SALTY - Stream 1

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 of developing 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.

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

What is involved in 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 will choose symptoms and practices with the greatest impact on end of life care as quality measures by involving regional/provincial health decision makers, managers and care providers in care facilities, and residents and their family members.

We will test our selected quality measures using RAI assessments 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.

Why is it important?

Nursing home care increasingly is end of life care. Almost all nursing home residents will die in the nursing home or will be transferred to hospital immediately before death. End of life care is poor in nursing homes, and is worse for residents with dementia. Multiple clinical complications (e.g., communication difficulties, functional limitations and multiple co-morbidities) are associated with dementia. Burdensome symptoms, such as pain or depression, are often overlooked in these residents. Residents with dementia also often receive inappropriate interventions, causing unnecessary suffering. Untreated burdensome symptoms can result in high health care costs, as can overtreatment. 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


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Steam 1 Leads

Dr Carole Estabrooks

Dr Matthias Hoben

Postdoctoral Fellows

Dr Maryam Nesari