Canadian Geriatrics Journal最新文献

{"title":"Survey on Current Practice of Canadian Physicians Regarding the Investigation in Older Patients with Delirium.","authors":"Antoine Laguë,&nbsp;Valérie Boucher,&nbsp;Pil Joo,&nbsp;Krishan Yadav,&nbsp;Charles Morasse,&nbsp;Marcel Émond","doi":"10.5770/cgj.25.580","DOIUrl":"https://doi.org/10.5770/cgj.25.580","url":null,"abstract":"<p><strong>Background: </strong>The current literature provides heterogeneous recommendation regarding the investigation of older delirious patients, which may lead to over-testing. Our study aims to describe Canadian physicians' current practice for the investigation of older patients with delirium. Our secondary objective is to define specific indications for performing a CT head scan in this population.</p><p><strong>Methods: </strong>Design: cross-sectional online survey. Participants: physicians who conduct their clinical practice in Canada and who care for older patients with delirium. Potential study participants were reached through Canadian associations: Canadian Geriatrics Society, the Canadian Association of Emergency Physicians, the Association des Médecins d'Urgence du Québec, and members of Choosing Wisely Canada.</p><p><strong>Results: </strong>We received 296 survey responses. More than 80% of respondents always order complete blood count, urea, and creatinine and electrolytes. Extended electrolytes, TSH, chest X-ray, electrocardiogram, urinalysis and urinary culture tests tend to be ordered somewhat frequently. Physicians mostly agreed to order a head CT scan for loss of consciousness, altered mental status, fall, and anticoagulation.</p><p><strong>Conclusions: </strong>Physicians' investigations for older patients with delirium are highly variable, even with the lack of evidence supporting a broad workup. Also, respondents mostly align with current recommendations of indications for CT head scans.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"25 3","pages":"279-284"},"PeriodicalIF":3.9,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/9e/72/cgj-25-279.PMC9427188.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40366053","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":"Engaging People With Lived Experience of Dementia in Research: Perspectives From a Multi-disciplinary Research Network.","authors":"Lauren E Bechard,&nbsp;Katherine S McGilton,&nbsp;Laura E Middleton,&nbsp;Howard Chertkow,&nbsp;Saskia Sivananthan,&nbsp;Jennifer Bethell","doi":"10.5770/cgj.25.583","DOIUrl":"https://doi.org/10.5770/cgj.25.583","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>Data were from an online, anonymous survey of researchers within the Canadian Consortium on Neurodegeneration in Aging.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"25 3","pages":"254-261"},"PeriodicalIF":3.9,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/f8/86/cgj-25-254.PMC9427184.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40366047","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":"Exploring Harm Reduction in Supportive Housing for Formerly Homeless Older Adults.","authors":"Lara L Nixon,&nbsp;Victoria F Burns","doi":"10.5770/cgj.25.551","DOIUrl":"https://doi.org/10.5770/cgj.25.551","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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?</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"25 3","pages":"285-294"},"PeriodicalIF":3.9,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/27/9c/cgj-25-285.PMC9427187.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40365585","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":"Changes in Physical Functioning and Fall-Related Factors in Older Adults Due to COVID-19 Social Isolation.","authors":"Fernando Damasceno de Albuquerque Angelo,&nbsp;Fabiano de Souza Fonseca,&nbsp;Breno Quintella Farah,&nbsp;Rodrigo Cappato de Araújo,&nbsp;Bruno Remígio Cavalcante,&nbsp;Natália Barros Beltrão,&nbsp;André Luiz Torres Pirauá","doi":"10.5770/cgj.25.591","DOIUrl":"https://doi.org/10.5770/cgj.25.591","url":null,"abstract":"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 (p<.001), 7% in power (p=.001), 11% in functional mobility (p=.001), 20% in functional muscle fitness (p=.001), and 60% in upper body flexibility (p=.001) and 33% lower body flexibility (p=.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.","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"25 3","pages":"240-247"},"PeriodicalIF":3.9,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/4d/59/cgj-25-240.PMC9427190.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40366048","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":"Listening to Trainee Concerns and Suggestions During COVID-19: a Report from the Canadian Consortium on Neurodegeneration in Aging (CCNA).","authors":"Abdelhady Osman,&nbsp;Amanda Duncan,&nbsp;Patricia Giurca,&nbsp;Colleen J Maxwell,&nbsp;Nellie Kamkar,&nbsp;David B Hogan,&nbsp;Manuel Montero-Odasso","doi":"10.5770/cgj.25.564","DOIUrl":"https://doi.org/10.5770/cgj.25.564","url":null,"abstract":"<p><strong>Background: </strong>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^th, 2020 and May 19^th, 2020 to identify the challenges faced by CCNA trainees because of the pandemic and how to best support trainees in response to those challenges.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"25 3","pages":"262-268"},"PeriodicalIF":3.9,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/d9/cgj-25-262.PMC9427181.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40365584","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 Qualitative Exploration of Proactive Falls Prevention by Canadian Primary Care Providers.","authors":"Amanda A Nova,&nbsp;George A Heckman,&nbsp;Lora M Giangregorio,&nbsp;Mohamed Alarakhia","doi":"10.5770/cgj.25.582","DOIUrl":"https://doi.org/10.5770/cgj.25.582","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"25 3","pages":"295-299"},"PeriodicalIF":3.9,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/79/40/cgj-25-295.PMC9427185.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40366050","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":"Canadian Geriatrics Society Scientific Sessions, April 7–9, 2022: Book of Abstracts","authors":"Various authors","doi":"10.5770/cgj.25.635","DOIUrl":"https://doi.org/10.5770/cgj.25.635","url":null,"abstract":"Results: Individuals with low structural and cognitive social capital had lower SEP, higher stress levels, and worse health behaviours than those with high structural and cognitive social capital. 'Temerty Faculty of Medicine, University of Toronto, Medical Sciences Building, 2Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Li Ka Shing Knowledge Institute of St. Michael's Hospital, 3Faculty of Medicine, University of Ottawa, 4Department of Anesthesiology and Pain Medicine, University of Ottawa, 5Department of Surgery, University of Alberta. Opportunities included building in elements for program success (hospital-system buy-in, cross-specialty team collaboration, workflow integration, and built-in evaluation) and virtual care to improve rural access. Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 2.","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":"25 1","pages":"300 - 332"},"PeriodicalIF":3.9,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46630050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends and Factors Associated with Suicide Deaths in Older Adults in Ontario, Canada.","authors":"Eada M P Novilla-Surette,&nbsp;Salimah Z Shariff,&nbsp;Britney Le,&nbsp;Richard G Booth","doi":"10.5770/cgj.25.541","DOIUrl":"https://doi.org/10.5770/cgj.25.541","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":" ","pages":"134-161"},"PeriodicalIF":3.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/30/1e/cgj-25-134.PMC9156420.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40390563","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":"Levels of Medical Intervention and End-of-Life Practices in Long-Term Care Centres.","authors":"Jérôme Leclerc-Loiselle,&nbsp;Sylvie Gendron,&nbsp;Andréanne Côté,&nbsp;Serge Daneault","doi":"10.5770/cgj.25.531","DOIUrl":"https://doi.org/10.5770/cgj.25.531","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":" ","pages":"197-201"},"PeriodicalIF":3.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b2/d2/cgj-25-197.PMC9156424.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40391021","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":"Optimizing the Physical & Social Environment Within Hospitals for Patients with Dementia: a Systematic Review.","authors":"Caitlan D Reich,&nbsp;Hannah Lyons,&nbsp;Jayna M Holroyd-Leduc","doi":"10.5770/cgj.25.494","DOIUrl":"https://doi.org/10.5770/cgj.25.494","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>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.</p>","PeriodicalId":56182,"journal":{"name":"Canadian Geriatrics Journal","volume":" ","pages":"222-232"},"PeriodicalIF":3.9,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c4/8b/cgj-25-222.PMC9156422.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40390565","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}