What is the SALTY Project?

SALTY (Seniors Adding Life to Years) is a four-year multidisciplinary, multi-sector program developed by a team of researchers, clinicians, knowledge users, caregivers and trainees from across Canada. SALTY aims to improve the experience of the final years in long term care for older adults, their families and care providers. The program has four streams. TREC is part of the SALTY team and is responsible for Stream 1.

Stream 1 aims to develop an approach that enables researchers, policy makers and care facilities to validly and reliably measure quality of end of life care in nursing homes on an ongoing basis.

Burdensome symptoms such as pain, shortness of breath, and depression are common in nursing home residents at the end of life. Yet, these symptoms can be prevented or treated. Nursing home residents also often experience avoidable care practices such as hospital transitions, physical restraints or antipsychotic medications with no indication.

What is SALTY Stream 1?

In our previous work, we identified lists of burdensome symptoms and potentially inappropriate practices at the end of life in nursing homes. From these lists we are choosing symptoms and practices with the greatest impact on end of life care as quality measures. Throughout this process we are working with regional/provincial health decision makers, managers and care providers in care facilities, and residents and their family members.

We are testing our selected quality measures using resident data collected through the TREC research program. We will use the national repository of RAI data (maintained by the Canadian Institute for Health Information) to further examine the quality measures, in particular, to evaluate variations in quality of end of life care at the facility level and the sensitivity of the quality measures to change over time.

At the end, through panel discussions with multiple knowledge user audiences, we will assess the interpretability and seek ideas on the implementation of our quality measures in nursing homes to reduce symptom burden and develop practices that are more appropriate.

Key Aims

1. To identify symptoms and practices with the greatest impact on quality of end of life care
2. To build and test longitudinal quality measures for end of life care in nursing homes

Why is it Important?

Nursing home care is more and more becoming end of life care. Most nursing home residents will die there or will be transferred to a hospital just before death. End of life care is poor in nursing homes, and worse for residents with dementia. Many clinical complications such as communication difficulties and multiple health issues are associated with dementia. Burdensome symptoms, like pain or depression, are often overlooked in these residents. Residents with dementia often receive inappropriate interventions, causing unnecessary suffering. Untreated burdensome symptoms, as well as over-treatment, can result in increased health care costs. Reducing burdensome symptoms and inappropriate practices that are common at the end of life is essential to improving quality of care.

For more information on SALTY and its other three Streams please visit the SALTY Project's Home Page.