population, and to identify interventions that can be used to improve clinical practice. Background/Significance: Prophylactic use of probiotics have been purported to decrease the incidences of AAD and CDAD. Previous studies have yielded contradictory results on the efficacy of probiotics. The objective of this study was to evaluate the impact of administration of probiotics on the rate of infectious diarrhea in the Long Term Care (LTC) population Method: This was a retrospective cohort study. The charts of residents of a LTC facility who were 65 years of age and older, and were administered antibiotic therapies, with or without co-administration of probiotics were reviewed. A data collection instrument was created for this study and piloted prior to its utilization. A chi-square test of independence was calculated to obtain the results. Results: Forty-four residents received probiotics with antibiotics, five cases of diarrhea were reported; no cases of CDAD were reported. In 39 residents who received antibiotics without probiotics, two cases of diarrhea and one case of CDAD were reported. Conclusion: The study showed no statistically significant evidence to support the effectiveness of probiotic use in the prevention of AAD and CDAD in a long term care facility. The incidence of AAD was higher in the group with probiotics