Canadian Geriatrics Journal最新文献

Introduction: Urinary incontinence (UI), the complaint of involuntary leakage of urine, has a substantial impact on the quality of life of older adults. Most UI research is driven by researchers and lacks the patient perspective. The goal of this qualitative study was to gain the perspective of older adults in formulating a research agenda tailored to address their questions and improve their experience with managing UI.

Methods: Implementing a community-based participatory research framework, an advisory group of eight older adults with UI were recruited to be on the research team. An initial focus group was conducted to learn about their research needs. Nominal Group Technique was used to reach saturation of themes and data was analyzed thematically. Employing a Delphi consensus method, a national online questionnaire containing 20 priorities for future UI research and education was developed in collaboration with the advisory group.

Results: 59 older adults with UI rated each priority on a Likert scale. Priorities which advanced to the second round were re-rated, with an 85% response rate. 11 priorities of ≥80% agreement were retained. The highest rated priorities included relationship between physical activity and UI; support for those with UI; causes of UI and its management; sleep and UI; and public restroom accessibility.

Conclusions: Findings from this study will help researchers and health-care professionals understand and address the needs of older adults with UI. Efforts should be made to translate research findings in this area and disseminate them in a medium accessible to older adults.

Background: Older people are prone to multiple chronic diseases and, as a result, require multiple medications. At present, there is no study to verify whether the use of high-risk perioperative medications (HRPOMs) will adversely affect postoperative outcomes in the relatively old patient. In this study, we aimed to analyze the risks of HRPOMs for prolonged length of hospital stay (LOS) in advanced-aged (≥ 75 years) patients undergoing spinal surgery.

Methods: Medical records of advanced-aged patients who underwent spinal surgeries were retrospectively reviewed. Patients were divided into those who had prolonged LOS (≥ eight days) versus those who did not (< eight days). The demographics, medical comorbidities, and perioperative medications were analyzed. Univariate and multivariate regression were used to determine perioperative risk factors for prolonged LOS.

Results: A total of 268 patients were included with a median age of 79 years (interquartile range [IQR]=76, 82) and 127 (47.4%) patients had a prolonged LOS. In multivariate logistic analysis, higher body mass index (odds ratio [OR] = 1.116; 95% CI, 1.031-1.209), operation time (OR) = 1.009; 95% CI, 1.005-1.012), and number of postoperative HRPOMs (OR= 1.910; 95% CI, 1.464-2.492) were identified as independent predictors for prolonged LOS. The use of metformin was associated with lower likelihood of prolonged LOS in diabetic patients (OR = 0.365; 95% CI, 0.157-0.846).

Conclusion: Our results indicate that the higher number of postoperative HRPOMs, rather than a specific HRPOMs type, is a risk factor for prolonged LOS. The continued preoperative use of metformin in patients with diabetes has a positive impact on the postoperative outcomes.

Background: There is a large literature on the prevalence of disability in older men, but less data on the incidence of new disability.

Objectives: 1. To determine the incidence of moderate-to-severe disability in a prospective cohort study of aging men; and 2. To determine predisposing risk factors for new moderate to severe disability.

Design & setting: The Manitoba Follow-up Study is a closed cohort study. In 1948, the initial sample was 3,983 men who qualified for air crew training in the Royal Canadian Air Force. In 2004, there were 796 men who were still alive and responded to the annual questionnaire with no missing data, and who did not have disability. The mean age at that time was 84.

Methods: We calculated the incidence of new moderate-to-severe disability from 2004 to 2017, calculated the time to disability, and constructed survival analysis models to determine factors which predicted disability.

Results: The incidence of disability increased with the aging of the cohort and ranged from 4% to 12% per year. In unadjusted models, poor self-rated health (SRH), low life satisfaction, a low score on the Physical Component Score (PCS) of the Short Form-36, and the number of chronic conditions were all associated with new disability. In adjusted models, SRH, the PCS, and the number of chronic conditions were associated with new disability.

Conclusions: Global measures of well-being, as well as multimorbidity, predict new disability.

Background: Patient health is greatly impacted by increased likelihood of malnutrition if food is not consumed. Food waste also contributes to greenhouse gas emissions and may be possibly reduced by offering vegetarian food options. Therefore, a Plan-Do-Study-Act intervention of "Vegetarian Week" was conducted in an urban geriatric rehabilitation unit.

Method: Food waste was measured using the Visual Estimation Method, and the proportion of waste before and after the intervention was compared using a two-tailed z-test. Surveys assessed patients' attitudes towards vegetarian meals.

Results: Study population was of 54 (2022) and 65 (2023) patients with the majority being male (62.5%), average age 74.5 years, average length of stay 33 days. Comparing pre- and post-intervention periods, overall food wastage increased at: breakfast (22% to 32%), lunch (22% to 32%), and dinner (20% to 25%) with p values <.001. Considering lunch entrées only, wastage increased from 17% to 38%, with vegetarian entrees wasted (46%) more than non-vegetarian ones (34%). Vegetarian patients wasted (37%) as much as non-vegetarians (39%). Survey response rate pre-PDSA was 45%, with most patients (76%) reporting eating an omnivorous diet, a prior awareness of personal and planetary health benefits of vegetarian diets (59%), and previously trying vegetarian dishes (62%). Post-PDSA survey response rate was lower (22%) with 57% not willing to try vegetarian dishes again.

Conclusion: Through evaluation of the patient food experience with Visual Estimation Method and surveys, the very complex issue of food satisfaction was explored in older adults. Although food waste was not decreased during this "Vegetarian Week" pilot, improving patient and planetary health requires ongoing efforts.

Background: Preventing and addressing social isolation and loneliness among older adults is important because of the known associations with negative health outcomes. The Canadian Coalition for Seniors' Mental Health (CCSMH) took on the task of creating clinical guidelines.

Method: A multidisciplinary working group was established. The process was guided by an initial rapid scoping review of the literature focused on older adults. An adapted GRADE approach was utilized.

Results: CCSMH has produced first-ever clinical guidelines on social isolation and loneliness in older adults. Prevention, including recognition of risk factors and educational approaches focused on clinicians and students, is recommended. Targeted screening with validated tools is recommended. A comprehensive assessment is optimal to treat any underlying conditions and to identify contributing factors that may be responsive to psychosocial interventions. An individualized approach to interventions with shared decision-making is recommended. A variety of possible interventions include social prescribing, social activity, physical activity, psychological therapies, animal-assisted therapies and ownership, leisure skill development and activities, and the use of technology.

Conclusion: The problem of social isolation and loneliness is a "geriatric" giant that needs to be recognized and addressed. Because of its complexity, it will require the collective attention of many individuals and organizations working together at multiple levels of society, to raise awareness and find solutions. We recommend that health-care and social service providers use these guidelines as a comprehensive tool to identify, assess, and implement strategies to reduce the negative impact of social isolation and loneliness.

Background: There is a projected and growing gap of geriatricians in Canada. Geriatricians play a crucial role in addressing the health needs of older adults. We aimed to understand the factors that influence the choice of first-practice location for new geriatricians in the context of an aging Canadian population.

Methods: We distributed an online survey to geriatric medicine subspecialty residents and recently licensed geriatricians in Canada. The survey was developed through expert opinions, career planning sessions, and a literature review. There were nine survey sections: general characteristics, location determinants, practice determinants, colleague determinants, support and space, non-clinical opportunities, income models, lifestyle factors, and recruitment determinants. The data were analyzed descriptively.

Results: A total of 61 respondents (51 English, 10 French) completed the survey. The respondents were new practicing geriatricians (37) and geriatric medicine residents (24). Most planned to practice in Ontario (26.2%) or Quebec (27.9%), and 75.4% were women. Flexibility in work-life balance (95.1%), collegiality (93.4%) and reasonable call schedules (93.4%) were the most important factors influencing first practice location. Income did not rank among the highest priorities for choosing the first practice location relative to other factors but was mentioned in open-ended responses to recruitment questions.

Conclusions: This is the first survey identifying the determinants of first practice location in geriatric medicine in Canada. Work-life balance and collegial support are a priority for new geriatricians and may be the strongest incentives a program can provide. For recruitment, income incentives may be beneficial to building new specialized geriatric services. Future research will examine determinants of first practice location among Care of the Elderly clinicians.

Background: There has been increasing concern over the growing number of Alternate Level of Care (ALC) patients in Canada who must wait in hospitals for more appropriate settings to meet their needs. ALC patients may have to stay in hospitals for days or months due to a lack of available long-term care capacity, home care services, or other discharge routes.

Method: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews (PRISMA-ScR) method to review 35 papers on the topic of ALC patients and delayed discharge in Canada from different perspectives, including (1) the shared characteristics of ALC patients in Canada; and (2) their impact on the Canadian health-care system, medical staff, and family members. Furthermore, from the reviewed works, (3) we also investigate the factors that impact the length of the hospital stays.

Results: We highlighted how the ALC problem is increasing healthcare costs, disrupting services, increasing waiting times, and compromising access to valuable resources. We found evidence suggesting that this far-reaching crisis affects the patients, their families, and the medical personnel. We discovered several logistical issues (such as access to long-term care) affecting the patient's hospital length of stay.

Conclusions: Our research contributes to understanding this intricate problem, and helps policymakers take steps to tackle this challenge to ensure timely and appropriate care for all patients.

Background: Canada is undergoing a demographic shift, with projections indicating that over 25% of the country's population will be 65 years or older by 2063. While this has raised critical concerns about Canada's preparedness to meet the social and health-care needs of an aging population, the increasing incidence of food insecurity is particularly affecting vulnerable groups, such as older Canadians, with implications for their health-care service utilization. Despite this observation, there are nascent studies examining the role of household food insecurity status on unmet health-care needs among older people in Canada. The main objective of our study is to assess the association between household food insecurity and unmet health-care needs among older Canadians.

Methods: We used data from a selected sample of 21,178 participants as part of the 2017-18 Canadian Community Health Survey and applied logistic regression analysis.

Results: Our findings indicate that older people experiencing any type of food insecurity, that is, either moderate (OR=3.07, p<.01) or severe (OR=4.09, p<.01) were more likely to have reported unmet health-care needs compared to their counterparts in food secure households, even after controlling for a range of demographic, socioeconomic, and health and health-care variables. Our finding is concerning, considering that older people in Canada who are in most need of health-care services due to their food insecurity status are instead reporting unmet health-care needs.

Conclusion: This revelation calls for urgent policy attention to reduce the episodes of household food insecurity among older people in Canada. Specifically, to improve their access to health-care services, providing them with periodic grocery rebates as part of the social protection package for seniors in Canada would help mitigate the problem of food insecurity among them.

Background: Hospitalized older adults have unique physical, emotional, and psychosocial needs. We sought to understand older patients' and care partners' experiences with multicomponent interventions that support age-friendly care and identify areas for improvement.

Methods: We conducted a mixed methods study using surveys and interviews to explore older adult patients' (65 years or older) and their care partners' experiences with hospital-delivered multicomponent initiatives. We recruited participants from the Geriatric Rehabilitation (GRU) and Musculoskeletal (MSK) Rehabilitation units in a Canadian academic hospital from October 2021 to April 2022 until we reached data saturation and no new themes emerged.

Results: We recruited 18 participants, 10 patients (mean age 78 years, 80.0% female) and 8 care partners (mean age 61, 87.5% female). Surveys revealed overall positive experiences with multicomponent interventions. Interviews revealed five themes: 1) various forms of companionship for patients, 2) recreation and entertainment, 3) physical activity, 4) communication, and 5) pleasant physical environment. Having forms of companionship and proper communication with the care team were highlighted as areas of importance. Physical activity was highly valued, but participants expressed hesitation around safety of mobilizing without physiotherapists. Recreational activities helped distract from social isolation during a hospital stay and participants had diverse preferences for activities. Participants had strong memories of the physical environment, including the lack of natural light, institutionallike décor, and smells.

Conclusion: Companionship, recreation and entertainment, physical activity, communication, and the physical environment were important to hospitalized patients and their care partners. Hospital administrators and policy makers should consider these when targeting areas to improve care for the aging population.

Background: Transitional care programs help improve continuity of care and post-discharge outcomes for frail older adults who are hospitalized. In this study, we examined the effectiveness of a transitional care model, based in a long-term care (LTC) home, on the functional independence of older hospitalized patients post-discharge.

Methods: We used a propensity-score matched cohort, whereby cases comprised patients who were admitted to a transitional care program-called the Sub-Acute Care for Frail Elderly (SAFE) Unit-following a hospitalization between March 1, 2018 and June 30, 2019. Controls were matched to Usual Care patients discharged from hospitals within the same health region and accrual period who did not receive transitional care in the SAFE Unit. Outcomes included acute care, LTC, and home care use within six-month post-discharge.

Results: Compared to Usual Care, SAFE Unit patients were less likely to be admitted into an LTC home (RR 0.44, 95% CI 0.23-0.86) within six months post-discharge. Additionally, on average, SAFE Unit patients spent 34 fewer days in LTC homes than controls. SAFE Unit patients also incurred significantly fewer home care service days (median: 52 days, IQR: 12-132 days) than Usual Care patients (median: 65.5 days, IQR: 19-158 days), particularly in terms of their reliance on general nursing and personal support. Both groups had similar risks of six-month hospital readmission and having an ED visit.

Conclusion: Rehabilitative and restorative-focused care provided through transitional programs, such as the SAFE Unit, have the potential to enable independent living for older hospitalized patients discharged to the community.