Canadian Geriatrics Journal最新文献

Background: Reported estimates of frailty prevalence vary considerably. At least partially attributable to differences in the conceptualization of frailty used, a better understanding of the inter-relationships among frailty domains could clarify contributors to the noted heterogeneity.

Methods: A global frailty index (FI) created from baseline data on 30,097 Canadian Longitudinal Study on Aging comprehensive cohort participants was used to define physical, psychological, cognitive, and social domain-specific FIs. These were divided into quintiles with the highest 20% (Q5) representing the frailest participants. Logistic regression was used to estimate the associations between age group and biological sex with domain-specific FIs in unadjusted and adjusted (income, smoking status, nutritional risk, physical activity, social participation, interaction between sex and age group) models. The association between Q5 membership among the frailty domains was estimated using polychoric correlation coefficients.

Results: The prevalence of physical and cognitive frailty increased with age, but psychological frailty decreased, especially in males. Social frailty showed gradual increases with age in females that were only evident in the oldest age group (75-85) among men. The age-groups*sex interaction p value was p<.001 for social. Polychoric correlations were highest between the psychological/physical and psychological/social domains, and decreased with increasing age for all combinations.

Conclusion: We found that domain-specific frailty prevalences differed by age group and sex with low associations among frailty domains, particularly at older ages. Understanding the evolution of these findings could be instrumental in developing tailored interventions to prevent frailty or modify its trajectory.

Background: Canada is a bilingual country; however, outside of Quebec, health-care services are predominantly offered in English. With the increasing older adult population and stretched health-care resources, Francophone older adults may face significant challenges in accessing care due to their linguistic minority status. This study explores the experiences of caregivers of Francophone older adults in the Greater Toronto Area (GTA).

Methods: Using a convenience sampling strategy, caregivers of patients who had undergone geriatric assessment at the Centre Francophone du Grand Toronto (CFGT) were recruited. Participants underwent 45-minute, semi-structured interviews and completed demographic questionnaires. Three independent reviewers conducted qualitative content analysis of the interview transcripts, using the socioecological model of health and NVivo12.

Results: Nine participants were primarily female (n=5), with age ranges of 40-49 (n=2), 50-59 (n=3), and 60+ (n=4). They originated from North America (n=5), Africa (n=3), and the Middle East (n=1); about half preferred English over French. Thematic analysis identified three key themes: 1) Barriers Accessing Health Care in the French Language; 2) The Need for Interpreter Support; 3) Importance of Comprehensive Francophone Community Services.

Conclusions: Despite the presence of organizations (e.g., CFGT), this study reveals a significant gap in French-language services for older adults in the GTA, leading to increased challenges for their caregivers. Due to linguistic barriers, caregivers must act as interpreters to mitigate the risks associated with miscommunication and potentially worse health outcomes. Addressing these issues requires increasing bilingual health-care providers, enhancing funding for Francophone community services, and improving support systems (e.g., interpreters).

[This retracts the article DOI: 10.5770/cgj.27.786.].

Limited anxiety tools validated against a diagnostic gold standard in the context of dementia have been identified. A systematic review update was completed to identify publications since 2017 describing tools to detect anxiety in persons with dementia compared to a diagnostic gold standard. The original search strategy was replicated in MEDLINE, Embase, and PsycINFO. Pooled prevalence and diagnostic accuracy estimates were calculated based on three or more studies presenting comparable information from either the original or updated review search. No pooled estimates were calculated in the original review given limited evidence. One study evaluating the Rating Anxiety in Dementia (RAID) scale, Neuropsychiatric Inventory, and Hamilton Anxiety Rating Scale met review inclusion criteria. The pooled prevalence of generalized anxiety disorder (GAD) (n=3, 36.7%, 95% Confidence Interval (CI): 24.3-49.2%) and diagnostic accuracy outcomes for the RAID scale (≥11 cut-off) to detect GAD (n=3, sensitivity: 89%, 95% CI: 78-95%; specificity: 73%, 95% CI: 60-82%) were calculated using data from two studies identified in the original review and the newly included study from the review update. The RAID scale has the most evidence and adequate sensitivity to support its use in identifying anxiety in persons with dementia. Validated tools to detect anxiety in persons with dementia remain understudied.

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.

Background: 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.

Methods: 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 The Theory of Planned Behavior.

Results: 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.

Discussion: 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.

Conclusion: 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.

Background: 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.

Method: 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.

Results: 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).

Conclusions: 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.

Background: 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.

Method: 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.

Results: 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.

Conclusions: Our findings reveal a plethora of strategies implemented by homes, with ranging reports of perceived success.

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.