Canadian Geriatrics Journal最新文献

{"title":"Electronic Documentation of Goals of Care Designation Discussions Among Alberta-based Geriatric Patients.","authors":"Suzanne E Aronyk, Kimberley Higgins, Lesley Charles, Peter George Jaminal Tian","doi":"10.5770/cgj.28.841","DOIUrl":"10.5770/cgj.28.841","url":null,"abstract":"<p><strong>Background: </strong>Goals of Care Designations are important medical orders that are used to determine the appropriate level of medical intervention for individuals in the event of life limiting illness. Canada has an aging population and individuals are living with higher levels of chronic illness and comorbidity. As patient autonomy increases, it has become increasingly important to have accurate and up-to-date documentation of a patient's medical wishes for life sustaining care.</p><p><strong>Methods: </strong>This was a retrospective chart review of 400 randomly selected patients 65 years of age and over, seen at the University of Alberta Hospital outpatient clinic for Comprehensive Geriatric Assessment from July 1, 2022 to June 30, 2023. We extracted the frequency of Goals of Care Designation (GCD) documentation determined by historical data available within selected patient charts, the setting of each discussion, and the specialty of each provider completing Goals of Care documentation.</p><p><strong>Results: </strong>Only 49.3% (197/400) of patients had any documented GCD entered on their electronic medical record (EMR). Of the 356 completed GCD forms, 267 (75%) were completed in an inpatient setting; the majority of GCD forms were completed by a specialist in Internal Medicine (39.89%, n=142) or Family Medicine (37.64%, n=134).</p><p><strong>Conclusions: </strong>Our study revealed that less than half of patients had any GCD documentation in the provincial EMR. As accurate Goals of Care documentation is vital to patient care and autonomy, every opportunity should be taken by health-care professionals to complete this essential documentation.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 3","pages":"251-256"},"PeriodicalIF":1.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364492/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980252","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":"Feedback Quality in Geriatric Medicine: Analyzing Entrustable Professional Activities in a Competency-Based Curriculum.","authors":"Azin Dolatabadi, Aathmika Nandan, Dov Gandell","doi":"10.5770/cgj.28.848","DOIUrl":"10.5770/cgj.28.848","url":null,"abstract":"<p><strong>Background: </strong>Competency-based medical education (CBME) aims to enhance the quality of medical training by providing timely, actionable feedback through entrustable professional activities (EPAs). However, variability in feedback quality remains a concern across residency programs.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of EPA feedback forms from a geriatric medicine program, comparing two distinct time periods: 2019-2020 and 2021-2022. This program averages eight residents per year with 30 full-time faculty members. The quality of feedback was assessed based on timeliness, task orientation, actionability, and polarity.</p><p><strong>Results: </strong>404 EPAs were initiated and completed in 2019-2020, with 69% (n=278) being timely, 89% (n=360) task oriented, 50% (n=203) very actionable, and 62% (n=250) corrective in polarity. 851 EPAs were initiated in 2021-2022 and 76% (n=645) were completed, with 64% (n=410) being timely, 78% (n=501) task oriented, 40% (n=259) very actionable, and 47% (n=305) corrective in polarity. Timely feedback was more likely to be task-oriented (χ²(1)=11.87, <i>p</i><.001), actionable (χ²(2)=24.40, <i>p</i><.001), and corrective (χ²(3)=22.80, <i>p</i><.001) in the second timeframe. Compared to the second timeframe, EPAs completed in the first timeframe were more likely to be task oriented (χ²(1)=22.08, <i>p</i><.001), actionable (χ²(2)=25.54, <i>p</i><.001), and corrective in polarity (χ²(3)=25.89, <i>p</i><.001).</p><p><strong>Conclusions: </strong>Our study revealed lower quality feedback over time since implementing CBME at a geriatric medicine subspecialty training program. The root causes of the reduction in quality were not explored but are theorized to be multifactorial. Further investigation into the reasons for the reduction in feedback quality will help direct interventions to better sustain the quality of CBME implementation.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 3","pages":"221-227"},"PeriodicalIF":1.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980291","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":"Application of Lean Principles to the Comprehensive Geriatric Assessment to Reduce Cycle Time.","authors":"Junghyun Park, Eunice Lipinski, Pauline Fisher, Amanjot Sidhu","doi":"10.5770/cgj.28.850","DOIUrl":"10.5770/cgj.28.850","url":null,"abstract":"<p><strong>Background: </strong>Prolonged cycle times for new geriatric medicine assessments at the Centre for Healthy Aging have reduced the capacity to see patients. Using a time series design, the aim of the project was to decrease the average cycle time for new patients during one geriatrician's clinic from 114 to 90 minutes by May 1, 2024.</p><p><strong>Methods: </strong>Lean methodology was used for diagnostics by creating a value stream map of the workflow. This informed change ideas to improve efficiency by implementing a shared note within the electronic health record for information sharing and an assessment guide for targeted cognitive testing. The primary outcome measure was total cycle time. Balancing measures were patient clinic experience scores and counseling time. Process measures included caregiver interview time, pre-clinic intake completion rate, assessment guide use rate, and nursing assessment time.</p><p><strong>Results: </strong>Total cycle time decreased 19% from 114 minutes (19 patients) to 93 minutes (33 patients). Pre-clinic intake assessment completion rate increased from 60 to 80% and caregiver interview time decreased from 45 to 33 minutes. There was 100% uptake of the assessment guide, and nursing assessment time decreased from 43 to 31 minutes. Counseling time remained stable, and the average clinic experience scores did not decline from the baseline.</p><p><strong>Conclusions: </strong>This is the first study examining potential methods to improve efficiency of the comprehensive geriatric assessment by using value stream mapping. Spread of change ideas across the centre will be examined next with the goal of increasing capacity using available resources.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 3","pages":"244-250"},"PeriodicalIF":1.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980159","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":"Usefulness of Muscle Stiffness Evaluated by Ultrasonography for Detecting Muscle Change Related to Contracture in Frail Older Adults.","authors":"Koichi Nakagawa, Hideki Kataoka, Rinko Inoue, Kyo Goto, Junichiro Yamashita, Yuki Nishi, Yuichiro Honda, Junya Sakamoto, Tomoki Origuchi, Minoru Okita","doi":"10.5770/cgj.28.827","DOIUrl":"10.5770/cgj.28.827","url":null,"abstract":"<p><strong>Background: </strong>Ultrasonography can be used to evaluate the echo intensity (EI) and strain ratio (SR) to identify muscle quality and stiffness, respectively. EI and SR are affected by aging, frailty, and joint angle positions. We investigated the effects of aging and frailty on muscle EI and SR at different joint angle positions, and identified a useful measurement method to reflect muscle changes related to contractures in frail older adults.</p><p><strong>Methods: </strong>This study had a cross-sectional design. Twenty-two healthy young adults (young group), 22 non-frail older adults (non-frail group), and 22 frail older adults (frail group) participated in this study. The range of motion (ROM) of hip abduction, EI, and SR of the adductor longus in the zero- and full-abduction positions were measured. To investigate the effects of aging and frailty, the Kruskal-Wallis test, followed by the post-hoc Steel-Dwass test, was used. In addition, to confirm whether EI and SR in each position were useful for assessing contracture, Spearman's correlation test was used.</p><p><strong>Results: </strong>ROM and SR in full-abduction were significantly lower in the frail group than in the other groups and lower in the non-frail group than in the young group. The SR in full-abduction (ρ = 0.73, <i>p</i> < .001) and in zero-abduction (ρ = 0.41, <i>p</i> < .001) showed strong and moderate correlation with the ROM, respectively.</p><p><strong>Conclusions: </strong>SR in full-abduction is affected by both frailty and aging and is useful for evaluating muscle stiffness related to contracture in frail older adults.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 3","pages":"212-220"},"PeriodicalIF":1.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364493/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980294","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":"\"There's Huge Value in Knowing What's Going On\": a Mixed Methods Study to Explore Geriatricians' Perspectives on Best Practices for Information Transfer Between Hospital-Based Geriatricians and Primary Care Physicians.","authors":"Sandrine Couture, Dimitri Yang, Sabrina Lessard, Aigul Zaripova, Jennifer Tchervenkov, Carolyn Pavoni, Claire Godard-Sebillotte","doi":"10.5770/cgj.28.830","DOIUrl":"10.5770/cgj.28.830","url":null,"abstract":"<p><strong>Background: </strong>Geriatricians' work provides holistic recommendations to improve the health of older adults, considering medical, social, psychological, and functional domains. Their implementation most often relies on primary care physicians. Extant evidence suggests benefit from systematized information transfer between hospital-based specialists and primary care physicians. Yet, direct communication between hospitals and primary care physicians is rare. We aimed to describe the information transfer practice of hospital-based geriatricians in Quebec, Canada.</p><p><strong>Methods: </strong>We sent a survey to all (146) geriatricians and Geriatric Medicine residents of Quebec on their current practice and opinions on information transfer and obtained 64 responses. We then performed 20-minute semi-structured interviews with 13 participants to further explore knowledge on information transfer, barriers and facilitators, risks and benefits, and recommendations to improve transmission.</p><p><strong>Results: </strong>While geriatricians believe that their recommendations should be transmitted to primary care physicians and that the absence of a systematic information transfer procedure has a negative impact on quality of care, only 1.6% report having such a procedure in place in their practice. They think that the absence of information transfer procedures disrupts the communications of key diagnoses and medication changes, and leads to duplicated interventions. Harnessing technology to facilitate information transfer is viewed as a solution.</p><p><strong>Conclusion: </strong>Information transfer between hospital-based geriatricians and primary care physicians in Quebec is rare. The absence of a systematic information transfer procedure is seen by geriatricians as a hindrance to the provision of safe, high-quality care to older adults.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 3","pages":"235-243"},"PeriodicalIF":1.2,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364490/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980177","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":"Creation of a Rehabilitation Prediction Rule: a Prioritization Procedure.","authors":"Pauline Wu, Zahra Goodarzi, Jacqueline McMillan","doi":"10.5770/cgj.28.826","DOIUrl":"10.5770/cgj.28.826","url":null,"abstract":"<p><p>Older adults may require longer recovery periods prior to being discharged from the hospital after an acute care stay. For some, returning to their previous living arrangement may no longer be safe or feasible after an acute care admission, and they may require alternate levels of care. It can be challenging to evaluate which patients may benefit most from inpatient rehabilitation versus those for whom alternate levels of care are more suitable. Using a prioritization procedure, this study identified and ranked predictive factors for successful inpatient rehabilitation (defined as discharge to previous living arrangement) from most to least important. The final round of the prioritization procedure resulted in a list of the top 20 predictive factors, ranked by health-care providers in the field, from most to least important. Predictive factors included demographic information, past medical history factors, acute care illness factors, and results of investigations performed during the index hospitalization. The top ranked predictive factors related to patients' previous living arrangements, level of independence before hospitalization, and presence or absence of cognitive impairment. The bottom ranked predictive factors related to physical measures and results of inpatient investigations at the time of transfer. These findings highlight the importance of considering patients' lived experiences prior to hospitalization when determining who may obtain the greatest benefit from further, intensive inpatient rehabilitation following an acute care hospitalization.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 2","pages":"161-168"},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094087/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217702","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":"Post-discharge Home Care Services Use, Long-Term Care Placement, and Survival in Older Adults with Major Trauma: a Population-Based Cohort Study from Ontario, Canada.","authors":"Christopher C D Evans, Wenbin Li","doi":"10.5770/cgj.28.828","DOIUrl":"10.5770/cgj.28.828","url":null,"abstract":"<p><strong>Background: </strong>There are few studies describing health services use and longer-term survival in older adults with major injuries. Our objectives were to characterize the outcomes of older adults experiencing a major injury, and to assess for associations between injury and rates of home-care services use (HCS), long-term care (LTC) placement, and survival.</p><p><strong>Methods: </strong>We conducted a retrospective case-control study including adults 65 years or older admitted for a major injury (trauma survivors) or were uninjured (controls) between 2009 and 2023 in Ontario, Canada. Trauma survivors were matched 1:1 to controls based on age, sex, and number of comorbidities. Primary outcomes were rates of HCS use and LTC admissions for up to five years following discharge. Secondary outcomes were types of HCS use and survival. Multivariate regression was used to compare rates of HCS and LTC use. Cox proportional hazards models were used to assess time to LTC admission or death.</p><p><strong>Results: </strong>The study cohort consisted of 31,508 individuals. Older adult trauma survivors experienced a twofold increased rate of home-care service use (odds ratio [OR]: 2.3, 95% confidence interval [CI]: 2.1-2.4), a 30% increased rate of LTC admissions (OR: 1.3, 95% CI: 1.0-1.6), and a 40% increased rate of death (hazard ratio: 1.4, 95% CI: 1.4-1.5).</p><p><strong>Conclusions: </strong>Compared to controls, older adults surviving trauma use HCS at significantly higher rates, require LTC placement more frequently, and experience a decreased rate of survival.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 2","pages":"106-114"},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094091/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217705","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":"Last Veterans-a Short History.","authors":"Christopher Frank","doi":"10.5770/cgj.28.844","DOIUrl":"10.5770/cgj.28.844","url":null,"abstract":"","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 2","pages":"180-182"},"PeriodicalIF":1.2,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12380255/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144980155","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":"Biological Sex and the Association Between Grip Strength and Cardiovascular Disease: a Scoping Review.","authors":"Christian W Mendo, Andreo Ciarciello, Arielle Vary-O'Neal, Natalie Clairoux, Marie-Pierre Sylvestre, Mark R Keezer","doi":"10.5770/cgj.28.814","DOIUrl":"10.5770/cgj.28.814","url":null,"abstract":"<p><strong>Background: </strong>This scoping review examines how biological sex has been considered in studies investigating the association between grip strength and cardiovascular outcomes and risk factors.</p><p><strong>Methods: </strong>We used the Askey and O'Malley framework, reported as per the PRISMA extension for scoping reviews. A search was conducted in four electronic bibliographic databases to identify relevant peer-reviewed studies published after 2001.</p><p><strong>Results: </strong>Of the 39 included studies, 82.0% (n = 32) used biological sex as a confounder variable in the association of interest. Two studies used interaction terms between biological sex and grip strength and found no statistically significant interactions. Five studies used sex-stratified analyses alone. Three of these studies found that the cardiovascular risk due to low grip strength is higher in males than in females. Two other studies used both interaction terms between biological sex and grip strength and sex-stratification analyses and found no statistically significant differences. Sociocultural gender was not considered in any of the identified studies.</p><p><strong>Conclusion: </strong>We found that biological sex was often considered as a confounder variable in the association between grip strength and cardiovascular outcomes, as well as cardiovascular risk factors. On the other hand, two studies reported the presence of effect modification by sex rather than confounding, that these associations were stronger in males versus females. Five other studies did not identify evidence of interaction nor effect modification. Future research is needed to clarify the nature of these associations and understand any potential biological mechanisms.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 2","pages":"169-179"},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094089/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217692","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":"Perceptions of Frailty in Long-Term Care.","authors":"Kayla Atchison, Pauline Wu, Ann M Toohey, Daniel Gaetano, Jacqueline McMillan, Jenna Naylor, Sharon Kaasalainen, Michelle N Grinman, Vivian Ewa, Jessica Simon, James Silvius, Aynharan Sinnarajah, Beth Gorchynski, David B Hogan, Jayna Holroyd-Leduc, Zahra Goodarzi","doi":"10.5770/cgj.28.817","DOIUrl":"10.5770/cgj.28.817","url":null,"abstract":"<p><strong>Background: </strong>An early palliative approach to care may best suit the care needs of older persons with frailty living in long-term care (LTC). The study objective was to evaluate the barriers and facilitators to care for frailty in the LTC setting.</p><p><strong>Methods: </strong>Semi-structured interviews were completed with physicians, nurse practitioners, registered nurses, allied health-care providers, care partners, and residents with care experience in LTC. Framework analysis methods that leveraged behaviour change theories were used to analyze the interview data and produce practice-oriented findings.</p><p><strong>Results: </strong>Twenty-eight interviews were completed. Seven themes were identified: resident characteristics related to frailty; frailty detection and diagnosis; frailty treatment and care planning; frailty and prognosis conversations; palliative and end-of-life care; communication amongst LTC collaborators; and the LTC environment. All codes were labelled as barriers or facilitators and assigned to a primary domain within the Theoretical Domains Framework.</p><p><strong>Conclusions: </strong>The lack of clinical recognition of frailty in the LTC setting was a key barrier to clinical pathway implementation. There is a need for frailty to be linked to prognosis and care decisions, for frailty to be directly addressed through individualized treatments, and for an early palliative approach to care to be accessible to residents. Identifying barriers to care for frailty is a critical step toward clinical care pathway implementation which may improve care and outcomes for residents of LTC.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"28 2","pages":"136-144"},"PeriodicalIF":1.6,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12094099/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144217704","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}