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Canadian Geriatrics Journal
Journal Prestige (SJR): 0.494

Citation Impact (citeScore): 1
Number of Followers: 6

This is an Open Access Journal

Open Access journal
ISSN (Print) 1925-8348 - ISSN (Online) 1925-8348
Published by Canadian Geriatrics Society

[1 journal]

The Intelligibility of the Reversed-Stethoscope Technique in Age-Related
Hearing Loss
- Authors: Raphaelle M. Koerber, Linh Vaccarello, Allan Ho
  Pages: 127 - 133
  Abstract: BACKGROUND This study evaluated the effectiveness of the reverse stethoscope technique in improving speech intelligibility. In this technique, a clinician places the earpieces of their stethoscope into the ears of a hearing-impaired patient and speaks into the chest piece. METHODS The International Speech Test Signal was presented to four Littman® stethoscope models and a Pocketalker® personal voice amplifier using an Audioscan® hearing instrument test box. The acoustic outputs of the stethoscopes and voice amplifier were measured across the frequency spectrum of speech. The Speech Intelligibility Index of the resulting speech was calculated for natural speech and for each device in relation to 10 standardized hearing losses representing the population of older adults. RESULTS For each of the 10 hearing losses, the speech signal emitted by the stethoscopes was quieter and yielded lower speech intelligibility scores than regular speech. In contrast, the voice amplifier provided mid and high frequency amplification and improved speech intelligibility scores for all but the mildest hearing losses. CONCLUSIONS The reverse stethoscope technique worsens the clarity of speech and should not be used with older, hearing-impaired patients. Instead, clinicians should use regular speech or, preferably, personal voice amplifiers.
  PubDate: 2022-06-01
  DOI: 10.5770/cgj.25.527
  Issue No: Vol. 25, No. 2 (2022)
Trends and Factors Associated with Suicide Deaths in Older Adults in
Ontario, Canada
- Authors: Eada M.P. Novilla-Surette, Salimah Z. Shariff, Britney Le, Richard G. Booth
  Pages: 134 - 161
  Abstract: Background
  Suicide in older adults is a significant overlooked problem worldwide. This is especially true in Canada where a national suicide prevention strategy has not been established. Methods
  Using linked health-care administrative databases, this population-level study (2011 to 2015) described the incidence of older adult suicide (aged 65+), and identified clinical and socio-demographic factors associated with suicide deaths. Results
  The findings suggest that suicide remains a persistent cause of death in older adults, with an average annual suicide rate of about 100 per million people over the five-year study per-iod. Factors positively associated with suicide vs. non-suicide death included being male, living in rural areas, having a mental illness, having a new dementia diagnosis, and hav-ing increased emergency department visits in the year prior to death; whereas, increased age, living in long-term care, having one or more chronic health condition, and increased interactions with primary health care were negatively associ-ated with a suicide death. Conclusion
  Factors associated with suicide death among older adults highlighted in this study may provide better insights for the development and/or improvement of suicide prevention pro-grams and policies.
  PubDate: 2022-06-01
  DOI: 10.5770/cgj.25.541
  Issue No: Vol. 25, No. 2 (2022)
Community and Provider Evaluation of a Canadian Dementia Support Services
Program
- Authors: Mallorie T. Tam, Jill A. Dosso, Julie M. Robillard
  Pages: 162 - 170
  Abstract: Background
  Community programs and services dedicated to support those living with dementia and care partners can improve their qual-ity of life. In close collaboration with the Alzheimer Society of British Columbia, we evaluated the First Link® dementia support services, aiming to identify key strengths and areas of improvements to inform the services offered. Methods
  A survey instrument was developed and distributed to people living with dementia, care partners, and health-care providers. Results
  A total of 1,123 surveys were analyzed. Overall, respondents were satisfied with First Link dementia support services. Key strengths of the program included providing information and education for their clients to learn more about dementia and other resources in the community. Areas for improvement that were identified as part of this evaluation included additional supports for participants’ mental health and well-being in terms of reducing stress, burden and isolation. Findings uncov-ered discrepancies in the way people living with dementia, care partners, and health-care providers view the effectiveness of the First Link dementia support services. Conclusion
  An evaluation of programs and services for people living with dementia and their care partners can provide valuable insights about their experiences which can ensure that their needs are addressed.
  PubDate: 2022-06-01
  DOI: 10.5770/cgj.25.548
  Issue No: Vol. 25, No. 2 (2022)
A Clinical Response Team Providing Support to Long-Term Care Homes with
COVID-19 Outbreaks in Eastern Ontario—a Cohort Study
- Authors: James Downar, Kaitlyn Boese, Genevieve Lalumiere, Ghislain Bercier, Shannon Leduc, Jill Rice, Amit Arya, Valerie Charbonneau
  Pages: 171 - 174
  Abstract: Background
  The greatest impact of the COVID-19 pandemic in Canada has been on long-term care facilities which have accounted for a large majority of the mortality seen in this country. We developed a clinical response team to perform mass as-sessment and provide support to long-term care facilities in Eastern Ontario with large outbreaks in the hope of reducing the impact of the outbreaks. Methods
  This is a retrospective cohort study of all residents of LTC facilities supported by our multidisciplinary clinical response team. We collected data about the timing of the outbreak and our deployment, as well as the total number of COVID-19 cases and deaths, and measured the correlation between the timing of our deployment and the observed mortality rate. Results
  Our clinical team was deployed to 14 long-term care facilities, representing 719 cases and 243 deaths (mean ± standard error of mortality 34% ± 4%). Our team was deployed a mean ± standard error of 16 ± 2 days after the declaration of an out-break. There was a significant correlation between an earlier deployment of our clinical team and a lower mortality rate for that outbreak (Pearson’s r = 0.70, p < .01). Interpretation
  This retrospective, uncontrolled study of a non-standardized intervention has many potential limitations. However, the data suggest that timely deployment of our clinical response team may improve outcomes in the event of a large outbreak. This clinical team may be useful in future pandemics.
  PubDate: 2022-06-01
  DOI: 10.5770/cgj.25.561
  Issue No: Vol. 25, No. 2 (2022)
MedSafer to Support Deprescribing for Residents of Long-Term Care: a
Mixed-Methods Study
- Authors: Giulia-Anna Perri, Émilie Bortolussi-Courval, Christopher D. Brinton, Anna Berall, Anna Theresa Santiago, Mareiz Morcos, Todd C. Lee, Emily G. McDonald
  Pages: 175 - 182
  Abstract: Background
  Polypharmacy is prevalent in long-term care homes (LTCH) and increases the risk of adverse drug events. Feasible and effective deprescribing interventions applicable in the LTCH environment are needed. Methods
  We performed a mixed methods study to evaluate the feasi-bility, applicability, and effectiveness of an electronic depre-scribing tool, MedSafer, to facilitate quarterly medication reviews (QMRs) on two pilot units in an academic long-term care home (LTCH). Chart reviews collected resident health data. The prevalence of deprescribing at a standard QMR was compared with a QMR conducted three months later with MedSafer. Feedback from physicians on their experience with MedSafer was obtained through semi-structured interviews. Results
  Physicians found MedSafer helpful in guiding deprescribing decisions and suggested software improvements to increase the feasibility in LTCH. The average number of medications deprescribed per resident was significantly higher at the Med-Safer QMR (mean reduction = 1.1 medications, SD = 1.3) compared to the standard QMR (mean reduction = 0.5, SD = 0.9) (absolute difference of 0.5; SD 1.1; p = .02). Conclusion
  MedSafer has the potential to increase deprescribing in LTCHs by flagging potentially inappropriate medications. Integration in the electronic medical record might increase uptake in LTCHs. Further research should investigate the generalizability of MedSafer in a larger population and in non-academic LTCHs.
  PubDate: 2022-06-01
  DOI: 10.5770/cgj.25.545
  Issue No: Vol. 25, No. 2 (2022)
Older Age and Frailty are Associated with Higher Mortality but Lower ICU
Admission with COVID-19
- Authors: Melissa K. Andrew, Judith Godin, Jason LeBlanc, Guy Boivin, Louis Valiquette, Allison McGeer, Janet E. McElhaney, Todd F. Hatchette, May ElSherif, Donna MacKinnon-Cameron, Kevin Wilson, Ardith Ambrose, Sylvie Trottier, Mark Loeb, Stephanie W. Smith, Kevin Katz, Anne McCarthy, Shelly A. McNeil
  Pages: 183 - 196
  Abstract: Background
  We report characteristics and outcomes of adults admitted to Canadian Immunization Research Network (CIRN) Ser-ious Outcomes Surveillance (SOS) Network hospitals with COVID-19 in 2020. Methods
  Patients with laboratory-confirmed COVID-19 admitted to 11 sites in Ontario, Quebec, Alberta, and Nova Scotia up to December 31, 2020 were enrolled in this prospective observational cohort study. Measures included age, sex, demographics, housing, exposures, Clinical Frailty Scale, comorbidities; in addition, length of stay, intensive care unit (ICU) admission, mechanical ventilation, and survival were assessed. Descriptive analyses and multivariable logistic regressions were conducted. Results
  Among 2,011 patients, mean age was 71.0 (range 19–105) years. 29.7% were admitted from assisted living or long-term care facilities. The full spectrum of frailty was represented in both younger and older age groups. 81.8% had at least one underlying comorbidity and 27.2% had obesity. Mortality was 14.3% without ICU admission, and 24.6% for those admitted to ICU. Older age and frailty were independent predictors of lower ICU use and higher mortality; accounting for frailty, obesity was not an independent predictor of mortality, and associations of comorbidities with mortality were weakened. Conclusions
  Frailty is a critical clinical factor in predicting outcomes of COVID-19, which should be considered in research and clinical settings.
  PubDate: 2022-06-01
  DOI: 10.5770/cgj.25.546
  Issue No: Vol. 25, No. 2 (2022)
Levels of Medical Intervention and End-of-Life Practices in Long-Term Care
Centres
- Authors: Jérôme Leclerc-Loiselle, Sylvie Gendron, Andréanne Côté, Serge Daneault
  Pages: 197 - 201
  Abstract: Background
  Levels of medical intervention (LMI) are legal documents in which physicians record patient preferences, or those of their designated substitute decision-makers, concerning end-of-life care. Studies suggest that, although LMI are intended to orient clinical practice, their function tends to be limited to logistical aspects of care. How LMI shapes or guides patient-centred, end-of-life care remains unclear. The aim of this study was to examine possible associations between LMI and certain aspects of end-of-life care practices in LTCC, such as nurse-documented patient experiences of pain, and prescription and administration of medication. Methods
  A retrospective descriptive study of 100 files retrieved from a clinical database of deceased patients in LTCCs located in an urban integrated health and social service organization in Québec, Canada, was conducted. Results
  Significant associations between last documented LMI and frequency of narcotic prescription and administration, at either regular intervals or PRN, are highlighted. The time delay between last LMI assessment and patient death was one week or less for 39.4% of cases. Conclusion
  These results suggest that LMI assessment practices may not correspond to their intended use. A short time frame between last LMI (L-LMI) assessment and patient death may suggest less-than-optimal patient comfort in end-of-life care.
  PubDate: 2022-06-01
  DOI: 10.5770/cgj.25.531
  Issue No: Vol. 25, No. 2 (2022)
Enabling Healthy Aging to AVOID Frailty in Community Dwelling Older
Canadians
- Authors: Jananee Rasiah, Jeanette C. Prorok, Rheda Adekpedjou, Carol Barrie, Carlota Basualdo, Rachel Burns, Vincent De Paul, Catherine Donnelly, Amy Doyle, Christopher Frank, Sarah (Gibbens) Dolsen, Anik Giguère, Sonia Hsiung, Perry Kim, Emily G. McDonald, Heather O'Grady, Andrea Patey, John Puxty, Megan Racey, Joyce Resin, Joanie Sims-Gould, Susan Stewart, Olga Theou, Sarah Webster, John Muscedere
  Pages: 202 - 211
  Abstract: The Canadian population is aging. With aging, biological and social changes occur increasing the risk of developing chronic conditions and functional loss leading to frailty. Older adults living with frailty are more vulnerable to minor stressors, take longer to recover from illness, and have difficulty participating in daily activities. The Canadian Frailty Network’s (CFN) mis-sion is to improve the lives of older adults living with frailty. In September 2019, CFN launched the Activity & Exercise, Vaccination, Optimization of medications, Interaction & Socialization, and Diet & Nutrition (AVOID) Frailty public health campaign to promote assessing and reducing risk fac-tors leading to the development of frailty. As part of the cam-paign, CFN held an Enabling Healthy Aging Symposium with 36 stakeholders from across Canada. Stakeholders identified individual and community-level opportunities and challenges for the enablement of healthy aging and frailty mitigation, as part of a focused consultative process. Stakeholders ranked the three most important challenges and opportunities at the individual and community levels for implementing AVOID Frailty recommendations. Concrete actions, further research areas, policy changes, and existing resources/programs to enhance the AVOID Frailty campaign were identified. The results will help inform future priorities and behaviour change strategies for healthy aging in Canada.
  PubDate: 2022-06-01
  DOI: 10.5770/cgj.25.536
  Issue No: Vol. 25, No. 2 (2022)
One-Year Report of COVID-19 Impact on Geriatric Patients: a
Bio-Psycho-Social Approach
- Authors: Allen Y. Chang, Kimberly N. Babb
  Pages: 212 - 221
  Abstract: Background
  Since December of 2019, coronavirus 19 (COVID-19) has spread rapidly around the world. Our understanding of the infection has grown over the past year, and its impact on older adults is particularly significant. Apart from the direct impacts of COVID-19 infections, it has also led to lockdowns which, in turn, result in isolation and loneliness. Method
  We conducted a literature review of publicly available articles of the COVID-19 pandemic impact on the geriatric popula-tion between December 2019 and April 2021, a total of 748 articles. Results
  The review will be presented with the Bio-Psycho-Social model, covering how the biological, psychological, and sociological aspects of health are intertwined and impact older adults. Early studies have also highlighted the prevalence of post-COVID infection symptoms that typically fall under geriatric medicine care. We highlight the bidirectional impact of isolation and COVID-19 infections on geriatric health, as well as discuss pertinent topics such as vaccine efficacy, long-term sequelae of COVID-19 infections, and ageism. Conclusion
  This review seeks to present a one-year report of what is known about COVID-19 and geriatric medicine, as well as provide guidance to practitioners who care for older adults based on the most up-to-date literature.
  PubDate: 2022-06-01
  DOI: 10.5770/cgj.25.553
  Issue No: Vol. 25, No. 2 (2022)
Optimizing the Physical & Social Environment Within Hospitals for Patients
with Dementia: a Systematic Review
- Authors: Caitlan D. Reich, Hannah Lyons, Jayna M. Holroyd-Leduc
  Pages: 222 - 232
  Abstract: Background
  As the population ages, the number of individuals living with dementia is increasing. This has implications for the health-care system, as people living with dementia are hospitalized more frequently and for longer periods. Because patients living with dementia are at increased risk for adverse events during admission, understanding how the acute care physical and social environments influence their outcomes is impera-tive. Thus, the objective of this review was to identify studies that modified the physical and/or social environment in acute care in order to improve care for hospitalized patients living with dementia. Methods
  MEDLINE, Embase, and CINAHL databases were used to search for articles up to and including June 2021. PRISMA guidelines were followed. Two independent reviewers as-sessed citations and full texts against the following inclusion criteria: patients living with dementia/cognitive impairment, presence of a control group, and evidence of clinical or health systems outcomes. All published English-language articles meeting inclusion criteria were retrieved. Results
  Following the database search, 12,901 citations were retrieved with 11,334 remaining after duplication removal. Of these, 15 papers met inclusion criteria. Seven studies evaluated the physical environment (e.g., addition of electronic sensor alarms and environmental cues). The remaining studies evalu-ated specific programs (e.g., art, music, exercise, volunteer engagement, and virtual reality). The majority of studies were low to very low quality; only three studies were RCTs. Environmental cues may initially improve wayfinding, and exercise may reduce neuropsychiatric symptoms. Conclusions
  Although there are several interventions, there is a lack of high-quality evidence available to determine what exactly needs to be incorporated into acute care settings to reduce adverse outcomes for patients with dementia.
  PubDate: 2022-06-01
  DOI: 10.5770/cgj.25.494
  Issue No: Vol. 25, No. 2 (2022)