Canadian Geriatrics Journal[JOURNAL]
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200 papers
Measuring Potentially Avoidable Acute Care Transfers From Long-Term Care Homes in Quebec: a Cross Sectional Study.
Cetin-Sahin D, Karanofsky M, Cummings GG … +2 more , Vedel I, Wilchesky M
Can Geriatr J · 2023 Sep · PMID 37662066 · Full text
BACKGROUND: Potentially avoidable emergency department transfers (PAEDTs) and hospitalizations (PAHs) from long-term care (LTC) homes are two key quality improvement metrics. We aimed to: 1) Measure proportions of PAEDTs...
BACKGROUND: Potentially avoidable emergency department transfers (PAEDTs) and hospitalizations (PAHs) from long-term care (LTC) homes are two key quality improvement metrics. We aimed to: 1) Measure proportions of PAEDTs and PAHs in a Quebec sample; and 2) Compare them with those reported for the rest of Canada. METHODS: We conducted a repeated cross-sectional study of residents who were received at one tertiary hospital between April 2017 and March 2019 from seven LTC homes in Quebec, Canada. The MedUrge emergency department database was used to extract transfers and resident characteristics. Using published definitions, PAEDTs and PAHs were identified from principal emergency department and hospitalization diagnoses, respectively. PAEDT and PAH proportions were compared to those reported by the Canadian Institute for Health Information. RESULTS: A total of 1,233 transfers by 692 residents were recorded, among which 36.3% were classified as being potentially avoidable: 22.8% 'PAEDT only', 11.6% 'both PAEDT & PAH', and 1.9% 'PAH only'. Shortness of breath was the most common reason for transfer. Pneumonia was the most common diagnosis from the 'both PAEDT & PAH' category. PAEDTs and PAHs accounted for 95% and 37% of potentially avoidable transfers, respectively. Among 533 hospitalizations, 31.3% were PAHs. These proportions were comparable to the rest of Canada, with some differences in proportions of transfers due to congestive heart failure, urinary tract infection, and implanted device management. CONCLUSIONS: PAEDTs far outweigh PAHs in terms of frequency, and their monitoring is important for quality assurance as they may inform LTC-level interventions aimed at their reduction.
Utilization of Health Services Before and After Diagnosis in a Specialist Rural and Remote Memory Clinic.
Kosteniuk JG, Morgan DG, Osman BA … +5 more , Islam N, O'Connell ME, Kirk A, Quail JM, Osman M
Can Geriatr J · 2023 Sep · PMID 37662065 · Full text
BACKGROUND: Limited research exists on the use of specific health services over an extended time among rural persons with dementia. The study objective was to examine health service use over a 10-year period, five years...
BACKGROUND: Limited research exists on the use of specific health services over an extended time among rural persons with dementia. The study objective was to examine health service use over a 10-year period, five years before until five years after diagnosis in the specialist Rural and Remote Memory Clinic (RRMC). METHODS: Clinical and administrative health data of RRMC patients were linked. Annual health service utilization of the cohort ( = 436) was analyzed for 416 patients pre-index (57.5% female, mean age 71.2 years) and 419 post-index (56.3% female, mean age 70.8 years). Approximately 40% of memory clinic diagnoses were Alzheimer's disease (AD), 20% non-AD dementia, and 40% mild or subjective cognitive impairment or other condition. Post-index, 188 patients (44.9%) moved to permanent long-term care and were retained in the sample; 121 patients died (28.9%) and were removed yearly. RESULTS: Over the ten-year study period, a significant increase occurred in the average number of FP visits, all-type drug prescriptions, and dementia-specific drug prescriptions (all <.001). The highest proportion of patients hospitalized was observed one year pre-index, the highest average number of specialist visits was observed one year post-index, and both demonstrated a significant decreasing trend in the five-year post-index period ( = .037). CONCLUSIONS: A pattern of increasing FP visits and drug prescriptions over an extended period before and after diagnosis in a specialist rural and remote memory clinic highlights a need to support FPs in post-diagnostic management. Further research of longitudinal patterns in health service utilization is merited.
Survey and Interview Findings of an Environmental Scan of Perioperative Geriatric Models of Care in Canada.
Mistry M, Wong CL, Chan SW … +3 more , McIsaac DI, Khadaroo RG, Cheung B
Can Geriatr J · 2023 Sep · PMID 37662064 · Full text
BACKGROUND: Best practice recommendations support the implementation of perioperative geriatric care models that tailor to the specific needs of older adults undergoing surgery. The objective of this study was to describ...
BACKGROUND: Best practice recommendations support the implementation of perioperative geriatric care models that tailor to the specific needs of older adults undergoing surgery. The objective of this study was to describe the current proactive perioperative geriatric programs and pathways in Canadian hospitals. METHODS: A survey of geriatricians, surgeons, and anesthesiologists practicing in Canada combined with phone interviews of a subset of participants were used to determine characteristics of perioperative geriatric pathways or programs including eligibility, team composition, and intervention elements. RESULTS: Analysis of 132 survey respondents and 24 interviews showed 47% (40 out of 85) of hospitals described had elements of a perioperative geriatrics program and 20% had two or more elements. Eleven themes emerged including: how perioperative geriatric care programs built geriatric competencies in other health-care providers; geriatric assessment identified risks not captured in standard perioperative risk assessment; perceived value for patients and the health-care team; delirium prevention was addressed; most programs were reactive; most programs were informal; virtual care may be used to meet demand; successful implementation required system buy-in with collaboration across subspecialties; mechanisms to drive improvement were accountability and data evaluation; few clinicians with geriatric expertise; and other priorities limited program implementation. CONCLUSIONS: There were few hospitals in Canada with perioperative geriatric care models and even fewer with elements spanning the entire perioperative pathway. Strengths, weaknesses, opportunities, and threats to inform the implementation and sustainability of perioperative geriatric care in the Canadian context were identified in this national environmental scan.
Pharmacological Management of Agitation and Delirium in Older Adults: a Survey of Practices in Canadian Emergency Departments.
Russek NS, Skappak C, Scheuermeyer F … +4 more , Brousseau AA, McLeod SL, Melady D, Spencer M
Can Geriatr J · 2023 Sep · PMID 37662063 · Full text
Agitation is a common presenting symptom of delirium for older adults in the emergency department (ED). No medications have been found to reduce delirium severity, symptoms, or mortality, yet they may cause harm. Guideli...
Agitation is a common presenting symptom of delirium for older adults in the emergency department (ED). No medications have been found to reduce delirium severity, symptoms, or mortality, yet they may cause harm. Guidelines suggest using medications only when patients are posing a risk of harm, situations which may arise frequently in the ED. We sought to characterize prescribing patterns of medications for agitation by ED physicians in Canadian hospitals. In this multicenter study, we surveyed physicians in Vancouver, Toronto, and Sherbrooke. Descriptive statistics were used to summarize group characteristics and starting doses were compared to order sets. Fisher exact tests were used for demographic comparison. Ordinal linear regression models were run to identify a relationship between starting dose of medications and location. Of the 137 physicians invited, 77 (56%) completed the survey. Use of order sets was greatest in Sherbrooke and least in Vancouver. The most common medications used across sites were haloperidol, lorazepam, and quetiapine. Benzodiazepines were used across all sites but were used significantly more frequently in Vancouver than the other sites. Practice location was a significant predictor of starting dose of haloperidol, with Sherbrooke and Toronto having a lower starting dose than Vancouver. Higher use of order sets correlated with lower and more consistent starting doses. Benzodiazepines are used across EDs in Canada despite little evidence for efficacy in delirium and risk of harm. Implementation of order sets may be a useful way to standardize ED management of older adults experiencing hyperactive delirium.
Social Vulnerability and Frailty in Hospitalized Older Adults.
Mah JC, Godin J, Stevens SJ … +3 more , Keefe JM, Rockwood K, Andrew MK
Can Geriatr J · 2023 Sep · PMID 37662062 · Full text
BACKGROUND: Social vulnerability is the accumulation of disadvantageous social circumstances resulting in susceptibility to adverse health outcomes. Associated with increased mortality, cognitive decline, and disability,...
BACKGROUND: Social vulnerability is the accumulation of disadvantageous social circumstances resulting in susceptibility to adverse health outcomes. Associated with increased mortality, cognitive decline, and disability, social vulnerability has primarily been studied in large population databases rather than frail hospitalized individuals. We examined how social vulnerability contributes to hospital outcomes and use of hospital resources for older adults presenting to the Emergency Department. METHODS: We analyzed patients 65 years of age or older admitted through the Emergency Department and consulted to internal medicine or geriatrics at a Canadian tertiary care hospital from July 2009 to September 2020. A 20-item social vulnerability index (SVI) and a 57-item frailty index (FI) were calculated, using a deficit accumulation approach. Outcomes were length of stay (LOS), extended hospital LOS designation, alternative level of care (ALC) designation, in-hospital mortality, and discharge to long-term care (LTC). RESULTS: In 1,146 patients (mean age 80.5±8.3, 54.0% female), mean SVI was 0.40±0.16 and FI was 0.44±0.14. The SVI scores were not associated with admission to hospital. Amongst those admitted, for every 0.1 unit increase in SVI, LOS increased by 1.15 days (<.001) after adjusting for age, sex and FI. SVI was associated with staying over the expected LOS (aOR: 1.19, 1.051.34, =.009) and ALC status (aOR 1.39, 1.121.74, <.004). SVI was not associated with in-hospital mortality, but was associated with incident discharge to LTC (aOR 1.03, 1.021.04, <.001). CONCLUSION: Independent of frailty, being socially vulnerable was associated with increased LOS, designation as ALC, and being discharged to LTC from hospital. Consideration of social vulnerability's influence on prolonged hospitalization and long-term care needs has implications for screening and hospital resources.
Retrospective Use of the Pictorial Fit-Frail Scale for Determination of Frailty Level in Hospitalized Older Adults with a Hip Fracture.
Bohnsack A, Faig K, Cook A … +8 more , Gionet S, Shanks J, Benjamin S, Steeves A, MacLellan C, Flewelling AJ, McGibbon C, Jarrett P
Can Geriatr J · 2023 Sep · PMID 37662061 · Full text
The Pictorial Fit-Frail Scale (PFFS) is a frailty tool consisting of visual images to comprehensively assess frailty across 14 domains that can be completed by health professionals, patients, or caregivers. The objective...
The Pictorial Fit-Frail Scale (PFFS) is a frailty tool consisting of visual images to comprehensively assess frailty across 14 domains that can be completed by health professionals, patients, or caregivers. The objective of this study was to explore the feasibility of using the PFFS retrospectively to determine a patient's frailty level using data from the hospital electronic health records (EHRs) of older adults admitted with an isolated hip fracture. A random sample of 200 hip fracture patients admitted to a Level 1 Trauma Center hospital in New Brunswick was selected for review using the PFFS. The majority (94.5%) of hospital EHRs contained the clinical information needed to populate most of the 14 PFFS domains, allowing for determination of a frailty score. The mean raw PFFS frailty score was 9.7 (SD 6.6), consistent with moderate frailty. For all patients, a Frailty Index (FI) score was calculated, with the mean being 0.27 (SD 0.18), again consistent with moderate frailty. Comparing the PFFS score to the FI score, the percentage categorized as not frail or very mildly frail fell from 33.3% to 20.1%, and those considered severely frail rose from 30.7% to 34.9%. The PFFS can be successfully used retrospectively with hospital EHRs to determine the frailty level of older patients. When converted to the FI score, there was an increase in the frequency and severity of frailty. This tool may provide a useful way to stratify older adults by frailty that can be helpful in evaluating health outcomes based on frailty levels.
Talking About Notes: Using a Design-Based Research Approach to Develop a Discharge Summary Template on a Geriatric Inpatient Unit.
Burrell A, Goldszmidt M
Can Geriatr J · 2023 Sep · PMID 37662060 · Full text
BACKGROUND: Discharge summaries are important educational tools, guiding trainees in their collection and documentation of data. As geriatric competencies are integrated in medical curricula, documentation on in-patient...
BACKGROUND: Discharge summaries are important educational tools, guiding trainees in their collection and documentation of data. As geriatric competencies are integrated in medical curricula, documentation on in-patient geriatric rotations should represent the unique care and education provided, yet often follow generic templates. What content should be included in a geriatric discharge summary has not previously been explored and was the purpose of this study. METHODS: A mixed-methods, designed-based research approach was used to assess note quality on a geriatric in-patient unit and iteratively co-develop a template with examples through three phases: 1) needs assessment, 2) consensus building, and 3) template development. RESULTS: Sixty-eight discharge summaries were assessed by five geriatricians, with 14 gaps identified. Many of these reflected elements that were present but addressed generically without attention to the specificity required from a geriatric perspective. In response, the team developed a geriatric-specific template with explicit examples. Through the consensus process three barriers to quality notes and trainee education were identified: the chronic state of low-quality notes being accepted as the norm, time limitations due to the high volume of patients, and high volume of clinical documents. CONCLUSIONS: The identification of gaps in geriatric discharge summaries allowed for the co-development of an instructional template and examples that goes beyond simple headings and highlights the importance of applying and documenting geriatric competencies. Although we encourage others to take up and modify the tools for trainees in their local context, more importantly, we encourage them to take up the dialogue about note quality.
Dual Sensory Impairment and Functional Status in a Prospective Cohort Study.
Janower A, St John P
Can Geriatr J · 2023 Sep · PMID 37662059 · Full text
OBJECTIVE: To examine the impact of visual impairment, hearing impairment, and dual sensory impairment (DSI) on functional status in older adults. METHODS: Secondary analysis of the Manitoba Health and Aging Study, a pop...
OBJECTIVE: To examine the impact of visual impairment, hearing impairment, and dual sensory impairment (DSI) on functional status in older adults. METHODS: Secondary analysis of the Manitoba Health and Aging Study, a population-based cohort study of 1751 adults age 65+. Data were collected from 1991 to 1992 (Time 1), with follow-up five years later (Time 2). Vision and hearing were self-reported. Functional status was measured using the Older Americans Resource and Services (OARS). Logistic regression models were constructed to assess functional status at both Time 1 and Time 2. RESULTS: Dual sensory impairment (DSI) at Time 1 predicted poor functional status at both Time 1 and Time 2. The adjusted odds ratios (OR; 95% confidence interval [CI]) for poor functional status at Time 1 for those with only hearing impairment was 1.74 (1.25, 2.44) for visual impairment was 2.95 (2.19, 3.98), and for DSI was 3.58 (2.58, 4.95). At Time 2, the adjusted ORs for poor functional status for those with only hearing impairment was 1.32 (0.86, 2.03), for visual impairment was 1.63 (1.05, 2.52), and for DSI was 2.61 (1.54, 4.40). CONCLUSIONS: DSI is associated with lower functional status, but the effect of visual impairment is more pronounced than hearing impairment.
Radiomic Biomarkers as a Non-Invasive Tool for Assessing Biological Age.
Chambers KH
Can Geriatr J · 2023 Sep · PMID 37662058 · Full text
Abstract loading — click title to view on PubMed.
Corrigendum: Leisure sedentary time is associated with self-reported falls in middle-aged and older females and males: an analysis of the CLSA.
Lustosa LG, Rudoler D, Theou O … +1 more , Dogra S
Can Geriatr J · 2023 Sep · PMID 37662057 · Full text
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Potential Factors Influencing Adoption of a Primary Care Pathway to Prevent Functional Decline in Older Adults.
Fanaki C, Fortin J, Sirois MJ … +6 more , Kröger E, Elliott J, Stolee P, Gregg S, Sims-Gould J, Giguere A
Can Geriatr J · 2023 Jun · PMID 37265986 · Full text
INTRODUCTION: To help recognize and care for community-dwelling older adults living with frailty, we plan to implement a primary care pathway consisting of frailty screening, shared decision-making to select a preventive...
INTRODUCTION: To help recognize and care for community-dwelling older adults living with frailty, we plan to implement a primary care pathway consisting of frailty screening, shared decision-making to select a preventive intervention, and facilitated referral to community-based services. In this study, we examined the potential factors influencing adoption of this pathway. METHODS: In this qualitative, descriptive study, we conducted semi-structured interviews and focus groups with patients aged 70 years and older, health professionals (HPs), and managers from four primary care practices in the province of Quebec, representatives of community-based services and geriatric clinics located near the practices. Two researchers conducted an inductive/deductive thematic analysis, by first drawing on the and then adding emergent subthemes. RESULTS: We recruited 28 patients, 29 HPs, and 8 managers from four primary care practices, 16 representatives from community-based services, and 10 representatives from geriatric clinics. Participants identified several factors that could influence adoption of the pathway: the availability of electronic and printed versions of the decision aids; the complexity of including a screening form in the electronic health record; public policies that limit the capacity of community-based services; HPs' positive attitudes toward shared decision-making and their work overload; and lack of funding. CONCLUSIONS: These findings will inform the implementation of the care pathway, so that it meets the needs of key stakeholders and can be scaled up.
Geriatric Specialists' Perspectives on Telemedicine during the COVID-19 Pandemic: a Concurrent Triangulation Mixed-Methods Study.
Chuen VL, Dholakia S, Kalra S … +3 more , Watt J, Wong C, Ho JM
Can Geriatr J · 2023 Jun · PMID 37265985 · Full text
During the COVID-19 pandemic, physicians provided virtual care to minimize viral transmission. This concurrent triangulation mixed-methods study assesses the use of synchronous telephone and video visits with patients an...
During the COVID-19 pandemic, physicians provided virtual care to minimize viral transmission. This concurrent triangulation mixed-methods study assesses the use of synchronous telephone and video visits with patients and asynchronous eConsults by geriatric providers, and explores their perspectives on telemedicine use during the pandemic. Participants included physicians practicing in Ontario, Canada who were certified in Geriatric Medicine, or Care of the Elderly, or who were the most responsible physician in a long-term care for at least 10 patients. Participants' perspectives were solicited using an online survey and themes were generated through a reflexive thematic analysis of survey responses. We assessed the current use of each telemedicine tool and compared the proportion of participants using telemedicine before the pandemic with self-predicted use after the pandemic. We received 29 surveys from eligible respondents (87.9% completion rate), with 75.9% being geriatricians. The telephone was most used (96.6%), followed by video (86.2%) and eConsults (64%). Most participants using telephone and video visits had newly implemented them during the pandemic and intend to continue using these tools post-pandemic. Our thematic analysis revealed that telemedicine plays an important role in the continuity of care during the pandemic, with increased self-reported positive perspectives and openness towards use of virtual care tools, although limited by inadequate physical exams or cognitive testing. Its ongoing use depends on the availability of continued remuneration.
Do older people with poor sleep quality have worse cardiac autonomic control?
Rocha ASL, de Barros Siqueira V, Maduro PA … +4 more , Batista LDSP, Neves VR, Gambassi BB, Schwingel PA
Can Geriatr J · 2023 Jun · PMID 37265984 · Full text
OBJECTIVE: To identify the differences in cardiac autonomic control between older people with good and poor sleep quality. MATERIAL AND METHODS: This is a cross-sectional study with 40 older people aged ≥ 60 years, regis...
OBJECTIVE: To identify the differences in cardiac autonomic control between older people with good and poor sleep quality. MATERIAL AND METHODS: This is a cross-sectional study with 40 older people aged ≥ 60 years, registered at a community health center in Petrolina, Pernambuco, Brazil. The sleep quality was assessed with the Pittsburgh Sleep Quality Index (PSQI). To assess heart rate variability (HRV), the RR intervals (RRI) were recorded for 10 min with a validated smartphone app and a wireless transmitter Polar H7 positioned on the patient's chest. The HRV parameters were calculated with Kubios HRV, and the data were analyzed in SPSS. Subjects with good and poor sleep quality (PSQI >5) were compared with the Mann-Whitney U test. RESULTS: A total of 31 older people were included in the final analysis, with 18 (58.1%) of them having poor sleep quality. Older people with good sleep quality have similar cardiac autonomic control to those with poor sleep quality. The medians of time (mean RRI, pNN50, SDNN, and RMSSD) and frequency-domain HRV parameters (LFms, LFnu, HFms, HFnu, and LF/HF ratio) were statistically similar ( > .05) in older people with good and poor sleep quality. According to the effect size, the HRV indicators were slightly better among those with good sleep quality. CONCLUSION: There were no statistical differences in cardiac autonomic control between older people with good and poor sleep quality.
Retrospective Cross-sectional Analysis of Older Adults Living with Frailty and Anticoagulant Use for Atrial Fibrillation.
Bolt J, Barry AR, Yuen J … +3 more , Madden K, Dhillon M, Inglis C
Can Geriatr J · 2023 Jun · PMID 37265983 · Full text
BACKGROUND: Oral anticoagulation (OAC) is recommended for most individuals with atrial fibrillation (AF), including those who are frail. Based on previous literature, those who are frail may be less likely to be prescrib...
BACKGROUND: Oral anticoagulation (OAC) is recommended for most individuals with atrial fibrillation (AF), including those who are frail. Based on previous literature, those who are frail may be less likely to be prescribed OAC, and up to one-third may receive an inappropriate dose if prescribed a direct oral anticoagulant (DOAC). The objectives of this study were to determine the proportion of frail ambulatory older adults with AF who are prescribed OAC, compare the rates of OAC use across the frailty spectrum, assess the appropriateness of DOAC dosing, and identify if frailty and geriatric syndromes impact OAC prescribing patterns. METHODS: Retrospective cross-sectional review of individuals with AF referred to an ambulatory clinic for older adults living with frailty and/or geriatric syndromes. Rockwood clinical frailty score of ≥4 was used to define frailty and DOAC appropriateness was assessed based on the Canadian Cardiovascular Society AF guidelines. RESULTS: Two hundred and ten participants were included. The mean age was 84 years, 49% were female and the median frailty score was 5. Of the 185 participants who were frail, 82% were prescribed an OAC (83% with frailty score of 4, 85% with a frailty score of 5, and 78% with a frailty score of 6). Of those prescribed a DOAC, 70% received a guideline-approved dose. CONCLUSIONS: Over 80% of ambulatory older adults with frailty and AF were prescribed an OAC. However, of those prescribed a DOAC, 30% received an unapproved dose, suggesting more emphasis should be placed on initial and ongoing dosage selection.
Leisure Sedentary Time is Associated with Self-Reported Falls in Middle-aged and Older Females and Males: an Analysis of the CLSA.
Lustosa LG, Rudoler D, Theou O … +1 more , Dogra S
Can Geriatr J · 2023 Jun · PMID 37265982 · Full text
AIM: The purpose of this analysis was to report the prevalence of falls and falls-related injuries among those reporting different volumes of weekly sedentary time, and to understand the association of sedentary time and...
AIM: The purpose of this analysis was to report the prevalence of falls and falls-related injuries among those reporting different volumes of weekly sedentary time, and to understand the association of sedentary time and falls, accounting for functional fitness. METHODS: Baseline and first follow-up data from the Canadian Longitudinal Study on Aging (CSLA) were analyzed (n=22,942). Participants self-reported whether they had a fall in the past 12 months (at baseline) and whether they had an injury that was a result of a fall (follow-up). In-home interviews collected self-reported leisure sedentary time using the Physical Activity Scale for Elderly. Functional fitness was assessed using grip strength, timed-up-and-go, and chair rise tests during clinic visits. RESULTS: The prevalence of falls was higher among those who reported higher sedentary time. For example, among males aged 65 and older who reported lower sedentary time (<1,080 min/week), the prevalence of falls in the past 12 months (at baseline) was 7.8% compared to 9.8% in those reporting higher sedentary time. The odds of reporting a fall (at baseline) was 21% higher in those who reported higher sedentary time (OR: 1.21; 95%CI: 1.11-1.33) in adjusted models. No associations were found between sedentary time and injuries due to a fall. CONCLUSIONS: Reporting high volumes of sedentary time may increase the risk of falls. Future research using device-based estimates of total sedentary time and breaks in sedentary time is needed to further elucidate this association.
Using Shared Decision-Making Resources in Long-Term Care: a Qualitative Study.
Thompson W, McCarthy LM, Galley E … +2 more , Homan L, Farrell B
Can Geriatr J · 2023 Jun · PMID 37265981 · Full text
BACKGROUND: Shared decision-making (SDM) incorporates people's individual preferences and context into individualized, person-centred decisions. Persons living in long-term care (LTC) should only take medications that ar...
BACKGROUND: Shared decision-making (SDM) incorporates people's individual preferences and context into individualized, person-centred decisions. Persons living in long-term care (LTC) should only take medications that are a good fit for them as individuals. METHODS: We conducted a pilot study to understand experiences of two LTC homes in Ontario as they tested implementing SDM resources to support medication decisions. LTC homes conducted two Plan-Do-Study-Act (PDSA) cycles supported by an Advisory Group composed of LTC home representatives and stakeholders involved in resource design. Rapid qualitative analysis of transcripts and field notes from Advisory Group meetings elucidated how SDM resources were used. RESULTS: Each site was positively engaged but implemented resources differently. The pharmacist and physicians at Site 1 introduced proton-pump inhibitor (PPI) deprescribing as their primary intervention, identifying suitable residents, informing residents and families of the deprescribing process, and providing selected SDM resources to residents, caregivers and staff. Representatives reported limited engagement with SDM resources and difficulty measuring the impact of PPI deprescribing. Representatives from Site 2 disseminated the SDM resources to residents and caregivers for use at care conferences and focused on front-line staff education and involvement. This site reported that some residents/caregivers were interested in participating in SDM and using the resources, while others were not. The impact of the resources on SDM at this site was unclear. CONCLUSIONS: Within the context of LTC, further research is needed to clarify the meaning and importance of SDM in medication decision-making. Implementation of SDM will likely require a multi-faceted approach.
Abstracts: Abstracts from the 42nd Annual Scientific Meeting of the Canadian Geriatrics Society: Compassionate Care for All: Renewing Our Passion, Recalibrating our Compass; April 13-15, 2023; Vancouver, British Columbia.
Can Geriatr J · 2023 Jun · PMID 37265980 · Full text
Abstract loading — click title to view on PubMed.
The Effect of a Standing Intervention on Falls in Long Term Care: a Secondary Analysis of a Randomized Controlled Trial.
Gallibois M, Handrigan G, Caissie L … +7 more , Cooling K, Hébert J, Jarrett P, McGibbon C, Read E, Sénéchal M, Bouchard DR
Can Geriatr J · 2023 Jun · PMID 37265979 · Full text
BACKGROUND: Older adults in long term care (LTC) spend over 90% of their day engaging in sedentary behaviour. Sedentary behaviour may exacerbate functional decline and frailty, increasing the risk for falls. The purpose...
BACKGROUND: Older adults in long term care (LTC) spend over 90% of their day engaging in sedentary behaviour. Sedentary behaviour may exacerbate functional decline and frailty, increasing the risk for falls. The purpose of this study is to explore the impact of a 22-week standing intervention on falls among LTC residents at 12-month follow-up. METHODS: This was a planned secondary analysis of the Stand if You Can randomized controlled trial. The original trial randomized 95 participants (n = 47 control; n = 48 intervention) to either a sitting control or a supervised standing intervention group (100 minutes/week) for 22 weeks. Falls data were available to be collected over 12 months post-intervention for 89 participants. The primary outcome was a hazard of fall (Yes/No) during the 12-month follow-up period. RESULTS: A total of 89 participants (average age 86 years ± 8.05; 71.9% female) were followed for 12-months post-intervention. Participants in the intervention group (n=44) had a significantly greater hazard ratio of falls (2.01; 95% CI = 1.11 to 3.63) than the control group (n=45) when accounting for the history of falls, frailty status, cognition level, and sex. CONCLUSION: Participants who received a standing intervention over 22 weeks were twice as likely to fall 12 months after the intervention compared with the control group. However, the prevalence of falls did not surpass what would be typically observed in LTC facilities. It is imperative that future studies describe in detail the context in which falls happen and collect more characteristics of participants in the follow-up period to truly understand the association between standing more and the risk of falls.
Facilitators and Barriers to Nurses Screening for Frailty in Acute Care in a Provincial Health-Care System: a Survey Study Guided by the Theoretical Domains Framework.
France J, Lalonde M, McIsaac DI … +2 more , Squires JE, Backman C
Can Geriatr J · 2023 Jun · PMID 37265978 · Full text
BACKGROUND: Older adults living with frailty represent the largest population of hospitalized patients in Canada, but they do not always receive the quality of care needed. Nurses are well-positioned to screen for frailt...
BACKGROUND: Older adults living with frailty represent the largest population of hospitalized patients in Canada, but they do not always receive the quality of care needed. Nurses are well-positioned to screen for frailty, but current frailty screening practices are poorly understood. METHODS: A cross-sectional survey study was conducted over a six-week period with nurses from Alberta, Canada working in acute care with older adults. Demographics were descriptively reported. Frailty screening methods were quantified on 5-point frequency scales, reported descriptively and compared by practice area using linear regression. The top-five mean scores from a 43-item, 6-point Likert-type questionnaire based on the Theoretical Domains Framework were compared by practice area. RESULTS: Frailty screening by clinical impression was "usually" used (median = 4, IQR = 4-5), while tools were "rarely" used (median = 2, IQR = 1-3). Medical and/or surgical nursing had higher general frailty screening tool use (β = 0.81, = .31, < .001), but no significant ( > .05) differences for using clinical impression, or preference of screening method. The top facilitator was the disbelief that frailty screening negatively impacts relationships with older adults. The top barrier was belief that conducting frailty screening was routine. Nursing practice area influenced frailty screening beliefs. CONCLUSIONS: There is an opportunity to implement frailty screening tools into the nursing practice of Alberta' nurses working in acute care. Frailty screening tools that become routine have greater likelihood for utilization. Nursing practice areas may have unique situations that require tailored approached to tool implementation.
Comparative Risk of Harm Associated with Zopiclone or Trazodone Use in Nursing Home Residents: a Retrospective Cohort Study in Alberta, Canada.
Watt JA, Bronskill SE, Lin M … +5 more , Youngson E, Ho J, Hemmelgarn B, Straus SE, Gruneir A
Can Geriatr J · 2023 Mar · PMID 36865408 · Full text
BACKGROUND: There is growing evidence of harm associated with trazodone and nonbenzodiazepine sedative hypnotics (e.g., zopiclone); however, their comparative risk of harm is unknown. METHODS: We conducted a retrospectiv...
BACKGROUND: There is growing evidence of harm associated with trazodone and nonbenzodiazepine sedative hypnotics (e.g., zopiclone); however, their comparative risk of harm is unknown. METHODS: We conducted a retrospective cohort study with linked health administrative data, which enrolled older (≥66 years old) nursing home residents living in Alberta, Canada, between December 1, 2009, and December 31, 2018; the last follow-up date was June 30, 2019. We compared the rate of injurious falls and major osteoporotic fractures (primary outcome) and all-cause mortality (secondary outcome) within 180 days of first prescription of zopiclone or trazodone with cause-specific hazard models and inverse probability of treatment weights to control for confounding; primary analysis was intention-to-treat and secondary analysis was per-protocol (i.e., residents censored if dispensed the other exposure drug). RESULTS: Our cohort included 1,403 residents newly dispensed trazodone and 1,599 residents newly dispensed zopiclone. At cohort entry, the mean resident age was 85.7 (standard deviation [SD] 7.4), 61.6% were female, and 81.2% had dementia. New zopiclone use was associated with similar rates of injurious falls and major osteoporotic fractures (intention-to-treat-weighted hazard ratio 1.15, 95% confidence interval [CI] 0.90-1.48; per-protocol-weighted hazard ratio 0.85, 95% CI 0.60-1.21) and all-cause mortality (intention-to-treat-weighted hazard ratio 0.96, 95% CI 0.79-1.16; per-protocol-weighted hazard ratio 0.90, 95% CI 0.66-1.23) compared to trazodone. CONCLUSIONS: Zopiclone was associated with a similar rate of injurious falls, major osteoporotic fractures, and all-cause mortality compared to trazodone-suggesting one medication should not be used in lieu of the other. Appropriate prescribing initiatives should also target zopiclone and trazodone.
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