Recently published papers

Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. The Lancet, doi:

McCaskell DS, Molloy AJ, Childerhose L, Costigan FA, Reid JC, McCaughan M, Clarke F, Cook DJ, Rudkowski JC, Farley C, Karachi T, Rochwerg B, Newman A, Fox-Robichaud A, Herridge MS, Lo V, Feltracco D, Burns K, Porteous R, Seely AJE, Ball I, Seczek A, Kho MEProject management lessons learned from the multicentre CYCLE pilot randomized controlled trial. Trials. 2019;20(1):532.

Abstract: Clinical trials management can be studied using project management theory. The CYCLE pilot randomized controlled trial (RCT) was conducted to determine the feasibility of a future rehabilitation trial of early in-bed cycling in the intensive care unit (ICU). In-bed cycling is a novel intervention, not typically available in ICUs. Implementation of this intervention requires personnel with specialized clinical expertise caring for critically ill patients and use of the in-bed cycle. Our objective was to describe the implementation and conduct of our pilot RCT using a project management approach.

Mansfield A, Danells CJ, Inness EL, Musselman K, Salbach NMA survey of Canadian healthcare professionals’ practices regarding reactive balance trainingPhysiotherapy Theory and Practice, doi: 10.1080/09593985.2019.1650856

Mann K, Lengyel CO, Slaughter SE, Carrier N, Keller HResident and Staff Mealtime Actions and Energy Intake of Long-Term Care Residents With Cognitive Impairment: Analysis of the Making the Most of Mealtimes StudyJournal of Gerontological Nursing. 2019;45(8):32-42.

Thompson MQ, Theou O, Tucker GR, Adams RJ, Visvanathan R. Recurrent Measurement of Frailty Is Important for Mortality Prediction: Findings from the North West Adelaide Health StudyJournal of the American Geriatrics Society. doi:

Theou O, Andrew M, Suriani Ahip S, Squires E, McGarrigle L, Blodgett JM, Goldstein J, Hominick K, Godin J, Hougan G, Armstrong JJ, Wallace L, Ghazali Sazlina S, Moorhouse P, Fay S, Visvanathan R, Rockwood KThe Pictorial Fit-Frail Scale: Developing a Visual Scale to Assess FrailtyCan Geriatr J. 2019 Jun; 22(2): 64–74. 2019 Jun 30. doi: 10.5770/cgj.22.357

Harman LE, Guthrie DM, Cohen J, Declercq A, Fisher K, Goodridge D, Hirdes JP, Seow H. Potential quality indicators for seriously ill home care clients: a cross-sectional analysis using Resident Assessment Instrument for Home Care (RAI-HC) data for OntarioBMC Palliat Care. 2019; 18: 3. 2019 Jan 9. doi: 10.1186/s12904-018-0389-y

Song Y, Hoben M, Weeks L, Bostrom A-M, Goodarzi ZS, Squires J, Doan H, Wagg A, Reid RC, Estabrooks CFactors associated with the responsive behaviours of older adults living in long-term care homes towards staff: a systematic review protocolBMJ Open 2019;9:e028416. doi: 10.1136/bmjopen-2018-028416

Ploeg J, Valaitis RK, Cleghorn L, Yous M-L, Gaber J, Agarwal G, Kastner M, Mangin D, Oliver D, Parascandalo F, Risdon C, Dolovich L. Perceptions of older adults in Ontario, Canada on the implementation and impact of a primary care programme, Health Teams Advancing Patient Experience: Strengthening Quality (Health TAPESTRY): a descriptive qualitative studyBMJ Open 2019;9:e026257. doi: 10.1136/bmjopen-2018-026257

Demery Varin MG, Stacey D, Baumbusch JL, Estabrooks C, Squires JE. Predictors of Nurses’ Research Use in Canadian Long-term Care HomesThe Journal of Post-Acute and Long-Term Care Medicine. DOI:

Fan-Lun C, Chung C, Lee EHG, Pek E, Ramsden R, Ethier C, Soong C. Reducing unnecessary sedative-hypnotic use among hospitalised older adultsBMJ Quality & Safety: 03 July 2019. doi: 10.1136/bmjqs-2018-009241

McDonald EG, Wu PE, Rashidi B, Forster AJ, Huang A, Pilote L, Papillon-Ferland L, Bonnici A, Tamblyn R, Whitty R, Porter S, Battu K, Downar J, Lee TCThe MedSafer Study: A Controlled Trial of an Electronic Decision Support Tool for Deprescribing in Acute CareJournal of the American Geriatrics Society: 27 June 2019.

Muscedere J, Barrie C, Chan K, Cooper B, Critchley K, Kim P, Lorbergs A, Mackenzie I, Martineau C, Noseworthy T, O’Neil M, Resin J, Sinha S, Williams R. Frailty and Aging: How the Danish Experience Might Inform CanadaHealthcare Quarterly 22(1) April 2019 : 14-21.doi:10.12927/hcq.2019.25841

Abstract: Scandinavian countries are widely acknowledged as leaders in innovative models of care for their aging populations. To learn what might be potentially applicable to the health system in Canada, the Canadian Frailty Network (CFN) led a contingent of government, administrative, research and patient representatives to Denmark to directly observe Danish approaches for providing healthcare for older adults living with frailty. In this paper and based on what we learned from these observations, we discuss healthcare challenges faced by Canada’s aging population for which Danish strategies provide clues as to where and how to improve care and system efficiencies, thereby maximizing the value of Canadian healthcare. 

Click here to read about our Denmark initiative and how learning from this trip is being put into practice, and a return visit from Danish officials to Canada where they learned more about frailty innovations in the works here—such as those featured in CFN’s Innovation Showcase in September 2018, like the COACH program in PEI and the Hospital Without Walls in Ontario.

de Vries B, Gutman G, Humble A, Gahagan J, Chamberland L, Aubert P, Fast J, Mock S. End-of-life preparations among LGBT older Canadian adults: The missing conversations. International Journal of Aging and Human Development (2019), 88(4) 358-379.
Soobiah C, Straus SE, Manley G, Marr S, PausJenssen E, Teare S, Hamid J, Tricco AC, Moore A. Application of the Patient Engagement Evaluation Tool (PEET): A cross-sectional survey to assess knowledge user engagement in a systematic review on the comparative effectiveness of geriatrician-led models of care. DOI:

Jones A, Bronskill SE, Agarwal G, Seow H, Feeny D, Costa AThe primary care and other health system use of home care patients: a retrospective cohort analysis. CMAJ Open May 23, 2019 vol. 7 no. 2E360-E370

Stall NM, Campbell A, Reddy M, Rochon PA. Words Matter: The Language of Family Caregiving. The American Geriatrics Society May 21, 2019

Hebert PC, Morinville A, Costa A, Heckman G, Hirdes JRegional variations of care in home care and long-term care: a retrospective cohort study. CMAJ Open May 19, 2019 vol. 7 no. 2 E341-E350 https://doi: 10.9778/cmajo.20180086

Abstract: Many aging adults undergo progressive loss of autonomy, develop increasingly complex medical needs and experience multiple care transitions. We sought to determine the degree of variation in rates of transfer from home care services and long-term care in several Canadian jurisdictions.

Squires JE, Aloisio LD, Grimshaw JM, Bashir K, Dorrance K, Coughlin M, Hutchinson AM, Francis J, Michie S, Sales A, Brehaut J, Curran J, Ivers N, Lavis J, Noseworthy T, Vine J, Hillmer M, Graham ID. Attributes of context relevant to healthcare professionals’ use of research evidence in clinical practice: a multi-study analysis. Implementation Science 2019 14:52

McCarron TL, Moffat K, Wilkinson G, Zelinsky S, Boyd JM, White D, Hassay D, Lorenzetti DL, Marlett NJ, Noseworthy TUnderstanding patient engagement in health system decision-making: a co-designed scoping review. Systematic Reviews 2019 8:97

Adekpedjou R, Stacey D, Briere N, Freitas A, Garvelink MM, Joyce Dogba M, Durand PJ, Desroches S, Croteau J, Rivest L-P, Legare FEngaging Caregivers in Health-Related Housing Decisions for Older Adults With Cognitive Impairment: A Cluster Randomized Trial. The Gerontologist, gnz045,

Abstract: Informal caregivers are rarely as involved as they want to be in the housing decisions of cognitively impaired older adults. Lack of awareness of available options and their benefits and risks may lead to decisions that do not reflect older adults’ preferences, and to guilt and regret. We assessed the effect of training home care teams in interprofessional shared decision-making (SDM) on the proportion of caregivers who report being active in this decision.

Maltais M, Aubertin-Leheudre M, Dray C, Fielding RA, Rolland Y, Cesari M, Vellas B. Highlights from the 2019 International Congress on Frailty and Sarcopenia Research. J Frailty Aging (2019).

Krawczyk M, Sawatzky RRelational use of an electronic quality of life and practice support system in hospital palliative consult care: A pilot study. Palliat Support Care. 2018 Mar 8:1-6. doi: 10.1017/S1478951518000020

White DE, Virk N, Jackson M, Stelfox HT, Wasylak T, Ghali W. Experimenting with Governance: Alberta’s Strategic Clinical Networks. Healthcare Quarterly 21(4) January 2019; 37-42.doi:10.12927/hcq.2019.25742.

Gibbs JC, McArthur C, Milligan J, Clemson L, Lee L, Boscart VM, Heckman G, Stolee P, Giangregorio LMMeasuring the Implementation of Lifestyle-Integrated Functional Exercise in Primary Care for Older Adults: Results of a Feasibility Study. Can J Aging. 2019 Apr 5:1-17; DOI: 10.1017/S0714980818000739.

Chamberlain SA, Duggleby W, Teaster P, Estabrooks CCharacteristics and unmet care needs of unbefriended residents in long-term care: a qualitative interview study. Aging & Mental Health 2019, DOI: 10.1080/13607863.2019.1566812

Chan J, Griffith LE, Costa AP, Leyenaar MSCommunity paramedicine: A systematic review of program descriptions and training. CJEM March 2019; DOI:

Bagshaw S, Adhikari N, Burns K, Friedrich J, Bouchard J, Lamontagne F, McIntyre L, Cailhier J-F, Dodek P, Stelfox H, Herridge M, Lapinsky S, Muscedere J, Barton J, Griesdale D, Soth M, Ambosta A, Lebovic G, Wald RSelection and Receipt of Kidney Replacement in Critically Ill Older Patients with AKICJASN March 2019, CJN.05530518; DOI:

Morrison J, Laur C, Keller HSCREEN III: working towards a condensed screening tool to detect nutrition risk in community-dwelling older adults using CLSA data. European Journal of Clinical Nutrition (2019). DOI:

Donald E, Stajduhar KA scoping review of palliative care for persons with severe persistent mental illness.

You JJ, Allatt P, Howard M, Carole A Robinson, Jessica SimonRebecca SudoreAmy TanCarrie Bernard, Marilyn SwintonXuran JiangDoug KleinMichael McKenzieGillian Fyles and Daren Keith Heyland. Short Graphic Values History Tool for decision making during serious illness. BMJ Supportive & Palliative Care doi: 10.1136/bmjspcare-2018-001698

Stolee P, Elliott J, Byrne K, Sims-Gould J, Tong C, Chesworth B, Egan M, Ceci C, Forbes D. A Framework for Supporting Post-acute Care Transitions of Older Patients With Hip Fracture.

Zarrin A, Tourchian N, Heckman GAChronic Disease Self-Management Among Iranian Older Adults: A Scoping Review. DOI: 10.1177/0733464819832198

Chamberlain S, Hoben M, Squires J, Cummings G, Norton P, & Estabrooks C. (2019). Who Is (Still) Looking After Mom and Dad? Few Improvements in Care Aides’ Quality-of-Work LifeCanadian Journal on Aging / La Revue Canadienne Du Vieillissement, 38(1), 35-50. doi:10.1017/S0714980818000338

Theou O, Jayanama K, Fernández-Garrido J, Buigues C, Pruimboom L, Hoogland AJ, Navarro-Martínez R, Rockwood K, Cauli O. Can a Prebiotic Formulation Reduce Frailty Levels in Older People? J Frailty Aging 2018;8(1):48-52

Van Scoy LJ, Day AG, Howard M, Sudore RL, Heyland DKAdaptation and Preliminary Validation of the Advance Care Planning Engagement Survey for Surrogate Decision Makers. DOI:

Cho N, Boland L, McIsaac DI. The association of female sex with application of evidence-based practice recommendations for perioperative care in hip fracture surgery

Kim DH, Afilalo J, Shi SM. Evaluation of Changes in Functional Status in the Year After Aortic Valve Replacement. JAMA Intern Med. February 4, 2019. doi:10.1001/jamainternmed.2018.6738

Campitelli MA, Maxwell CJ, Maclagan LC, Ko DT, Bell CM, Jeffs, L, Morris AM, Lapane KL, Daneman N, Bronskill SE. One-year survival and admission to hospital for cardiovascular events among older residents of long-term care facilities who were prescribed intensive- and moderate-dose statins

Abstract: Statins are used widely in older adults, particularly those living in long-term care facilities (LTC). In Ontario, over one-third of all residents of LTC are statin users, including 28% of frail residents who have a limited likelihood of 1-year survival; nearly one-quarter of users received high doses. Historically, however, randomized clinical trials studying the efficacy and safety of statins rarely include adults aged 75 years and older, and most have not included LTC residents. This leaves clinicians with little guidance when making ongoing decisions about treatment with statins, such as the appropriate dosing. This study sought to examine the rates of 1-year survival and admission to hospital for cardiovascular events among older LTC residents who were prescribed intensive-dose statins compared with those receiving moderate-dose statins. A retrospective cohort study using population-based administrative data from Ontario identified 21 808 residents in LTC who were 76 years of age and older and were prevalent statin users, and categorized residents as intensive- or moderate-dose users. The rates of mortality and admission to hospital for cardiovascular events at 1 year were similar between LTC residents taking intensive-dose statins compared with those taking moderate-dose statins. This lack of benefit should be considered when prescribing statins to vulnerable LTC residents who are at potentially increased risk of statin-related adverse events.

Click here to learn more about this CFN-funded research.

Heckman GA, Hirdes JP, Hébert PC, Morinville A, Amaral ACKB, Costa A, McKelvie RS. Predicting Future Health Transitions Among Newly Admitted Nursing Home Residents With Heart Failure. JAMDA 2018 12 17 online (in press). DOI:

Abstract: To understand how a heart failure diagnosis and admission health instability predict health transitions and outcomes among newly admitted nursing home residents, a retrospective cohort study of linked administrative data was conducted involving older adults, aged 65 years and above, admitted to nursing homes in Ontario, Alberta, and British Columbia, Canada, from 2010 to 2016. The final sample included 143,067 residents. Adverse events were most common in the first 90 days. A diagnosis of heart failure predicted worsening health instability, hospitalizations, and mortality. The magnitude of the impact of a heart failure diagnosis was greatest for lower baseline health instability. Residents with the highest degree of health instability were also most likely to die in hospital. A diagnosis of heart failure and health instability provide complementary information to predict transfers, deaths, and adverse outcomes. Clearly identifying these at-risk patients may be useful in targeting interventions in nursing homes.

Click here to learn more about this CFN-funded research.

Barclay R, Webber S, Ripat J, Grant T, Jones C. A, Lix L M., Mayo N, van Ineveld C, Salbach N MSafety and feasibility of an interactive workshop and facilitated outdoor walking group compared to a workshop alone in increasing outdoor walking activity among older adults: a pilot randomized controlled trial.

Constantinescu A, Li H, Yu J, Hoggard C, Holroyd-Leduc JExploring Rural Family Physicians’ Challenges in Providing Dementia Care: A Qualitative Study.  Canadian Journal on Aging / La Revue Canadienne Du Vieillissement, 37(4), 390-399.

Dupuis-Blanchard S, Gould O. Nursing Homes Without Walls for Aging in PlaceCanadian Journal on Aging / La Revue Canadienne Du Vieillissement, 37(4), 442-449.

Konietzny C, Kaasalainen S, Dal-Bello Haas V, Merla C, Te A, Di Sante E, . . . Hadjistavropoulos, T. (2018). Muscled by the System: Informal Caregivers’ Experiences of Transitioning an Older Adult into Long-term Care. Canadian Journal on Aging / La Revue Canadienne Du Vieillissement, 37(4), 464-473. doi:10.1017/S0714980818000429

Rockwood K, Howlett SE. Fifteen years of progress in understanding frailty and health in aging. BMC Medicine201816:220.

Giguère A, Farmanova E, Holroyd-Leduc JM, Straus SE, Urquhart R, Carnovale V, Breton E, Guo S, Maharaj N, Durand PJ, Légaré F, Turgeon AF, Aubin M. Key stakeholders’ views on the quality of care and services avilable to frail seniors in Canada. BMC Geriatrics 2018 18:290. BMC Geriatrics201818:290.

Abstract: Frail seniors often receive ineffective care, which does not meet their needs. It is still unclear how healthcare systems should be redesigned to be more sensitive to the needs and values of frail seniors and their caregivers. We thus aimed to describe key stakeholders’ perspectives on the current healthcare and services available to frail seniors. Our findings suggest redesigning assessment, communication with frail seniors and their caregivers, targeting care and services to the needs, and integrating care better across settings and in time. A systematic identification of frail older people is the first step to adapt healthcare systems to this population’s needs. Participation of frail older people and their caregivers to decision making would also allow choosing care plans meeting their care goals. The integration of care and services across settings, over time, and with various providers, is also needed to meet frail senior needs.

Kortes-Miller K, Boulé J, Wilson K & Stinchcombe A.(2018) Dying in Long-Term Care: Perspectives from Sexual and Gender Minority Older Adults about Their Fears and Hopes for End of Life, Journal of Social Work in End-of-Life & Palliative Care, DOI: 10.1080/15524256.2018.1487364

Maxwell CJ, Campitelli MA, Diong C, Mondor L, Hogan DB, Amuah JE, Leslie S, Seitz D, Gill S, Thavorn K, Wodchis WP, Gruneir A, Teare G, Bronskill SE.  Variation in the health outcomes associated with frailty among home care clients: relevance of caregiver distress and client sex. BMC Geriatr. 2018; 18:211. Epub 2018 Sep 12.