Canadian Geriatrics Journal最新文献

{"title":"Frailty of Health Care Systems.","authors":"Philip D St John, David B Hogan","doi":"10.5770/cgj.28.889","DOIUrl":"10.5770/cgj.28.889","url":null,"abstract":"<p><p>Frailty is a state of vulnerability to stressors which has long been a focus of Geriatric Medicine, and is gaining acceptance in other fields. The notion of frailty considers individuals, but many similarities exist between individuals and health care systems (HCS). We have drawn parallels between frail individuals and frail health care systems. We have adapted a commonly used measure of frailty-the \"Frailty Phenotype\", to measure HCS which are vulnerable to acute and chronic stresses. Finally, we note the \"double jeopardy\" of frail older adults within frail HCS. Ensuring that HCS remain robust and unlikely to fail should be a priority for health-care policy makers.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 4","pages":"396-399"},"PeriodicalIF":1.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12646699/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643393","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":"Evaluating a Paramedic-Led Fall-Referral Program in Nova Scotia: a Mixed-Methods Study.","authors":"Luke Duignan, Izabelle Opra, Alix Je Carter, Florence Grenapin, Scott McCulloch, Andrew Travers, Jan Jensen, Pan Andreou, Suzanne Baker, Judah Goldstein","doi":"10.5770/cgj.28.886","DOIUrl":"10.5770/cgj.28.886","url":null,"abstract":"<p><strong>Background: </strong>Falls in older adults are a worldwide health issue, and lead to high morbidity, mortality, and health-care costs. Paramedics play a unique and important role in post-fall management. The objectives of this study were to measure the frequency with which paramedics made referrals to fall-prevention programs, understand the factors influencing these decisions, and compare outcomes between those who received a referral with those who did not.</p><p><strong>Methods: </strong>This mixed-methods study evaluated a paramedic fall-referral program in Nova Scotia for older adults with non-transport dispositions after a 911 response. Patient demographics and outcomes were analyzd using a matched cohort approach, while paramedic beliefs regarding the program were explored using <i>The Theory of Planned Behavior</i>.</p><p><strong>Results: </strong>From 2014 to 2019, a total of 289 referrals were made, and a matched cohort analysis (1:2) found no significant difference in the mean number of fall-related 911 calls in the following 12 months between those who were referred (m=0.31, SD=0.94) and those who were not (m=0.30, SD=1.28). Paramedics acknowledged the importance of fall prevention, but felt a lack of education, loop closure-feedback to the referring paramedic, and patient reluctance to consider the program, were all significant barriers to referral.</p><p><strong>Discussion: </strong>This study assessed Nova Scotia's paramedic fall-prevention referral program, revealing low referral frequency despite high numbers of fall-related 911 calls, and no significant reduction in relapse 911 calls. Barriers to referral included patient reluctance, poor systematization, and lack of education and feedback.</p><p><strong>Conclusion: </strong>The study highlights opportunities for improving referral systems, as paramedics play a bigger role in the prevention of age-related health issues such as falls.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 4","pages":"336-342"},"PeriodicalIF":1.8,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12646691/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643456","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":"A Cross-Sectional Descriptive Study Using Health Administrative Data to Examine the Characteristics of Older Adults Incurring Delayed Discharge Days for Non-Clinical Reasons During the COVID-19 Pandemic in Alberta, Canada.","authors":"Jason Chan, Andrea Gruneir","doi":"10.5770/cgj.28.865","DOIUrl":"10.5770/cgj.28.865","url":null,"abstract":"<p><strong>Background: </strong>Our study strived to 1) describe the characteristics of older adults incurring delayed discharge days in Alberta from Apr 01, 2019 to March 31, 2022; 2) examine the prevalence and length of delayed discharge days during the COVID-19 pandemic.</p><p><strong>Method: </strong>We conducted a cross-sectional descriptive study using provincial health administrative data. We included adults ≥65 discharged from hospital from Apr 01, 2019-Mar 31, 2022 in Alberta and whose hospital stay included at least one delayed discharge day. The demographic characteristics of participants were reported in proportions or mean/median. Study period was divided into pandemic waves (pre-pandemic: Apr 1, 2019-Jan 31, 2020; Wave 1: Feb 1, 2020-Aug 31, 2020; Wave 2: Sept 1, 2020-Feb 14, 2021; Wave 3 and beyond: Feb 15, 2021-Mar 31, 2022). Prevalence of delayed discharge in each wave and their median length of stay (IQR) were reported.</p><p><strong>Results: </strong>From Apr 01, 2019 to Mar 31, 2022, there were 367,912 hospitalizations among older adults living in Alberta. 3.73% (n=13,717) contained at least one delayed discharge day. The percentage of delayed discharge prior to COVID-19 and during each wave stayed consistent. Wave 3 had the shortest median length of stay (29, IQR 15-51). Wave 2 (45.2%) and Wave 3 (45.3%) had higher proportion of patients requiring maximal assistance on the Activities of Daily Living (ADLs). From pre-COVID to Wave 3, there were increases in the proportions of patients discharged to long term care (36.4% in pre-COVID to 40.8% by Wave 3).</p><p><strong>Conclusions: </strong>Frequency of delayed discharge hospitalizations was consistent across the pandemic waves. Wave 3 had shorter length of delayed discharge hospitalization. The proportion of patients who were discharged to LTC increased over the course of the pandemic.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 4","pages":"353-358"},"PeriodicalIF":1.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12646693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643444","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":"Challenges Facing Canadian Long-Term Care Homes and Retirement Homes During the COVID-19 Pandemic.","authors":"Christine Fahim, Ayaat T Hassan, Keelia Quinn de Launay, Alyson Takaoka, Elikem Togo, Lisa Strifler, Vanessa Bach, Nimitha Paul, Ana Mrazovac, Jessica Firman, Vincenza Gruppuso, Jamie M Boyd, Sharon E Straus","doi":"10.5770/cgj.28.854","DOIUrl":"10.5770/cgj.28.854","url":null,"abstract":"<p><strong>Background: </strong>COVID-19 exposed long-standing systemic challenges experienced by congregate settings and created a crisis for long-term care homes (LTCHs) and retirement homes (RHs). This study explored the pandemic-related challenges LTCHs and RHs faced and the strategies they used to mitigate them.</p><p><strong>Method: </strong>Ninety-one key informant interviews were held with LTCH and RH leadership across 47 homes (33 LTCHs, 14 RHs) in Ontario, Canada from February 2021 to July 2022. Data were analyzed following the framework method.</p><p><strong>Results: </strong>Findings confirmed evidence of three main challenges. First, leaders were challenged to implement infection prevention and control (IPAC) protocols and measures. Second, leaders required supports to facilitate COVID-19 vaccine access and to promote vaccine acceptance. Finally, LTCH/RH staff experienced well-being and mental health challenges in the face of COVID-19 pressures. Despite widespread attention and efforts to support these congregate settings, challenges persisted over one year into the pandemic.</p><p><strong>Conclusions: </strong>Our findings reveal a plethora of strategies implemented by homes, with ranging reports of perceived success.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 4","pages":"359-373"},"PeriodicalIF":1.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12646696/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643447","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":"Interventions to Improve Cognitive Outcomes in Older Adults with Traumatic Brain Injury and Association Between Social Determinants of Health and Intervention Effectiveness: A Scoping Review.","authors":"Yu Qing Huang, Harneet Hothi, Sophie Weiss, Peter Hoang, Jessie McGowan, Nathalie Bier, Sharon Elizabeth Straus, Jennifer Ann Watt","doi":"10.5770/cgj.28.868","DOIUrl":"10.5770/cgj.28.868","url":null,"abstract":"<p><strong>Background: </strong>At least one million Canadians are at risk of experiencing a traumatic brain injury (TBI) in later life, which can lead to cognitive decline. We identified interventions studied to improve cognitive outcomes in older adults with TBI, and examined how social determinants of health (SDoH) may influence their effectiveness.</p><p><strong>Methods: </strong>We followed JBI guidance and searched five electronic databases from inception until March 2023 for studies evaluating the clinical and cost effectiveness, and safety of interventions being studied to improve cognitive outcomes in older adults with TBI. We abstracted SDoH following the PROGRESS-Plus framework.</p><p><strong>Results: </strong>We included 20 studies and 44,462 predominantly men/male (65%) participants with a mean age of 65.9 years; studies reported 51 cognitive outcomes. Three studies reported on race or ethnicity, eight studies reported on education, and no studies differentiated gender from sex. No studies reported on the association between SDoH and intervention effectiveness. We did not identify any economic evaluations. We classified 10 interventions into four categories: non-pharmacologic cognitive strategies (number of studies [n]=16), medications (n=1), non-invasive procedures (n=2), and invasive procedures (n=1). Invasive procedures and non-pharmacologic cognitive strategies had a statistically significant positive effect on cognitive measures in one and seven studies, respectively. Non-invasive procedures (n=2) did not have significant cognitive effects. Use of hypnotics (benzodiazepines and non-benzodiazepines) was significantly associated with a shorter time to incident dementia in one study.</p><p><strong>Conclusion: </strong>Non-pharmacologic cognitive strategies were the most-studied interventions for improving cognitive outcomes in older adults with TBI. Future research should better integrate a health equity lens and standardize outcome measurement.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 4","pages":"382-395"},"PeriodicalIF":1.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12646695/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643464","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":"Anti-Amyloid Therapies for Alzheimer's Disease: Not the Way Forward.","authors":"Christian Bocti, Howard Bergman","doi":"10.5770/cgj.28.888","DOIUrl":"10.5770/cgj.28.888","url":null,"abstract":"","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 4","pages":"400-402"},"PeriodicalIF":1.2,"publicationDate":"2025-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12646698/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145643484","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":"Care Partner Perspectives on Driving Cessation in Dementia in the Province of Saskatchewan, Canada.","authors":"Dena Sommer, Elaine Stasiulis, Mark J Rapoport, Patti Kelm, Gary Naglie","doi":"10.5770/cgj.28.819","DOIUrl":"10.5770/cgj.28.819","url":null,"abstract":"<p><p>Driving cessation is an expected eventuality in dementia care that has significant consequences for people with dementia (PWD) and care partners (CPs) alike. In collaboration with the Alzheimer Society of Saskatchewan, we explored CPs' experiences of the driving cessation process. Using an online survey including closed- and open-ended questions, we collected data from 44 CPs of current drivers and from 207 CPs of former drivers. Our quantitative and qualitative analyses identified three key findings. First, although CPs want and expect regulatory bodies and medical practitioners to be involved in the driving cessation process, their involvement is often less than anticipated. Second, driving cessation poses unique challenges to CPs in rural areas given the centrality of driving in smaller communities and limited transportation options to access services. Finally, CPs of former drivers found several positive benefits from the driving cessation process that were unanticipated. In conclusion, these three areas represent opportunities for education, support, and resources for PWD, CPs, and professionals through the driving cessation process.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 3","pages":"271-280"},"PeriodicalIF":1.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980260","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":"Qualitative Interview with Older Adults and Caregivers on their Perspectives with Self-Management and Remote Vital Sign Monitoring.","authors":"Carissa S Y Chan, Sarah Park, Titilola Yakubu, Nooshin Jafari, Kendall Ho","doi":"10.5770/cgj.28.833","DOIUrl":"10.5770/cgj.28.833","url":null,"abstract":"<p><strong>Background: </strong>Research underscores the role of self-management capabilities as a strategy for enhancing the well-being of older adults by mitigating potential health risks and functional decline. Self-management tools like remote vital sign monitoring serve as critical indicators for detecting adverse health outcomes. Thus, the study aims to understand prior experiences of older adults and caregivers in self-management, along with soliciting their perspective on the technical advantages and barriers of using technology in medicine, citing their experience with remote vital sign monitoring as an example.</p><p><strong>Methods: </strong>Through semi-structured qualitative interviews, 32 participants were interviewed virtually about their personal experience with prior remote vital sign monitoring. Eligibility included older adults and/or caregivers of older adults. Participants who were unable to read or understand English were excluded, unless sufficient support was provided to navigate the study procedures.</p><p><strong>Results: </strong>The full interview transcriptions were captured under the following five major themes: health-care experience, personal perception of technology in medicine, impact of remote vital sign monitoring, contactless monitoring system considerations, and acceptance and collaboration in remote vital sign measurement.</p><p><strong>Conclusion: </strong>Based on participants' prior experience using remote vital sign monitoring, compatibility, data security and privacy, and patient education were identified as important considerations when developing monitoring systems for older adults and caregivers.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 3","pages":"257-263"},"PeriodicalIF":1.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364499/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980297","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":"Depiction of a Novel Patient Navigator Program to Support Delayed Discharges Among Older Adults Admitted to Acute Care.","authors":"Grace Liu, Amanda Knoepfli, Tracey DasGupta, Naomi Ziegler, Emma Elliot, Mahala English, Sander L Hitzig, Sara J T Guilcher","doi":"10.5770/cgj.03.852","DOIUrl":"10.5770/cgj.03.852","url":null,"abstract":"<p><strong>Background: </strong>A novel Patient Navigator Program (PNP) was introduced at a Canadian hospital's Reactivation Care Centre (RCC) to support transitions by helping older adults navigate the complexities of delayed discharge stays by improving their transition from hospital to home. The PNP was comprised of a community agency patient navigator who was embedded into the RCC setting to support transitions in care, and who followed patients up to 90 days post-hospital discharge. The purpose of this study was to describe the PNP, which included detailing the needs of patients (i.e., socio-demographics, case-mix, delayed discharge), the scope of service provision (i.e., referral process, follow-up duration), and patient outcomes (i.e., post-discharge location).</p><p><strong>Methods: </strong>A cohort observational design was used to collect data on the PNP mainly via the patient navigator's clinical tracking sheet, and secondly via the hospital's administrative system. Data analysis included the use of frequencies and descriptive statistics.</p><p><strong>Results: </strong>Between November 2021 and October 2022, 100 patients were referred to the PNP, with 70 patients (39% male; 61% female; median age of 81 years) being admitted to the patient navigator's caseload. The patient navigator provided follow-up care for a median of 58 days, and supported 76% of the patients (n=53) to return to their next point of care (e.g., homes or to a supportive housing setting).</p><p><strong>Conclusion: </strong>The PNP led to a high proportion of patients being discharged back to the community. This study provides insights to providers and decision-makers interested in implementing PNP care models in a hospital in partnership with a community agency.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 3","pages":"264-270"},"PeriodicalIF":1.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980265","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":"A Description of QT-Interval Prolonging Drug Interactions with Fluoroquinolones in Older Women with Uncomplicated Urinary Tract Infections.","authors":"Shanna C Trenaman, Maia von Maltzahn, Samuel Alan Stewart, Hala Tamim, Ingrid Sketris, Emily Black","doi":"10.5770/cgj.28.835","DOIUrl":"10.5770/cgj.28.835","url":null,"abstract":"<p><strong>Background: </strong>Fluoroquinolone (FQ) antibiotics are associated with QT-interval prolongation and Torsades de Pointes (TdP). Female sex, older age, and other QT-interval prolonging medications further increase risk for TdP. Our aim was to describe QT-interval prolonging drug interactions when FQs were dispensed to women who resided in long-term care (LTC) for uncomplicated urinary tract infections (UTIs).</p><p><strong>Methods: </strong>This retrospective cohort study used administrative health data from the Nova Scotia Seniors' Pharmacare program from January 2005 through March 2020. The cohort included women residing in LTC dispensed a FQ antibiotic within five days of a diagnostic code for an uncomplicated UTI in physician billing data. Additional drug dispensations were collected 30 and 90 days after the FQ to identify drug interactions that resulted in potentially increased QT-interval prolongation risk. Drug interactions were described. A Mann-Kendall trend test assessed the change in the frequency of FQ-drug interactions over the study period.</p><p><strong>Results: </strong>Annual dispensation of FQs ranged from 12-28% of antibiotic dispensations for presumed uncomplicated UTI. The proportion of FQ dispensations associated with a QT-interval prolonging drug interaction increased over time (<i>p</i>=.00007). Within 30 days of the FQ dispensation, the most common drug interactions identified were: furosemide (n=702, 20.3% of FQ-drug interactions), citalopram (n=566, 16.4% of FQ-drug interactions), and trazodone (n=461, 13.3% of FQ-drug interactions).</p><p><strong>Conclusions: </strong>An increasing proportion of women dispensed a FQ for uncomplicated UTI experienced a potential QT-interval prolonging drug interaction over the study period. When prescribing FQs to older women, addressing potentially modifiable risk factors for TdP, and monitoring closely, is warranted.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 3","pages":"228-234"},"PeriodicalIF":1.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980182","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}