Canadian Geriatrics Journal最新文献

{"title":"An Environmental Scan of Alternate Level of Care (ALC) Policies in Ontario, Canada.","authors":"Diya Ahmad, Andrea Pace, Laura Jamieson, Kristina M Kokorelias, Guillaume Lim Fat","doi":"10.5770/cgj.29.933","DOIUrl":"10.5770/cgj.29.933","url":null,"abstract":"<p><strong>Background: </strong>Alternate level of care (ALC) patients occupy hospital beds despite no longer requiring acute services, impacting patient flow and contributing to overcrowding. Ontario hospitals have updated legislation and policies to address this issue, yet protocols vary across centres. This study conducted an environmental scan of ALC policies to examine differences in patient identification, management, and support.</p><p><strong>Methods: </strong>The research employed a multi-phase approach, beginning with a review of ALC policies obtained through direct inquiry from relevant institutions and publicly available documents. Policies were analyzed using content analysis to systematically identify common practices and differences across key areas, including risk identification, clinical criteria, leadership roles, early discharge planning, and patient engagement. A coding framework was developed based on Ontario Health guidelines and used as a comprehensive guiding document for comparison. Two researchers independently coded the documents to ensure consistency, and discrepancies were resolved through discussion to reach consensus. Key patterns and themes were then synthesized to highlight areas of convergence and divergence across the policies.</p><p><strong>Results: </strong>Qualitative content analysis of 10 policy documents revealed consistency in the core definition of ALC patients but variability among clinical criteria, substitute decision-maker roles, caregiver supports, discharge-planning protocols, and language. Variability existed in the application of senior- friendly care principles, with emphasis on discharge rather than successful transitions, suggesting opportunities for improvement in person-centred care.</p><p><strong>Conclusions: </strong>ALC policies vary greatly and exhibit both strengths and gaps in addressing patient flow and care coordination. Comprehensive discharge-planning models, which maintain a person-centred approach, could help mitigate patient flow challenges without loss of senior-friendly care principles by strengthening caregiver engagement and standardizing ALC patient identification and management practices. These findings identify the need for a more cohesive and formalized ALC management strategy in Ontario, with implications for the development of national policies and protocols worldwide.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"29 3","pages":"180-188"},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528760/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Need for a Fast-track Pathway to Streamline Disease-modifying Treatments in Early Alzheimer's Disease.","authors":"Durjoy Lahiri","doi":"10.5770/cgj.29.975","DOIUrl":"10.5770/cgj.29.975","url":null,"abstract":"","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"29 3","pages":"209-210"},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528767/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Facilitators in Using Personal Hearing Amplifiers from the Perspective of Healthcare Providers.","authors":"Mansi A Arora, Janice Xu, Kristina M Kokorelias, Raphaelle Koerber, Hamsa Krishnapillai, Samir K Sinha","doi":"10.5770/cgj.29.932","DOIUrl":"10.5770/cgj.29.932","url":null,"abstract":"<p><strong>Background: </strong>Hearing loss is experienced by two-thirds of hospitalized older adults and is associated with poor access to healthcare and negative health outcomes. Personal hearing amplifiers (PHAs) are evidence-based assistive devices provided in many hospitals to improve accessibility. However, studies note difficulties in implementing the appropriate use of PHAs. This study seeks to identify barriers and facilitators in using PHAs by healthcare providers in an academic hospital.</p><p><strong>Methods: </strong>An ethnographic interview protocol was developed and used to guide voluntary semi-structured interviews with 33 geriatricians, nurses and other allied health professionals, and patient-facing volunteers at Mount Sinai Hospital. The audio interviews were transcribed verbatim and a reflexive thematic analysis was performed. Finally, member checking was completed by sharing results with interviewees who consented to re-contacting and interest-holders within the hospital's geriatrics program to receive feedback.</p><p><strong>Results: </strong>Thematic analysis revealed that regardless of profession, PHAs were perceived as valuable yet underutilized. Under this overarching theme, three key themes were identified around PHA use: barriers to accessibility and availability, lack of designated responsibility, and lack of integration into clinical practice. These findings highlight both the facilitators and barriers associated with implementing PHAs.</p><p><strong>Discussion: </strong>PHAs are important accessibility tools, and this study has identified barriers and facilitators to their use by healthcare providers and volunteers communicating with patients with hearing loss. These findings lay the groundwork to test future interventions to promote the increased uptake of PHA devices and greater access to healthcare for older patients experiencing hearing loss.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"29 3","pages":"173-179"},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528759/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence and Risk of Heart Failure Among Older Adults Experiencing Homelessness: A Systematic Review and Meta-Analysis.","authors":"Peter M Hoang, Josephine Ding, Laith Almasri, Jeswende Seedu, Riyad Asgarali, Yu Qing Huang, Charmaine De Castro, Paula Rochon, Maurita Harris, Kristina M Kokorelias","doi":"10.5770/cgj.29.938","DOIUrl":"10.5770/cgj.29.938","url":null,"abstract":"<p><strong>Background: </strong>Understanding the prevalence and risk of heart failure (HF) among older adults is crucial for informing the design and implementation of interventions and guiding equitable healthcare delivery.</p><p><strong>Methods: </strong>A systematic search was conducted in MEDLINE, Embase, Cochrane Database of Systematic Reviews, CINAHL, and Web of Science from inception to April 2025. We included studies of adults aged 50 years or older experiencing homelessness. Outcomes included HF prevalence, risk of HF, and HF mortality. Screening, extraction, and risk-of-bias assessments were completed in duplicate. Random effects meta-analysis using generalized linear mixed models was used to estimate the prevalence of HF. The risk and mortality of HF were analyzed using random effects models, with housed older adults serving as the comparator.</p><p><strong>Results: </strong>Thirty-four studies with 573,697 individuals experiencing homelessness were included in this study (weighted mean age: 59.0 years, weighted female percentage: 19.9%). The prevalence of HF was 12.0% (95% confidence interval (CI) 7.3-19.0; I² = 99.9%). The odds of HF compared to housed adults (weighted mean age: 70.8 years) was 0.93 (95% CI 0.71-1.23; I² = 99.7%). The unadjusted odds of mortality from HF was 0.40 (95% CI 0.22-0.74; I² = 100%).</p><p><strong>Conclusions: </strong>This meta-analysis suggests that older adults experiencing homelessness have a prevalence of HF similar to or higher than population-based studies of housed adults of a similar age. Housing status was not associated with the odds of HF and was associated with a decreased odds of mortality, although substantial heterogeneity across studies limits evidence certainty.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"29 3","pages":"200-208"},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528768/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Duty to Protect? The Troubling Pattern of Legislative Noncompliance and Missed Police Involvement in Ontario's Long-Term Care Sector.","authors":"Vivian Stamatopoulos, Shannon Vettor, Emily Hladkowicz","doi":"10.5770/cgj.29.930","DOIUrl":"10.5770/cgj.29.930","url":null,"abstract":"<p><strong>Background: </strong><i>Ontario's Fixing Long-Term Care Act, 2021</i> requires long-term care (LTC) licensees to immediately notify police of any alleged, suspected, or witnessed abuse, neglect, or other conduct that may constitute a criminal offence. This study examines compliance with mandatory police notification requirements using publicly available Ministry of Long-Term Care (MLTC) inspection reports.</p><p><strong>Methods: </strong>We conducted a qualitative analysis with descriptive quantitative summaries of MLTC inspection reports issued in 2024. A 20% random sample of Ontario LTC homes was selected, and all associated inspection reports (N = 457) were retrieved. Using predefined keywords (\"abuse,\" \"neglect,\" \"police\"), relevant reports were identified (n = 193) and analyzed thematically to examine legislative compliance, documentation of police involvement, and enforcement responses.</p><p><strong>Results: </strong>Twenty-one of 193 reports (10.8%) mentioned police and were the focus of our analysis. In 16 of 21 reports, there were accounts of abuse and/or neglect, including theft, fraud, and physical and sexual assault, but police were only notified and dispatched to an LTC home in 2 of the 16 reports (12.5%). The remaining 14/16 cases (87.5%) involved incidents of resident-involved abuse or neglect where police were not contacted. Four of 21 reports (19%) involved noncompliance pertaining to required qualifications and missing or falsified police record checks. The final report cited a prior, second-hand account of police involvement for alleged resident aggression.</p><p><strong>Conclusion: </strong>This study provides the first review of compliance practices of LTC licensees in Ontario and their legal duty to report incidents of abuse, neglect, and other suspected criminal activity to police. Inconsistencies in documentation and variation in violations issued for comparable incidents suggest that these events are often addressed within regulatory or clinical frameworks, with limited documented engagement of criminal processes.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"29 3","pages":"156-172"},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528761/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Adding Mindfulness to Instability Resistance Training Enhance Dual-Task Mobility and Fall-Related Outcomes in Older Adults with Motoric Cognitive Risk Syndrome? A Randomized Controlled Trial.","authors":"Gabriel de Amorim Batista, Vinicius Yan Santos Nascimento, Bruno Remígio Cavalcante, Mateus Santos Silva, Higo Faraday Paraíso Leão, Laís Regina de Holanda Santos, Dayane Tays da Silva, Mariana Ferreira de Souza, Ana Carolina Rodarti Pitangui, Rodrigo Cappato de Araújo","doi":"10.5770/cgj.29.945","DOIUrl":"10.5770/cgj.29.945","url":null,"abstract":"<p><strong>Background: </strong>Older adults with motoric cognitive risk syndrome (MCR) exhibit impairments in dual-task mobility. Non-pharmacological interventions, such as physical exercise and cognitive strategies, have been proposed to mitigate physical and cognitive decline. However, the effectiveness of combining these approaches remains unclear.</p><p><strong>Objective: </strong>To evaluate the effects of instability resistance training (IRT) performed with or without mindfulness on mobility under single- and dual-task conditions and fall-related outcomes in older adults with MCR.</p><p><strong>Methods: </strong>In this parallel-group randomized controlled trial, 56 community-dwelling older adults with MCR (≥65 years) were allocated to IRT or combined with mindfulness (IRT + Mind). Both groups trained twice weekly for 24 weeks. Primary outcomes included single- and dual-task Timed Up and Go (TUG). Secondary outcomes were dual-task cost, concern about falling (Falls Efficacy Scale-International), and balance confidence (Activities-specific Balance Confidence Scale). Outcomes were analyzed using generalized mixed models.</p><p><strong>Results: </strong>For single-task TUG, a significant main effect of time was observed (<i>p</i> < .001), with similar improvements in both groups (0.62-0.80 s). Dual-task TUG performance improved over time for both cognitive conditions, with significant group × time interactions favoring the IRT group (<i>p</i> ≤ .049). Dual-task cost did not change significantly. Balance confidence improved significantly over time in both groups (mean increase ≈14 points; <i>p</i> < .001), whereas concern about falling remained unchanged.</p><p><strong>Conclusion: </strong>IRT improved mobility and confidence in balance in older adults with MCR. The addition of mindfulness did not provide incremental benefits, suggesting that motor-based training alone is sufficient to promote functional gains in this population.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"29 3","pages":"189-199"},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528763/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fall Risk Identification with Innovative Technologies for Aging in Place: A Clinical Needs Assessment Study.","authors":"Titilola Yakubu, Nooshin Jafari, Michael Lim, Jamie Lam, Michelle Lin, Di Jiang, Kendall Ho","doi":"10.5770/cgj.29.898","DOIUrl":"10.5770/cgj.29.898","url":null,"abstract":"<p><strong>Background: </strong>Falls are a leading cause of injury and loss of independence among older adults. While gait-monitoring technologies offer promise for early fall risk detection, adoption is hindered by usability, cost, and integration challenges. Few studies incorporate perspectives from both patients and providers to inform user-centred design.</p><p><strong>Objective: </strong>To identify barriers, facilitators, and design considerations for implementing gait-monitoring and fall-assessment technologies among older adults, caregivers, and healthcare providers.</p><p><strong>Methods: </strong>A qualitative needs assessment was conducted with older adults (≥65 years), caregivers, and healthcare providers in British Columbia, Canada. Participants were recruited via REACH BC, community organizations, and professional networks. Data collection included demographic surveys, standardized questionnaires (EuroQol 5-Dimension 5-Level (EQ-5D-5L), Patient Activation Measure (PAM-13), Fall Efficacy Scale), and semi-structured interviews. Thematic analysis was performed using NVivo 12.</p><p><strong>Results: </strong>Twenty-nine older adults/caregivers participated. Most reported slight-to-moderate functional limitations and high engagement in self-care. Four key themes emerged: (i) navigating health and fall prevention-proactive self-management but access barriers; (ii) embracing and questioning health technologies-interest tempered by complexity and perceived relevance; (iii) openness to gait monitoring and boundaries of trust-conditional acceptance, privacy concerns; (iv) designing for real lives-preferences for comfortable, discreet, affordable devices and integration into clinical workflows. Providers valued continuous data but cited cost, patient tech-readiness, and actionable output as critical.</p><p><strong>Conclusion: </strong>Stakeholders expressed interest in gait-monitoring technologies that are affordable, discreet, easy to use, and respectful of autonomy. Aligning device design with both personal comfort and clinical utility, and addressing privacy and integration challenges, may improve adoption and support safe aging in place.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"29 3","pages":"147-155"},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528758/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867737","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Association Between the Japanese Version of Montreal Cognitive Assessment Tasks and Driving as the Primary Mode of Transport Among Community-Dwelling Older Adults.","authors":"Yuya Nakajima, Hidenori Onishi, Yasutaka Mizukami, Tomoko Okamoto, Taisei Inoue, Akemi Koujimoto, Associate Degree, Naohiro Konoshita, Tokuharu Tanaka, Akiko Matsunaga, Masafumi Kubota, Masamichi Ikawa, Hideaki Hori, Yasutaka Kobayashi, Hiroyuki Hayashi, Osamu Yamamura","doi":"10.5770/cgj.29.991","DOIUrl":"https://doi.org/10.5770/cgj.29.991","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.5770/cgj.29.917.].</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"29 3","pages":"334"},"PeriodicalIF":1.8,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13528764/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148867722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FI-CGA and eFI-CGA in Frailty Care: a Scoping Review.","authors":"Xiaowei Song, Barry Clarke, Grace Park, Kenneth Rockwood","doi":"10.5770/cgj.29.804","DOIUrl":"10.5770/cgj.29.804","url":null,"abstract":"<p><strong>Background: </strong>Comprehensive geriatric assessment (CGA) is the reference standard for diagnosing and managing frailty. By evaluating a broad range of health, functional, cognitive, and social problems, the CGA enables the construction of a deficit accumulation Frailty Index (FI-CGA). Recent advances have integrated the electronic CGA (eCGA) into electronic health/medical records and other digital platforms, allowing automated coding and summarization of CGA data to generate an electronic Frailty Index (eFI-CGA).</p><p><strong>Methods: </strong>We reviewed over two decades of research on the development, validation, and application of the FI-CGA, eCGA, and eFI-CGA in health-care contexts, conducted following the PRISMA-ScR guidelines. A comprehensive search was performed in MEADLINE and CINAHL databases, including English language publications from 2004 to July 1, 2025. The 38 studies that met all criteria are included in the final review. Data were synthesized descriptively and analyzed thematically.</p><p><strong>Results: </strong>The evidence suggests that the FI-CGA is a robust, adaptable predictor of adverse outcomes including mortality, hospitalization, and functional decline. Digital adaptations improve feasibility, accuracy, and workflow, supporting wider application in acute, long-term, primary, and community care. The transition from manual to eCGA-based frailty measurements marks a significant advance toward scalable, integrated frailty care. Emerging implementations are targeting earlier detection, risk stratification, and personalized interventions.</p><p><strong>Conclusion: </strong>The digital eCGA and eFI-CGA tools hold potential to enhance (\"geriatrize\") capacity to identify and manage frailty across care settings. Further research is needed to validate them across populations, and leverage innovative technologies to advance frailty care, in these ways promoting healthy aging.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"29 2","pages":"107-123"},"PeriodicalIF":1.8,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13215377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving the Delivery of Brain Health Care to All. Keeping our Eye on the Main Prize in an Era of Emerging Anti-Amyloid Therapies.","authors":"Manuel Montero-Odasso, Linda Lee, David B Hogan","doi":"10.5770/cgj.29.941","DOIUrl":"10.5770/cgj.29.941","url":null,"abstract":"","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"29 2","pages":"144-146"},"PeriodicalIF":1.8,"publicationDate":"2026-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13215368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148058434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}