Recently published papers

Yoon MN, Ickert C, Slaughter SE, Lengyel C, Carrier N, Keller H. Oral health status of long-term care residents in Canada: Results of a national cross-sectional study. First published: 11 July 2018. Gerontology. 2018;1-6. https://doi.org/10.1111/ger.12356

Abstract: This study described the oral health and oral prosthetic status of long-term care residents in four Canadian provinces. Oral health can have significant impact on the health and quality of life of older adults. Seniors in long-term care are highly dependent on care staff for basic activities of daily living and are at risk for poor oral health. Five hundred and fifty-nine randomly selected residents were examined from thirty-two long-term care homes in Alberta, Manitoba, Ontario and New Brunswick, Canada. Four experienced registered dental hygienists, one in each province, completed a standardised oral health examination with each participant, examining lip health, breath odour, saliva appearance, natural teeth count, gingival inflammation, tooth and jaw pain, denture status, mucosal status and oral health abnormalities. Of the examined residents, 57.6% were dentate (had teeth), with an average of 16.4 (SD = 8.0) teeth. Most dentate residents had moderate or severe inflammation on at least one tooth (79.6%). Sixty per cent of residents wore dentures, and 43.2% of toothless residents had poor hygiene of their dentures. Nine per cent of residents required urgent dental treatment for oral health problems such as broken teeth, infection, severe decay and ulcers. This study provides an estimate of the prevalence of oral health problems in residents living in long-term care homes across Canada and indicates that improvement in oral health care is needed. Future work on development strategies aimed at optimising oral health for long-term care residents is required.

Arora RC, Brown CH, Sanjanwala RM, McKelvie R. “NEW” Prehabilitation: A 3-Way Approach to Improve Postoperative Survival and Health-Related Quality of Life in Cardiac Surgery Patients. DOI: https://doi.org/10.1016/j.cjca.2018.03.020

Abstract:Transfer of patient care from an intensive care unit (ICU) to a hospital ward is often challenging, high risk and inefficient. To address this knowledge gap, and to generate recommendations for how transfers of care from the ICU might be improved, this study sought the perspectives of a diverse group of patients, their family members, and ICU and hospital ward physicians and nurses (providers) from multiple institutions. The 35 participants described 3 interrelated, overarching themes perceived as barriers or facilitators to high-quality patient transfers: resource availability, communication and institutional culture. Common recommendations suggested to improve ICU transfers included implementing standardized communication tools that streamline provider–provider and provider–patient communication, using multimodal communication to facilitate timely, accurate, durable and mutually reinforcing information transfer; and developing procedures to manage delays in transfer to ensure continuity of care for patients in the ICU waiting for a hospital ward bed.

Abstract: Older patients admitted to hospitals are at risk for hospital-acquired morbidity related to immobility. The aim of this study was to implement and evaluate an evidence-based intervention targeting staff to promote early mobilisation in older patients admitted to general medical inpatient units. The early mobilisation implementation intervention for staff was multi-component and tailored to local context at 14 academic hospitals in Ontario, Canada. The primary outcome was patient mobilisation. Secondary outcomes included length of stay (LOS), discharge destination, falls and functional status. The targeted patients were aged = 65 years and admitted between January 2012 and December 2013. The intervention was evaluated over three time periods—pre-intervention, during and post-intervention using an interrupted time series design. in total, 12,490 patients (mean age 80.0 years [standard deviation 8.36]) were included in the overall analysis. This is a large-scale study evaluating an implementation strategy for early mobilisation in older, general medical inpatients. The positive outcome of this simple intervention on an important functional goal of getting more patients out of bed is a striking success for improving care for hospitalised older patients.

Abstract: The objective of this study was to identify barriers to and enablers of advance care planning (ACP) perceived by physicians and other health professionals in primary care. A self-administered survey of family physicians and other health professionals in primary care was undertaken in Ontario, Alberta and British Columbia. Physicians rated insufficient time, inability to electronically transfer the advance care plan across care settings, decreased interaction with patients near the end of life owing to transfer of care, and patients’ difficulty understanding limitations and complications of treatment options as the highest barriers. Other health professionals additionally identified their own lack of knowledge and difficulty accessing the physician as barriers. Themes identified as enablers included greater public engagement, clinician attitudes, creating capacity for clinicians, integrating ACP into practice, and system and policy supports. The study concluded that in primary care, there are barriers to engaging patients in ACP at the patient, provider, and system levels that could potentially be addressed through the informed development of multifaceted interventions.

Click here to learn more about this CFN-funded research (CORE 2013-13).

Keller HH, Valaitis R, Laur CV, McNicholl T, Xu Y, Dubin JA, Curtis L, Obiorah S, Ray S, Bernier P, Gramlich L, Stickles-White M, Laporte M, Bell J. Multi-site implementation of nutrition screening and diagnosis in medical care units: Success of the More-2-Eat project. Clinical Nutrition xxx (2018) 1-9. https://doi.org/10.1016/j.clnu.2018.02.009

Abstract: Improving the detection and treatment of malnourished patients in hospital is needed to promote recovery. The aim of this study was to: 1) describe the change in rates of detection and triaging of care for malnourished patients in 5 hospitals that were implementing an evidence-based nutrition care algorithm, and 2) demonstrate that following this algorithm leads to increased detection of malnutrition and increased treatment to mitigate this condition. Study sites worked towards implementing the Integrated Nutrition Pathway for Acute Care (INPAC), including screening (Canadian Nutrition Screening Tool) and triage (Subjective Global Assessment; SGA) to detect and diagnose malnourished patients. The success of this multi-site study demonstrated that implementation of nutrition screening and diagnosis is feasible and leads to appropriate care. INPAC promotes efficiency in nutrition care while minimizing the risk of missing malnourished patients.

Shears M, Takoka A, Rochwerg B, Bagshaw SM, Johnstone J, Holding A, Tharmalingam S, Miller T, Clarke F, Rockwood K, LiG, Thabane L, Muscedere J, Stelfox HT, Cook DJ, Canadian Critical Care Trials Group.Assessing frailty in the intensive care unit: A reliability and validity study. J Crit Care. 2018 Feb 8;45:197-203. doi: 10.1016/j.jcrc.2018.02.004. [Epub ahead of print]

Abstract: This study sought to describe pre-ICU frailty in critically ill patients using the Clinical Frailty Scale (CFS). Patients =18years admitted to 2 ICUs in Hamilton, Canada, were included. Three Clinical Frailty Scale (CFS) scores were using: 1) chart review, 2) family interview, 3) patient interview. Subsequently, an overall impression was captured in a final score. Mean differences were calculated to assess the RC intra-rater reliability and inter-rater reliability of chart reviews by the RC, Occupational Therapist (OT), and Geriatrics Resident (GR). Scores were also compared between younger and older patients. We also analyzed the relationship between CFS scores and mortality. We found that CFS scores can be generated using medical chart review and can be reliably completed by ICU clinicians and research staff.

Giguere A, Lebel P. Morin M, Proust F, Rodríguez C, Carnovale V, Champagne L, Légaré F, Carmichael P-H, Martineau B, Karazivan P, Durand, P. (2018). What Do Clinical Supervisors Require to Teach Residents in Family Medicine How to Care for Seniors? Canadian Journal on Aging / La Revue Canadienne Du Vieillissement, 37(1), 32-49. doi:10.1017/S0714980817000460

Abstract: We assessed clinicians’ continuing professional development (CPD) needs at family practice teaching clinics in the province of Quebec. Our mixed methodology design comprised an environmental scan of training programs at four family medicine departments, an expert panel to determine priority clinical situations for senior care, a supervisors survey to assess their perceived CPD needs, and interviews to help understand the rationale behind their needs. From the environmental scan, the expert panel selected 13 priority situations. Key needs expressed by the 352 survey respondents (36% response rate) included behavioral and psychological symptoms of dementia, polypharmacy, depression, and cognitive disorders. Supervisors explained that these situations were sometimes complex to diagnose and manage because of psychosocial aspects, challenges of communicating with patients and families, and coordination of interprofessional teams. Supervisors also reported more CPD needs in long-term and home care, given the presence of caregivers and complexity of senior care in these settings.

Chamberlain S, Baik S, & Estabrooks C. (2018). Going it Alone: A Scoping Review of Unbefriended Older Adults. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement, 37(1), 1-11. doi:10.1017/S0714980817000563.

Abstract: Older adults who have reduced decision-making capacity and no family or friends to compensate for these deficiencies are known as unbefriended and require a public guardian. The purpose of this study was to review the peer-reviewed and grey literature to determine the scope of available research on unbefriended older adults in Canada and the United States. We found limited research examining unbefriended older adults. No Canadian studies or reports were located. Unbefriended older adults were childless or had fewer children, were more cognitively impaired, and were older than older adults who were not unbefriended. These findings demonstrate a stark scarcity of studies on unbefriended older adults. Research is urgently needed using standardized data collection of guardianship status in order to enable studies of the prevalence of public guardianship in Canada.

Wilson K., Kortes-Miller K., & Stinchcombe A. (2018). Staying Out of the Closet: LGBT Older Adults’ Hopes and Fears in Considering End-of-Life. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement, 37(1), 22-31. doi:10.1017/S0714980817000514

Abstract: Canada is experiencing population aging, and given the heterogeneity of older adults, there is increasing diversity in late life. The purpose of this study was to help fill the research gaps on LGBT aging and end-of-life. Through focus groups, we sought to better understand the lived experience of older LGBT individuals and to examine their concerns associated with end-of-life. Our analysis highlights the idea that identifying as LGBT matters when it comes to aging and end-of-life care. In particular, gender identity and sexual orientation matter when it comes to social connections, in the expectations individuals have for their own care, and in the unique fear related to staying out of the closet and maintaining identity throughout aging and end-of-life. This study underscores the need to consider gender identity and sexual orientation at end-of-life. In particular, recognition of intersectionality and social locations is crucial to facilitating positive aging experiences and end-of-life care.

Sinn, C., Betini, R., Wright, J., Eckler, L., Chang, B., Hogeveen, S., . . . Hirdes, J. (2018). Adverse Events in Home Care: Identifying and Responding with interRAI Scales and Clinical Assessment Protocols. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement, 37(1), 60-69. doi:10.1017/S0714980817000538

Abstract: Outcomes of adverse events in home care are varied and multifactorial. This study tested a framework combining two health measures to identify home care recipients at higher risk of long-term care placement or death within one year. Both measures come from the Resident Assessment Instrument-Home Care (RAI-HC), a standardized comprehensive clinical assessment. Persons scoring high in the Method for Assigning Priority Levels (MAPLe) algorithm and Changes in Health, End-stage disease, Signs and Symptoms (CHESS) scale were at the greatest risk of placement or death and more than twice as likely to experience either outcome earlier than others. The target group was more likely to trigger mood, social relationship, and caregiver distress issues, suggesting mental health and psychosocial interventions might help in addition to medical care and/or personal support services. Home care agencies can use this framework to identify home care patients who may require a more intensive care coordinator approach.

Keller HH, Lengyel C, Carrier N, Slaughter SE. Prevalence of inadequate micronutrient intakes of Canadian long-term care residents. British Journal of Nutrition, 1-10. doi:10.1017/S0007114518000107. Published online: 15 February 2018.

Abstract: This study determines the prevalence of inadequate micronutrient intakes consumed by long-term care (LTC) residents. This cross-sectional study was completed in thirty-two LTC homes in four Canadian provinces. Weighed and estimated food and beverage intake were collected over 3 non-consecutive days from 632 randomly selected residents. More than 50 % of participants in both sexes consumed inadequate amounts of folate, vitamins B6, Ca, Mg and Zn (males only), with >90 % consuming amounts below the EAR/AI for vitamin D, E, K, Mg (males only) and K. Vitamin D supplements resolved inadequate intakes for 50–70 % of participants. High proportions of LTC residents have intakes for nine of twenty nutrients examined below the EAR or AI. Strategies to improve intake specific to these nutrients are needed.

Matteo Cesari Islene Araujo de Carvalho Jotheeswaran Amuthavalli Thiyagarajan Cyrus Cooper Finbarr C Martin Jean-Yves Reginster Bruno Vellas John R Beard. Evidence for The Domains Supporting The Construct of Intrinsic Capacity.The Journals of Gerontology: Series A, early acceptance published February 2, 2018, https://doi.org/10.1093/gerona/gly011.

Abstract: Healthy ageing can be defined as “the process of developing and maintaining the functional ability that enables wellbeing in older age”. Functional ability (i.e., the health-related attributes that enable people to be and to do what they have reason to value) is determined by intrinsic capacity (i.e., the composite of all the physical and mental capacities of an individual), the environment (i.e., all the factors in the extrinsic world that form the context of an individual’s life), and the interactions between the two. This innovative model recently proposed by the World Health Organization has the potential to substantially modify the way in which clinical practice is currently conducted, shifting from disease-centered towards function-centered paradigms. By overcoming the multiple limitations affecting the construct of disease, this novel framework may allow the worldwide dissemination of a more proactive and function-based approach towards achieving optimal health status. In order to facilitate the translation of the current theoretical model into practice, it is important to identify the inner nature of its constituting constructs. In this paper, we consider intrinsic capacity. Using the International Classification of Functioning, Disability and Health (ICF) framework as background and taking into account available evidence, five domains (i.e., locomotion, vitality, cognition, psychological, sensory) are identified as pivotal for capturing the individual’s intrinsic capacity (and therefore also reserves) and, through this, pave the way for its objective measurement.

Watt J, Tricco AC, Talbot-Hamon C, Pham B, Rios P, Grudniewicz A, Wong C, Sinclair D, Straus SE. Identifying Older Adults at Risk of Delirium Following Elective Surgery: A Systematic Review and Meta-Analysis. J GEN INTERN MED (2018). https://doi.org/10.1007/s11606-017-4204-x.

Abstract: Postoperative delirium is a common preventable complication experienced by older adults undergoing elective surgery. In this systematic review and meta-analysis, we identified prognostic factors associated with the risk of postoperative delirium among older adults undergoing elective surgery. Medline, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and AgeLine were searched for articles published between inception and April 21, 2016, and 5692 titles and abstracts were screened. Forty-one studies (9384 patients) reported delirium-related prognostic factors. Though caution must be used in interpreting meta-analyses of non-randomized studies due to the potential influence of unmeasured confounding, we identified protective and potentially modifiable prognostic factors, including smoking, frailty, and psychotropic medication use, which should be further studied to develop interventions aimed at mitigating potential harm.

Gajic-Feljanoski O, Papaioannou A, Kennedy C, Ioannidis G, Berger C, Wong AKO, Rockwood K, Kirkland S, Raina P, Thabane L, Adachi JD for the CaMos Research Group. Osteoporotic fractures and obesity affect frailty progression: a longitudinal analysis of the Canadian multicentre osteoporosis study. BMC GeriatricsBMC series – open, inclusive and trusted201818:4. https://doi.org/10.1186/s12877-017-0692-0

Abstract: Despite knowing better how to screen older adults, understanding how frailty progression might be modified is unclear. This study explored effects of modifiable and non-modifiable factors on changes in frailty in community-dwelling adults aged 50+ years who participated in the Canadian Multicentre Osteoporosis Study (CaMos). Rates of change in frailty over 10 y