Canadian Geriatrics Journal最新文献

Background: Entrustable Professional Activities (EPAs) have become a cornerstone for an increasing number of competency-based medical education programs. Today, frameworks of EPAs are being used in most, if not all, medical specialties. These frameworks can break a discipline down to its constituting tasks, and structure the training and evaluation of residents. In 2018, The Royal College of Physicians and Surgeons of Canada created an EPA framework for Geriatric Specialty residency programs nationwide. The present study aims to evaluate this EPA framework through focus groups consisting of several stakeholder groups.

Methods: Participants were recruited to be part of one of five focus groups-one for each stakeholder group of interest. The five focus groups consisted of: physician faculty, residents, allied health professionals, administrators/managers, and patients. Each focus group met once virtually over ZOOM^® for no longer than 90 minutes. Meeting transcripts were iteratively coded based on emerging themes, and were compared for similarities and gaps between stakeholder perspectives.

Results: Multi-stakeholder consultation yielded feedback on many specific EPAs, suggestions for new EPAs, and additional input which gave rise to four themes: (i) EPA scope, (ii) Operationalization, (iii) Interprofessional Collaboration, and (iv) Patient Advocacy. Lastly, we received their thoughts on how the framework defines Geriatrics relative to the work of Care of the Elderly physicians in Canada.

Conclusions: Consulting a variety of stakeholder groups generates a robust and diverse supply of feedback that holistically augments EPA frameworks to be more practical, appropriate, socially accountable and patient-centred.

Background: Fragility fractures are a serious and common consequence of falls in older adults. Orthogeriatric models of care reduce mortality and morbidity, but, despite this evidence, orthogeriatric programs (OGPs) are not standardized across Canada. The aim of this study was to better understand the facilitators and barriers of OGPs across Canada.

Methods: Data on OGPs across Canada were gathered via email survey to all Canadian Geriatric Society (CGS) members and distributed April 1st to May 1st 2021. Respondents answered 15 questions, using SKIP LOGIC, and data analysis was conducted with Qualtrics^XM software.

Results: 62 CGS members completed the survey. Respondents came from nine provinces/territories, with most being physicians from academic centres. 77% respondents indicated an existing OGP at their site, commonly an optional or automatic geriatrician consult. 23% indicated no formal OGP, of which 56% had an alternative service automatically consulted for older adults with fragility fracture, commonly internal medicine or a hospitalist. Responders indicated the most important factor in establishing an OGP is clinical leadership (56%, 10/18), and the most common barriers are lack of hospital prioritization and lack of funding (41%, 62/153).

Conclusions: The survey found that clinical leadership, hospital prioritization, and available funding are imperative to establishing OGPs. Limitations include the survey being distributed only to CGS members, a lower response rate, and respondents predominantly from academic centres in Ontario. Further qualitative data from other specialties (for example, orthopedics) and greater representation from community hospitals would be helpful to understand additional perceived barriers and facilitators.

Background: Hip fractures in older adults often lead to adverse health outcomes, which may be related to time to surgery and longer hospital stays. The experience of older adults with hip fractures in New Brunswick is not known.

Methods: This was a retrospective observational study. All hip fracture patients 65 years of age and older admitted to one hospital designated as a Level One Trauma Centre between April 1, 2015 and March 31, 2019 comprised the sample.

Results: The majority (86.5%) received surgery within 48 hours and those who had surgery beyond this time frame had a significantly longer stay in acute care (OR: 3.79, 95% CI: 2.05-7.15). The mean total length of stay (Total-LOS) for patients discharged after their acute care needs were met was 9.8 days (SD=8.1) compared to patients experiencing delays in discharge for nonmedical reasons which was 26.3 days (SD=33.7). An extended stay in acute care (OR: 1.93, 95% CI: 1.09-3.43) and increasing age (OR: 1.03, 95% CI: 1.001-1.06) were associated with a higher likelihood of death at one year post-discharge. Time to surgery beyond 24 hours (OR: 2.80, 95% CI: 1.13-7.38) was associated with a higher likelihood of death 30 days post-discharge.

Conclusions: Most patients had surgery within the national benchmark of less than 48 hours. The Total-LOS increased 2.5-fold in patients who remained in hospital after their acute care needs were met. A better understanding of patient characteristics, such as frailty, may better predict patients at risk for longer hospital stays and adverse health outcomes.

Background: Only few studies addressed the topic of Fibromyalgia Syndrome (FMS) effects on geriatric population quality of life and drug usage. The objective of this study was to demonstrate the significant impact of FMS in terms of quality of life (QOL) in geriatric aged patients.

Methods: 80 patients were studied, 40 with FMS according to FMS 2016 classification criteria, and 40 non-FMS controls. The patients were all above the age of 65 years. The FMS and control group completed Widespread Pain Index (WPI) and Symptom Severity Score (SSS). Three questionnaires, Fibromyalgia Impact Questionnaire (FIQ), Short Form (SF-36) Questionnaire, and Health Assessment Questionnaire Disability Index (HAQ-DI) were completed. These with additional medical records were used to classify symptoms and severity in both groups.

Results: Fibromyalgia patients demonstrated significant higher disability scores, (FIQ of 79.5 vs. 33.9, p<.01, and HAQ-DI of 2.00 vs. 1.00, p<.01 for FMS vs. non-FMS, respectively), and lower social functioning in comparison to non-FMS controls (SF-36 of social functioning 0.31 vs. 0.92, p<.01 for FMS vs. non-FMS, respectively). The FMS group had a higher use of pain management medications (opioid use of 12 patients vs. 0, p<.01, use of non-steroidal anti-inflammatory drugs by 11 FMS patients vs. 4 non-FMS controls, p<.01).

Conclusions: Patients with FMS older than 65 years of age demonstrate poorer outcomes and worse symptoms in comparison to matched-aged non-FMS control group. An association was found between FMS and the effect on the quality of life in this population.

The quality of medical care provided to older residents in nursing homes may depend upon available staffing models; this study examined the relationship between physician and nurse practitioner (NP) presence, care involvement, and resident outcomes. The secondary analysis of data collected in the Translating Research in Elder Care (TREC) study during 2019-20 included items on daily presence of physicians and NPs on units, physician involvement in care planning, and ability to contact physician or NP when necessary linked to routinely collected Resident Assessment Instrument-Minimum Data Set version 2.0 data. Eight logistic regression models tested the association between measures of staffing involvement and each outcome (antipsychotic use without indication (APM), physical restraint use, hospital transfers, and polypharmacy). The sample consisted of 10,888 residents across 320 care units in 90 facilities. Of the units, 277 (86%) reported a physician or NP visited daily, 160 (72.1%) reported that the physician was involved in care planning, and 318 (99%) units reported that the physician or NP could be reached when needed. Following adjustment for multiple confounding variables, there were no statistically significant associations between presence/involvement of medical professionals and resident outcomes (for example, physician or NP presence on the unit and hospitalization transfers [AOR=1.17, 95% CI: 0.46-3.10] or polypharmacy [AOR=1.37, 95% CI: 0.64-2.93]). We found non-significant associations between medical staff presence and involvement and selected resident outcomes, suggesting either the presence of many unaccounted for confounding inter-related resident-care provider variables or underlying insensitivity of the available data.

Background: While the benefits of exercise on cognitive functions have already been reviewed, little is known about the impact of exercise on language performance. This scoping review was conducted to identify existing evidence on exercise-induced changes in language performance in healthy aging individuals and adults with stroke or neurodegenerative conditions.

Methods & results: Using the Arksey and O'Malley framework, 29 studies were included. Eleven studies in healthy aging indicated enhanced language performance, with 72.72% having significant improvement in semantic/phonological Verbal Fluency (VF) following exercise. Among 18 studies on older adults with stroke or neurodegenerative conditions, 11 reported better language performance, with 44.44% having significant improvement in picture naming/description and semantic/phonological VF by exercise. The seven remaining studies reported no significant change in language performance in persons with stroke or neurodegenerative conditions.

Conclusion: Overall, exercise interventions showed improvement in language performance in healthy aging, while selective enhancement was shown for language performance in persons with either stroke or neurodegenerative conditions.

Objectives: To estimate the level of physical activity among geriatric population, to determine the motivating factors for being active and identifying barriers that prevent participants from engaging in physical activity.

Methods: A community-based cross-sectional study was carried out at one of the wards within Ahmedabad city following multi-stage random sampling. The calculated sample size was 230. A pre-designed, validated, short version International Physical Activity Questionnaire (IPAQ) and Behaviour Regulation in Exercise Questionnaire (BREQ-3) were used for data collection by personal interview. From selected sampling-frame, geriatric people residing in every 5th household were interviewed after obtaining oral informed consent following simple-random sampling.

Results: Of total 230 study participants, 67 (29.13%) were physically active (cumulative for Category 2 and Category 3), while the remaining 163 (70.87%) were found physically inactive (i.e., minimally active [Category 1]). Motivational scores, particularly in identified regulation, showed higher median scores across subdomains of the BREQ-3. Amotivation exhibited a strong negative correlation with physical activity, while intrinsic regulation displayed a strong positive correlation.

Conclusion: More than two-third of study participants were physically inactive. Level of educational status, type of previous occupation involved, presence of addiction, BMI, electronic device usage duration per day and presence of chronic illness were statistically significant determinants to decide involvement of elderly people in category of physical activity. Amotivation, external and introjected regulation had negative correlation with physical activity, while intrinsic regulation and RAI (Relative Autonomy Index) showed positive correlation with physical activity. None of the behavioural regulators had statistically significant association with category of physical activity.

Background: The literature to date is unable to clearly characterize the appropriateness of virtual care for falls prevention services from the patient perspective. In response to COVID-19, the Falls Prevention Program (FPP) at Sunnybrook Health Sciences Centre was modified to include virtual components. We set out to uncover the experiences of this unique older-adult patient population to inform FPP quality improvement and appropriate incorporation of technology post-pandemic.

Methods: FPP patients during the COVID-19 pandemic (February 2020 - February 2022) and their primary caregivers met inclusion criteria. Out of 18 eligible patients, 10 consented to participate in 20-minute, semi-structured telephone interviews conducted and transcribed by the first author. Inductive coding followed by theme generation occurred through collaborative analysis.

Results: The participants (n=10) were 60% female, mean age 84 years (SD 5.8), 60% living alone, and 70% university educated. We generated three main themes: 1) First Steps First, revealed a common desire for physical and mental support and the perceived essentials of a successful FPP highlighting the importance of program length and individualized attention; 2) Overcoming Obstacles, highlighted participants' experiences overcoming barriers with technology in the context of an isolating pandemic; and 3) Advancing Care Post-Pandemic, elaborated on the appropriateness of virtual care and delved into the importance of program personalization.

Conclusion: The interviewed older adults revealed agreement on the FPP's necessity and the importance of increasing program length, one-on-one interaction, and program flexibility for unique patient needs. Incorporating virtual assessment prior to in-person exercises was largely favoured and should be considered as an appropriate use of technology post-pandemic.

[This corrects the article DOI: 10.5770/cgj.27.712.].

Background: As health-care demand is growing, our health-care system will require the optimization of the care trajectories. Patients with an alternate level of care (ALC) status could be a target for flow optimization. We aimed to characterize ALC patients and risk factors for ALC status, and to propose an integrated model to analyze the trajectory of ALC patients and discuss solutions to reduce their burden.

Methods: A case-control design was used to compare 60 ALC and 60 non-ALC patients admitted to the geriatric unit of the Centre hospitalier de l'Université de Montréal in 2021, collecting medical and sociodemographic data. Based on our model, univariate statistical analyses were computed to compare groups and identify risk factors for ALC status.

Results: ALC patients were less independent (22% performed five to six activities of daily living vs. 43%, p = .03). Both groups were comparable in terms of mobility and neurocognitive disorders. ALC patients were more likely to receive a new diagnosis of a neurocognitive disorder or new behavioural or psychological symptoms (37% vs. 15%, p = .008). Up to 25% of ALC patients were admitted despite presenting no active medical condition (vs. 3% of non-ALC patients, p = .002).

Conclusions: The optimization of the care trajectory of ALC patients is mainly based on pre-hospital and post-hospital factors. A proportion of ALC admissions might be avoidable with additional investment in home care resources and relocation procedures. Fluidity of ALC trajectory may benefit from improved orientation at discharge procedures. Full optimization of ALC trajectories requires a systemic understanding of the health-care system.