Canadian Geriatrics Journal[JOURNAL]
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200 papers
Development of a Frailty Ladder Using Rasch Analysis: If the Shoe Fits.
Mayo NE, Aubertin-Leheudre M, Mate K … +5 more , Figueiredo S, Fiore JF, Auais M, Scott SC, Morais JA
Can Geriatr J · 2023 Mar · PMID 36865407 · Full text
BACKGROUND: The current measurement approach to frailty is to create an index of frailty status, rather than measure it. The purpose of this study is to test the extent to which a set of items identified within the frail...
BACKGROUND: The current measurement approach to frailty is to create an index of frailty status, rather than measure it. The purpose of this study is to test the extent to which a set of items identified within the frailty concept fit a hierarchical linear model (e.g., Rasch model) and form a true measure reflective of the frailty construct. METHODS: A sample was assembled from three sources: community organization for at-risk seniors (n=141); colorectal surgery group assessed post-surgery (n=47); and hip fracture assessed post-rehabilitation (n=46). The 234 individuals (age 57 to 97) contributed 348 measurements. The frailty construct was defined according to the named domains within commonly used frailty indices, and items drawn to reflect the frailty came from self-report measures. Performance tests were tested for the extent to which they fit the Rasch model. RESULTS: Of the 68 items, 29 fit the Rasch model: 19 self-report items on physical function and 10 performance tests, including one for cognition; patient reports of pain, fatigue, mood, and health did not fit; nor did body mass index (BMI) nor any item representing participation. CONCLUSION: Items that are typically identified as reflecting the frailty concept fit the Rasch model. The Frailty Ladder would be an efficient and statistically robust way of combining results of different tests into one outcome measure. It would also be a way of identifying which outcomes to target in a personalized intervention. The rungs of the ladder, the hierarchy, could be used to guide treatment goals.
Enhancing Physical and Community MoBility in OLDEr Adults with Health Inequities Using CommuNity Co-Design (EMBOLDEN): Results of an Environmental Scan.
Newbold KB, Valaitis R, Phillips S … +9 more , Alvarez E, Neil-Sztramko S, Sihota D, Tandon M, Nadarajah A, Wang A, Moore C, Orr E, Ganann R
Can Geriatr J · 2023 Mar · PMID 36865406 · Full text
BACKGROUND: Using the comparatively new environmental scan methodology, a protocol was developed and conducted to inform the co-design and implementation of a novel intervention to promote mobility among older adults in...
BACKGROUND: Using the comparatively new environmental scan methodology, a protocol was developed and conducted to inform the co-design and implementation of a novel intervention to promote mobility among older adults in Hamilton, Ontario, Canada. The EMBOLDEN program seeks to promote physical and community mobility in adults 55 years and older who face barriers accessing community programs and who reside in areas of high inequity in Hamilton, and to address the following areas of focus: physical activity, nutrition, social participation, and system navigation supports. METHODS: The environmental scan protocol was developed using existing models and drew insights from census data, a review of existing services, organizational representative interviews, windshield surveys of selected high-priority neighbourhoods, and Geographic Information System (GIS) mapping. RESULTS: A total of 98 programs for older adults from 50 different organizations were identified, with the majority (92) supporting mobility, physical activity, nutrition, social participation, and system navigation. The analysis of census tract data identified eight high-priority neighbourhoods characterized by large shares of older adults, high material deprivation, low income, and high proportion of immigrants. These populations can be hard to reach and face multiple barriers to participation in community-based activities. The scan also revealed the nature and types of services geared toward older adults in each neighbourhood, with each priority neighbourhood having at least one school and park. Most areas had a range of services and supports (i.e., health care, housing, stores, religious options), although there was a lack of diverse ethnic community centres and income-diverse activities specific to older adults in most neighbourhoods. Neighbourhoods also differed in the geographic distribution number of services, along with the number of recreational services specific to older adults. Barriers included financial and physical accessibility, lack of ethnically diverse community centres, and food deserts. CONCLUSIONS: Scan results will inform the co-design and implementation of the Enhancing physical and community MoBility in OLDEr adults with health inequities using commuNity co-design intervention-EMBOLDEN.
Dementia Risk Prediction in a Longitudinal Geriatric Parkinson's Disease Cohort: Evaluation and Application of the Montreal Parkinson Risk of Dementia Scale.
Bohn L, McFall GP, Gee M … +3 more , Postuma RB, Dixon RA, Camicioli R
Can Geriatr J · 2023 Mar · PMID 36865405 · Full text
BACKGROUND: Parkinson's disease (PD) increases risk for dementia and cascading adverse outcomes. The eight-item Montreal Parkinson Risk of Dementia Scale (MoPaRDS) is a rapid, in-office dementia screening tool. We examin...
BACKGROUND: Parkinson's disease (PD) increases risk for dementia and cascading adverse outcomes. The eight-item Montreal Parkinson Risk of Dementia Scale (MoPaRDS) is a rapid, in-office dementia screening tool. We examine predictive validity and other characteristics of the MoPaRDS in a geriatric PD cohort by testing a series of alternative versions and modelling risk score change trajectories. METHODS: Participants were 48 initially non-demented PD patients (Mage = 71.6 years, range = 65-84) from a three-year, three-wave prospective Canadian cohort study. A dementia diagnosis at Wave 3 was used to stratify two baseline groups: PD with Incipient Dementia (PDID) and PD with No Dementia (PDND). We aimed to predict dementia three years prior to diagnosis using baseline data for eight indicators that harmonized with the original report, plus education. RESULTS: Three MoPaRDS items (age, orthostatic hypotension, mild cognitive impairment [MCI]) discriminated the groups both independently and as a composite three-item scale (area under the curve [AUC] = 0.88). The eight-item MoPaRDS reliably discriminated PDID from PDND (AUC = 0.81). Education did not improve predictive validity (AUC = 0.77). Performance of the eight-item MoPaRDS varied across sex (AUCfemales = 0.91; AUCmales = 0.74), whereas the three-item configuration did not (AUCfemales = 0.88; AUCmales = 0.91). Risk scores of both configurations increased over time. CONCLUSIONS: We report new data on the application of the MoPaRDS as a dementia prediction tool for a geriatric PD cohort. Results support the viability of the full MoPaRDS, and indicate that an empirically determined brief version is a promising complement.
Self-Medication Practices, Use of Brand-Name, and Over-the-Counter Medicines by Peruvian Older Adults.
Herrera-Añazco P, Mougenot B, Benites-Meza JK … +5 more , Barturén-Alvarado LC, Zumarán-Nuñez CJ, Boyd-Gamarra MA, Runzer-Colmenares FM, Benites-Zapata VA
Can Geriatr J · 2023 Mar · PMID 36865404 · Full text
BACKGROUND: Older adults are a particularly vulnerable group to drug use and self-medication. The aim of the study was to evaluate self-medication as a factor associated with the purchase of brand-name and over-the-count...
BACKGROUND: Older adults are a particularly vulnerable group to drug use and self-medication. The aim of the study was to evaluate self-medication as a factor associated with the purchase of brand-name and over-the-counter (OTC) drugs in older adults in Peru. METHODS: A secondary analysis was performed using an analytical cross-sectional design of data from a nationally representative survey from 2014 to 2016. The exposure variable was self-medication, defined as the purchase of medicines without a prescription. The dependent variables were purchases of brand-name and OTC drugs, both as a dichotomous response (yes/no). Information of sociodemographic variables, health insurance, and the types of drugs purchased by the participants was collected. Crude prevalence ratios (PR) were calculated and adjusted using generalized linear models of the Poisson family, considering the complex sample of the survey. RESULTS: In this study, 1,115 respondents were evaluated, with a mean age of 63.8 years and a male proportion of 48.2%. The prevalence of self-medication was 66.6%, while the proportions of purchases of brand-name and OTC drugs were 62.4% and 23.6%, respectively. The adjusted Poisson regression analysis revealed an association between self-medication and the purchase of brand-name drugs (adjusted PR [aPR]=1.09; 95% confidence interval [CI]: 1.01-1.19). Likewise, self-medication was associated with the purchase of OTC medications (aPR=1.97; 95%CI: 1.55-2.51). CONCLUSIONS: This study evidenced a high prevalence of self-medication in Peruvian older adults. Two-thirds of the surveyed people bought brand-name drugs, whereas one-quarter bought OTC drugs. Self-medication was associated with a greater likelihood of buying brand-name and OTC drugs.
The Effects of Stepping Exercise on Blood Pressure, Physical Performance, and Quality of Life in Female Older Adults with Stage 1 Hypertension: a Randomized Controlled Trial.
Sarinukul C, Janyacharoen T, Donpunha W … +3 more , Nakmareong S, Ruksapukdee W, Sawanyawisuth K
Can Geriatr J · 2023 Mar · PMID 36865403 · Full text
BACKGROUND: Hypertension is a common disease, particularly in older adults. In a previous study, we found that an eight-week course of stepping exercise improved physical performance in healthy older adults as measured u...
BACKGROUND: Hypertension is a common disease, particularly in older adults. In a previous study, we found that an eight-week course of stepping exercise improved physical performance in healthy older adults as measured using the six-minute walk test (468 vs. 426 m in controls; = .01). This study aims to further evaluate the effects of stepping exercise on blood pressure, physical performance, and quality of life in older adults with stage 1 hypertension. METHODS: This was a randomized, controlled trial comparing older adults with stage 1 hypertension who performed stepping exercise with controls. The stepping exercise (SE) was performed at moderate intensity three times/week over an eight-week period. Participants in the control group (CG) received verbal and written (pamphlet) lifestyle modification advice. Blood pressure at Week 8 was the primary outcome, while quality of life score and physical performance on the 6-minute walk test (6MWT), timed up and go test (TUGT), and five times sit to stand test (FTSST) were secondary outcomes. RESULTS: There were 17 female patients in each group (total of 34). After eight weeks of training, participants in the SE group showed significant improvements in systolic blood pressure (SBP; 132.0 vs. 145.1 mmHg; <.01), diastolic blood pressure (DBP; 67.3 vs. 87.6 mmHg; <.01), 6MWT (465.6 vs. 437.0; <.01), TUGT (8.1 vs. 9.2 sec; <.01), and FTSST (7.9 vs. 9.1 sec; <.01) compared to controls. Regarding within-group comparison, participants in the SE also showed significant improvement in all outcomes from baseline, while any such outcomes in the CG were comparable from baseline (SBP: 144.1 to 145.1 mmHg; = .23; DBP: 84.3 to 87.6 mmHg; = .90). CONCLUSIONS: The stepping exercise examined is an effective non-pharmacological intervention for blood pressure control in female older adults with stage 1 hypertension. This exercise also resulted in improvements in physical performance and quality of life.
The Relationship Between Physical Activity and Limited Range of Motion in the Older Bedridden Patients.
Murata C, Kataoka H, Aoki H … +9 more , Nakashima S, Nakagawa K, Goto K, Yamashita J, Okita S, Takahashi A, Honda Y, Sakamoto J, Okita M
Can Geriatr J · 2023 Mar · PMID 36865402 · Full text
BACKGROUND: The purpose of this study is to examine the association between physical activity and contracture in older patients confined to bed in long-term care (LTC) facilities. METHODS: Patients wore ActiGraph GT3X+ f...
BACKGROUND: The purpose of this study is to examine the association between physical activity and contracture in older patients confined to bed in long-term care (LTC) facilities. METHODS: Patients wore ActiGraph GT3X+ for 8 hours on their wrists, and vector magnitude (VM) counts were obtained as the amount of activity. The passive range of motion (ROM) of joints was measured. The severity of ROM restriction classified, as the tertile value of the reference ROM of each joint, was scored 1-3 points. Spearman's rank correlation coefficients (Rs) were used to measure the association between the VM counts per day and ROM restrictions. RESULTS: The sample comprised 128 patients with a mean (SD) age of 84.8 (8.8) years. The mean (SD) of VM was 84574.6 (115195.2) per day. ROM restriction was observed in most joints and movement directions. ROMs in all joints and movement directions, except wrist flexion and hip abduction, were significantly correlated with VM. Furthermore, the VM and ROM severity scores showed a significant negative correlation (Rs = -0.582, < .0001). CONCLUSIONS: A significant correlation between the physical activity and ROM restrictions indicates that a decrease in the amount of physical activity could be one of the causes of contracture.
A Preliminary Assessment of the Psychometric Properties of a New Communication Aid to Support Assessments of Financial Decision-Making Capacity in People with Aphasia.
Carr FM
Can Geriatr J · 2023 Mar · PMID 36865401 · Full text
BACKGROUND: Financial decision-making is complex and requires an in-depth assessment. In the presence of communication disorders, like aphasia, such assessments become challenging and require the use of a dedicated commu...
BACKGROUND: Financial decision-making is complex and requires an in-depth assessment. In the presence of communication disorders, like aphasia, such assessments become challenging and require the use of a dedicated communication aid. No communication aid currently exists to support financial decision-making capacity (DMC) assessments for persons with aphasia (PWA). We sought to establish the validity, reliability, and feasibility of a newly constructed communication aid desigqned for this purpose. METHODS: A mixed methods study was performed, divided into three phases. Phase one was aimed at capturing current understanding of DMC and communication by community-dwelling seniors, using focus groups. The second phase involved the development of a new communication aid to assist with the assessment of financial DMC for PWA. The third phase aimed to establish the psychometric properties of this new visual communication aid. RESULTS: The new communication aid is a 37-page, paper-based document, with 34 picture-based questions. Due to unforeseen difficulties in participant recruitment for evaluating the communication aid, a preliminary evaluation was performed on the results from eight participants. These indicated the communication aid had moderate inter-rater reliability (Gwet's AC1 kappa of 0.51 [CI 0.4362 to 0.5816, < .000]), good internal consistency (0.76), and was usable. CONCLUSIONS: This newly developed communication aid is one of a kind, and provides essential support for PWA requiring a financial DMC assessment, which was not previously available. Preliminary evaluation of its psychometric properties is promising; however, further validation is required to confirm its validity and reliability in the proposed sample size.
Personalized Telehealth: Redesigning Complex Care Delivery for the 65+ During the COVID Pandemic: a Survey of Patients, Caregivers, and Health-care Providers.
Nene S, Rauch M, Belanger D … +6 more , Bennett R, Berry G, Saad N, Wall M, Morais JA, Morin SN
Can Geriatr J · 2023 Mar · PMID 36865400 · Full text
BACKGROUND: In the context of the ongoing COVID-19 pandemic, rapid transitions have been made towards telehealth. Optimal use of telehealth in elderly patients remains poorly understood and adaptation challenges persist....
BACKGROUND: In the context of the ongoing COVID-19 pandemic, rapid transitions have been made towards telehealth. Optimal use of telehealth in elderly patients remains poorly understood and adaptation challenges persist. Our study aimed at identifying perceptions, barriers, and possible facilitators to telehealth use amongst elderly patients with comorbidities, their caregivers, and health-care providers (HCPs). METHODS: Health-care providers, patients 65 years and older with multiple comorbidities, and caregivers were recruited from outpatient clinics and invited to complete an electronic self-administered or telephone-administered survey on their perceptions of telehealth and of barriers to its implementation. RESULTS: A total of 39 health-care providers, 40 patients, and 22 caregivers responded to the survey. Most patients (90%), caregivers (82%), and HCPs (97%) had experienced telephone visits, but few were conducted via videoconference platforms. Patients and caregivers showed interest in pursuing some future telehealth visits (68%, 86%, respectively), but felt they lacked access to technology and skills (n=8, 20%), and some felt that telehealth visits may be inferior to in-person visits (n=9, 23%). HCPs showed interest in incorporating telehealth visits into practice (n=32, 82%), but identified challenges in lack of administrative support (n=37), lack of HCP (n=28) and patient (n=37) technological skills, and limited infrastructure (n=37)/internet access (n=33). CONCLUSIONS: Older patients, caregivers, and HCPs show interest in pursuing future telehealth visits but elucidate similar barriers. Facilitating access to technology, as well as to administrative and technology support guides, could promote high quality and equal access to virtual care for the older adult.
Cultural Competence-Lessons From an Exceptional Case of Care Delivery to My Mom.
Denbow-Burke O, Burke N, Norris M
Can Geriatr J · 2022 Dec · PMID 36505919 · Full text
Abstract loading — click title to view on PubMed.
Assessing the Effects of Dietary Protein Supplementation on Sarcopenia in Community-Dwelling Older Adults.
Hou V, Madden K
Can Geriatr J · 2022 Dec · PMID 36505918 · Full text
Sarcopenia, an age-associated skeletal muscle disorder characterized by muscle loss, is associated with disability in elderly populations. This literature review summarizes the impact of protein intake and supplementatio...
Sarcopenia, an age-associated skeletal muscle disorder characterized by muscle loss, is associated with disability in elderly populations. This literature review summarizes the impact of protein intake and supplementation on the indicators of severe sarcopenia-muscle mass, muscle strength, and physical function in community-dwelling older adults. We performed a literature search on PubMed, EMBASE, and MedLine, and included studies that evaluated the effects of protein intake with or without exercise intervention and on sarcopenia in community-dwelling older adults. Information regarding study participants, protein intervention, and sarcopenia-related outcomes were collected. Protein supplementation with or without exercise positively improves muscle mass, and aspects of muscle strength and physical function in sarcopenic and pre-frail older adults, while it elicited inconclusive effects in healthy populations. Greater dietary animal-based and soy-based protein diets can improve muscle mass in older adults. In conclusion, protein supplementation can improve muscle mass and reduce the risk of sarcopenia in sarcopenia and pre-frail older adults, while future studies should continue to investigate the effects of protein supplementation on indicators of sarcopenia in healthy older adults.
Multimorbidity and COVID-19 in Canada: How the Pandemic Has Highlighted a Key and Yet Underappreciated Risk Factor.
Downer MB, Sinha SK
Can Geriatr J · 2022 Dec · PMID 36505917 · Full text
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Medication Prescribed Within One Year Preceding Fall-Related Injuries in Ontario Older Adults.
Ming Y, Zecevic AA, Booth RG … +3 more , Hunter SW, Tirona RG, Johnson AM
Can Geriatr J · 2022 Dec · PMID 36505916 · Full text
BACKGROUND: Serious injuries secondary to falls are becoming more prevalent due to the worldwide ageing of societies. Several medication classes have been associated with falls and fall-related injuries. The purpose of t...
BACKGROUND: Serious injuries secondary to falls are becoming more prevalent due to the worldwide ageing of societies. Several medication classes have been associated with falls and fall-related injuries. The purpose of this study was to describe medication classes and the number of medication classes prescribed to older adults prior to the fall-related injury. METHODS: This population-based descriptive study used secondary administrative health-care data in Ontario, Canada for 2010-2014. Descriptive statistics were reported for Anatomic Therapeutic Chemical 4 level medication classes. Frequency of medications prescribed to older adults was calculated on different sex, age groups, types of medications, and injures. RESULTS: Over five years (2010-2014), 288,251 older adults (63.2% females) were admitted to an emergency department for a fall-related injury (40.0% fractures, 12.1% brain injury). In the year before the injury, 48.5% were prescribed statins, 27.2% antidepressants, 25.0% opioids, and 16.6% anxiolytics. Females were prescribed more diuretics, antidepressants, and anxiolytics than males; and people aged 85 years and older had a higher percentage of diuretics, antidepressants, and antipsychotics. There were 36.4% of older adults prescribed 5-9 different medication classes and 41.2% were prescribed 10 or more medication classes. DISCUSSION: Older adults experiencing fall-related injuries were prescribed more opioids, benzodiazepines, and antidepressants than previously reported for the general population of older adults in Ontario. Higher percentage of females and more 85+ older adults were prescribed with psychotropic drugs, and they were also found to be at higher risk of fall-related injuries. Further associations between medications and fall-related injuries need to be explored in well-defined cohort studies.
The Use of Telemedicine in Older-Adults During the COVID-19 Pandemic: a Weekly Cross-Sectional Analysis in Ontario, Canada.
Chu C, Brual J, Fang J … +4 more , Fleury C, Stamenova V, Bhattacharyya O, Tadrous M
Can Geriatr J · 2022 Dec · PMID 36505915 · Full text
The COVID-19 pandemic led to rapid adoption of telemedicine for health-care service delivery. There are concerns that older adults, the highest users of the health-care system, would be left behind because of this shift....
The COVID-19 pandemic led to rapid adoption of telemedicine for health-care service delivery. There are concerns that older adults, the highest users of the health-care system, would be left behind because of this shift. It remains unclear how the pandemic impacted telemedicine and other health-care service use in this group. We conducted a population-based, weekly cross-sectional study using administrative data from Ontario, Canada. Telemedicine use was measured for the overall older-adult population aged 65+ and across sociodemographic groups from January 2018 to March 2021. We also assessed the use of key health-care services between high and low patient users of telemedicine who were diagnosed with dementia. We found that telemedicine visits outnumbered in-person visits in older adults during the pandemic (average of 74 vs. 62 visits per 1000 per week). Of all specialties, psychiatrists delivered the most telemedicine visits, reaching 90% of visits in a week. Higher rates of telemedicine use during COVID-19 were found for patients who resided in urban regions (84 visits per 1000 per week), but no differences were found across income quintiles. Among dementia patients, high telemedicine users had higher health-care utilization than low telemedicine users (i.e., 21,108 vs. 3,276 outpatient visits per week) during the pandemic. Findings suggest that telemedicine was crucial in helping older adults, a group most vulnerable to COVID-19, maintain access to care during the pandemic. Telemedicine presents an important opportunity for older adults; however, future research should focus on barriers to equitable access and quality of care provided through telemedicine.
Prevalence of Frailty Among Hospitalized Older Adults in New Brunswick, Canada: an Administrative Data Population-Based Study.
Gallibois MA, Rogers K, Folkins C … +2 more , Jarrett P, Magalhaes S
Can Geriatr J · 2022 Dec · PMID 36505914 · Full text
BACKGROUND: Characterizing the prevalence and distribution of frailty within a population can help guide decision-making and policy development by identifying health service resource needs. Here we describe the prevalenc...
BACKGROUND: Characterizing the prevalence and distribution of frailty within a population can help guide decision-making and policy development by identifying health service resource needs. Here we describe the prevalence of frailty among hospitalized older adults in New Brunswick (NB), Canada. METHODS: NB administrative hospital claims data were used to identify hospitalized older adults aged 65 or older between April 1, 2017 and March 31, 2019. Frailty was quantified using the Hospital Frailty Risk Score (HFRS), a validated frailty tool derived from claims data. Individuals with a HFRS ranked as intermediate or high were categorized as frail. The distribution of frailty across sex and age are described. Crude prevalence estimates and corresponding 95% confidence intervals are presented. RESULTS: A total of 55,675 older adults (52% females) were hospitalized. The overall prevalence of frailty was 21.2% (95%CI: 20.9-21.6). Prevalence increased with age: 12.7% (95%CI: 12.3-13.1) in the 65-74 age group, 24.7% (95%CI: 24.1-25.3) in the 75-84 age group and 41.6% (95%CI: 40.6-42.7) for those aged 85 and over (<.001). DISCUSSION/CONCLUSION: The distribution of frailty is in line with that reported in other jurisdictions. We demonstrate the feasibility of the HFRS to identify and characterize frailty in a large sample of older adults who were hospitalized, using administrative data.
Restraint Practices in Incapable Wandering Patients During COVID-19: Ethics and Best Practice Recommendations.
Geen O, Gui S, Andreychuk S … +2 more , DeBono T, Yousuf H
Can Geriatr J · 2022 Dec · PMID 36505913 · Full text
Patients who wander as one of their psychological and behavioural symptoms of dementia are often unable to follow or recall Infection Prevention and Control precautions, putting them at risk of contracting or spreading C...
Patients who wander as one of their psychological and behavioural symptoms of dementia are often unable to follow or recall Infection Prevention and Control precautions, putting them at risk of contracting or spreading COVID-19. Physical and chemical restraints have been used to limit the risk of transmission to wandering patients and their care providers, but restraints are not the standard of care for wandering behaviour in non-pandemic scenarios. Although provincial policies on restraint use are available, their guidance may not provide the context-dependent information necessary for individual patient decisions. To address this knowledge gap, we reviewed the medical, ethical, and legal considerations through an interdisciplinary approach including nurses, physicians, ethicists, hospital leadership, risk management, and legal counsel. We present an ethical framework that front-line health-care workers can use to create a balanced patient-centred care plan for incapable wandering patients who are at risk of contracting or spreading COVID-19.
Factors Associated with Falls in Canadian Long Term Care Homes: a Retrospective Cohort Study.
Kuhnow J, Hoben M, Weeks LE … +2 more , Barber B, Estabrooks CA
Can Geriatr J · 2022 Dec · PMID 36505912 · Full text
BACKGROUND: Half of Canadians living in long-term care (LTC) homes will fall each year resulting in consequences to independence, quality of life, and health. The objective in this study was to analyze factors that contr...
BACKGROUND: Half of Canadians living in long-term care (LTC) homes will fall each year resulting in consequences to independence, quality of life, and health. The objective in this study was to analyze factors that contribute to, or are protective against, falls in Canadian LTC homes. METHODS: We analyzed of a retrospective cohort of a stratified random sample of Canadian LTC homes in Western Canada from 2011-2017. We accessed variables from the RAI-MDS 2.0 to assess the association of the dependent variable "fall within the last 31-180 days" with multiple independent factors, using generalized estimating equation models. RESULTS: A total of 28,878 LTC residents were analyzed. Factors found to increase the odds of falling were other fractures (OR 3.64 [95% confidence interval; CI 3.27, 4.05]), hip fractures (OR 3.58 [3.27, 3.93]), moderately impaired cognitive skills (OR 2.45 [2.28, 2.64]), partial support to balance standing (OR 2.44 [2.30, 2.57]), wandering (OR 2.31 [2.18, 2.44]). CONCLUSION: A range of factors identified were associated with falls for people living in LTC homes. Individual physical ability represented the largest group of independent factors contributing to falls. Residents who experience any fracture or an acute change in behaviour, mobility, or activities of daily living (ADL) should be considered at increased risk of falls.
A Novel Instrument for Caregivers in Managing Neuropsychiatric Symptoms of Dementia: Baycrest Quick-Response Caregiver Tool.
Madan R, Natadiria M, Berall A … +2 more , Santiago AT, Schwartz K
Can Geriatr J · 2022 Dec · PMID 36505911 · Full text
BACKGROUND: Family caregivers can experience significant stress related to behaviour changes in persons with dementia (PWD). Approaches to support caregivers with stress management when responding to changes in behaviour...
BACKGROUND: Family caregivers can experience significant stress related to behaviour changes in persons with dementia (PWD). Approaches to support caregivers with stress management when responding to changes in behaviours are needed. The Baycrest Quick-Response Caregiver Tool (BQRCT) was developed to provide caregivers with an online tool that can be used in real time to recognize and manage their emotions when managing neuropsychiatric symptoms of dementia. METHODS: A mixed-methods approach was used to evaluate the feasibility of this new tool. Family caregivers of persons with dementia received education about managing neuropsychiatric symptoms of dementia through the online tool. Caregiver demographic information and feedback about the tool was obtained through telephone and online surveys. Health-care providers accessed the tool and also provided feedback. RESULTS: The 21 caregivers who completed the study found the tool helpful and reported high feasibility that included being able to access, complete, and implement the strategies presented in the tool. The 18 health-care providers found the tool useful and most would recommend it to peers and clients. Participants also provided specific suggestions for improvement, such as including more examples of complex behaviours. CONCLUSIONS: This tool adds to and complements existing strategies for managing neuropsychiatric symptoms of dementia. Its accessibility through the online platform is especially useful for caregivers who are unable to seek help in person, and for health-care providers and caregivers seeking additional resources.
"I Hope That the People Caring for Me Know About Me": Exploring Person-Centred Care and the Quality of Dementia Care.
Franco BB, Boscart VM, Elliott J … +4 more , Dupuis S, Loiselle L, Lee L, Heckman GA
Can Geriatr J · 2022 Dec · PMID 36505910 · Full text
BACKGROUND: Person-centred care is at the core of high-quality dementia care but people living with dementia are often excluded from quality improvement efforts. We sought to explore person-centred care and quality of ca...
BACKGROUND: Person-centred care is at the core of high-quality dementia care but people living with dementia are often excluded from quality improvement efforts. We sought to explore person-centred care and quality of care from the perspectives of persons living with dementia in the community and their care partners. METHODS: We used a qualitative descriptive approach with in-person, semi-structured interviews with 17 participants (9 persons living with dementia and 8 care partners) from Ontario, Canada. RESULTS: Participants report that person-centred care is essential to the quality of dementia care. Three themes were identified that describe connections between person-centred care and quality of care: 1) "I hope that the people looking after me know about me", 2) "I just like to understand [what's happening] as we go down the road", and 3) "But the doctor doesn't even know all the resources that are available." Participants perceived that quality indicators over-emphasized technical/medical aspects of care and do not entirely capture quality of care. CONCLUSIONS: Persons living with dementia and their care partners provide important insights into person-centredness and quality of care. Their perspectives on "quality" may differ from clinicians and researchers. Research is needed to better integrate their perspectives in quality improvement and person-centred care.
Survey on Current Practice of Canadian Physicians Regarding the Investigation in Older Patients with Delirium.
Laguë A, Boucher V, Joo P … +3 more , Yadav K, Morasse C, Émond M
Can Geriatr J · 2022 Sep · PMID 36117746 · Full text
BACKGROUND: The current literature provides heterogeneous recommendation regarding the investigation of older delirious patients, which may lead to over-testing. Our study aims to describe Canadian physicians' current pr...
BACKGROUND: The current literature provides heterogeneous recommendation regarding the investigation of older delirious patients, which may lead to over-testing. Our study aims to describe Canadian physicians' current practice for the investigation of older patients with delirium. Our secondary objective is to define specific indications for performing a CT head scan in this population. METHODS: Design: cross-sectional online survey. Participants: physicians who conduct their clinical practice in Canada and who care for older patients with delirium. Potential study participants were reached through Canadian associations: Canadian Geriatrics Society, the Canadian Association of Emergency Physicians, the Association des Médecins d'Urgence du Québec, and members of Choosing Wisely Canada. RESULTS: We received 296 survey responses. More than 80% of respondents always order complete blood count, urea, and creatinine and electrolytes. Extended electrolytes, TSH, chest X-ray, electrocardiogram, urinalysis and urinary culture tests tend to be ordered somewhat frequently. Physicians mostly agreed to order a head CT scan for loss of consciousness, altered mental status, fall, and anticoagulation. CONCLUSIONS: Physicians' investigations for older patients with delirium are highly variable, even with the lack of evidence supporting a broad workup. Also, respondents mostly align with current recommendations of indications for CT head scans.
Geriatric Syndromes in Older Adults Hospitalized with COVID-19 in Montreal, Canada.
Couture S, Lepage MA, Godard-Sebillotte C … +4 more , Sourial N, Talbot-Hamon C, Kremer R, Grunbaum A
Can Geriatr J · 2022 Sep · PMID 36117745 · Full text
BACKGROUND: Older adults are more vulnerable to severe infection and mortality due to COVID-19. They have atypical presentations of the disease without respiratory symptoms, making early diagnosis clinically challenging....
BACKGROUND: Older adults are more vulnerable to severe infection and mortality due to COVID-19. They have atypical presentations of the disease without respiratory symptoms, making early diagnosis clinically challenging. We aimed to compare the baseline characteristics, presentation, and disease course of older (≥70 yrs & ≥90 yrs) and younger (<70 yrs) patients hospitalized with COVID-19. METHODS: Retrospective review of 429 consecutive patients hospitalized at two tertiary care hospitals in Montreal, Canada, with PCR-confirmed COVID-19. Baseline characteristics, presentation, in-hospital complications, and outcomes were recorded. Desegregation by age was performed to compare older versus younger individuals. Additional subgroup analyses were performed amongst patients ≥70 stratifying by sex, living situation, and those presenting with geriatric syndromes compared to those without. RESULTS: Patients ≥70 (n=260) presented less frequently with respiratory symptoms compared to patients <70 (n=169) (52% vs. 32%). 11% of patients ≥70 and 24% of patients ≥90 presented with a geriatric syndrome as their sole symptom compared to 3% of those <70. Older adults were more likely to develop disease complications (including delirium, acute kidney injury, and hypernatremia) and had higher in-hospital mortality (32% vs. 13%). Subgroup analyses revealed heightened vulnerability to complications in older men, those from long-term care, and those with at least one geriatric syndrome upon presentation. CONCLUSIONS: Older adults presenting to hospital with COVID-19 often have no respiratory symptoms and can present with only a geriatric syndrome. New geriatric syndromes in older individuals should trigger evaluation for COVID-19 and consideration for early initiation of multidisciplinary care to prevent complications.
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