Canadian Geriatrics Journal[JOURNAL]
Sun
200 papers
Assessing the Need for Caregiver Support in Saskatchewan, Canada: Gathering Perspectives and Setting Priorities.
Hall S, Holtslander L
Can Geriatr J · 2022 Sep · PMID 36117744 · Full text
BACKGROUND: An ageing population corresponds with a need for informal caregivers. Caregiving burden is the most compelling problem affecting caregivers of older adults. Previous research efforts have explored predictors...
BACKGROUND: An ageing population corresponds with a need for informal caregivers. Caregiving burden is the most compelling problem affecting caregivers of older adults. Previous research efforts have explored predictors of caregiving satisfaction and interventions for caregiving support. Our study aimed to set priorities for the future development of interventions for caregivers in Saskatchewan. Our objective was to engage caregivers in setting priorities for accessible interventions and support. The specific research question we sought to answer was: "What do the experiences of caregivers have to offer in setting priorities for caregiver support?" METHODS: We conducted an environmental scan of caregiver intervention programming in Canada. We then held two focus groups with caregivers to older adults, defined as 55 years or older for this study. Twenty-three caregivers attended the first focus group, and 10 caregivers participated in the second. We used a qualitative descriptive approach and data were analyzed using thematic analysis. RESULTS: Caregivers of older adults were eager to share barriers and facilitators of their role. Themes derived from data include: 1) lack of access; 2) conflict with self and others; 3) the burden of caregiving; and 4) declining health and wellness. CONCLUSION: Caregivers may struggle to find resources to support them in their caregiving role. Findings from this study indicate that there is a need for more interventions to support caregivers. Furthermore, our data highlight what outcomes caregivers in Saskatchewan want from those interventions.
A Qualitative Exploration of Proactive Falls Prevention by Canadian Primary Care Providers.
Nova AA, Heckman GA, Giangregorio LM … +1 more , Alarakhia M
Can Geriatr J · 2022 Sep · PMID 36117743 · Full text
BACKGROUND: Falls are a growing concern in Canada. Primary care providers are well positioned to address falls risk, but international literature suggests that best-practice guidelines are rarely followed. The objective...
BACKGROUND: Falls are a growing concern in Canada. Primary care providers are well positioned to address falls risk, but international literature suggests that best-practice guidelines are rarely followed. The objective of this study is to explore the perspectives of Canadian primary care providers around falls prevention and identify solutions. METHODS: We conducted one-on-one qualitative interviews with a maximum variation sample of nine primary care providers in Ontario (n=8) and Alberta (n=1) in Canada. Data were collected over telephone and in-person at the location of participants choosing. Audio recordings of the interviews were transcribed, then coded and analyzed with the Behaviour Change Wheel theoretical framework. RESULTS: Most participants reported relying on patient self-report, intuition, and reactive approaches to identifying falls risk. Reported barriers to falls prevention included low capability to gather information on patient history, context, and community resources; limited opportunity to manage patient complexity due to time constraints; and challenges with motivating patients to engage in care plans. Reported facilitators included team-based interprofessional care and provider motivation. CONCLUSIONS: This study has found that Canadian primary care providers face barriers to identifying and managing falls risk. These barriers may be rooted in primary care culture, structure, and tradition.
Low Physical Performance is Associated with a Poor Health-Related Quality of Life (HRQOL) in Community-Dwelling Older Mexicans".
Anahi LAK, Teresa LM, Miguel GL … +2 more , Estela GR, Oscar RC
Can Geriatr J · 2022 Sep · PMID 36117742 · Full text
OBJECTIVE: Identify the association between low physical performance and quality of life in older adults. METHODS: Cross-sectional analysis of the FraDySMex cohort study (Frailty, Daphnia and Sarcopenia in Mexican Adults...
OBJECTIVE: Identify the association between low physical performance and quality of life in older adults. METHODS: Cross-sectional analysis of the FraDySMex cohort study (Frailty, Daphnia and Sarcopenia in Mexican Adults). The physical performance was evaluated by Short Physical Performance Battery (SPPB), and the quality of life through the Visual Analogue Scale of the EuroQol-5D for the Health-Related Quality of Life (HRQOL). In addition, other variables such as socio-demographic, comorbidity, cognitive status, depressive symptoms, anxiety, frailty, and functional dependence were evaluated. RESULTS: 624 adults were included, 79.13% (CI 95% 75.72-82.26) women, aged 71.1±9.5 years. The prevalence of low physical performance frequency was 32.47% (CI 95% 28.88-36.31) and low HRQOL of 28.57% (CI 95% 25.05-32.29). The low physical performance was associated with a low HRQOL (OR= 2.09; CI 95% 1.35-3.23; =.001), adjusted for age, sex, comorbidity index, cognitive, anxiety, and depressive symptoms in the logistic regression. CONCLUSION: The low physical performance is associated with a low quality of life in older people.
Changes in Physical Functioning and Fall-Related Factors in Older Adults Due to COVID-19 Social Isolation.
de Albuquerque Angelo FD, de Souza Fonseca F, Farah BQ … +4 more , de Araújo RC, Cavalcante BR, Beltrão NB, Pirauá ALT
Can Geriatr J · 2022 Sep · PMID 36117741 · Full text
BACKGROUND: Social isolation has been one of the main measures for the prevention of COVID-19. It's possible that, in addition to the natural aging-related deficits, social isolation has accelerated the decline of the di...
BACKGROUND: Social isolation has been one of the main measures for the prevention of COVID-19. It's possible that, in addition to the natural aging-related deficits, social isolation has accelerated the decline of the different components of physical and mental capacity in older adults. This study aimed to compare the functional capacity and concern about falling in older adults before and during COVID-19 social isolation. METHOD: This observational longitudinal study was carried out with 45 community dwelling older adults (mean age 65.6 ± 4.6 years, 88.8% women). Functional capacity and concerns about falling assessments were carried out before the COVID-19 pandemic, and between the 16th and 18th week of social isolation. All testes were face-to-face, except the second FES-I assessment, which took place via telephone call in order to minimize a prolonged person-to-person contact. Muscle strength, muscle power, functional mobility, functional muscle fitness, upper and lower body flexibility, dynamic balance, and Efficacy Scale were assessments. RESULTS: Regarding functional capacity, there was 14% decline in muscle strength (<.001), 7% in power (=.001), 11% in functional mobility (=.001), 20% in functional muscle fitness (=.001), and 60% in upper body flexibility (=.001) and 33% lower body flexibility (=.003). The dynamic balance and the concern about falling showed no statistically significant differences. CONCLUSION: Thus, it can be concluded that there was a decline in older adults' functional capacity during COVID-19 social isolation.
Engaging People With Lived Experience of Dementia in Research: Perspectives From a Multi-disciplinary Research Network.
Bechard LE, McGilton KS, Middleton LE … +3 more , Chertkow H, Sivananthan S, Bethell J
Can Geriatr J · 2022 Sep · PMID 36117740 · Full text
BACKGROUND: Patient and public involvement/engagement in research on dementia is not new, but it is becoming increasingly common. The objective of this study was to describe researchers' knowledge, attitudes, and activit...
BACKGROUND: Patient and public involvement/engagement in research on dementia is not new, but it is becoming increasingly common. The objective of this study was to describe researchers' knowledge, attitudes, and activities related to engaging people with lived experience of dementia in research, and how these differ by research theme. METHODS: Data were from an online, anonymous survey of researchers within the Canadian Consortium on Neurodegeneration in Aging. RESULTS: Of the 84 researchers who completed the survey (response rate: 27%), 89% agreed they understood the meaning of engaging people with lived experience in research, although this was lower among biomedical researchers. Almost all (93%) agreed that people with lived experience could contribute meaningfully to research, and nearly two-thirds were already incorporating engagement in their research. Some engagement practices reported differed by research theme. Irrespective of the type of research they conduct, researchers were most often motivated by improving the relevance and quality of their research. CONCLUSIONS: These findings support an optimistic outlook for engaging people with lived experience of dementia in research, but identify differences across research themes. Understanding approaches to incorporate, evaluate, and adapt engagement activities across research disciplines are needed to enable researchers, as well as others involved in research, to develop and target strategies for patient and public involvement/engagement in research on dementia.
Exploring Harm Reduction in Supportive Housing for Formerly Homeless Older Adults.
Nixon LL, Burns VF
Can Geriatr J · 2022 Sep · PMID 36117739 · Full text
BACKGROUND: Exclusionary care policy contributes to the growing number of older adults experiencing homelessness and complex health challenges including substance misuse. The aim of this study was to examine how harm red...
BACKGROUND: Exclusionary care policy contributes to the growing number of older adults experiencing homelessness and complex health challenges including substance misuse. The aim of this study was to examine how harm reduction policy and practices are experienced and enacted for older adults with homeless histories and care staff in congregate supportive housing. METHODS: Drawing on harm reduction (HR) principles, Rhodes' risk environment framework, and 15 semi-structured interviews (six residents, nine staff) at a 70-bed supportive housing facility in Western Canada, this qualitative constructivist grounded theory study aimed to determine: How is harm reduction experienced and enacted from the perspectives of older adults and their care staff? RESULTS: HR policy and practices helped residents to feel respected and a sense of belonging, due largely to staff's understanding of structural vulnerability related to homelessness and their efforts to earn and maintain residents' trust. Physical and program structures in the facility combined with the social environment to mitigate harms due to substance- and nonsubstance-related risk behaviours. CONCLUSION: HR policy and practices in supportive living empower care providers and older adults to work together to improve housing and health stability. Wider adoption of HR approaches is needed to meet the needs of a growing number of older people experiencing homelessness and substance use challenges.
Listening to Trainee Concerns and Suggestions During COVID-19: a Report from the Canadian Consortium on Neurodegeneration in Aging (CCNA).
Osman A, Duncan A, Giurca P … +4 more , Maxwell CJ, Kamkar N, Hogan DB, Montero-Odasso M
Can Geriatr J · 2022 Sep · PMID 36117738 · Full text
BACKGROUND: The COVID-19 pandemic has caused significant disruption to research activities across Canada. The Training and Capacity Building (T&CB) Program of the Canadian Consortium on Neurodegeneration in Aging (CCNA)...
BACKGROUND: The COVID-19 pandemic has caused significant disruption to research activities across Canada. The Training and Capacity Building (T&CB) Program of the Canadian Consortium on Neurodegeneration in Aging (CCNA) conducted a survey between May 11, 2020 and May 19, 2020 to identify the challenges faced by CCNA trainees because of the pandemic and how to best support trainees in response to those challenges. METHODS: Graduate students and postdoctoral researchers working under the supervision of CCNA investigators (n=113) were invited to complete a web-based survey of 13 questions. Trainees were asked questions about the impact of COVID-19 on their research activities, degree progression, funding status, and suggestions for support from the T&CB Program during the COVID-19 pandemic. RESULTS: A total of 41 trainees responded to the survey (response rate: 36.3%); 83% of respondents reported that they experienced changes to their research activities as a result of COVID-19, and 50% anticipated that their degree completion would be delayed. Respondents requested information from the T&CB Program on funding for non-COVID-19 projects, alternative datasets, and short educational workshops. CONCLUSION: The majority of CCNA trainees surveyed experienced significant changes to their research activities as a result of the COVID-19 pandemic. The T&CB Program responded by switching to online programming and facilitating remote research. Further engagement with trainees is needed to ensure continued progress of research in age-related neurodegenerative disease in Canada post-pandemic.
MedSafer to Support Deprescribing for Residents of Long-Term Care: a Mixed-Methods Study.
Perri GA, Bortolussi-Courval É, Brinton CD … +5 more , Berall A, Santiago AT, Morcos M, Lee TC, McDonald EG
Can Geriatr J · 2022 Jun · PMID 35747414 · Full text
BACKGROUND: Polypharmacy is prevalent in long-term care homes (LTCH) and increases the risk of adverse drug events. Feasible and effective deprescribing interventions applicable in the LTCH environment are needed. METHOD...
BACKGROUND: Polypharmacy is prevalent in long-term care homes (LTCH) and increases the risk of adverse drug events. Feasible and effective deprescribing interventions applicable in the LTCH environment are needed. METHODS: We performed a mixed methods study to evaluate the feasibility, applicability, and effectiveness of an electronic deprescribing tool, MedSafer, to facilitate quarterly medication reviews (QMRs) on two pilot units in an academic long-term care home (LTCH). Chart reviews collected resident health data. The prevalence of deprescribing at a standard QMR was compared with a QMR conducted three months later with MedSafer. Feedback from physicians on their experience with MedSafer was obtained through semi-structured interviews. RESULTS: Physicians found MedSafer helpful in guiding deprescribing decisions and suggested software improvements to increase the feasibility in LTCH. The average number of medications deprescribed per resident was significantly higher at the MedSafer QMR (mean reduction = 1.1 medications, SD = 1.3) compared to the standard QMR (mean reduction = 0.5, SD = 0.9) (absolute difference of 0.5; SD 1.1; = .02). CONCLUSION: MedSafer has the potential to increase deprescribing in LTCHs by flagging potentially inappropriate medications. Integration in the electronic medical record might increase uptake in LTCHs. Further research should investigate the generalizability of MedSafer in a larger population and in non-academic LTCHs.
Levels of Medical Intervention and End-of-Life Practices in Long-Term Care Centres.
Leclerc-Loiselle J, Gendron S, Côté A … +1 more , Daneault S
Can Geriatr J · 2022 Jun · PMID 35747413 · Full text
BACKGROUND: Levels of medical intervention (LMI) are legal documents in which physicians record patient preferences, or those of their designated substitute decision-makers, concerning end-of-life care. Studies suggest t...
BACKGROUND: Levels of medical intervention (LMI) are legal documents in which physicians record patient preferences, or those of their designated substitute decision-makers, concerning end-of-life care. Studies suggest that, although LMI are intended to orient clinical practice, their function tends to be limited to logistical aspects of care. How LMI shapes or guides patient-centred, end-of-life care remains unclear. The aim of this study was to examine possible associations between LMI and certain aspects of end-of-life care practices in LTCC, such as nurse-documented patient experiences of pain, and prescription and administration of medication. METHODS: A retrospective descriptive study of 100 files retrieved from a clinical database of deceased patients in LTCCs located in an urban integrated health and social service organization in Québec, Canada, was conducted. RESULTS: Significant associations between last documented LMI and frequency of narcotic prescription and administration, at either regular intervals or PRN, are highlighted. The time delay between last LMI assessment and patient death was one week or less for 39.4% of cases. CONCLUSION: These results suggest that LMI assessment practices may not correspond to their intended use. A short time frame between last LMI (L-LMI) assessment and patient death may suggest less-than-optimal patient comfort in end-of-life care.
Older Age and Frailty are Associated with Higher Mortality but Lower ICU Admission with COVID-19.
Andrew MK, Godin J, LeBlanc J … +15 more , Boivin G, Valiquette L, McGeer A, McElhaney JE, Hatchette TF, ElSherif M, MacKinnon-Cameron D, Wilson K, Ambrose A, Trottier S, Loeb M, Smith SW, Katz K, McCarthy A, McNeil SA
Can Geriatr J · 2022 Jun · PMID 35747412 · Full text
BACKGROUND: We report characteristics and outcomes of adults admitted to Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network hospitals with COVID-19 in 2020. METHODS: Patients with l...
BACKGROUND: We report characteristics and outcomes of adults admitted to Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network hospitals with COVID-19 in 2020. METHODS: Patients with laboratory-confirmed COVID-19 admitted to 11 sites in Ontario, Quebec, Alberta, and Nova Scotia up to December 31, 2020 were enrolled in this prospective observational cohort study. Measures included age, sex, demographics, housing, exposures, Clinical Frailty Scale, comorbidities; in addition, length of stay, intensive care unit (ICU) admission, mechanical ventilation, and survival were assessed. Descriptive analyses and multivariable logistic regressions were conducted. RESULTS: Among 2,011 patients, mean age was 71.0 (range 19-105) years. 29.7% were admitted from assisted living or long-term care facilities. The full spectrum of frailty was represented in both younger and older age groups. 81.8% had at least one underlying comorbidity and 27.2% had obesity. Mortality was 14.3% without ICU admission, and 24.6% for those admitted to ICU. Older age and frailty were independent predictors of lower ICU use and higher mortality; accounting for frailty, obesity was not an independent predictor of mortality, and associations of comorbidities with mortality were weakened. CONCLUSIONS: Frailty is a critical clinical factor in predicting outcomes of COVID-19, which should be considered in research and clinical settings.
Community and Provider Evaluation of a Canadian Dementia Support Services Program.
Tam MT, Dosso JA, Robillard JM
Can Geriatr J · 2022 Jun · PMID 35747411 · Full text
BACKGROUND: Community programs and services dedicated to support those living with dementia and care partners can improve their quality of life. In close collaboration with the Alzheimer Society of British Columbia, we e...
BACKGROUND: Community programs and services dedicated to support those living with dementia and care partners can improve their quality of life. In close collaboration with the Alzheimer Society of British Columbia, we evaluated the First Link dementia support services, aiming to identify key strengths and areas of improvements to inform the services offered. METHODS: A survey instrument was developed and distributed to people living with dementia, care partners, and health-care providers. RESULTS: A total of 1,123 surveys were analyzed. Overall, respondents were satisfied with First Link dementia support services. Key strengths of the program included providing information and education for their clients to learn more about dementia and other resources in the community. Areas for improvement that were identified as part of this evaluation included additional supports for participants' mental health and well-being in terms of reducing stress, burden and isolation. Findings uncovered discrepancies in the way people living with dementia, care partners, and health-care providers view the effectiveness of the First Link dementia support services. CONCLUSION: An evaluation of programs and services for people living with dementia and their care partners can provide valuable insights about their experiences which can ensure that their needs are addressed.
The Intelligibility of the Reversed-Stethoscope Technique in Age-Related Hearing Loss.
Koerber RM, Vaccarello L, Ho A
Can Geriatr J · 2022 Jun · PMID 35747410 · Full text
BACKGROUND: This study evaluated the effectiveness of the reverse stethoscope technique in improving speech intelligibility. In this technique, a clinician places the earpieces of their stethoscope into the ears of a hea...
BACKGROUND: This study evaluated the effectiveness of the reverse stethoscope technique in improving speech intelligibility. In this technique, a clinician places the earpieces of their stethoscope into the ears of a hearing-impaired patient and speaks into the chest piece. METHODS: The International Speech Test Signal was presented to four Littman stethoscope models and a Pocketalker personal voice amplifier using an Audioscan hearing instrument test box. The acoustic outputs of the stethoscopes and voice amplifier were measured across the frequency spectrum of speech. The Speech Intelligibility Index of the resulting speech was calculated for natural speech and for each device in relation to 10 standardized hearing losses representing the population of older adults. RESULTS: For each of the 10 hearing losses, the speech signal emitted by the stethoscopes was quieter and yielded lower speech intelligibility scores than regular speech. In contrast, the voice amplifier provided mid- and high-frequency amplification and improved speech intelligibility scores for all but the mildest hearing losses. CONCLUSIONS: The reverse stethoscope technique worsens the clarity of speech and should not be used with older, hearing-impaired patients. Instead, clinicians should use regular speech or, preferably, personal voice amplifiers.
Optimizing the Physical & Social Environment Within Hospitals for Patients with Dementia: a Systematic Review.
Reich CD, Lyons H, Holroyd-Leduc JM
Can Geriatr J · 2022 Jun · PMID 35747409 · Full text
BACKGROUND: As the population ages, the number of individuals living with dementia is increasing. This has implications for the health-care system, as people living with dementia are hospitalized more frequently and for...
BACKGROUND: As the population ages, the number of individuals living with dementia is increasing. This has implications for the health-care system, as people living with dementia are hospitalized more frequently and for longer periods. Because patients living with dementia are at increased risk for adverse events during admission, understanding how the acute care physical and social environments influence their outcomes is imperative. Thus, the objective of this review was to identify studies that modified the physical and/or social environment in acute care in order to improve care for hospitalized patients living with dementia. METHODS: MEDLINE, Embase, and CINAHL databases were used to search for articles up to and including June 2021. PRISMA guidelines were followed. Two independent reviewers assessed citations and full texts against the following inclusion criteria: patients living with dementia/cognitive impairment, presence of a control group, and evidence of clinical or health systems outcomes. All published English-language articles meeting inclusion criteria were retrieved. RESULTS: Following the database search, 12,901 citations were retrieved with 11,334 remaining after duplication removal. Of these, 15 papers met inclusion criteria. Seven studies evaluated the physical environment (e.g., addition of electronic sensor alarms and environmental cues). The remaining studies evaluated specific programs (e.g., art, music, exercise, volunteer engagement, and virtual reality). The majority of studies were low to very low quality; only three studies were RCTs. Environmental cues may initially improve wayfinding, and exercise may reduce neuropsychiatric symptoms. CONCLUSIONS: Although there are several interventions, there is a lack of high-quality evidence available to determine what exactly needs to be incorporated into acute care settings to reduce adverse outcomes for patients with dementia.
One-Year Report of COVID-19 Impact on Geriatric Patients: a Bio-Psycho-Social Approach.
Chang AY, Babb KN
Can Geriatr J · 2022 Jun · PMID 35747408 · Full text
BACKGROUND: Since December of 2019, coronavirus 19 (COVID-19) has spread rapidly around the world. Our understanding of the infection has grown over the past year, and its impact on older adults is particularly significa...
BACKGROUND: Since December of 2019, coronavirus 19 (COVID-19) has spread rapidly around the world. Our understanding of the infection has grown over the past year, and its impact on older adults is particularly significant. Apart from the direct impacts of COVID-19 infections, it has also led to lockdowns which, in turn, result in isolation and loneliness. METHOD: We conducted a literature review of publicly available articles of the COVID-19 pandemic impact on the geriatric population between December 2019 and April 2021, a total of 748 articles. RESULTS: The review will be presented with the Bio-Psycho-Social model, covering how the biological, psychological, and sociological aspects of health are intertwined and impact older adults. Early studies have also highlighted the prevalence of post-COVID infection symptoms that typically fall under geriatric medicine care. We highlight the bidirectional impact of isolation and COVID-19 infections on geriatric health, as well as discuss pertinent topics such as vaccine efficacy, long-term sequelae of COVID-19 infections, and ageism. CONCLUSION: This review seeks to present a one-year report of what is known about COVID-19 and geriatric medicine, as well as provide guidance to practitioners who care for older adults based on the most up-to-date literature.
A Clinical Response Team Providing Support to Long-Term Care Homes with COVID-19 Outbreaks in Eastern Ontario-a Cohort Study.
Downar J, Boese K, Lalumiere G … +5 more , Bercier G, Leduc S, Rice J, Arya A, Charbonneau V
Can Geriatr J · 2022 Jun · PMID 35747407 · Full text
BACKGROUND: The greatest impact of the COVID-19 pandemic in Canada has been on long-term care facilities which have accounted for a large majority of the mortality seen in this country. We developed a clinical response t...
BACKGROUND: The greatest impact of the COVID-19 pandemic in Canada has been on long-term care facilities which have accounted for a large majority of the mortality seen in this country. We developed a clinical response team to perform mass assessment and provide support to long-term care facilities in Eastern Ontario with large outbreaks in the hope of reducing the impact of the outbreaks. METHODS: This is a retrospective cohort study of all residents of LTC facilities supported by our multidisciplinary clinical response team. We collected data about the timing of the outbreak and our deployment, as well as the total number of COVID-19 cases and deaths, and measured the correlation between the timing of our deployment and the observed mortality rate. RESULTS: Our clinical team was deployed to 14 long-term care facilities, representing 719 cases and 243 deaths (mean ± standard error of mortality 34% ± 4%). Our team was deployed a mean ± standard error of 16 ± 2 days after the declaration of an outbreak. There was a significant correlation between an earlier deployment of our clinical team and a lower mortality rate for that outbreak (Pearson's = 0.70, < .01). INTERPRETATION: This retrospective, uncontrolled study of a non-standardized intervention has many potential limitations. However, the data suggest that timely deployment of our clinical response team may improve outcomes in the event of a large outbreak. This clinical team may be useful in future pandemics.
Trends and Factors Associated with Suicide Deaths in Older Adults in Ontario, Canada.
Novilla-Surette EMP, Shariff SZ, Le B … +1 more , Booth RG
Can Geriatr J · 2022 Jun · PMID 35747406 · Full text
BACKGROUND: Suicide in older adults is a significant overlooked problem worldwide. This is especially true in Canada where a national suicide prevention strategy has not been established. METHODS: Using linked health-car...
BACKGROUND: Suicide in older adults is a significant overlooked problem worldwide. This is especially true in Canada where a national suicide prevention strategy has not been established. METHODS: Using linked health-care administrative databases, this population-level study (2011 to 2015) described the incidence of older adult suicide (aged 65+), and identified clinical and socio-demographic factors associated with suicide deaths. RESULTS: The findings suggest that suicide remains a persistent cause of death in older adults, with an average annual suicide rate of about 100 per million people over the five-year study period. Factors positively associated with suicide vs. non-suicide death included being male, living in rural areas, having a mental illness, having a new dementia diagnosis, and having increased emergency department visits in the year prior to death; whereas, increased age, living in long-term care, having one or more chronic health condition, and increased interactions with primary health care were negatively associated with a suicide death. CONCLUSION: Factors associated with suicide death among older adults highlighted in this study may provide better insights for the development and/or improvement of suicide prevention programs and policies.
Enabling Healthy Aging to AVOID Frailty in Community Dwelling Older Canadians.
Rasiah J, Prorok JC, Adekpedjou R … +22 more , Barrie C, Basualdo C, Burns R, De Paul V, Donnelly C, Doyle A, Frank C, Dolsen SG, Giguère A, Hsiung S, Kim P, McDonald EG, O'Grady H, Patey A, Puxty J, Racey M, Resin J, Sims-Gould J, Stewart S, Theou O, Webster S, Muscedere J
Can Geriatr J · 2022 Jun · PMID 35747405 · Full text
The Canadian population is aging. With aging, biological and social changes occur increasing the risk of developing chronic conditions and functional loss leading to frailty. Older adults living with frailty are more vul...
The Canadian population is aging. With aging, biological and social changes occur increasing the risk of developing chronic conditions and functional loss leading to frailty. Older adults living with frailty are more vulnerable to minor stressors, take longer to recover from illness, and have difficulty participating in daily activities. The Canadian Frailty Network's (CFN) mission is to improve the lives of older adults living with frailty. In September 2019, CFN launched the Activity & Exercise, Vaccination, Optimization of medications, Interaction & Socialization, and Diet & Nutrition (AVOID) Frailty public health campaign to promote assessing and reducing risk factors leading to the development of frailty. As part of the campaign, CFN held an Enabling Healthy Aging Symposium with 36 stakeholders from across Canada. Stakeholders identified individual and community-level opportunities and challenges for the enablement of healthy aging and frailty mitigation, as part of a focused consultative process. Stakeholders ranked the three most important challenges and opportunities at the individual and community levels for implementing AVOID Frailty recommendations. Concrete actions, further research areas, policy changes, and existing resources/programs to enhance the AVOID Frailty campaign were identified. The results will help inform future priorities and behaviour change strategies for healthy aging in Canada.
Time-to-Incision for Hip Fractures in a Canadian Level-1 Trauma Centre: Are We Respecting the Guidelines?
Denis A, Montreuil J, Reindl R … +3 more , Berry GK, Harvey EJ, Bernstein M
Can Geriatr J · 2022 Mar · PMID 35310476 · Full text
BACKGROUND: Surgical intervention within 48 hours is recommended for hip fractures in the elderly in order to reduce post-operative complications and lower mortality rates. The purpose of this retrospective study is to e...
BACKGROUND: Surgical intervention within 48 hours is recommended for hip fractures in the elderly in order to reduce post-operative complications and lower mortality rates. The purpose of this retrospective study is to explore the causes of surgical delays for acute geriatric hip fractures. METHODS: This is a retrospective cohort study involving a total of 109 consecutive geriatric patients who sustained proximal femur fractures ("hip fractures"), who subsequently underwent definitive fixation. Clinical, demographic, and direct costing data were extracted via a modern system and electronic medical records on a centralized data warehouse. Surgical delays and length of stay were analyzed according to clinical variables. RESULTS: The established benchmark of a time-to-surgery of less than 48 hours was respected for 63 (57.8%) patients. Patients on oral anticoagulant (ACO) waited significantly longer, on average 58 hours compared to 44 for non-anticoagulated patients ( = .007). Patients with higher ASA scores waited significantly longer ( = .0018). More importantly, patients treated within 48 hours were discharged significantly earlier, on average after 10 days compared to 16 days for patients who waited more than 48 hours before receiving surgical treatment ( = .003), regardless of the pre-operative waiting time. CONCLUSION: Fewer than 60% of patients received surgery within the 48-hour benchmark after being admitted for an acute hip fracture in a Level-1 trauma centre. Patients with more comorbidities waited longer and stayed longer in the hospital after surgery. Implementing strategic, evidence-based changes should be done using this data to improve care of this vulnerable population.
The Use of Anticonvulsant Adjuncts to Treat Alcohol Withdrawal Syndrome in Older Adults.
Montgomery S, Dahri K, Rayani K … +2 more , Kwok J, Chan P
Can Geriatr J · 2022 Mar · PMID 35310475 · Full text
BACKGROUND: We evaluated the prescribing practices of anticonvulsant (AC) adjuncts to benzodiazepines in managing Alcohol Withdrawal Syndrome (AWS). We also examined the prescription of relapse prevention agents for Alco...
BACKGROUND: We evaluated the prescribing practices of anticonvulsant (AC) adjuncts to benzodiazepines in managing Alcohol Withdrawal Syndrome (AWS). We also examined the prescription of relapse prevention agents for Alcohol Use Disorder (AUD), and adverse events related to AWS treatment. METHODS: Records were reviewed retrospectively pertaining to medically ill adults aged 60 and above with AWS and admitted to a medicine or hospitalist unit of a Canadian centre between June 2013 and June 2018. Duration and dosing of benzodiazepine, dosing and type of AC and AUD agent, and adverse events were collected. A multivariable regression model was employed. RESULTS: 83 encounters were included in the study and 28 were prescribed an AC. The amount and duration of benzodiazepine administered were not statistically different between the benzodiazepine only and the AC adjunct groups, once severe AWS complications were accounted for. Five new prescriptions of traditional AUD agents were provided on discharge. No AC-associated adverse events occurred. CONCLUSIONS: AC adjuncts for AWS did not decrease the amount of benzodiazepine administered nor shorten the duration of treatment. Their routine use is not supported by our findings. Our study highlights a missed opportunity for AUD agents to be prescribed during hospitalization.
The Ottawa 3DY Predicts Mortality in a Prospective Cohort Study.
St John PD, Molnar FJ
Can Geriatr J · 2022 Mar · PMID 35310474 · Full text
BACKGROUND: The Ottawa 3DY (O3DY) is a simple measure of cognition. OBJECTIVES: 1) To determine if the O3DY predicts mortality; and 2) To compare the discrimination of the O3DY to the Mini-Mental State Examination (MMSE)...
BACKGROUND: The Ottawa 3DY (O3DY) is a simple measure of cognition. OBJECTIVES: 1) To determine if the O3DY predicts mortality; and 2) To compare the discrimination of the O3DY to the Mini-Mental State Examination (MMSE) and Modified MMSE (3MS). METHODS: Analyses of a population based cohort study of 1,751 participants aged 65+; conducted in 1991/2 with follow-up over five years. The O3DY, age, sex, education, comorbid conditions, the MMSE, and the 3MS were measured: 4.5% of the participants had missing data for the O3DY; 42.8% were considered as positive (one or more errors), and 52.7% were considered as negative (no errors). Logistic regression models were constructed with the outcome of death at time 2. A Receiver Operator Curve (ROC) was constructed and the Area Under the ROC (AUROC) was calculated using a c-statistic. RESULTS: The unadjusted odds ratio (OR) and 95% confidence interval (CI) for mortality was 1.96 (1.56, 2.47); and the adjusted OR was 1.33 (1.02, 1.72). The AUROC was 0.66 for the 3MS, 0.65 for the MMSE, and 0.60 for the O3DY. CONCLUSIONS: The O3DY predicts mortality over a long time frame, although the discrimination is less than that of longer measures of cognition.
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