Canadian Geriatrics Journal[JOURNAL]
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200 papers
Step-Count Distribution as an Indicator of Walking Reserve in People with Gait Vulnerabilities.
Abou-Sharkh A, Morin SN, Mate KKV … +1 more , Mayo NE
Can Geriatr J · 2025 Jun · PMID 40463643 · Full text
BACKGROUND: Steps per day can provide a lot of information about the activity of the average person whose main source of activity is derived from walking. This study looks at the distribution of step-count data to identi...
BACKGROUND: Steps per day can provide a lot of information about the activity of the average person whose main source of activity is derived from walking. This study looks at the distribution of step-count data to identify different subgroups of people which could be used to indicate walking reserve. METHODS: A time series design of a secondary data analysis was conducted to track the variability of daily step count for 44 seniors post-fracture. The mean age was 75.8 years (SD: 9.75). The full percentile distribution was used in a cluster analysis and group-based trajectory analysis was used for the longitudinal data. Ordinal regression was used to identify factors associated with cluster membership. RESULTS: Four clusters best represented the distribution of reserve in this sample, hypothesized to be defined as the difference between the median and 90 percentile of the step-count distribution. Cluster 1, with the lowest reserve would also be classified as sedentary based on median step count (1,555 step count; 1,314 reserve). Cluster 2 represented people with limited activity with low reserve (4,081 step count; 2,439 reserve). Cluster 3 represented active people with high reserve (7,197 step count; 4,370 reserve). Cluster 4, was very active with very high reserve (9,202 step count, 6,964 reserve).The factors associated with cluster membership were gait speed, sit-to-stand, and depression. CONCLUSIONS: The median and 90 percentile over a longer period indicates the potential "reserve" for participating in activities that demand additional walking.
Frailty Focused Enhancements to Seniors' Hospital Care (FrESH): a Mixed Methods Study Reporting the Efficacy of Specialized Education for Front-line Staff.
Peterson JE, Fowler SA, Faig KJ … +2 more , Yetman LM, Feltmate PJG
Can Geriatr J · 2025 Jun · PMID 40463642 · Full text
BACKGROUND: Acute care hospital stays often lead to increased frailty and functional decline in older adults. Interventions such as specialized education for nurses can improve health outcomes and decrease lengths of sta...
BACKGROUND: Acute care hospital stays often lead to increased frailty and functional decline in older adults. Interventions such as specialized education for nurses can improve health outcomes and decrease lengths of stay for these patients. This study aimed to identify the facilitators and barriers to providing care to older adults in acute care, and the efficacy of specialized education for front-line staff. METHODS: A specialized education program for front-line staff, Frailty Focused Enhancements to Seniors' Hospital Care (FrESH), was developed and delivered across five family medicine units in New Brunswick (NB). A mixed methods approach was used to assess the knowledge, attitudes, and experiences of staff caring for hospitalized older adults, and evaluate the impact of providing specialized education. Patient-level data on delirium, mobility, and medications pre- and post-specialized education intervention were collected and analyzed. RESULTS: Sixty-three front-line staff participated. Analysis of questionnaires demonstrated that staff had positive attitudes and beliefs about caring for older adults; however, knowledge of geriatric care principles was limited and remained unchanged. There was no significant change in patient-level measures post-intervention. Environmental constraints hindered staff from implementing best practices, leading to practical challenges to care delivery. While respondents expressed satisfaction with the education, their capacity to deliver the type of care presented in the education sessions was not achievable. CONCLUSION: Staff identified the need for specialized education; however, there was no impact on care after participation. Results will inform changes to the specialized education programs targeting care for hospitalized older adults in acute care.
Post-discharge Home Care Services Use, Long-Term Care Placement, and Survival in Older Adults with Major Trauma: a Population-Based Cohort Study from Ontario, Canada.
Evans CCD, Li W
Can Geriatr J · 2025 Jun · PMID 40463641 · Full text
BACKGROUND: There are few studies describing health services use and longer-term survival in older adults with major injuries. Our objectives were to characterize the outcomes of older adults experiencing a major injury,...
BACKGROUND: There are few studies describing health services use and longer-term survival in older adults with major injuries. Our objectives were to characterize the outcomes of older adults experiencing a major injury, and to assess for associations between injury and rates of home-care services use (HCS), long-term care (LTC) placement, and survival. METHODS: We conducted a retrospective case-control study including adults 65 years or older admitted for a major injury (trauma survivors) or were uninjured (controls) between 2009 and 2023 in Ontario, Canada. Trauma survivors were matched 1:1 to controls based on age, sex, and number of comorbidities. Primary outcomes were rates of HCS use and LTC admissions for up to five years following discharge. Secondary outcomes were types of HCS use and survival. Multivariate regression was used to compare rates of HCS and LTC use. Cox proportional hazards models were used to assess time to LTC admission or death. RESULTS: The study cohort consisted of 31,508 individuals. Older adult trauma survivors experienced a twofold increased rate of home-care service use (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 2.1-2.4), a 30% increased rate of LTC admissions (OR: 1.3, 95% CI: 1.0-1.6), and a 40% increased rate of death (hazard ratio: 1.4, 95% CI: 1.4-1.5). CONCLUSIONS: Compared to controls, older adults surviving trauma use HCS at significantly higher rates, require LTC placement more frequently, and experience a decreased rate of survival.
Creation of a Rehabilitation Prediction Rule: a Prioritization Procedure.
Wu P, Goodarzi Z, McMillan J
Can Geriatr J · 2025 Jun · PMID 40463640 · Full text
Older adults may require longer recovery periods prior to being discharged from the hospital after an acute care stay. For some, returning to their previous living arrangement may no longer be safe or feasible after an a...
Older adults may require longer recovery periods prior to being discharged from the hospital after an acute care stay. For some, returning to their previous living arrangement may no longer be safe or feasible after an acute care admission, and they may require alternate levels of care. It can be challenging to evaluate which patients may benefit most from inpatient rehabilitation versus those for whom alternate levels of care are more suitable. Using a prioritization procedure, this study identified and ranked predictive factors for successful inpatient rehabilitation (defined as discharge to previous living arrangement) from most to least important. The final round of the prioritization procedure resulted in a list of the top 20 predictive factors, ranked by health-care providers in the field, from most to least important. Predictive factors included demographic information, past medical history factors, acute care illness factors, and results of investigations performed during the index hospitalization. The top ranked predictive factors related to patients' previous living arrangements, level of independence before hospitalization, and presence or absence of cognitive impairment. The bottom ranked predictive factors related to physical measures and results of inpatient investigations at the time of transfer. These findings highlight the importance of considering patients' lived experiences prior to hospitalization when determining who may obtain the greatest benefit from further, intensive inpatient rehabilitation following an acute care hospitalization.
Perceptions of Frailty in Long-Term Care.
Atchison K, Wu P, Toohey AM … +13 more , Gaetano D, McMillan J, Naylor J, Kaasalainen S, Grinman MN, Ewa V, Simon J, Silvius J, Sinnarajah A, Gorchynski B, Hogan DB, Holroyd-Leduc J, Goodarzi Z
Can Geriatr J · 2025 Jun · PMID 40463639 · Full text
BACKGROUND: An early palliative approach to care may best suit the care needs of older persons with frailty living in long-term care (LTC). The study objective was to evaluate the barriers and facilitators to care for fr...
BACKGROUND: An early palliative approach to care may best suit the care needs of older persons with frailty living in long-term care (LTC). The study objective was to evaluate the barriers and facilitators to care for frailty in the LTC setting. METHODS: Semi-structured interviews were completed with physicians, nurse practitioners, registered nurses, allied health-care providers, care partners, and residents with care experience in LTC. Framework analysis methods that leveraged behaviour change theories were used to analyze the interview data and produce practice-oriented findings. RESULTS: Twenty-eight interviews were completed. Seven themes were identified: resident characteristics related to frailty; frailty detection and diagnosis; frailty treatment and care planning; frailty and prognosis conversations; palliative and end-of-life care; communication amongst LTC collaborators; and the LTC environment. All codes were labelled as barriers or facilitators and assigned to a primary domain within the Theoretical Domains Framework. CONCLUSIONS: The lack of clinical recognition of frailty in the LTC setting was a key barrier to clinical pathway implementation. There is a need for frailty to be linked to prognosis and care decisions, for frailty to be directly addressed through individualized treatments, and for an early palliative approach to care to be accessible to residents. Identifying barriers to care for frailty is a critical step toward clinical care pathway implementation which may improve care and outcomes for residents of LTC.
The Experience of Caregivers of Older Adults With Dementia in Using Telemedicine in a Primary Care Setting of Canada During COVID-19.
Klinton JS, Zhao R, Rodríguez MA … +3 more , Ruiz AGS, Vedel I, Khanassov V
Can Geriatr J · 2025 Jun · PMID 40463638 · Full text
BACKGROUND: Primary care is essential in dementia management, offering diagnosis, treatment, and support for people living with dementia (PLWD) and their caregivers. Telemedicine became a key advancement during the COVID...
BACKGROUND: Primary care is essential in dementia management, offering diagnosis, treatment, and support for people living with dementia (PLWD) and their caregivers. Telemedicine became a key advancement during the COVID-19 pandemic, offering crucial access to care. This study explores the pros and cons of telemedicine for dementia care during the pandemic to guide future improvements. METHODS: Data collection involved semi-structured interviews with caregivers recruited from a Montreal memory clinic and secondary analysis of two other studies related to dementia and telemedicine, focusing on the educational needs of patients and the impact of the pandemic on health-care services. Data analysis employed the framework method, combining inductive and deductive approaches to code the data and develop categories aligned with Chang's framework, providing insights into caregivers' experiences and the challenges and benefits of telemedicine. RESULTS: The study involved interviews with four caregivers of people with dementia, complemented by secondary analysis from two Canadian studies. Through framework analysis, four themes were developed: relationship and communication; the advantages and selective suitability of telemedicine (TM) in dementia care; preferences for in-person consultations; and the need to improve awareness and technical confidence in TM. CONCLUSION: This study highlights the potential of telemedicine (TM) as an effective modality for dementia care, particularly during situations like the COVID-19 pandemic, but emphasizes that it cannot fully replace in-person consultations due to the enduring preference for face-to-face interactions.
Breaking the Inverse Care Law for Fall Prevention Programs: a Collaborative and Community-led Approach.
Chan NC, Pedulla J, Remark A … +4 more , Bartleman S, Macpherson A, Abrams H, Chang M
Can Geriatr J · 2025 Mar · PMID 40051598 · Full text
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Variations in Prescribing Rates of End-of-Life Medications Among Long-Term Care Residents in Alberta Compared with Ontario-a Retrospective Cohort Study.
Simon JE, Bhattarai A, Apoint-Hao ZY … +15 more , Roberts RL, Milani C, Webber C, Ewa V, Clarke AE, Isenberg SR, Kobewka D, Qureshi D, Bush SH, Boese K, Arya A, Robert B, Downar J, Tanuseputro P, Sinnarajah A
Can Geriatr J · 2025 Mar · PMID 40051597 · Full text
BACKGROUND: Prescribing rates for subcutaneous medications may be an indicator of quality of end-of-life care in long-term care (LTC). It is not known if this system level measure is valid across jurisdictions. We compar...
BACKGROUND: Prescribing rates for subcutaneous medications may be an indicator of quality of end-of-life care in long-term care (LTC). It is not known if this system level measure is valid across jurisdictions. We compared prescribing rates of medications used for end-of-life symptom relief among LTC residents in Alberta and Ontario. METHODS: This retrospective cohort study of LTC residents compared those who died between January 1, 2017, and March 17, 2020 in Alberta, with a published cohort from Ontario. Prescribed end-of-life medications during a resident's last 14 days of life were extracted from administrative dispensation records. LTC homes were ranked into quintiles based on prescribing rates within each home, and the home characteristics were described. The proportion of residents who transferred out of LTC in the last 14 days of life was also determined, as another quality measure. RESULTS: We identified 10,038 decedents in 117 LTC homes. Among LTC decedents, 16.9% were prescribed ≥1 injectable end-of-life medication and 44.9% were prescribed at least one end-of-life medication by any route of administration, within the last 14 days of life. Across prescribing quintiles, there were no associations with transfer rates prior to death. Comparing Alberta to Ontario, there were markedly lower rates of injectable medicine prescribing (16.9% vs. 64.7%). Potential reasons and data limitations were explored. CONCLUSIONS: Rates of injectable end-of life medication prescribing differed across Alberta LTC homes; however, current provincial data limitations impact the validity of using these rates as a comparative indicator of the quality of end-of-life care.
The COVID-19 Pandemic and Dementia: a Multijurisdictional Meta-Analysis of the Impact of the First Two Pandemic Waves on Acute Health-care Utilization and Mortality in Canada.
Cetin-Sahin D, Godard-Sebillotte C, Bronskill SE … +20 more , Seitz D, Morgan DG, Maclagan LC, Sourial N, Quail J, Gruneir A, Wilchesky M, Rochette L, Massamba VK, Youngson E, Diong C, Smith EE, Arsenault-Lapierre G, Le Berre M, Maxwell CJ, Kosteniuk J, Bosson-Rieutort D, Wang T, Miskucza K, Vedel I
Can Geriatr J · 2025 Mar · PMID 40051596 · Full text
BACKGROUND: Previous studies on the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons living with dementia (PLWD) were mostly conducted in a single jurisdiction or focused on a limited number of outco...
BACKGROUND: Previous studies on the impact of the coronavirus disease 2019 (COVID-19) pandemic on persons living with dementia (PLWD) were mostly conducted in a single jurisdiction or focused on a limited number of outcomes. Our study estimates the impact of the first two pandemic waves on emergency department (ED) visits (all-cause/ambulatory care sensitive conditions), hospitalizations (all-cause/30-day readmissions), and all-cause mortality in four Canadian jurisdictions. METHODS: Using administrative databases from Alberta, Ontario, Saskatchewan, and Quebec, we assembled two closed retrospective cohorts (2019/pre-pandemic control and 2020/pandemic) of PLWD aged 65+. Within community and nursing home settings, the rates of the above-mentioned outcomes in three pandemic periods (first wave, interim period, second wave) were compared to the corresponding pre-pandemic periods. We performed random effects meta-analyses on the provincial incident rate ratios. RESULTS: Pre-pandemic and pandemic cohorts included 167,095 vs. 173,240 (community) and 93,374 vs. 92,434 (nursing home) individuals, respectively. During the first wave, community and nursing home populations experienced significant declines in the rates of all-cause ED visits (36% vs. 40%) and hospitalizations (25% vs. 22%), which persisted in the following periods in the community. These declines were greater for the rates of ambulatory care sensitive condition ED visits and 30-day readmissions. Mortality was 36% higher in nursing homes (first wave) and 13% higher in the community (second wave). CONCLUSIONS: It is key to prepare for future health crises and ensure that PLWD receive necessary care and services and do not have such a high mortality rate. Attention should be equally given to PLWD living in their homes and nursing homes.
Laboratory Test Use and Values in the Last Year of Life-a Matched Cohort Design.
Roberts RL, Imsirovic H, Talarico R … +7 more , Li W, Carrington A, Patel K, Manuel D, Tanuseputro P, Hawken S, Webber C
Can Geriatr J · 2025 Mar · PMID 40051595 · Full text
BACKGROUND: As individuals approach death, they experience declines in their cognitive, physical, motor, sensory, physiologic, and psychosocial functions. In this exploratory study we examined individuals' physiologic ch...
BACKGROUND: As individuals approach death, they experience declines in their cognitive, physical, motor, sensory, physiologic, and psychosocial functions. In this exploratory study we examined individuals' physiologic changes in the last year of life by examining laboratory tests commonly used in clinical practice. METHODS: Using health administrative datasets, we conducted an observational matched cohort study to assess laboratory test use and values over a decedent's last 12 months and a matched observation window for non-decedents. Laboratory tests included tests for electrolytes: potassium and sodium; complete blood count: hemoglobin and leukocytes; diabetes: hemoglobin A1c; and kidney or liver function: albumin-serum, alanine aminotransferase, and creatinine. RESULTS: We identified 376,463 decedents, 367,474 (97.6%) of whom were matched to non-decedents (similar age and sex). For each test, the proportion of non-decedents who received the test was stable over the 12-month observation period. A higher proportion of decedents had a laboratory test than non-decedents for all but the diabetes test. As decedents neared death, there was a gradual increase in test use until their final month of life, when test use dramatically increased. Across all laboratory tests, test values remained similar for non-decedents over the 12-month observation period. However, for decedents, there were differences in the magnitude and direction of the test values over the 12 months. CONCLUSION: Our findings indicate distinct changes in decedents' laboratory test use and values over their last 12 months. Future work should explore whether laboratory tests could predict survival or improve the performance of mortality prediction models.
Understanding Local Consultation Patterns of Inpatient Geriatric Medicine Teams: a Cross-Sectional Study.
Reich KM, Watt J, Li B … +2 more , Jiang J, Goodarzi Z
Can Geriatr J · 2025 Mar · PMID 40051593 · Full text
BACKGROUND: Geriatric consultation for Comprehensive Geriatric Assessment (CGA) improves outcomes of older adults living with frailty who are hospitalized, but consultation patterns and utilization of inpatient geriatric...
BACKGROUND: Geriatric consultation for Comprehensive Geriatric Assessment (CGA) improves outcomes of older adults living with frailty who are hospitalized, but consultation patterns and utilization of inpatient geriatric consultation teams by other hospital-based services are poorly understood. METHODS: We conducted a cross-sectional study using linked health administrative data to describe characteristics of older adults (≥ 65 years) who received a CGA while hospitalized between January 1, and December 31, 2019. We identified hospital-based services requesting CGA and the frequency and reasons for referral. We used multivariable logistic regression to estimate the association between patient-level characteristics and receiving a CGA. RESULTS: A total of 29,090 older adults were admitted to hospital; 38.7% were classified as frail and 5.4% (1,563 patients) received at least one CGA. The top three reasons for requesting a CGA were to assess the need for care on an inpatient geriatric rehabilitation unit (43%), and for assessment and management of delirium (27%) and dementia (24%). Referrals were most frequently received from Hospitalists (48%). Frailty was associated with increased odds of receiving a CGA (adjusted odds ratio [aOR] 12.02; 95% confidence interval [CI] 9.67-14.82). A diagnosis of cancer was associated with lower odds of receiving a CGA (aOR 0.75; 95% CI 0.60-0.93). CONCLUSIONS: Inpatient geriatric consultation teams support 5.4% of hospitalized older adults. With the rapidly growing aging population, future efforts are needed to explore the optimal delivery of inpatient geriatric services to support its sustainable provision.
Assessing Cognition Remotely: Expanding the Reach of Cognitive Testing for Older Adults at Risk for Dementia in a Randomized Controlled Trial.
Steeves A, Faig K, McGibbon C … +2 more , Sexton A, Jarrett P
Can Geriatr J · 2025 Mar · PMID 40051592 · Full text
Little is known about whether cognitive assessments can be completed remotely by older adults at risk for dementia, and there is no consensus on which tool is best. The SYNchronising Exercises, Remedies in GaIt and Cogni...
Little is known about whether cognitive assessments can be completed remotely by older adults at risk for dementia, and there is no consensus on which tool is best. The SYNchronising Exercises, Remedies in GaIt and Cognition at Home (SYNERGIC@Home) study evaluated the feasibility of a home-based, double-blind, randomized-controlled trial to improve gait and cognition in individuals at risk for dementia. This paper reports a secondary analytic outcome of the cognitive tests used. The three aims were: 1) to examine whether the Montreal Cognitive Assessment (MoCA 8.1 Audiovisual), Cognitive-Functional Composite2 (CFC2), and Telephone Cognitive Screen (T-CogS) could be administered remotely; 2) to compare each tool; 3) to evaluate changes in cognition following the intervention. Sixty participants were randomized to one of four physical/cognitive exercise intervention arms, with 52 participants completing the intervention. Cognitive tests were done in the homes of participants via Zoom for Healthcare™. All 52 participants completed the assessments. The interquartile range (IQR) for the MoCA was 4, the CFC2 was 8, and the T-CogS was 1. At baseline, 11.5% scored perfectly on the MoCA, 0% scored perfectly on the CFC2, and 62% scored perfectly on the T-CogS. Scores on the MoCA (=.076), CFC2 (=.053), and T-CogS (=.281) were not statistically significantly different from baseline to post-intervention. This study demonstrates that these cognitive tests can be administered remotely, with the MoCA and the CFC2 being the most sensitive to variability in scores.
Virtual Goals of Care Consultation for Advanced Frailty: a Qualitative Implementation Study Providing Insights from the Pandemic.
Shetty N, MacLeod T, Miller AP … +5 more , Buckler M, Mallery L, Krueger-Naug AM, von Maltzahn M, Moorhouse P
Can Geriatr J · 2025 Mar · PMID 40051591 · Full text
BACKGROUND: During the COVID-19 pandemic, long-term care (LTC) facilities faced challenges in establishing appropriate goals of care (GoC) for residents during health crises. To address this, a virtual specialist consult...
BACKGROUND: During the COVID-19 pandemic, long-term care (LTC) facilities faced challenges in establishing appropriate goals of care (GoC) for residents during health crises. To address this, a virtual specialist consultation program was implemented to align care interventions with residents' frailty and expected outcomes. METHODS: We explored barriers and enablers to the implementation and sustainability of the program using structured interviews (n=20) with LTC leadership, health-care staff, and members of the program. Data were coded according to the constructs of the Consolidated Framework for Implementation Research (CFIR) using thematic analysis. RESULTS: Participants described how the program improved care and reduced unnecessary transfers. Implementation was enabled by a high degree of tension for change, relative priority, relative advantage, and the team's shared mental model of frailty-care. Inconsistencies in GoC approaches and information silos between LTC and acute-care challenged implementation. Sustainability was hindered by decreased pandemic urgency, resulting in reallocation of resources to usual care. The need for a specialized GoC service in LTC became less obvious outside of a crisis. CONCLUSIONS: This implementation study provides important insights for future spread and scale of embedding virtual specialist consultation services into LTC. The findings underscore the importance of collegial relationships and shared care philosophies to effectively implement frailty-informed care initiatives during crises. However, sustaining cross-sectoral GoC services may be challenging amidst evolving workloads and prevailing cultural perceptions of end-of-life care needs.
The Canadian Coalition for Seniors' Mental Health Canadian Clinical Practice Guidelines for Assessing and Managing Behavioural and Psychological Symptoms of Dementia (BPSD).
Hatch S, Seitz DP, Bruneau MA … +14 more , Ewa V, Feldman S, Goldberg Y, Goodarzi Z, Herrmann N, Colborne DH, Henri-Bhargava A, Ismail Z, Kirkham J, Kumar S, Lanctôt KL, Thompson W, Porter J, Watt JA
Can Geriatr J · 2025 Mar · PMID 40051590 · Full text
In Canada, approximately 730,000 people are currently living with dementia. Over 75% will experience behavioural and psychological symptoms of dementia (BPSD). There is a lack of consensus on best practices for the asses...
In Canada, approximately 730,000 people are currently living with dementia. Over 75% will experience behavioural and psychological symptoms of dementia (BPSD). There is a lack of consensus on best practices for the assessment and management of BPSD. In 2024, the Canadian Coalition for Seniors Mental Health (CCSMH) developed a Clinical Practice Guideline (CPG) for assessing and managing BPSD, specifically for agitation, depression, anxiety, psychosis, and sexual expressions of potential risk, and deprescribing antipsychotics and psychotropic medications. Development of the BPSD CPG followed the Guideline International Network (GIN)-McMaster Guideline Development checklist. The guideline is intended for people living with dementia, caregivers of people living with dementia, and health-care providers in community, outpatient, inpatient, long-term care, and other residential care settings. Recommendations were informed by a Canada-wide prioritization exercise to identify CPG topics and preferred terms for describing BPSD. A systematic review of existing dementia CPGs, an overview of systematic reviews on assessing and managing BPSD, and systematic reviews of tools for measuring psychosis, anxiety, and depressive symptoms in people living with dementia was undertaken, along with a rapid review of studies of pharmacologic and nonpharmacologic interventions for reducing sexual expressions of potential risk in people living with dementia. Guideline panel members voted on recommendation strength and quality of evidence, per the Grading of Recommendations, Assessment, Development, and Evaluations approach. This CPG resulted in 11 good practice statements and 63 guideline recommendations that will inform BPSD best practices in a Canadian health-care context.
To What Extent are Alberta Nursing Homes and Supportive Living Facilities Integrated with Their Community? A Sequential Quantitative-Qualitative Study.
Gao MC, Rajabali S, Wagg A
Can Geriatr J · 2025 Mar · PMID 40051589 · Full text
BACKGROUND: Nursing homes and supportive living facilities (continuing care homes [CCH]) are often regarded as separate from their communities. Although occasional studies highlight volunteering or intergenerational acti...
BACKGROUND: Nursing homes and supportive living facilities (continuing care homes [CCH]) are often regarded as separate from their communities. Although occasional studies highlight volunteering or intergenerational activities, there is little systematic evaluation of the existence of activities in CCH that may promote community integration. METHODS: Study Design: The study utilized a sequential quantitative-qualitative approach: cross-sectional survey followed by semi-structured interviews. Setting: All registered long-term care (nursing home) and supportive living facilities (Levels 3, 4, and 4 Dementia) within Alberta. Subjects: The survey and interviews were conducted with directors of care. The survey was distributed to 334 facilities. Data saturation in the interviews was reached with seven participants. RESULTS: 140 responses were received; 116 were analyzable (34.7% response rate). The range of activities varied widely. Prior to Covid-19, the most common were spiritual activities entering CCH (96.5%) and volunteers entering CCH (93.0%); CCH rarely had activities such as child daycare (5.2%). 12.9% of spiritual activities entering CCH had not been restarted following the pandemic, but homes were planning to restart this activity (16) or start it as a new activity (1). There was no statistically significant relationship between any activity and facility owner-operator model, size, type, or geography (urban/rural) at any survey time category. Four themes emerged from the interviews: resident quality of life and well-being, home's capacity and openness, sources of support, and planning and programming for implementation. CONCLUSIONS: This study addresses a knowledge gap regarding community integration in CCH and provides insight on the types of community-integrated activities occurring in Alberta's CCH.
Neuropsychiatric Symptoms and Psychotropic Medication Use Following SARS-Cov-2 Infection Among Elderly Residents in Long-Term Care Facilities.
Cruz-Santiago D, Meng X, Canac-Marquis M … +6 more , Sengupta A, Brassard JP, Pavey E, Girouard H, Vinh DC, Gouin JP
Can Geriatr J · 2025 Mar · PMID 40051588 · Full text
BACKGROUND: SARS-CoV-2 infection can lead to persistent post-acute neuropsychiatric symptoms. Older adults with multimorbidity may be at increased risk of post-acute symptoms after COVID-19. The goals of the present stud...
BACKGROUND: SARS-CoV-2 infection can lead to persistent post-acute neuropsychiatric symptoms. Older adults with multimorbidity may be at increased risk of post-acute symptoms after COVID-19. The goals of the present study were to assess the associations of SARS-CoV-2 infection with neuropsychiatric symptoms and psychotropic medication prescription among older adults living in long-term care facilities. METHODS: Nursing home residents (n=111) participated in this three-month longitudinal study. Nurse ratings of neuropsychiatric symptoms were conducted at baseline and at the three-month follow-up. SARS-CoV-2 infection status and psychotropic medication prescription were extracted from a medical chart review. RESULTS: About 73.9% of participants were infected with SARS-CoV-2 on average 480.49 (SD= 228) days before study enrollment. There were no significant changes in neuropsychiatric symptoms during the study follow-up period. Participants with a SARS-CoV-2 infection had more agitation compared to those who were never infected. However, this effect disappeared after adjusting for age, sex, history of psychiatric disorder, neurocognitive status, and multimorbidity. Participants with SARS-CoV-2 had a higher number of psychotropic medication prescription. This effect was driven by increased use of antidepressants and antipsychotic medications. CONCLUSION: Both acute and short-term neuropsychiatric symptoms associated with COVID-19 may contribute to long-term psychoactive polypharmacy among older adults living in long-term facilities.
Unmet Health Care Needs Among Older People in Canada: Does Household Food Insecurity Matter?
Antabe R, Sano Y, Kyeremeh E … +1 more , Amoak D
Can Geriatr J · 2024 Dec · PMID 39619384 · Full text
BACKGROUND: Canada is undergoing a demographic shift, with projections indicating that over 25% of the country's population will be 65 years or older by 2063. While this has raised critical concerns about Canada's prepar...
BACKGROUND: Canada is undergoing a demographic shift, with projections indicating that over 25% of the country's population will be 65 years or older by 2063. While this has raised critical concerns about Canada's preparedness to meet the social and health-care needs of an aging population, the increasing incidence of food insecurity is particularly affecting vulnerable groups, such as older Canadians, with implications for their health-care service utilization. Despite this observation, there are nascent studies examining the role of household food insecurity status on unmet health-care needs among older people in Canada. The main objective of our study is to assess the association between household food insecurity and unmet health-care needs among older Canadians. METHODS: We used data from a selected sample of 21,178 participants as part of the 2017-18 Canadian Community Health Survey and applied logistic regression analysis. RESULTS: Our findings indicate that older people experiencing any type of food insecurity, that is, either moderate (OR=3.07, <.01) or severe (OR=4.09, <.01) were more likely to have reported unmet health-care needs compared to their counterparts in food secure households, even after controlling for a range of demographic, socioeconomic, and health and health-care variables. Our finding is concerning, considering that older people in Canada who are in most need of health-care services due to their food insecurity status are instead reporting unmet health-care needs. CONCLUSION: This revelation calls for urgent policy attention to reduce the episodes of household food insecurity among older people in Canada. Specifically, to improve their access to health-care services, providing them with periodic grocery rebates as part of the social protection package for seniors in Canada would help mitigate the problem of food insecurity among them.
Balancing Patients' Eating Habits with Planetary Health-Pilot Study to Decrease Food Waste with Vegetarian Lunches using a Quality Improvement Approach.
Wong EM, Maclean S
Can Geriatr J · 2024 Dec · PMID 39619383 · Full text
BACKGROUND: Patient health is greatly impacted by increased likelihood of malnutrition if food is not consumed. Food waste also contributes to greenhouse gas emissions and may be possibly reduced by offering vegetarian f...
BACKGROUND: Patient health is greatly impacted by increased likelihood of malnutrition if food is not consumed. Food waste also contributes to greenhouse gas emissions and may be possibly reduced by offering vegetarian food options. Therefore, a Plan-Do-Study-Act intervention of "Vegetarian Week" was conducted in an urban geriatric rehabilitation unit. METHOD: Food waste was measured using the Visual Estimation Method, and the proportion of waste before and after the intervention was compared using a two-tailed -test. Surveys assessed patients' attitudes towards vegetarian meals. RESULTS: Study population was of 54 (2022) and 65 (2023) patients with the majority being male (62.5%), average age 74.5 years, average length of stay 33 days. Comparing pre- and post-intervention periods, overall food wastage increased at: breakfast (22% to 32%), lunch (22% to 32%), and dinner (20% to 25%) with values <.001. Considering lunch entrées only, wastage increased from 17% to 38%, with vegetarian entrees wasted (46%) more than non-vegetarian ones (34%). Vegetarian patients wasted (37%) as much as non-vegetarians (39%). Survey response rate pre-PDSA was 45%, with most patients (76%) reporting eating an omnivorous diet, a prior awareness of personal and planetary health benefits of vegetarian diets (59%), and previously trying vegetarian dishes (62%). Post-PDSA survey response rate was lower (22%) with 57% not willing to try vegetarian dishes again. CONCLUSION: Through evaluation of the patient food experience with Visual Estimation Method and surveys, the very complex issue of food satisfaction was explored in older adults. Although food waste was not decreased during this "Vegetarian Week" pilot, improving patient and planetary health requires ongoing efforts.
Exploring the Priorities of Older Adults in Managing Urinary Incontinence: a Patient-Oriented Research Approach.
Kirillovich M, Rajabali S, Wagg A
Can Geriatr J · 2024 Dec · PMID 39619382 · Full text
INTRODUCTION: Urinary incontinence (UI), the complaint of involuntary leakage of urine, has a substantial impact on the quality of life of older adults. Most UI research is driven by researchers and lacks the patient per...
INTRODUCTION: Urinary incontinence (UI), the complaint of involuntary leakage of urine, has a substantial impact on the quality of life of older adults. Most UI research is driven by researchers and lacks the patient perspective. The goal of this qualitative study was to gain the perspective of older adults in formulating a research agenda tailored to address their questions and improve their experience with managing UI. METHODS: Implementing a community-based participatory research framework, an advisory group of eight older adults with UI were recruited to be on the research team. An initial focus group was conducted to learn about their research needs. Nominal Group Technique was used to reach saturation of themes and data was analyzed thematically. Employing a Delphi consensus method, a national online questionnaire containing 20 priorities for future UI research and education was developed in collaboration with the advisory group. RESULTS: 59 older adults with UI rated each priority on a Likert scale. Priorities which advanced to the second round were re-rated, with an 85% response rate. 11 priorities of ≥80% agreement were retained. The highest rated priorities included relationship between physical activity and UI; support for those with UI; causes of UI and its management; sleep and UI; and public restroom accessibility. CONCLUSIONS: Findings from this study will help researchers and health-care professionals understand and address the needs of older adults with UI. Efforts should be made to translate research findings in this area and disseminate them in a medium accessible to older adults.
Effectiveness of the Sub-Acute Care for Frail Elderly (SAFE) Transitional Care Unit on Short-Term Functional Independence in Frail Older Patients Discharged from Hospital.
Robert B, Sun AH, Sinden D … +3 more , Eddeen AB, Murmann M, Hsu AT
Can Geriatr J · 2024 Dec · PMID 39619381 · Full text
BACKGROUND: Transitional care programs help improve continuity of care and post-discharge outcomes for frail older adults who are hospitalized. In this study, we examined the effectiveness of a transitional care model, b...
BACKGROUND: Transitional care programs help improve continuity of care and post-discharge outcomes for frail older adults who are hospitalized. In this study, we examined the effectiveness of a transitional care model, based in a long-term care (LTC) home, on the functional independence of older hospitalized patients post-discharge. METHODS: We used a propensity-score matched cohort, whereby cases comprised patients who were admitted to a transitional care program-called the Sub-Acute Care for Frail Elderly (SAFE) Unit-following a hospitalization between March 1, 2018 and June 30, 2019. Controls were matched to Usual Care patients discharged from hospitals within the same health region and accrual period who did not receive transitional care in the SAFE Unit. Outcomes included acute care, LTC, and home care use within six-month post-discharge. RESULTS: Compared to Usual Care, SAFE Unit patients were less likely to be admitted into an LTC home (RR 0.44, 95% CI 0.23-0.86) within six months post-discharge. Additionally, on average, SAFE Unit patients spent 34 fewer days in LTC homes than controls. SAFE Unit patients also incurred significantly fewer home care service days (median: 52 days, IQR: 12-132 days) than Usual Care patients (median: 65.5 days, IQR: 19-158 days), particularly in terms of their reliance on general nursing and personal support. Both groups had similar risks of six-month hospital readmission and having an ED visit. CONCLUSION: Rehabilitative and restorative-focused care provided through transitional programs, such as the SAFE Unit, have the potential to enable independent living for older hospitalized patients discharged to the community.
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