Canadian Geriatrics Journal[JOURNAL]
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200 papers
"How Can We Help You?" Older Adults' and Care Partners' Perspectives on Improving Care in Hospital: A Mixed Methods Study.
Lupo M, Wong E, Reppas-Rindlisbacher C … +3 more , Lee J, Gabor C, Patterson C
Can Geriatr J · 2024 Dec · PMID 39619380 · Full text
BACKGROUND: Hospitalized older adults have unique physical, emotional, and psychosocial needs. We sought to understand older patients' and care partners' experiences with multicomponent interventions that support age-fri...
BACKGROUND: Hospitalized older adults have unique physical, emotional, and psychosocial needs. We sought to understand older patients' and care partners' experiences with multicomponent interventions that support age-friendly care and identify areas for improvement. METHODS: We conducted a mixed methods study using surveys and interviews to explore older adult patients' (65 years or older) and their care partners' experiences with hospital-delivered multicomponent initiatives. We recruited participants from the Geriatric Rehabilitation (GRU) and Musculoskeletal (MSK) Rehabilitation units in a Canadian academic hospital from October 2021 to April 2022 until we reached data saturation and no new themes emerged. RESULTS: We recruited 18 participants, 10 patients (mean age 78 years, 80.0% female) and 8 care partners (mean age 61, 87.5% female). Surveys revealed overall positive experiences with multicomponent interventions. Interviews revealed five themes: 1) various forms of companionship for patients, 2) recreation and entertainment, 3) physical activity, 4) communication, and 5) pleasant physical environment. Having forms of companionship and proper communication with the care team were highlighted as areas of importance. Physical activity was highly valued, but participants expressed hesitation around safety of mobilizing without physiotherapists. Recreational activities helped distract from social isolation during a hospital stay and participants had diverse preferences for activities. Participants had strong memories of the physical environment, including the lack of natural light, institutionallike décor, and smells. CONCLUSION: Companionship, recreation and entertainment, physical activity, communication, and the physical environment were important to hospitalized patients and their care partners. Hospital administrators and policy makers should consider these when targeting areas to improve care for the aging population.
New Disability in a Cohort Study of Older Men-The Manitoba Follow-Up Study.
St John PD, Nowicki S, Tate RB
Can Geriatr J · 2024 Dec · PMID 39619379 · Full text
BACKGROUND: There is a large literature on the prevalence of disability in older men, but less data on the incidence of new disability. OBJECTIVES: 1. To determine the incidence of moderate-to-severe disability in a pros...
BACKGROUND: There is a large literature on the prevalence of disability in older men, but less data on the incidence of new disability. OBJECTIVES: 1. To determine the incidence of moderate-to-severe disability in a prospective cohort study of aging men; and 2. To determine predisposing risk factors for new moderate to severe disability. DESIGN & SETTING: The Manitoba Follow-up Study is a closed cohort study. In 1948, the initial sample was 3,983 men who qualified for air crew training in the Royal Canadian Air Force. In 2004, there were 796 men who were still alive and responded to the annual questionnaire with no missing data, and who did not have disability. The mean age at that time was 84. METHODS: We calculated the incidence of new moderate-to-severe disability from 2004 to 2017, calculated the time to disability, and constructed survival analysis models to determine factors which predicted disability. RESULTS: The incidence of disability increased with the aging of the cohort and ranged from 4% to 12% per year. In unadjusted models, poor self-rated health (SRH), low life satisfaction, a low score on the Physical Component Score (PCS) of the Short Form-36, and the number of chronic conditions were all associated with new disability. In adjusted models, SRH, the PCS, and the number of chronic conditions were associated with new disability. CONCLUSIONS: Global measures of well-being, as well as multimorbidity, predict new disability.
Relationship Between Perioperative Medication and Prolonged Postoperative Hospital Stay in Older Adults with Spinal Surgery: a Retrospective Cohort Study.
Shen J, Yan S, Chhetri JK … +6 more , Chu Y, Wang P, Feng S, Wang T, Wang C, Zhao G
Can Geriatr J · 2024 Dec · PMID 39619378 · Full text
BACKGROUND: Older people are prone to multiple chronic diseases and, as a result, require multiple medications. At present, there is no study to verify whether the use of high-risk perioperative medications (HRPOMs) will...
BACKGROUND: Older people are prone to multiple chronic diseases and, as a result, require multiple medications. At present, there is no study to verify whether the use of high-risk perioperative medications (HRPOMs) will adversely affect postoperative outcomes in the relatively old patient. In this study, we aimed to analyze the risks of HRPOMs for prolonged length of hospital stay (LOS) in advanced-aged (≥ 75 years) patients undergoing spinal surgery. METHODS: Medical records of advanced-aged patients who underwent spinal surgeries were retrospectively reviewed. Patients were divided into those who had prolonged LOS (≥ eight days) versus those who did not (< eight days). The demographics, medical comorbidities, and perioperative medications were analyzed. Univariate and multivariate regression were used to determine perioperative risk factors for prolonged LOS. RESULTS: A total of 268 patients were included with a median age of 79 years (interquartile range [IQR]=76, 82) and 127 (47.4%) patients had a prolonged LOS. In multivariate logistic analysis, higher body mass index (odds ratio [OR] = 1.116; 95% CI, 1.031-1.209), operation time (OR) = 1.009; 95% CI, 1.005-1.012), and number of postoperative HRPOMs (OR= 1.910; 95% CI, 1.464-2.492) were identified as independent predictors for prolonged LOS. The use of metformin was associated with lower likelihood of prolonged LOS in diabetic patients (OR = 0.365; 95% CI, 0.157-0.846). CONCLUSION: Our results indicate that the higher number of postoperative HRPOMs, rather than a specific HRPOMs type, is a risk factor for prolonged LOS. The continued preoperative use of metformin in patients with diabetes has a positive impact on the postoperative outcomes.
Determinants of First Practice Location among Canadian Geriatric Medicine Trainees and Recent Graduates: Findings of a Cross-sectional Survey in 2023.
Mah JC, Kanagalingam T, Best S … +7 more , Elhayek S, Thain J, Morais JA, Lamarre M, Bhangu J, Borrie MJ, Sirisegaram L
Can Geriatr J · 2024 Dec · PMID 39619377 · Full text
BACKGROUND: There is a projected and growing gap of geriatricians in Canada. Geriatricians play a crucial role in addressing the health needs of older adults. We aimed to understand the factors that influence the choice...
BACKGROUND: There is a projected and growing gap of geriatricians in Canada. Geriatricians play a crucial role in addressing the health needs of older adults. We aimed to understand the factors that influence the choice of first-practice location for new geriatricians in the context of an aging Canadian population. METHODS: We distributed an online survey to geriatric medicine subspecialty residents and recently licensed geriatricians in Canada. The survey was developed through expert opinions, career planning sessions, and a literature review. There were nine survey sections: general characteristics, location determinants, practice determinants, colleague determinants, support and space, non-clinical opportunities, income models, lifestyle factors, and recruitment determinants. The data were analyzed descriptively. RESULTS: A total of 61 respondents (51 English, 10 French) completed the survey. The respondents were new practicing geriatricians (37) and geriatric medicine residents (24). Most planned to practice in Ontario (26.2%) or Quebec (27.9%), and 75.4% were women. Flexibility in work-life balance (95.1%), collegiality (93.4%) and reasonable call schedules (93.4%) were the most important factors influencing first practice location. Income did not rank among the highest priorities for choosing the first practice location relative to other factors but was mentioned in open-ended responses to recruitment questions. CONCLUSIONS: This is the first survey identifying the determinants of first practice location in geriatric medicine in Canada. Work-life balance and collegial support are a priority for new geriatricians and may be the strongest incentives a program can provide. For recruitment, income incentives may be beneficial to building new specialized geriatric services. Future research will examine determinants of first practice location among Care of the Elderly clinicians.
Canadian Clinical Guidelines on Social Isolation and Loneliness in Older Adults.
Conn DK, Billard T, Dupuis-Blanchard S … +6 more , Freedman AK, Hoang PM, Levasseur M, Newall NE, Sullivan MP, Wister AV
Can Geriatr J · 2024 Dec · PMID 39619376 · Full text
BACKGROUND: Preventing and addressing social isolation and loneliness among older adults is important because of the known associations with negative health outcomes. The Canadian Coalition for Seniors' Mental Health (CC...
BACKGROUND: Preventing and addressing social isolation and loneliness among older adults is important because of the known associations with negative health outcomes. The Canadian Coalition for Seniors' Mental Health (CCSMH) took on the task of creating clinical guidelines. METHOD: A multidisciplinary working group was established. The process was guided by an initial rapid scoping review of the literature focused on older adults. An adapted GRADE approach was utilized. RESULTS: CCSMH has produced first-ever clinical guidelines on social isolation and loneliness in older adults. Prevention, including recognition of risk factors and educational approaches focused on clinicians and students, is recommended. Targeted screening with validated tools is recommended. A comprehensive assessment is optimal to treat any underlying conditions and to identify contributing factors that may be responsive to psychosocial interventions. An individualized approach to interventions with shared decision-making is recommended. A variety of possible interventions include social prescribing, social activity, physical activity, psychological therapies, animal-assisted therapies and ownership, leisure skill development and activities, and the use of technology. CONCLUSION: The problem of social isolation and loneliness is a "geriatric" giant that needs to be recognized and addressed. Because of its complexity, it will require the collective attention of many individuals and organizations working together at multiple levels of society, to raise awareness and find solutions. We recommend that health-care and social service providers use these guidelines as a comprehensive tool to identify, assess, and implement strategies to reduce the negative impact of social isolation and loneliness.
Alternate Level of Care Patients in Canada: a Scoping Review.
Maisonnave M, Rajabi E, Taghavi M … +1 more , VanBerkel P
Can Geriatr J · 2024 Dec · PMID 39619375 · Full text
BACKGROUND: There has been increasing concern over the growing number of Alternate Level of Care (ALC) patients in Canada who must wait in hospitals for more appropriate settings to meet their needs. ALC patients may hav...
BACKGROUND: There has been increasing concern over the growing number of Alternate Level of Care (ALC) patients in Canada who must wait in hospitals for more appropriate settings to meet their needs. ALC patients may have to stay in hospitals for days or months due to a lack of available long-term care capacity, home care services, or other discharge routes. METHOD: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) method to review 35 papers on the topic of ALC patients and delayed discharge in Canada from different perspectives, including (1) the shared characteristics of ALC patients in Canada; and (2) their impact on the Canadian health-care system, medical staff, and family members. Furthermore, from the reviewed works, (3) we also investigate the factors that impact the length of the hospital stays. RESULTS: We highlighted how the ALC problem is increasing healthcare costs, disrupting services, increasing waiting times, and compromising access to valuable resources. We found evidence suggesting that this far-reaching crisis affects the patients, their families, and the medical personnel. We discovered several logistical issues (such as access to long-term care) affecting the patient's hospital length of stay. CONCLUSIONS: Our research contributes to understanding this intricate problem, and helps policymakers take steps to tackle this challenge to ensure timely and appropriate care for all patients.
COVID-19-Associated Outcomes of Critical Illness in Patients with Frailty: a Cohort Study.
Montgomery CL, Davenport A, Milovanovic L … +3 more , Bagshaw SM, Rolfson DB, Rewa OG
Can Geriatr J · 2024 Sep · PMID 39234285 · Full text
BACKGROUND: Pre-admission frailty has been associated with higher hospital mortality in patients with critical illness. We aimed to measure the prevalence of frailty and its associated outcomes in patients with COVID-19...
BACKGROUND: Pre-admission frailty has been associated with higher hospital mortality in patients with critical illness. We aimed to measure the prevalence of frailty and its associated outcomes in patients with COVID-19 critical illness. METHODS: A historical cohort study of all adults admitted to ICU with a pneumonia diagnosis in Alberta, Canada between May 1, 2020, and October 31, 2020. At ICU admission patients were routinely assessed for frailty using the Clinical Frailty Scale (CFS). Frailty was defined as a CFS score ≥5. Primary outcomes were pre-admission frailty prevalence and hospital mortality. RESULTS: The cohort (n=521) prevalence of frailty was 34.2% (n=178), mean (SD) age was 58.8 (14.9) years, APACHE II 22.8 (8.0), and 39.5% (n=206) were female. COVID-19 pneumonia was diagnosed in (19.0%; n=99) admissions; pre-admission frailty was present in 20.2% (n=20) vs. 79.8% (n=79) non-frail (<.001). Among ICU patients admitted with COVID-19, hospital mortality in frail patients was 35.4% (n=63) vs. 14.0% (n=48) in non-frail (<.001). CONCLUSION: Pre-admission frailty was present in 20.2% of COVID-19 ICU admissions and was associated with higher risk of hospital mortality. Frailty assessment may yield valuable prognostic information when considering COVID-19 ICU admission; however, further study is needed to identify effect on patient-centred outcomes in this heterogeneous population.
The Association Between the Presence of Medical Care and Resident Outcomes in Canadian Nursing Homes: a Retrospective Cross-Sectional Analysis.
Bali K, Wagg A, Murphy R … +1 more , Gruneir A
Can Geriatr J · 2024 Sep · PMID 39234284 · Full text
The quality of medical care provided to older residents in nursing homes may depend upon available staffing models; this study examined the relationship between physician and nurse practitioner (NP) presence, care involv...
The quality of medical care provided to older residents in nursing homes may depend upon available staffing models; this study examined the relationship between physician and nurse practitioner (NP) presence, care involvement, and resident outcomes. The secondary analysis of data collected in the Translating Research in Elder Care (TREC) study during 2019-20 included items on daily presence of physicians and NPs on units, physician involvement in care planning, and ability to contact physician or NP when necessary linked to routinely collected Resident Assessment Instrument-Minimum Data Set version 2.0 data. Eight logistic regression models tested the association between measures of staffing involvement and each outcome (antipsychotic use without indication (APM), physical restraint use, hospital transfers, and polypharmacy). The sample consisted of 10,888 residents across 320 care units in 90 facilities. Of the units, 277 (86%) reported a physician or NP visited daily, 160 (72.1%) reported that the physician was involved in care planning, and 318 (99%) units reported that the physician or NP could be reached when needed. Following adjustment for multiple confounding variables, there were no statistically significant associations between presence/involvement of medical professionals and resident outcomes (for example, physician or NP presence on the unit and hospitalization transfers [AOR=1.17, 95% CI: 0.46-3.10] or polypharmacy [AOR=1.37, 95% CI: 0.64-2.93]). We found non-significant associations between medical staff presence and involvement and selected resident outcomes, suggesting either the presence of many unaccounted for confounding inter-related resident-care provider variables or underlying insensitivity of the available data.
Canadian Inpatient Orthogeriatric Models of Care: A Mixed Methods Survey of Facilitators and Barriers.
Trafford D, Liu Y, Papaioannou A … +2 more , Ioannidis G, Thain J
Can Geriatr J · 2024 Sep · PMID 39234283 · Full text
BACKGROUND: Fragility fractures are a serious and common consequence of falls in older adults. Orthogeriatric models of care reduce mortality and morbidity, but, despite this evidence, orthogeriatric programs (OGPs) are...
BACKGROUND: Fragility fractures are a serious and common consequence of falls in older adults. Orthogeriatric models of care reduce mortality and morbidity, but, despite this evidence, orthogeriatric programs (OGPs) are not standardized across Canada. The aim of this study was to better understand the facilitators and barriers of OGPs across Canada. METHODS: Data on OGPs across Canada were gathered via email survey to all Canadian Geriatric Society (CGS) members and distributed April 1st to May 1st 2021. Respondents answered 15 questions, using SKIP LOGIC, and data analysis was conducted with Qualtrics software. RESULTS: 62 CGS members completed the survey. Respondents came from nine provinces/territories, with most being physicians from academic centres. 77% respondents indicated an existing OGP at their site, commonly an optional or automatic geriatrician consult. 23% indicated no formal OGP, of which 56% had an alternative service automatically consulted for older adults with fragility fracture, commonly internal medicine or a hospitalist. Responders indicated the most important factor in establishing an OGP is clinical leadership (56%, 10/18), and the most common barriers are lack of hospital prioritization and lack of funding (41%, 62/153). CONCLUSIONS: The survey found that clinical leadership, hospital prioritization, and available funding are imperative to establishing OGPs. Limitations include the survey being distributed only to CGS members, a lower response rate, and respondents predominantly from academic centres in Ontario. Further qualitative data from other specialties (for example, orthopedics) and greater representation from community hospitals would be helpful to understand additional perceived barriers and facilitators.
Exercise and Language Performance in Healthy Aging, Stroke and Neurodegenerative Conditions: a Scoping Review.
Khalili R, Kehayia E, Roig M
Can Geriatr J · 2024 Sep · PMID 39234282 · Full text
BACKGROUND: While the benefits of exercise on cognitive functions have already been reviewed, little is known about the impact of exercise on language performance. This scoping review was conducted to identify existing e...
BACKGROUND: While the benefits of exercise on cognitive functions have already been reviewed, little is known about the impact of exercise on language performance. This scoping review was conducted to identify existing evidence on exercise-induced changes in language performance in healthy aging individuals and adults with stroke or neurodegenerative conditions. METHODS & RESULTS: Using the Arksey and O'Malley framework, 29 studies were included. Eleven studies in healthy aging indicated enhanced language performance, with 72.72% having significant improvement in semantic/phonological Verbal Fluency (VF) following exercise. Among 18 studies on older adults with stroke or neurodegenerative conditions, 11 reported better language performance, with 44.44% having significant improvement in picture naming/description and semantic/phonological VF by exercise. The seven remaining studies reported no significant change in language performance in persons with stroke or neurodegenerative conditions. CONCLUSION: Overall, exercise interventions showed improvement in language performance in healthy aging, while selective enhancement was shown for language performance in persons with either stroke or neurodegenerative conditions.
Quality of Life Among Hospitalized Fibromyalgia Older Adults: a Case-Control Study.
Fawaz A, Suliman M, Robin M … +6 more , Brikman S, Shabshin N, Novofastovsky I, Egbaria M, Mader R, Bieber A
Can Geriatr J · 2024 Sep · PMID 39234281 · Full text
BACKGROUND: Only few studies addressed the topic of Fibromyalgia Syndrome (FMS) effects on geriatric population quality of life and drug usage. The objective of this study was to demonstrate the significant impact of FMS...
BACKGROUND: Only few studies addressed the topic of Fibromyalgia Syndrome (FMS) effects on geriatric population quality of life and drug usage. The objective of this study was to demonstrate the significant impact of FMS in terms of quality of life (QOL) in geriatric aged patients. METHODS: 80 patients were studied, 40 with FMS according to FMS 2016 classification criteria, and 40 non-FMS controls. The patients were all above the age of 65 years. The FMS and control group completed Widespread Pain Index (WPI) and Symptom Severity Score (SSS). Three questionnaires, Fibromyalgia Impact Questionnaire (FIQ), Short Form (SF-36) Questionnaire, and Health Assessment Questionnaire Disability Index (HAQ-DI) were completed. These with additional medical records were used to classify symptoms and severity in both groups. RESULTS: Fibromyalgia patients demonstrated significant higher disability scores, (FIQ of 79.5 vs. 33.9, <.01, and HAQ-DI of 2.00 vs. 1.00, <.01 for FMS vs. non-FMS, respectively), and lower social functioning in comparison to non-FMS controls (SF-36 of social functioning 0.31 vs. 0.92, <.01 for FMS vs. non-FMS, respectively). The FMS group had a higher use of pain management medications (opioid use of 12 patients vs. 0, <.01, use of non-steroidal anti-inflammatory drugs by 11 FMS patients vs. 4 non-FMS controls, <.01). CONCLUSIONS: Patients with FMS older than 65 years of age demonstrate poorer outcomes and worse symptoms in comparison to matched-aged non-FMS control group. An association was found between FMS and the effect on the quality of life in this population.
Level, Motivation and Barriers to Participate in Physical Activity among Geriatric Population at Ahmedabad City, India: An Epidemiological Factsheet.
Dave VR, Desai NB, Rathod V
Can Geriatr J · 2024 Sep · PMID 39234280 · Full text
OBJECTIVES: To estimate the level of physical activity among geriatric population, to determine the motivating factors for being active and identifying barriers that prevent participants from engaging in physical activit...
OBJECTIVES: To estimate the level of physical activity among geriatric population, to determine the motivating factors for being active and identifying barriers that prevent participants from engaging in physical activity. METHODS: A community-based cross-sectional study was carried out at one of the wards within Ahmedabad city following multi-stage random sampling. The calculated sample size was 230. A pre-designed, validated, short version International Physical Activity Questionnaire (IPAQ) and Behaviour Regulation in Exercise Questionnaire (BREQ-3) were used for data collection by personal interview. From selected sampling-frame, geriatric people residing in every 5th household were interviewed after obtaining oral informed consent following simple-random sampling. RESULTS: Of total 230 study participants, 67 (29.13%) were physically active (cumulative for Category 2 and Category 3), while the remaining 163 (70.87%) were found physically inactive (i.e., minimally active [Category 1]). Motivational scores, particularly in identified regulation, showed higher median scores across subdomains of the BREQ-3. Amotivation exhibited a strong negative correlation with physical activity, while intrinsic regulation displayed a strong positive correlation. CONCLUSION: More than two-third of study participants were physically inactive. Level of educational status, type of previous occupation involved, presence of addiction, BMI, electronic device usage duration per day and presence of chronic illness were statistically significant determinants to decide involvement of elderly people in category of physical activity. Amotivation, external and introjected regulation had negative correlation with physical activity, while intrinsic regulation and RAI (Relative Autonomy Index) showed positive correlation with physical activity. None of the behavioural regulators had statistically significant association with category of physical activity.
Multi-Stakeholder Validation of an Entrustable Professional Activities Framework for Canadian Geriatrics Residency Programs.
Fisk DCP, Clendenning BG, St John PD … +1 more , Francois J
Can Geriatr J · 2024 Sep · PMID 39234279 · Full text
BACKGROUND: Entrustable Professional Activities (EPAs) have become a cornerstone for an increasing number of competency-based medical education programs. Today, frameworks of EPAs are being used in most, if not all, medi...
BACKGROUND: Entrustable Professional Activities (EPAs) have become a cornerstone for an increasing number of competency-based medical education programs. Today, frameworks of EPAs are being used in most, if not all, medical specialties. These frameworks can break a discipline down to its constituting tasks, and structure the training and evaluation of residents. In 2018, The Royal College of Physicians and Surgeons of Canada created an EPA framework for Geriatric Specialty residency programs nationwide. The present study aims to evaluate this EPA framework through focus groups consisting of several stakeholder groups. METHODS: Participants were recruited to be part of one of five focus groups-one for each stakeholder group of interest. The five focus groups consisted of: physician faculty, residents, allied health professionals, administrators/managers, and patients. Each focus group met once virtually over ZOOM for no longer than 90 minutes. Meeting transcripts were iteratively coded based on emerging themes, and were compared for similarities and gaps between stakeholder perspectives. RESULTS: Multi-stakeholder consultation yielded feedback on many specific EPAs, suggestions for new EPAs, and additional input which gave rise to four themes: (i) EPA scope, (ii) Operationalization, (iii) Interprofessional Collaboration, and (iv) Patient Advocacy. Lastly, we received their thoughts on how the framework defines Geriatrics relative to the work of Care of the Elderly physicians in Canada. CONCLUSIONS: Consulting a variety of stakeholder groups generates a robust and diverse supply of feedback that holistically augments EPA frameworks to be more practical, appropriate, socially accountable and patient-centred.
Health Outcomes of Older Adults after a Hospitalization for a Hip Fracture.
MacLellan C, Faig K, Cooper L … +8 more , Benjamin S, Shanks J, Flewelling AJ, Dutton DJ, McGibbon C, Bohnsack A, Wagg J, Jarrett P
Can Geriatr J · 2024 Sep · PMID 39234278 · Full text
BACKGROUND: Hip fractures in older adults often lead to adverse health outcomes, which may be related to time to surgery and longer hospital stays. The experience of older adults with hip fractures in New Brunswick is no...
BACKGROUND: Hip fractures in older adults often lead to adverse health outcomes, which may be related to time to surgery and longer hospital stays. The experience of older adults with hip fractures in New Brunswick is not known. METHODS: This was a retrospective observational study. All hip fracture patients 65 years of age and older admitted to one hospital designated as a Level One Trauma Centre between April 1, 2015 and March 31, 2019 comprised the sample. RESULTS: The majority (86.5%) received surgery within 48 hours and those who had surgery beyond this time frame had a significantly longer stay in acute care (OR: 3.79, 95% CI: 2.05-7.15). The mean total length of stay (Total-LOS) for patients discharged after their acute care needs were met was 9.8 days (SD=8.1) compared to patients experiencing delays in discharge for nonmedical reasons which was 26.3 days (SD=33.7). An extended stay in acute care (OR: 1.93, 95% CI: 1.09-3.43) and increasing age (OR: 1.03, 95% CI: 1.001-1.06) were associated with a higher likelihood of death at one year post-discharge. Time to surgery beyond 24 hours (OR: 2.80, 95% CI: 1.13-7.38) was associated with a higher likelihood of death 30 days post-discharge. CONCLUSIONS: Most patients had surgery within the national benchmark of less than 48 hours. The Total-LOS increased 2.5-fold in patients who remained in hospital after their acute care needs were met. A better understanding of patient characteristics, such as frailty, may better predict patients at risk for longer hospital stays and adverse health outcomes.
Corrigendum: Measuring the Use of End-of-Life Symptom Relief Medications in Long-Term Care Homes-a Qualitative Study.
Roberts RL, Milani C, Webber C … +7 more , Bush SH, Boese K, Simon JE, Downar J, Arya A, Tanuseputro P, Isenberg SR
Can Geriatr J · 2024 Jun · PMID 38832096 · Full text
[This corrects the article DOI: 10.5770/cgj.27.712.].
[This corrects the article DOI: 10.5770/cgj.27.712.].
An Emergency Medical Technician Administered Falls-Assessment Protocol to Safely Identify Elderly Adults with Non-Urgent Conditions that may Avoid Transport to Emergency Department.
Hutchinson P, Nadeau A, Mercier E … +4 more , Bouchard J, Beaulieu S, Brousseau AA, Breton É
Can Geriatr J · 2024 Jun · PMID 38827431 · Full text
BACKGROUND: Approximately two-thirds of patients transported to emergency departments (ED) for a fall are discharged from the ED without urgent treatment. This pilot study tests the feasibility of implementing a pre-hosp...
BACKGROUND: Approximately two-thirds of patients transported to emergency departments (ED) for a fall are discharged from the ED without urgent treatment. This pilot study tests the feasibility of implementing a pre-hospital falls-assessment protocol performed by emergency medical technicians (EMTs) to determine whether a patient who fell needs an ED assessment or could be referred safely to a community resource. METHODS: The protocol was administered by trained EMTs to adults aged ≥ 65 after a fall between October 2019 and March 2020 in Sherbrooke (QC). All patients were transported to ED regardless of protocol outcome (transport recommended/not recommended). The objective was to assess if EMTs could complete the protocol and make the appropriate decision concerning the transport to ED. Secondary objectives aimed to assess the accuracy in identifying patients who do not require transport, and to measure the impact on avoidable ambulance transports. RESULTS: A total of 125 EMTs interventions were carried out: 17 patients were in the transport not recommended group, representing 14% of transport to hospital for falls-related EMTs calls that could be possibly avoided. Of these, 110 were transported to ED. Mean duration of on-site EMTs interventions was of 31 minutes. Forty-seven patients were admitted, mostly for infections and fractures, including four in the transport not recommended group. CONCLUSIONS: This study showed that EMTs can administer a falls-assessment protocol aimed at identifying patients that need an ED evaluation. Results permitted to amend the protocol before the second phase of the project evaluating the safety of the protocol.
Subspecialty Selection and Fellowship Training Satisfaction among American and Canadian Geriatric Psychiatry Fellows.
Sansfaçon J, Cinalioglu K, Gloeckler SG … +5 more , Kern M, Yarns BC, Lesage M, Hunter J, Rej S
Can Geriatr J · 2024 Jun · PMID 38827430 · Full text
The Geriatric Psychiatry Fellowship Subspecialty survey aimed to identify key motivating factors associated with choosing geriatric psychiatry as a career, and to assess training satisfaction among geriatric psychiatry f...
The Geriatric Psychiatry Fellowship Subspecialty survey aimed to identify key motivating factors associated with choosing geriatric psychiatry as a career, and to assess training satisfaction among geriatric psychiatry fellows/residents in Canada and the United States. American and Canadian geriatric psychiatry program directors were asked to distribute an online survey to their fellows. Descriptive statistics for quantitative items and Mann-Whitney U tests were performed to assess for differences by country of training. Thirty-one geriatric psychiatry fellows completed the survey. The most important motivating factors for pursuing a career in geriatric psychiatry were found to be "working with patients and families", "working in an interdisciplinary environment", and "intellectual stimulation". Fellows' overall training satisfaction was high, with American fellows more satisfied than Canadian residents ( = .047) on average, especially with regard to biomedical aspects of training ( = .01).
Quality Assurance and Prevention of COVID-19 Before Admission in Geriatric Rehabilitation Unit in Long-Term Care Facilities.
Kergoat MJ, Leclerc BS, Bolduc A … +3 more , Liu J, Cailhol A, Langevin S
Can Geriatr J · 2024 Jun · PMID 38827429 · Full text
BACKGROUND: This quality assurance study was conducted during the COVID-19 pandemic to describe the profile of patients aged 65 years and older admitted to a transition unit in a long-term care (LTC) facility and to eval...
BACKGROUND: This quality assurance study was conducted during the COVID-19 pandemic to describe the profile of patients aged 65 years and older admitted to a transition unit in a long-term care (LTC) facility and to evaluate the impact of admission modalities, compliance with screening and hand hygiene practices, risk of COVID-19, and time to access a geriatric rehabilitation unit (GRU). METHODS: A prospective study was conducted using administrative and medical records from three Montreal public LTC facilities offering a rehabilitation program for 312 patients admitted between May 2020 and February 2021. The results are reported for the entire sample and compared according to the mode of admission. RESULTS: The incidence of COVID-19 during the transition unit stay was estimated to be 11 cases or 3.5% in 14 days. Assessment of screening compliance showed deficiencies for 41.3% of patients, and the frequency of hand hygiene audits was not strictly adhered to. More COVID-19 cases were recorded in patients admitted to the transition unit by bed availability than in the cohort mode. The time to access a rehabilitation unit was 7.2 days or 23.5% shorter for patients admitted by bed availability. CONCLUSIONS: The study, conducted from a continuous practice improvement perspective, showed that the implementation of a transition unit in the LTC facilities helped control the transmission of COVID-19, but also revealed flaws in screening and hand hygiene practices.
"Dementia Doesn't Mean That Life Doesn't Have More Wonderful Things Ahead": A Qualitative Study Evaluating a Canadian Dementia Support Services Program.
Tam MT, Martin S, Jiang YF … +2 more , Machado A, Robillard JM
Can Geriatr J · 2024 Jun · PMID 38827428 · Full text
BACKGROUND: Community support programs can improve quality of life for people living with dementia and their care partners. Important to the successful implementation of such programs is close engagement with end-users t...
BACKGROUND: Community support programs can improve quality of life for people living with dementia and their care partners. Important to the successful implementation of such programs is close engagement with end-users to gain a better understanding of their needs. This study describes the perspectives of people living with dementia, care partners, and health-care providers on the First Link dementia support program provided by the Alzheimer Society of British Columbia (ASBC). METHODS: Following a large-scale survey (N=1,164), semi-structured interviews were conducted with participants to explore in greater detail the different needs and themes that emerged from the first phase of the study. The interviews explored: 1) experiences with the program; 2) future planning; 3) meaning of independence; and 4) impact of the program on emotional and physical well-being. RESULTS: A total of 48 participants were interviewed in this study. Knowledge and education were key factors that helped participants manage the impact of dementia. Learning about dementia, the experiences of others, strategies on how to manage symptoms, what to plan for in the future, and how to access different services in the community, was tied to increased feelings of confidence and comfort, and decreased stress. Participants also provided suggestions for improvement of the First Link dementia program such as further embedding the program into the patient journey, providing more services in remote areas, providing education for health-care providers, and increasing awareness of the program. CONCLUSION: By emphasizing the lived experiences and needs of those living with dementia and their caregivers, this work will inform future research-based program evaluations globally and, in turn, improve the existing services to support people living with-and impacted by-dementia.
Memory Support System in French: a Pilot Study.
Santos OA, Fievre J, Sweet L … +2 more , Knoefel F, Thomas N
Can Geriatr J · 2024 Jun · PMID 38827427 · Full text
Mild cognitive impairment (MCI) confers a higher risk of developing dementia. While largely preserved, instrumental activities of daily living (IADLs) may be affected to varying degrees by MCI. The Memory Support System...
Mild cognitive impairment (MCI) confers a higher risk of developing dementia. While largely preserved, instrumental activities of daily living (IADLs) may be affected to varying degrees by MCI. The Memory Support System (MSS) is a curriculum and calendar/note-taking system that has proven effective in sustaining independence in IADLs for individuals with MCI and in protecting mood among care partners. Until recently, the MSS has only been utilized among English- and Spanish-speaking samples. This study investigated the use of a translated and culturally adapted MSS in four French-speaking, community-dwelling participants with MCI and their support partners. Measures of treatment adherence, daily function, self-efficacy for memory, quality of life, mood, anxiety, and caregiver burden were assessed at baseline, treatment end, and eight-week follow-up. By treatment end and follow-up, participants with MCI showed improvement in adherence to the MSS calendar, IADLs, everyday abilities requiring memory and planning, self-efficacy, depression and anxiety symptoms, and quality of life. Care partners showed improvement in quality of life and depressive symptoms, while their caregiver burden and anxiety symptoms generally remained unchanged. Findings suggest that, with appropriate training, Francophones with MCI can and will use the MSS, and that MSS training may contribute to daily functioning and aspects of participant and care partner well-being.
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