Canadian Geriatrics Journal[JOURNAL]
Sun
200 papers
Resistance Training with Instability Does Not Hamper Total Training Volume and Muscle Strength Gains in Older Adults: a Secondary Analysis from REI Study.
Silva YA, Cavalcante BR, Calixtre LB … +4 more , Tomaz MLL, de Souza MF, Pitangui ACR, de Araújo RC
Can Geriatr J · 2024 Jun · PMID 38827426 · Full text
BACKGROUND: Resistance training with instability (REI) emerged as a promising training modality for older adults aiming to counteract age-related changes. OBJECTIVES: We compared the effects of 12 weeks of REI and tradit...
BACKGROUND: Resistance training with instability (REI) emerged as a promising training modality for older adults aiming to counteract age-related changes. OBJECTIVES: We compared the effects of 12 weeks of REI and traditional resistance exercise (RE) on muscle strength in older adults with cognitive impairment. We further explored if total training volume (TTV) significantly differs among training groups. METHODS: This is a secondary analysis of the REI study. Participants were randomly assigned to REI (n=22) or RE (n=23). RE protocol involved moderate-intensity, free-weight, and machines-based resistance exercises (3 sets, 10-15 repetitions). REI received a similar training protocol, in which exercises were simultaneously performed with instability/unstable devices (e.g., squat exercise under a foam pad or Bosu ball). Maximal isometric strength and isokinetic parameters were assessed at baseline and after completion of a 12-week intervention through a hydraulic handgrip and isokinetic dynamometer, respectively. TTV (sets × repetitions × load) was computed based on external training load over the 12 weeks. RESULTS: No differences were observed between groups (=.35) after the intervention. Over 12 weeks, REI and RE improved isometric handgrip strength (<.001) and isokinetic performance (=.04). We also did not find differences in the TTV between training groups (=.28). CONCLUSION: We demonstrated that both REI and RE training induced similar gains in muscle strength. Combining unstable surfaces/instability devices did not hamper TTV, which may have clinical applications in the context of exercise for older adults.
Transitioning Towards a Virtual Falls Prevention Program for Frail Seniors: Learning from the Experiences of Older Adults During the COVID-19 Pandemic.
Weiss SM, Kalocsai C, Liu B … +1 more , Norris M
Can Geriatr J · 2024 Jun · PMID 38827425 · Full text
BACKGROUND: The literature to date is unable to clearly characterize the appropriateness of virtual care for falls prevention services from the patient perspective. In response to COVID-19, the Falls Prevention Program (...
BACKGROUND: The literature to date is unable to clearly characterize the appropriateness of virtual care for falls prevention services from the patient perspective. In response to COVID-19, the Falls Prevention Program (FPP) at Sunnybrook Health Sciences Centre was modified to include virtual components. We set out to uncover the experiences of this unique older-adult patient population to inform FPP quality improvement and appropriate incorporation of technology post-pandemic. METHODS: FPP patients during the COVID-19 pandemic (February 2020 - February 2022) and their primary caregivers met inclusion criteria. Out of 18 eligible patients, 10 consented to participate in 20-minute, semi-structured telephone interviews conducted and transcribed by the first author. Inductive coding followed by theme generation occurred through collaborative analysis. RESULTS: The participants (n=10) were 60% female, mean age 84 years (SD 5.8), 60% living alone, and 70% university educated. We generated three main themes: 1) First Steps First, revealed a common desire for physical and mental support and the perceived essentials of a successful FPP highlighting the importance of program length and individualized attention; 2) Overcoming Obstacles, highlighted participants' experiences overcoming barriers with technology in the context of an isolating pandemic; and 3) Advancing Care Post-Pandemic, elaborated on the appropriateness of virtual care and delved into the importance of program personalization. CONCLUSION: The interviewed older adults revealed agreement on the FPP's necessity and the importance of increasing program length, one-on-one interaction, and program flexibility for unique patient needs. Incorporating virtual assessment prior to in-person exercises was largely favoured and should be considered as an appropriate use of technology post-pandemic.
Factors Associated with Alternate Level of Care Status Designation: a Case-Control Study and Model to Optimize Care Trajectories.
Lamarre M, Daignault M, Cheung VW … +2 more , Forget MF, Nguyen QD
Can Geriatr J · 2024 Jun · PMID 38827424 · Full text
BACKGROUND: As health-care demand is growing, our health-care system will require the optimization of the care trajectories. Patients with an alternate level of care (ALC) status could be a target for flow optimization....
BACKGROUND: As health-care demand is growing, our health-care system will require the optimization of the care trajectories. Patients with an alternate level of care (ALC) status could be a target for flow optimization. We aimed to characterize ALC patients and risk factors for ALC status, and to propose an integrated model to analyze the trajectory of ALC patients and discuss solutions to reduce their burden. METHODS: A case-control design was used to compare 60 ALC and 60 non-ALC patients admitted to the geriatric unit of the Centre hospitalier de l'Université de Montréal in 2021, collecting medical and sociodemographic data. Based on our model, univariate statistical analyses were computed to compare groups and identify risk factors for ALC status. RESULTS: ALC patients were less independent (22% performed five to six activities of daily living vs. 43%, = .03). Both groups were comparable in terms of mobility and neurocognitive disorders. ALC patients were more likely to receive a new diagnosis of a neurocognitive disorder or new behavioural or psychological symptoms (37% vs. 15%, = .008). Up to 25% of ALC patients were admitted despite presenting no active medical condition (vs. 3% of non-ALC patients, = .002). CONCLUSIONS: The optimization of the care trajectory of ALC patients is mainly based on pre-hospital and post-hospital factors. A proportion of ALC admissions might be avoidable with additional investment in home care resources and relocation procedures. Fluidity of ALC trajectory may benefit from improved orientation at discharge procedures. Full optimization of ALC trajectories requires a systemic understanding of the health-care system.
Timely Yet Long Overdue: Canadian Standards for Long-Term Care Homes.
Kirkham J, Keng A, Conn D … +8 more , Benjamin S, Seitz D, Rivard MF, Martinussen B, Grief C, Checkland C, Rabheru K, Canadian Coalition for Senior’s Mental Health (CCSMH) Policy Working Group
Can Geriatr J · 2024 Mar · PMID 38433886 · Full text
The impact of the COVID-19 pandemic highlighted systemic problems in Canadian long-term care (LTC). While high mortality rates in LTC received significant attention, the pandemic also took an enormous toll on mental heal...
The impact of the COVID-19 pandemic highlighted systemic problems in Canadian long-term care (LTC). While high mortality rates in LTC received significant attention, the pandemic also took an enormous toll on mental health of LTC residents, where mental health conditions, including cognitive disorders, are already much higher than in other community settings. The pandemic resulted in a renewed interest in improving quality of care in LTC and led to the recent development of several National Standards of Canada. The newly available Standards set ambitious targets, but many of the standards are practical and essential to moving beyond a focus on safety and physical needs in LTC and towards one that supports residents as whole persons. While the standards support good mental health indirectly, there is a need to recognize mental health in these settings as a fundamental human right and essential to quality of life, and for this to be reflected in ongoing and future standards development. Ensuring existing and forthcoming National Standards are meaningfully implemented, in whole or in part, will require extensive efforts at multiple levels. The guidance provided by Canadian Standards will shape this transformative process, necessitating aligned federal and provincial investments and policies, and stakeholder engagement to bring about the envisioned high-quality care.
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 Mar · PMID 38433885 · Full text
BACKGROUND: At the end of life, individuals may experience physical symptoms such as pain, and guidelines recommend medications to manage these symptoms. Yet, little is known about the symptom management long-term care (...
BACKGROUND: At the end of life, individuals may experience physical symptoms such as pain, and guidelines recommend medications to manage these symptoms. Yet, little is known about the symptom management long-term care (LTC) residents receive at the end of life. Our research team developed a metric-whether residents receive one or more prescriptions for an end-of-life symptom management medication in their last two weeks-to explore end-of-life care for LTC residents. This qualitative study aimed to inform the refinement of the end-of-life prescribing metric, including the acceptability and applicability to assess the quality of a resident's symptom management at end-of-life. METHODS: We conducted 14 semi-structured interviews with Ontario health-care providers (physicians and nurses) who work in LTC homes and family caregivers of residents who died in LTC. Interviews were conducted virtually between February 2021 and December 2022, and were analyzed using thematic analysis. RESULTS: We identified three major themes relating to perceptions of the metric: 1) appropriateness, 2) health-care provider applicability, and 3) caregiver applicability. Participants noted that the metric may be appropriate to assess end-of-life care, but noted important nuances. Regarding applicability, health-care providers found value in the metric and that it could inform their practice. Conversely, caregivers found limited value in the metric. CONCLUSION: The proposed metric captures a very specific aspect of end-of-life care-whether end-of-life medications were prescribed or not. Participants deemed that the metric may reflect whether LTC homes have processes to manage a resident's end-of-life symptoms with medication. However, participants thought the metric could not provide a complete picture of end-of-life care and its quality.
The Effect of Vitamin D Supplementation to Parameter of Sarcopenia in Elderly People: a Systematic Review and Meta-Analysis.
Widajanti N, Hadi U, Soelistijo SA … +3 more , Syakdiyah NH, Rosaudyn R, Putra HBP
Can Geriatr J · 2024 Mar · PMID 38433884 · Full text
BACKGROUND: Vitamin D plays an essential role in promoting skeletal muscle metabolism. Several studies show that vitamin D may help the elderly prevent sarcopenia. Nevertheless, the outcome remains debatable. Our meta-an...
BACKGROUND: Vitamin D plays an essential role in promoting skeletal muscle metabolism. Several studies show that vitamin D may help the elderly prevent sarcopenia. Nevertheless, the outcome remains debatable. Our meta-analysis aimed to summarize the effect of vitamin D supplementation on sarcopenia-related parameters. METHODS: We searched PubMed, Cochrane, Springer, SAGE Journals, and Scopus abstracts on 10th December 2021 for relevant studies. We included articles that studied the effect of vitamin D on muscle mass, muscle strength, and physical performance. The aim was to measure the muscle mass, muscle strength, and physical performance both at baseline and at the end of the intervention. RESULTS: A total of 6,628 participants from 35 studies were included. Most of the studies used oral vitamin D, whereas only one study used intramuscular injection. The effect of vitamin D supplementation showed no effect on appendicular skeletal muscle mass (SMD = .05 [95% CI, .33 - .44], = .79). Regarding muscle strength, vitamin D supplementation did not have a significant effect on muscle strength which is handgrip strength ( = .26). Respecting physical performance, vitamin D supplementation did not affect TUG (Timed Up and Go) ( = .45). CONCLUSIONS: Vitamin D supplementation had minimal effect on sarcopenia-related parameters. Further research into understanding the role of Vitamin D in preventing the progressivity of sarcopenia still needs to be explored.
Advancing Gerontology through Exceptional Scholarship (AGES): a Mentorship Initiative for Early Career Faculty.
Bacsu JR, Rahemi Z, Petrovsky D … +4 more , Sefcik JS, Kwan Ma KP, Baker ZG, Smith ML
Can Geriatr J · 2024 Mar · PMID 38433883 · Full text
Mentorship is critical to supporting professional development and growth of new and emerging faculty members. Working with the Gerontological Society of America (GSA), we created the Advancing Gerontology through Excepti...
Mentorship is critical to supporting professional development and growth of new and emerging faculty members. Working with the Gerontological Society of America (GSA), we created the Advancing Gerontology through Exceptional Scholarship (AGES) Initiative as a mentorship model to promote productivity and peer support for new and early career faculty members. In this commentary, we highlight the AGES Program as a prototype to facilitate peer support, collective learning, and co-authorship opportunities to advance new and early career faculty members, especially in the field of aging. Moreover, we identify four crucial strategies that cultivated and refined our AGES Program including: i) ensuring flexibility to address mentee needs; ii) establishing check-ins and accountability to enhance productivity; iii) fostering peer support and collective learning; and iv) delivering motivational and educational activities. Drawing on our experience with the AGES Program, this commentary provides recommendations to support other groups looking to develop high-quality mentorship programs to support new and early career faculty members in academia.
Frailty, Seasonal Sensitivity and Health-related Quality of Life in Older People Living in High Southern Latitudes: a Bayesian Analysis.
Mabe-Castro D, Gomez KT, Castillo-Aguilar M … +4 more , Jannas-Vela S, Guzmán-Muñoz E, Valdés-Badilla P, Núñez-Espinosa C
Can Geriatr J · 2024 Mar · PMID 38433882 · Full text
BACKGROUND: In older people, a notable research gap exists regarding the intricate dynamics between frailty, seasonal sensitivity, and health-related quality of life (HRQoL). This study aimed to determine the association...
BACKGROUND: In older people, a notable research gap exists regarding the intricate dynamics between frailty, seasonal sensitivity, and health-related quality of life (HRQoL). This study aimed to determine the association between frailty, seasonal sensitivity, and HRQoL in older people from high southern latitudes. METHODS: A cross-sectional observational study was conducted. Frailty, seasonal sensitivity, and HRQoL measurements were self-reported by participants through questionnaires. A total of 118 older people were recruited from a local community. The participants were selected through intentional non-probabilistic sampling. RESULTS: The adjusted models showed a trend where lower education was associated with a higher risk of frailty (BF = 0.218). For frailty and HRQoL, we observed a trend suggesting that HRQoL decreases with increasing severity of frailty (BF = 1.76). In addition, we observed a linear effect based on the severity of seasonal sensitivity, meaning that older people with higher perceived severity report a proportional decrease in HRQoL (BF = 6.66). CONCLUSION: Sociodemographic factors, such as lower education levels, have increased the risk of frailty. At the same time, frailty and seasonal sensitivity perceived severity were associated with a lower HRQoL in older people.
Piloting a Supplemental Assessment Tool with Younger Residents of Long-Term Care.
Samson EM, Moody E, Weeks LE
Can Geriatr J · 2024 Mar · PMID 38433881 · Full text
BACKGROUND: Young adults living with disabilities may sometimes end up in long-term care facilities which may not always meet their needs. Our project set out to pilot a supplemental assessment tool, a questionnaire to b...
BACKGROUND: Young adults living with disabilities may sometimes end up in long-term care facilities which may not always meet their needs. Our project set out to pilot a supplemental assessment tool, a questionnaire to be used upon admission of younger adults into long-term care. We wanted the opinions of both staff and younger residents on what modifications may be needed in the implementation processes to ensure effectiveness of the tool. METHODS: This project followed a qualitative design, implementing a previously designed supplemental assessment tool with five staff members and seven younger residents of two long-term care homes in Halifax, Nova Scotia. Residents completed the questionnaire with members of staff involved in admissions. Each group participated in follow-up interviews regarding their thoughts on implementation of the tool. Responses were analyzed using the constructs of the Consolidated Framework in Implementation Research following direct content analysis methods. RESULTS: Feedback from residents and staff suggested that the tool could not be used as a one-size-fits-all solution but that flexibility in the format, content, and structure of the tool would be beneficial to ensure its utility in a variety of settings. Issues raised by staff and residents included, but were not limited to, accessibility of the intervention, the availability of resources, the format of the intervention and topics covered within it, and ensuring that processes for implementation are clearly defined. CONCLUSIONS: Both staff and residents approved of the tool for use in the admissions process and agreed that it would enhance the admissions practices already in place.
Effects of 12-Weeks of Home-Based Exercise Training on Physical and Cognitive Function of Older Adults: Randomized Trial Comparing Virtual Versus Minimal Supervision in the Context of the Covid-19 Pandemic in Brazil.
Maranhão DCM, de Araújo Silva JD, Farah BQ … +4 more , Pirauá NBB, de Araújo RC, Cavalcante BR, Pirauá ALT
Can Geriatr J · 2024 Mar · PMID 38433880 · Full text
BACKGROUND: We investigated the effects of a 12-week home-based exercise program delivered with virtual or minimal supervision on the physical and cognitive function of community-dwelling older adults in the context of t...
BACKGROUND: We investigated the effects of a 12-week home-based exercise program delivered with virtual or minimal supervision on the physical and cognitive function of community-dwelling older adults in the context of the COVID-19 pandemic in Brazil. METHODS: The study was registered on the Brazilian Registry of Clinical Trials platform (code: RBR-8qby2wt). Thirty-eight older adults (81% female and 68±7 years old), non-disabled, and without cognitive impairment or dementia, were randomly assigned to a 12-week home-based exercise program: 1) virtual supervision (classes remotely delivered through video conference by trained staff), or 2) minimal supervision (once-weekly contact to touch base through standardized text messages). The participants initially performed two sets of 10 repetitions three times a week, with a 60-second interval. The volume and complexity of the exercises were progressively increased. (e.g., the number of sets increased to 3 and later to 4). At baseline and follow-up, we collected remote measurements of physical function (muscle strength and power, functional muscular fitness) and cognition (processing speed, inhibitory control, verbal fluency). RESULTS: Participants in the minimal supervision home-based exercise group significantly improved the Stroop test (-1.6 sec, 95% CI = -3.20; -0.09). No significant between-group differences were observed for physical and cognitive outcomes. CONCLUSION: A home-based exercise program delivered with virtual or minimal supervision can produce similar effects, and may help to maintain physical and cognitive capabilities among healthy, high-functioning older adults who experienced mobility restrictions due to the COVID-19 pandemic in Brazil.
A Pilot Study to Evaluate a New Hep-GRP Care Pathway to Improve Outcomes Among Canadian Older Adults with Liver Cirrhosis.
Zhu J, Carr F, Sun M … +3 more , Tian P, McLeod M, De Coutere S
Can Geriatr J · 2024 Mar · PMID 38433879 · Full text
BACKGROUND: Older adults with cirrhosis have complex medical needs that are not satisfied by organ specific management. Interdisciplinary approach may mitigate comorbidity and improve patient satisfaction. METHODS: A pil...
BACKGROUND: Older adults with cirrhosis have complex medical needs that are not satisfied by organ specific management. Interdisciplinary approach may mitigate comorbidity and improve patient satisfaction. METHODS: A pilot study consisted of dual specialist interdisciplinary referral pathway and mixed virtual care delivery model are prospectively evaluated in older adults (65 years and older) with cirrhosis during the COVID-19 pandemic between September and December 2022. Participant attitudes towards telemedicine were surveyed. RESULTS: 68 participants with cirrhosis were consecutively assessed by hepatology. The mean age was 73 years. 39 (57%) screened positive for one or more geriatric syndrome(s). Comprehensive geriatric assessments were conducted via telemedicine in 18 participants, with additional referrals to physiotherapy and nutritional education. Compared to a historic cohort matched for age, sex, and Child-Pugh class, acute health service utilization measured by ER visits among those received dual specialist interdisciplinary consultation were lowered by 1.11 per patient at three-month follow up period ( = .0006, 95% CI 0.47-1.74). Majority participants (87.6%) preferred telemedicine or mixed method visits. CONCLUSION: An interdisciplinary approach to older adults with cirrhosis will likely be beneficial, and routine screening for geriatric syndrome may lead to reduced acute health-care utilization in the short term. Telemedicine and virtual screening tools in seniors should be fully explored to improve access to care.
Is Dementia Related to a Longer Wait Time to be Assigned a New Primary Care Provider? An Analysis of the Nova Scotia Need a Family Practice Registry Derived from the PUPPY-Study.
McConnell ML, Marshall EG, Stock D … +2 more , Trenaman SC, Andrew MK
Can Geriatr J · 2023 Dec · PMID 38045885 · Full text
BACKGROUND: Access to Primary Care Providers (PCPs) is limited for many Canadians. "Unattached patients" are persons who do not have a PCP. Older adults living with dementia may face greater challenges seeking attachment...
BACKGROUND: Access to Primary Care Providers (PCPs) is limited for many Canadians. "Unattached patients" are persons who do not have a PCP. Older adults living with dementia may face greater challenges seeking attachment. This study investigated whether older adults living with dementia experience differential wait times for PCPs compared to those without a diagnosis of dementia. METHODS: This was an observational descriptive study of the centralized wait-list data from the Nova Scotia (NS) Need a Family Practice Registry (NaFPR). Time on provider wait-list by dementia diagnosis and age were compared. Number of days on the registry across these measures was estimated. Multivariable proportional hazards regression was used to compare hazards of remaining on the registry over time. RESULTS: Unattached older adults living with dementia were on the NaFPR for less time compared to those without dementia (381.4 vs. 428.8 days, respectively). After adjusting for age, self-reported gender, comorbidity, rurality, income quintiles, and overall deprivation, older adults with dementia had a 1.13-fold (95% CI: 1.04-1.24) increase in the likelihood of leaving the NaFPR. Potential contributors to this small difference could be placement in Long Term Care (LTC) and subsequent facility PCP attachment. CONCLUSIONS: Analysis of the NaFPR exhibited similarly time to PCP attachment despite a diagnosis of dementia. This represented an effective equality model of health care utilized in NS. Future studies should investigate whether an equity model with priority attachment for vulnerable patients would reduce hospitalization and LTC institutionalization.
Adherence to Exercise Training and Physical Function in Older Adults Diagnosed with Knee Osteoarthritis.
Nogueira RMDR, de Souza Moura J, Costa CPS … +8 more , Novais TM, de Lourdes Oliveira P, Ribeiro MJ, Maduro PA, de Jesus Furtado Almeida F, Soares SL, Schwingel PA, Gambassi BB
Can Geriatr J · 2023 Dec · PMID 38045884 · Full text
BACKGROUND: Knee osteoarthritis (KOA) provokes pain, muscle weakness, and consequent impairment in activities of daily living. On the other hand, adherence to exercise training (ET) is associated with the attenuation of...
BACKGROUND: Knee osteoarthritis (KOA) provokes pain, muscle weakness, and consequent impairment in activities of daily living. On the other hand, adherence to exercise training (ET) is associated with the attenuation of the impairments. The aims of the present study were to a) investigate adherence to ET in older adults with KOA diagnosed attending public service; and b) to analyze the physical function of the older adults with KOA who did not adhere to the ET in public service. METHODS: The adherence to ET programs was analyzed retrospectively from each patient's date of KOA diagnosis. After assessing the adherence to ET, the physical function of these older adults diagnosed with KOA (n=19) was analyzed and compared with another group composed of asymptomatic sedentary older adults without evidence of KOA (ASKOA) (n=17). RESULTS: Although all older adults with KOA received guidelines to practice ET, only 58% were able to start a program. Additionally, 100% of the sample could not perform ET uninterruptedly. According to the findings, close to 80% of older adults had difficulties scheduling ET sessions in public places. Subjects with KOA (12.1±3.1; IC95%:10.6-13.6) had worse lower limb functional capacity than ASKOA (8.1±1.0; IC95%:7.6-8.6; <.001; δ=4.0 sec; =1.7). Likewise, they had a lower dynamic balance than KOA (12.4±2.7; IC95%:11.1-13.7 vs. 8.0±1.1; IC95%:7.4-8.6; <.001; δ=4.4 sec; =2.1). CONCLUSIONS: The investigated sample has a lack of ET adherence by difficulties in scheduling ET sessions in public places. In addition, it demonstrated impairment in physical function in older adults with KOA.
Prevalence of Acetylsalicylic Acid Use for Primary Prevention of Cardiovascular Disease Amongst Older Adults From 2017-2021: a Retrospective Cross-Sectional Study.
Bolt J, Barry AR, Inglis C … +2 more , Lin S, Pan J
Can Geriatr J · 2023 Dec · PMID 38045883 · Full text
BACKGROUND: Three landmark trials on the use of acetylsalicylic acid (ASA) for primary prevention of cardiovascular disease (CVD) were published in 2018. Since then, major clinical practice guidelines have been updated w...
BACKGROUND: Three landmark trials on the use of acetylsalicylic acid (ASA) for primary prevention of cardiovascular disease (CVD) were published in 2018. Since then, major clinical practice guidelines have been updated with recommendations against the routine use of ASA for primary CVD prevention, particularly in older adults. However, little is known about the uptake of this evidence into real world practice. The purpose of this study was to assess the change in ASA usage for primary prevention of CVD in older adults between 2017 and 2021. METHODS: A retrospective cross-sectional study of ASA use for primary prevention in ambulatory older adults without known CVD in an urban Canadian city was conducted. RESULTS: Seven hundred and fifty-six participants were included. The mean age was 78.9 years (standard deviation 7.9) and 64.8% were female. One hundred and thirty (17.2%) participants used ASA for primary prevention, including 20.3% in 2017, 17.0% in 2018, 21.8% in 2019, 16.3% in 2020, and 11.0% in 2021 ( = .061). Female sex was associated with lower ASA use (odds ratio [OR] 0.44, 95% confidence interval [CI] 0.29-0.68) and hypertension was associated with higher ASA use (OR 2.72, 95% CI 1.73-4.29). CONCLUSIONS: Use of ASA for primary CVD prevention in older Canadians decreased between 2017 and 2021, suggesting an uptake of clinical trial data and practice guideline recommendations. Focusing on deprescribing of ASA for primary CVD prevention continues to be warranted, given the risks associated with ASA in this population.
Transforming Care for Older Adults Living with Complex Health Conditions in Ontario Post-Covid: Conference Proceedings and Recommendations.
Morrison AD, Ehsan S, Schwartz RE … +2 more , Webster SD, Puxty JAH
Can Geriatr J · 2023 Dec · PMID 38045882 · Full text
The virtual conference 'Transforming Care: Supporting Older Adults Post-COVID in Ontario' was held in October 2021. It was organized by Specialized Geriatric Services (SGS) East and held over three half-days. The guiding...
The virtual conference 'Transforming Care: Supporting Older Adults Post-COVID in Ontario' was held in October 2021. It was organized by Specialized Geriatric Services (SGS) East and held over three half-days. The guiding themes included: The Need, The Innovation, and The Transformation. Over 500 participants heard from ~50 clinicians, researchers, administrators, older adults, care partners, and community partners. The pandemic uncovered and exacerbated existing issues and pushed us to explore new ways to support older adults living with complex health conditions. The following key priorities were identified: older adults and their care partners call for personalized care experiences, and a lifespan approach to care delivery; aging in the community remains the most common preference; an integrated community care system that supports aging at-home should be prioritized; care delivery by SGS interprofessional teams and specialists is paramount to providing comprehensive care; building health human resource capacity should be a system priority; and promising innovations should be scaled and spread. Evidence shows that we cannot return to status-quo; post-pandemic planning of both who we serve and how we serve needs to be anchored in system renewal, not just recovery. Renewal means integrating lessons learned during the pandemic into the redesign of our systems of care. Investments in innovative, upstream strategies that support home and community-based care, and target health promotion and prevention are necessary. The provincial and regional infrastructure of SGS has the expertise and capacity to assist Ontario Health Teams in responding to the evolving health and social needs of this population.
Implementation of the Acute Care for Elders Strategy to Improve the Quality of Care Transitions in Quebec and Ontario: a Retrospective Multiple Case Study.
Ghandour EK, Leblond S, Binette S … +9 more , Rivard J, Joanisse J, Carreau L, Bert L, Boutier V, Fortin JP, Denis JL, Sinha S, Archambault P
Can Geriatr J · 2023 Dec · PMID 38045881 · Full text
BACKGROUND: In 2016, two Canadian hospitals participated in a quality improvement (QI) program, the International Acute Care for Elders (ACE) Collaborative, and sought to adapt and implement a transition coach interventi...
BACKGROUND: In 2016, two Canadian hospitals participated in a quality improvement (QI) program, the International Acute Care for Elders (ACE) Collaborative, and sought to adapt and implement a transition coach intervention (TCI). Both hospitals were challenged to provide optimal continuity of care for an increasing number of older adults. The two hospitals received initial funding, coaching, educational materials, and tools to adapt the TCI to their local contexts, but the QI project teams achieved different results. We aimed to compare the implementation of the ACE TCI in these two Canadian hospitals to identify the factors influencing the adaptation of the intervention to the local contexts and to understand their different results. METHODS: We conducted a retrospective multiple case study, including documentary analysis, 21 semi-structured individual interviews, and two focus groups. We performed thematic analysis using a hybrid inductive-deductive approach. RESULTS: Both hospitals met initial organizational goals to varying degrees. Our qualitative analysis highlighted certain factors that were critical to the effective implementation and achievement of the QI project goals: the magnitude of changes and adaptations to the initial intervention; the organizational approaches to the QI project implementation, management, and monitoring; the organizational context; the change management strategies; the ongoing health system reform and organizational restructuring. Our study also identified other key factors for successful care transition QI projects: minimal adaptation to the original evidence-based intervention; use of a collaborative, bottom-up approach; use of a theoretical model to support sustainability; support from clinical and organizational leadership; a strong organizational culture for QI; access to timely quality measures; financial support; use of a knowledge management platform; and involvement of an integrated research team and expert guidance. CONCLUSION: Many of the lessons learned and strategies identified from our analysis will help clinicians, managers, and policymakers better address the issues and challenges of adapting evidence-based innovations in care transitions for older adults to local contexts.
ACP Conversations with Chinese and South Asian Patients: Physicians' Perspectives of Barriers and Facilitating Factors.
Vashisht A, Gutman G, Kaur T
Can Geriatr J · 2023 Dec · PMID 38045880 · Full text
INTRODUCTION/OBJECTIVE: Advance Care Planning (ACP) discussions are infrequently conducted with physicians, even fewer among minorities. We explored physicians' experiences in engaging Chinese (CH) and South Asian (SA) p...
INTRODUCTION/OBJECTIVE: Advance Care Planning (ACP) discussions are infrequently conducted with physicians, even fewer among minorities. We explored physicians' experiences in engaging Chinese (CH) and South Asian (SA) patients in ACP conversations to understand initiation and participation patterns, topics covered, and barriers and facilitating factors. METHOD: Twenty-two physicians with 15%+ SA patients aged 55+ and 19 with 15%+ CH patients aged 55+ were interviewed. RESULTS: SA- and CH-serving physicians described similar initiation patterns, cultural context, and need for standardized ACP routines. However, the SA-serving physicians described greater involvement of family members, while CH-serving physicians described more communication barriers and family members' desire to hide the diagnosis from patients. CONCLUSION: Cultural taboos surrounding discussion around death and dying appear to influence CH older adults and families strongly. Lack of familiarity with ACP amongst the SA population accounts more for their limited engagement in ACP discussions.
Using Comprehensive Geriatric Assessment in Identifying Care Goals and Referral Services in a Frailty Intervention Clinic.
Aggarwal R, Brar S, Goodstadt M … +5 more , Devitt R, Penny S, Ramachandran M, Underwood D, Taylor CF
Can Geriatr J · 2023 Dec · PMID 38045879 · Full text
The proportion of older adults and frail adults in Canada is expected to rise significantly in upcoming years. Currently, a considerable number of older adults do not actively participate in developing their own care pla...
The proportion of older adults and frail adults in Canada is expected to rise significantly in upcoming years. Currently, a considerable number of older adults do not actively participate in developing their own care plans; prior research has indicated several benefits of patient engagement in this process. Thus, we conducted a mixed methods study that examined the prevalence of rehabilitation goals and identified these for 305 community dwelling older adults referred to a frailty intervention clinic utilizing Comprehensive Geriatric Assessment (CGA) between 2014 and 2018. Top patient concerns included mobility (84%), services, systems, and policies (51%), sensory functions and pain (50%), and self-care or domestic life (47%). The most common referrals or recommendations for patients included further follow-up with a physician or specialist (36%), referral to an onsite falls prevention clinic (31%), and medication modifications (31%). Based upon these findings, we recommend greater utilization of CGA within a team-based approach to improve patient care by allowing for greater collaboration and shared decision-making by health-care providers. Moreover, CGA can be an effective tool to meet the complex and unique health-care needs of frail patients while incorporating patient goals. This is vitally important considering the predicted growth in the population of frail and/or older patients, as well as the current challenges and shortfalls in meeting the health-care needs of this population.
Impact of Hospitalization on Patients Ability to Perform Basic Activities of Daily Living.
O'Brien MW, Mallery K, Rockwood K … +1 more , Theou O
Can Geriatr J · 2023 Dec · PMID 38045878 · Full text
Functional independence is dictated by the ability to perform basic activities of daily living (ADLs). Although hospitalization is associated with impairments in function, we know less about patients' functional trajecto...
Functional independence is dictated by the ability to perform basic activities of daily living (ADLs). Although hospitalization is associated with impairments in function, we know less about patients' functional trajectory following hospitalization. We examined patients' ability to do basic ADLs across pre-admission, admission, and follow-up (discharge or two-weeks post-admission) and determined which factors predicted changes in ADLs at follow-up. A secondary analysis of a small prospective cohort study of older patients (n=83, 50 females, 81 ± 8 years) from the Emergency Department and a Geriatric Unit were included. ADL scores (dressing, walking, bathing, eating, in and out of bed, and using the toilet) and frailty level (via the Clinical Frailty Scale) were measured. Comparing follow-up to pre-admission, patients reported worse ADL scores for dressing (36% of patients), walking (31%), bathing (34%), eating (25%), in and out of bed (37%), and using the toilet (35%). Most patients (59%) had more difficulty with 1+ ADL at follow-up versus pre-admission, with one-fourth of patients having greater difficulty with 3+ ADLs. Older age and higher frailty level were associated with (all, < .04) worse functional scores for eating, getting in and out of bed, and using the toilet (frailty only) at follow-up versus pre-admission. Here, most inpatients experienced worse difficulty performing multiple basic ADLs after hospital admission, potentially predisposing them for re-hospitalization and functional dependence. Older and frailer patients generally were less likely to recover to pre-admission levels. Hospitalization challenges patients' ability to perform ADLs in the short-term, post-discharge. Strategies to improve patients' functional trajectory are needed.
Addressing the Main Barrier to Sarcopenia Identification: Utility of Practical Office-Based Bioimpedance Tools Vs. Dual Energy X-ray Absorptiometry (DXA) Body Composition for Identification of Low Muscle Mass in Older Adults.
Juby AG, Davis CMJ, Minimaana S … +1 more , Mager DR
Can Geriatr J · 2023 Dec · PMID 38045877 · Full text
BACKGROUND: Sarcopenia is associated with increased morbidity and mortality. Clinically, sarcopenia can be overlooked, especially in obesity. Sarcopenia diagnostic criteria include muscle mass (MM) and function assessmen...
BACKGROUND: Sarcopenia is associated with increased morbidity and mortality. Clinically, sarcopenia can be overlooked, especially in obesity. Sarcopenia diagnostic criteria include muscle mass (MM) and function assessments. Muscle function can be readily assessed in a clinic setting (grip strength, chair stand test). However, MM requires dual-energy X-ray absorptiometry (DXA) Body Composition (BC) or other costly tools, not readily available. METHODS: Observational cohort pilot study of independently mobile, community dwelling older adults, comparing MM using two office-based, direct-to-consumer bioimpedance (BIA) scales (Ozeri [manufactured in China] and OMRON [OMRON HBF-510 Full Body Sensor, Shiokoji Horikawa, Kyoto, Japan] to DXA. The OMRON differs from the Ozeri scale because the OMRON also includes hand sensors. The European Working Group on Sarcopenia in Older People (EWGSOP) DXA or BIA low MM diagnostic cut-offs were used to classify participants as having low or normal MM. RESULTS: Fifty participants: 11 men, 39 women. Forty-two completed DXA. Age 75.8 yrs [67-90]. 81% obese based on body fat cut-offs. With DXA [ASM/height], 15 had low MM. Using BIA [mmass/height], 7 with Ozeri, and 27 with OMRON, had low MM. Positive predictive value for low MM versus DXA (as the gold standard) for Ozeri was 73.3% and OMRON was 92.8%. Good correlation between BIA scales and DXA for body fat estimates. CONCLUSIONS: OMRON captured all low MM participants identified by DXA plus all on DXA diagnostic borderline. Prevalence of obesity was high. Clinically, sarcopenic obese is the most difficult phenotype, as obesity masks low muscle mass. Low cost, readily available, direct-to-consumer BIA BC scales, especially with hand sensors, provide immediate, reliable information on muscle and fat mass. This can prompt appropriate investigation and/or intervention for sarcopenia or sarcopenic obesity.
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