Background: The number of older people dying in long-term care facilities is increasing; however, care at the end of life can be suboptimal. Interventions to improve palliative care delivery within these settings have been shown to be effective in improving care, but little is known about their implementation. Aim: The aim of this study was to describe the nature of implementation strategies and to identify facilitators and/or barriers to implementing palliative care interventions in long-term care facilities. Design: Scoping review with a thematic synthesis, following the ENTREQ guidelines. Data sources: Published literature was identified from electronic databases, including MEDLINE, EMBASE, PsycINFO and CINAHL. Controlled, non-controlled and qualitative studies and evaluations of interventions to improve palliative care in long-term care facilities were included. Studies that met the inclusion criteria were sourced and data extracted on the study characteristics, the implementation of the intervention, and facilitators and/or barriers to implementation. Results: The review identified 8902 abstracts, from which 61 studies were included in the review. A matrix of implementation was developed with four implementation strategies (facilitation, education/training, internal engagement and external engagement) and three implementation stages (conditions to introduce the intervention, embedding the intervention within day-to-day practice and sustaining ongoing change). Conclusion: Incorporating an implementation strategy into the development and delivery of an intervention is integral in embedding change in practice. The review has shown that the four implementation strategies identified varied considerably across interventions; however, similar facilitators and barriers were encountered across the studies identified. Further research is needed to understand the extent to which different implementation strategies can facilitate the uptake of palliative care interventions in long-term care facilities.

ObjectivesThis paper aims to investigate resident, facility and country characteristics associated with length of stay in long-term care facilities (LTCFs) across six European countries.SettingData from a cross-sectional study of deceased residents, conducted in LTCFs in Belgium, England, Finland, Italy, the Netherlands and Poland.ParticipantsAll residents aged 65 years and older at admission who died in a 3-month period residing in a proportional random sample of LTCFs were included.Primary and secondary outcome measuresThe primary outcome was length of stay in days, calculated from date of admission and date of death. Resident, facility and country characteristics were included in a proportional hazards model.ResultsThe proportion of deaths within 1 year of admission was 42% (range 32%–63%). Older age at admission (HR 1.04, 95% CI 1.03 to 1.06), being married/in a civil partnership at time of death (HR 1.47, 95% CI 1.13 to 1.89), having cancer at time of death (HR 1.60, 95% CI 1.22 to 2.10) and admission from a hospital (HR 1.84, 95% CI 1.43 to 2.37) or another LTCF (HR 1.81, 95% CI 1.37 to 2.40) were associated with shorter lengths of stay across all countries. Being female (HR 0.72, 95% CI 0.57 to 0.90) was associated with longer lengths of stay.ConclusionsLength of stay varied significantly between countries. Factors prior to LTCF admission, in particular the availability of resources that allow an older adult to remain living in the community, appear to influence length of stay. Further research is needed to explore the availability of long-term care in the community prior to admission and its influence on the trajectories of LTCF residents in Europe.

Tässä tutkimuksessa selvitettiin kotona asuvien enintään keskivaikeasti oireilevien muistisairautta sairastavien henkilöiden palveluprofiili. Lisäksi selvitettiin millaiset tilapäiset palvelut tukevat kotona asumista sekä millaisiin palveluihin henkilöt ohjautuivat seitsemän kuukauden kuluttua palvelutarpeen arvioinnista. Kotona asuvat henkilöt jaettiin säännöllisiä palveluja vasta hakeviin ja säännöllistä kotihoitoa saaviin. Säännöllisiä palveluja vasta hakevien palveluprofiili: melkein joka toinen muistisairas oli erittäin suuren palvelutarpeen tarvesegmentissä Kognitiovaje ja suuri ADL-avun tarve. Noin joka toisella muistisairaalla ei ollut säännöllisiä palveluja.  Säännöllisen kotihoidon saajien palveluprofiili: noin joka kolmas muistisairas oli suuren palvelutarpeen tarvesegmentissä Rajattu kognitiovaje. Heidän pääpalveluna oli kotihoito ja hyvin vähän muiden palvelujen käyttöä. Puolen vuoden seuranta-aikana säännöllisiä palveluita vasta hakevista noin joka kolmannella tapahtui muutosta palveluissa, säännöllisen kotihoidon saajista noin joka viidennellä. Muistisairaiden kotona asumista tuki läheisapu sekä lyhyet sairaalahoidon ja ympärivuorokautisen hoivan jaksot.