Search

The purpose of this study was to examine whether vehicle type based on size (car vs. other = truck/van/SUV) had an impact on the speeding, acceleration, and braking patterns of older male and female drivers (70 years and older) from a Canadian longitudinal study. The primary hypothesis was that older adults driving larger vehicles (e.g., trucks, SUVs, or vans) would be more likely to speed than those driving cars. Participants (n = 493) had a device installed in their vehicles that recorded their everyday driving. The findings suggest that the type of vehicle driven had little or no impact on per cent of time speeding or on the braking and accelerating patterns of older drivers. Given that the propensity for exceeding the speed limit was high among these older drivers, regardless of vehicle type, future research should examine what effect this behaviour has on older-driver road safety.

Technology Evaluation in the Elderly Network (TVN) was funded in July 2012 under the Canadian Networks of Centres of Excellence (NCE) program, to develop, rigorously evaluate, and ethically disseminate information about the use of technologies for the care of seriously ill elderly patients and their families. TVN’s vision is to position Canada as a global leader in providing the highest quality of care for its aging population. The focus is on the frail elderly with multiple chronic conditions, across all settings of care. As part of the NCE’s mandate and TVN’s strategic priorities and mission, we have developed a unique Interdisciplinary Training Program designed to promote and facilitate interdisciplinary learning by providing experiential and entrepreneurial opportunities. The goal is to develop Highly Qualified Personnel (HQP) with disciplinary, interdisciplinary, and transdisciplinary skills, experiences, and attitudes necessary to provide creative solutions to the complex and multi-faceted issues confronting the seriously ill, frail elderly. The TVN Interdisciplinary Training Program is based on an experiential learning approach that crosses health sciences, law, social sciences, and ethical aspects of working with the frail elderly. The program provides trainees with unique educational experiences that deepen appreciation for holistic care, increase exposure to interdisciplinary research through knowledge creation and translation projects, and advance intellectual and professional development. The goals for the TVN Interdisciplinary Training Program align with the NCE training mandate, which is to: 1) create a collaborative, multidisciplinary training program to develop HQP, 2) improve trainee’s viability for future employment, and 3) provide support to trainees to facilitate their success. The training program was launched in Summer 2013. We currently have over 120 HQP in approximately 23 different disciplines—including law, ethics, public policy, social work, engineering, and other disciplines— with an interest in improving care for the frail elderly participating in our training program. These individuals may be undergraduates, graduates, postdoctoral fellows, or working professionals. The program emphasizes the acquisition and application of knowledge and skills across all of its components. HQPs work in teams of four to identify and develop an online collaborative project. Online collaborative projects facilitate interprofessional collaboration through multi-sectoral and multidisciplinary learning by enabling interactions. They also participate in at least one, and up to two, external placements in a sector and/or discipline in which they have not been previously engaged, with reports or projects required at completion. Under the direction of their supervisors and mentors, students complete at least two academic products involving knowledge mobilization efforts. Mentorship is another component of the training program whereby HQPs meet with interdisciplinary mentors, patients and their families and support system (PFSS), and peers. After each meeting, they write a reflection on what they discovered through dialogue with their mentors, and how this discussion will influence their future studies and practice. HQPs collaborate online through a learning management system that provides opportunities to interact with colleagues, access disciplinary and interdisciplinary data, and diagnostic tools. There are three main ways an HQP can enter into the program: the Interdisciplinary Fellowship Program;as HQP within TVN-funded research programs; orin the Summer Student Award Program. One of the components of the TVN Interdisciplinary Training Program is to strongly encourage HQPs to disseminate their work through publication and meetings. The main dissemination event of TVN is the annual conference; the 2nd TVN Annual Conference on Improving Care for the Frail Elderly was held in Toronto, September 21–23, 2014. The goal was to bring together key researchers, practitioners, educators, policymakers, advocates, and organizations devoted to improving health care for the seriously ill, frail elderly, and to highlight HQP research. All HQPs in the Summer Student Award Program, the Interdisciplinary Fellowship Project, and 1 HQP in each TVN-funded project submitted an abstract for this conference. The abstracts were reviewed for quality and the authors presented them as posters during the conference. Herein we present the compilation of research abstracts that were presented by TVN HQP at our annual conference. The annual conference will continue to expand in coming years, and next year we will accept abstracts from all researchers who are engaged with the seriously ill, frail elderly., Introduction: Engagement in shared health-care decision-making has been recognized as an important, and often lacking, aspect of person-centred care. We aimed to draw on available theory, evidence, and experience to develop guidelines for engaging older adults and their families in decisions around their own health care. Aims: To share results from the CHOICE (Choosing Healthcare Options by Involving Canada’s Elderly) knowledge synthesis project. Guidelines for engaging older adults and their families in health-care decision-making will be presented. Methods: We conducted a realist synthesis (Greenhalgh et al., 2011; Pawson et al., 2005) of available knowledge on strategies for engagement of older patients and their caregivers in health care decision-making. The search methodology was informed by a framework for realist syntheses (Wong et al., 2013), as well as Arksey and O’Malley’s (2005) design considerations for scoping reviews. Our synthesis encompassed theoretical frameworks and both peer-reviewed and grey literature. Search terms included: health care, decision making, public, health care decision making, engagement, and public engagement. Expert consultation included interviews with academics (n=5), two focus group interviews with seniors and families, and two half-day workshops organized with our partner Patients Canada. Results: The initial search generated over 15,000 articles; of these, 2921 were pertinent to health-care decision-making and were retained for further review. Theoretical and empirical work identifies a range of strategies and levels of engagement of older patients, but offers most support for approaches in which older patients and families are informed and active partners in decision-making and equal members of health-care teams. Conclusions: We have developed guidelines and recommendations for creating productive partnerships between older adults, their families, and health-care providers. These partnerships can result in more informed clinical decisions, and more effective health care., Context: Effective literature searches are imperative to systematic review (SR) conduct. Failure to design comprehensive searches compromises the validity of results and conclusions. Unfortunately, the quality, comprehensiveness, and transparency of published search strategies are variable. Novice researchers may lack guidance to tackle such issues. We recently conducted a SR of trials comparing antipsychotics for delirium treatment to alternatives (pharmacological or nonpharmacological strategies) for adults in acute care settings. Purposes: To describe the methodology used to design the search strategy and study screening forms using the aforementioned SR for illustration purposes. Methods: With the assistance of a professional librarian, we queried the following databases for primary sources: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health, and the Latin American and Caribbean Health Sciences Literature. Concepts encompassed in our search strategy included: 1) the population (i.e., patients in acute care settings experiencing delirium), and 2) the intervention (antipsychotics) and comparison interventions (non-antipsychotic). For each concept, we identified controlled vocabulary provided by the selected databases (e.g., MeSH for MEDLINE, EMTREE for EMBASE), by navigating index trees and examining definitions provided in scope notes. We scanned relevant publications for additional controlled vocabulary, text words, and their synonyms. Appropriate truncations and wildcards were used to control for spelling variations; all possible drug names were included. Bolean operators were used to combine controlled vocabulary and text words using “OR” within each concept and “AND” between concepts. We applied the Cochrane filter for randomized controlled trials and a filter to limit to humans. No language restriction was imposed. Test searches were performed at various steps (before and after combination of terms) to ascertain the number of hits and to verify studies known to meet the inclusion criteria were present. The final search strategy was written for MEDLINE and thereafter customized to the other databases by a professional librarian. We searched for secondary sources in the Database of Abstracts of Reviews of Effects and the Health Technology Assessment Database. To identify other potentially relevant studies, we searched the Web of Science Citation Index, Conference Proceedings Citation Index and trial registration websites for ongoing trials, reference citations of selected publications, and contacted principal investigators of eligible trials and content experts. Pre-specified study inclusion and exclusion criteria developed in consultation with content experts informed the design of the study selection form. This form was piloted on 5 papers by 2 study team members and then applied after removal of duplicates and obviously irrelevant studies. Results: The search strategy yielded 16,925 publications following duplicate removal. After abstract and title review, 127 full text references were assessed; seven met inclusion criteria. Conclusion: Designing an effective search strategy that identifies all eligible indexed studies without high numbers of irrelevant studies requires careful planning and involvement of professional librarians. Despite a rigorous search strategy, we identified a large number of irrelevant studies with significant resources required to identify eligible studies., Traumatic Brain Injury (TBI) can be a devastating injury for an older adult. The elderly are more likely than younger adults to suffer emotional, physical and behavioural consequences and may require a longer period of time for recovery following a TBI. Much of what is currently known about recovery for older adults is based on information provided by family or clinician ratings. More recently, researchers and clinicians working in the field of rehabilitation acknowledge that a patient’s subjective perspective of their problems and the degree to which they are bothered by them is a critical indicator of outcome following TBI. Gathering information on the breadth and scope of the patient’s Quality of Life (QoL) is crucial information for clinicians caring for the elder, as well as researchers seeking to quantify the true burden of TBI, and may help to determine/predict outcome after a TBI. There is no current synthesis of the evidence on QoL measures used with TBI patients. As such, clinicians and researchers may be unclear as to which QoL tools are best suited for this vulnerable population. Implementing standardized QoL measurements will help facilitate comparison within a clinical practice and care for a single TBI survivor, as well as facilitate comparison across multiple survivors in research studies. Objective: This review assesses the scope, characteristics, methods of administration, dimensions of measurement and use in different types of TBI severity of QoL instruments used with older adults surviving TBI. Participants: Studies reviewed must have evidence of including patients at least 65 years or older with a TBI. Methods: We systematically reviewed six databases and extracted QoL instruments that were used to assess elderly survivors of TBI. Results: The initial search yielded 3145 abstracts. After removal of duplicates, title and abstract review, and full text screening, 73 articles were included for review. We uncovered a total of 27 multidimensional Qol tools that have been used with elder TBI survivors. Conclusions: We found five promising measures (based on frequency and currency of use) to consider for a measurement tool to evaluate of an elder’s perspective on QoL after TBI. The tools include the generic measure of SF-36, (also the short version SF-12), the EQ-5D, the WHO-QoL (also the short version WHO-QoL BREF), the Sickness Impact Profile, as well as the TBI-specific measure of QOLIBRI. There is limited literature that assesses QoL specifically for elderly survivors of TBI. As elderly individuals may have unique needs as compared to younger populations with regards to QoL following TBI, future research should be conducted to evaluate current measures and/or develop future measures that may be specifically targeted to the aged., Introduction: Engaging the community in health-care research and planning has been recognized as an important component of system improvement. The input and involvement of older persons is particularly critical, given that older adults are high users of the health-care system, but are often excluded from health research studies. Unfortunately, guidelines for how to engage older adults in these initiatives are not readily available in the literature. Aim: Guidelines for engaging older adults and their families in health-care research and policy will be presented, based on the CHOICE (Choosing Healthcare Options by Involving Canada’s Elderly) knowledge synthesis project. Methods: In the CHOICE project, we conducted a realist synthesis of available knowledge on strategies for engagement of older adults and their families (including other informal caregivers) in health care. The search methodology was informed by a framework for realist syntheses, as well as Arksey and O’Malley’s (2005) design considerations for scoping reviews. Our synthesis encompassed theoretical frameworks and peer-reviewed and grey literature. Expert consultation included interviews with academics (n=5), two focus group interviews with seniors and families, and two half-day workshops organized with our partner Patients Canada. Results: The initial search generated over 15,000 articles; of these, 1,624 identified as relevant to health-care research and planning were retained for further review. Theoretical and empirical work identifies a range of strategies and levels of engagement of older adults and their families in health-care research and policy. This project reveals that level of involvement should be authentic; appropriate for both the desired level of engagement of older adults and matched by the ability of the system to realize this involvement. Conclusions: Guidelines and recommendations for the engagement of older adults, their families and caregivers in health-care research and policy have been developed. Limitations: Due to the limited available information specifically focused on engagement of older adults (65+), our search strategy included papers focusing on engagement of all adults over 18 years of age, which may have limited the applicability of some of the findings. To overcome this, we held focus group interviews with older adults to review and interpret the study findings and develop recommendations specific to this population. Suggestions for future research: We plan to test the guidelines and recommendations from the CHOICE project, in collaboration with members of our SHARP (Seniors Helping as Research Partners) network., Background/Rationale: Older critically ill patients represent approximately half of all patients who receive life support with acute dialysis therapy while in ICU. However, we currently have very limited information on the optimal circumstances for starting renal replacement therapy (RRT) in older patients with acute kidney injury (AKI) and no specific data on older critically ill Canadians. This contributes to large variations in practice between providers and hospitals, and across jurisdictions, and undermines the optimal selection and delivery of high-quality care to older critically ill patients with AKI. Objective: The primary objective of this project is to evaluate whether in older critically ill patients with AKI there are clinically important differences in survival, receipt of life-sustaining therapies, commitment to ongoing support, and changes in goals of care amongst those who do receive or those who do not receive RRT while in ICU. Methods: This is a multi-centre prospective observational cohort study with a target accrual of 500 patients from 15 to 20 centers across Canada. Eligible patients will be 65 years of age or older, admitted to an intensive care unit (ICU), and exhibit evidence of AKI as defined by protocol. Both the presence of a drug overdose/toxicity that necessitates RRT initiation and/or the receipt of any form of RRT in the past 4 weeks will be cause for study exclusion. Upon fulfilling eligibility and obtaining informed consent (or deferred consent where permitted), participants will have baseline data captured and will be followed daily during their stay in ICU. In addition, participants and/or surrogates will be approached and interviewed to provide additional pre-morbid and baseline data specifically captured for OPTIMAL-AKI. Each participant will be contacted at 6 months and 12 months from time of enrollment to ascertain long-term outcomes. Progress: As of August 2014, recruitment is under way at 8 centers and greater than 10% of the target accrual has been achieved. We anticipate that seven more centers will become active before the end of the year and that recruitment will continue until autumn 2015., Objective: The objective of this preliminary review to scope the research literature was to identify the essential data elements to be included in a standardized transition form. Background: This project builds on the OPTIC Program (Older Person’s Transitions in Care) examining transitions experienced by NH residents, when they require urgent or emergent care and are transferred from their nursing home (NH) via emergency medical services (EMS) to an emergency department (ED). The OPTIC study conducted by our team found a substantial lack of information communicated consistently between providers and settings during transitions of care. Results identified significant gaps in medical information, documentation of care needs and inclusion of pertinent resident information and personal assistive devices (hearing aids, dentures and glasses). The latter were recorded as accompanying the resident less than 5% of the time. This is astonishing, considering the significant complexity and vulnerability of these older adults. As a result, the OPTIC team developed a communication form to pilot-test in a sample of transitions from 15 NHs to one ED and back. The data elements included in this form were informed by the OPTIC study results and a literature review that revealed the essential medical information and documents required for residents during transitions of care. Methods: This preliminary review focused on the transitions of care that older adults experience. Searches for scientific articles were conducted using Medline, Psycinfo and EMBASE, and Google Scholar for grey literature. To be considered for inclusion in the review, articles had to meet the following criteria: 1) published in English, 2) between the years of 1995 and 2013, 3) address transitions of care between NH and ED, and 4) address questions relevant to the nature of communication, documentation, and information shared between providers. Studies were excluded if they addressed the handoff process in one care setting. Following title, abstract and manuscript review, 16 articles were included and essential data elements used for documentation were extracted and tallied once for each article in which they were listed. Results: Over 75 data elements were found and grouped into the following categories: transfer information, resident history, medication, basic vital information, mental status information, physical status information, precautions, resident focused information, information from sending facility, information from receiving facility, and information from more than one setting. The top scoring data elements from each category, respectively, included reason for transfer, past medical history, current medications, recent vital signs, baseline mental function, baseline physical function, allergies, DNR/code status, provider facility contact information, treatment provided, and recent lab work results. Implications: Based on pilot-testing of these essential data elements, we hope to confirm that a standardized evidence-based communication form used by all health-care providers across settings during transitions of care improves communication, provides evidence for best practice, and ultimately results in better care for NH residents. Furthermore, this preliminary scoping of the literature informs the protocol required for a full systematic review of the literature on essential communication data elements during transitions of care., Long-term care homes provide aging adults with assistance with activities of daily living, scheduled leisure activities, and medical services. Our work focuses on designing a socially assistive robot named Tangy, which will help residents in long-term care facilities with maintaining social connections and cognitive ability. Tangy is designed to autonomously schedule, facilitate, and promote engagement using the group recreational activity Bingo and telepresence sessions for residents. Focus group sessions were conducted with elderly residents, family members, and health-care professionals from a long-term care facility to obtain feedback about the design considerations, attitudes, expectations, and acceptance of Tangy. Participants were shown demonstrations of Tangy’s capabilities and then guided through an open discussion. The focus group sessions were transcribed and organized to identify recurring themes throughout the participants’ responses. The results show that the participants indicated that Tangy could be beneficial for long-term care residents and health-care staff. They believed that Tangy could help alleviate the recreational staff’s work load by facilitating Bingo, and they were enthusiastic about the ability of the telepresence activity to help residents connect with their families. Moreover, health-care staff and family members suggested a wide variety of additional assistive capabilities to promote engagement and acceptance of the robot, such as multiple-language support, reminders and prompts, and modifications to the robot’s appearance. Furthermore, they were generally positive about the introduction of socially assistive robots in the residential care homes, although some concerns about various barriers to the adoption of the technology were brought up., Intensive Care Unit (ICU) patients are the sickest patients in a hospital and receive constant, one-on-one, specialized care in an environment utilizing life support technologies and significant resources (Field, Prinja, & Rowan, 2008). When their condition improves, they are usually transferred to a regular hospital ward, an environment with fewer resources and staff. Patients and their families often find the transition from ICU to a hospital ward very challenging. Here they become ‘one patient amongst many’ (Field et al., 2008), and the nurse to patient ratio switches from one-to-one to one-to-many. Moving these vulnerable patients to an environment with limited resources is a risky medical transition and, due to the demand for ICU beds, patients may be given little advance notice of their move (Forsberg, Lindgren, & Engström, 2011). In Canada, over 250,000 patients will be transferred from ICUs this year; however, many patients will suffer adverse consequences during the transition (Forsberg et al., 2011), and 18,000 patients will be re-admitted to the ICU (Leeb, Jokovic, Sandhu, & Zinck, 2006). These data indicate both the risk associated with ICU to hospital transfers and the inadequacies of the transition process. (Field et al., 2008). Relocation stress and transfer anxiety are terms frequently used in the medical community to describe the transition experience (Chaboyer, 2010; Suen, Lee, & Wong, 2010). Previous research describes patients who are transferred from ICU to hospital ward as exhibiting both physiological stress (altered heart rate, blood pressure, respiration, and sleep patterns) and psychological stress (insecurity, fear, anger, and tension) (Suen et al, 2010). Data suggests that family members exhibit similar emotions such as fear, mistrust, and vulnerability (McKinney & Deeny, 2002; Odell, 2000). We are conducting a study to better understand patient and family experiences during patient transfer from ICU to hospital ward. The goal of the study is to improve ICU to ward transition experiences by listening to the lived experiences of patients and families. The research question guiding the study is: What are the experiences of patients and family members when a patient is moved from the ICU to a regular hospital ward? Data will be collected using the PACER (Pacer and Community Engagement Research) method of peer-to-peer research to engage patients and families. (Marlett & Emes, 2010). PACER is a collaborative inquiry and research framework consisting of three phases: SET (initial phase, which involves a focus group of representative participants who share relevant experiences and become advisors to help set the study’s direction and goals), COLLECT (data collection and analysis phase, which involves up to 12 semi-structured interviews with patients and family members), and REFLECT (final phase, which involves a focus group with the original SET participants to review the findings, analyse data and identify recommendations). By listening to and analyzing the lived experiences of patients and families, we will gain a deeper understanding of the transfer experience. By engaging patients and families throughout the entire process, our research will be distinguished from more traditional investigations., Background and Objectives: Older adults with chronic life-limiting illnesses present unique challenges within acute care hospital settings. The use of quality of life (QOL) assessments may enable clinicians to more efficiently attend to fluctuations in patient and family caregiver’s QOL. The aim of this integrated knowledge translation (KT) research project is to adapt and integrate an electronic tablet/mobile practice support system for clinicians in a tertiary palliative care setting. This system will facilitate routine assessment of concerns and needs relevant to the QOL of older people with chronic life-limiting illnesses and their family caregivers. We refer to this as a Quality of Life Assessment and Practice Support System (QPSS). This project involves three phases: 1) Preliminary development—using focus groups with clinical team members to inform the selection of appropriate tools and to tailor the system; 2) Usability testing—a small subset of clinicians, patients, and family caregivers will be invited to try the system and provide feedback; and 3) Implementation—making the system available for routine use by any clinician on the unit. The purpose of this abstract is to present the results of Phase I of the project. Methods: Phase 1 included a diverse sample of eleven clinicians who participated in 3 audio-taped facilitated focus groups (FG). The initial FG asked participants to consider: 1) ideal characteristics of QOL assessment instruments; 2) feedback system features to report assessment information to clinicians; and 3) linkage with site-specific practice recommendations. Findings from the first FG were presented to participants in the 2nd FG, including four potential QOL instruments comprising both patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). Participants were encouraged to express concerns and identify potential barriers related to these instruments. FG3 included an initial demonstration of the QPSS and discussion about the incorporation of existing practices/protocols. Results: Clinicians revealed that they wanted instruments that assessed various social, physical, psychological, and existential aspects of QOL, satisfaction with the care team, and communication with family regarding advance care planning. Desired features of the feedback system included: the capability of amalgamating and presenting data visually (e.g., graphs); visualizing changes over time; ranking areas of greatest concern/needs; accessing assessment results in “real time” at the point of care; printing reports that can be used in rounds and filed in paper charts; preventing duplication in documentation; and simplifying documentation where possible. Desired features of the device itself included: be lightweight; be easy to use; and have the ability to be cleaned/ sanitized between uses. Additionally, recommendations were that automated prompts address areas of concern/need, interventions could be tracked and existing available practice recommendations be easily accessed. Conclusion: Clinicians’ perspectives helped determine which QOL assessments may be most applicable to their practice setting, how these might best be integrated into their practice, and what reporting and feedback features are desired. Next steps include using clinician, patient, and caregiver feedback to evaluate and further adapt the QPSS., This work focuses on designing the functions and behaviours of the robot Tangy in order for the robot to provide assistive activities to residents of long-term care facilities. The assistive activities include facilitating both a Bingo game with a group of users and a one-on-one telepresence session with a user and his/her family members/friends, as well as also providing reminders. The Tangy robot is designed to: 1) navigate through the environment using a combination of different sensors, 2) detect users of interest within the environment, and 3) interact with these users using speech, gestures, and a touch screen tablet. Each activity requires certain assistive behaviours to be executed. The Reminder activity performs two distinct behaviours, which consist of navigating to where the user is located and providing a reminder to the specific user regarding an upcoming activity. The main behaviours for Tangy when facilitating the Bingo activity are separated into three categories during the game: 1) calling out Bingo numbers, 2) providing assistance, and 3) providing social utterances and gestures. The behaviours for the Telepresence activity are to navigate to where the user is located, prompt the user for the video call, and track and follow the user during the video session. We describe some initial performance results of Tangy (e.g., sensing & behaviour selection accuracy) from a preliminary study., The purpose of this poster is to describe how collaboration with knowledge users shaped the direction of a knowledge synthesis research study. The aim of the knowledge synthesis project was to produce evidence-based recommendations for the selection and utilization of patient- and family-reported outcomes (PROMs) and patient- and family-reported experiences (PREMs) for seriously ill elderly patients and their families in acute care settings. The knowledge synthesis was informed by the initial stages of the Knowledge-to-Action framework and included close collaboration with an intentionally selected and diverse team. Team members were invited from local and national communities of researchers, content experts, well-connected knowledge users, decision makers, and trainees. These team members represent a variety of areas including government, local health authority, medicine, nursing, psychometrics, and library sciences. Knowledge users partnered in developing the aims and objectives of the project, and collaborated in shaping the knowledge synthesis processes along the way. The team members were engaged on an ongoing basis to identify gaps, refine synthesis questions, discuss emerging results, and prepare for knowledge translation. The strength of having a diverse team approach is that research is shaped so that research outcomes become relevant to multiple populations, including various user communities. One example of multiple perspectives within the research team is that clinician team members valued the clinical usability, while researcher team members emphasized the importance of ensuring reliability and validity of the instruments. A flow chart illustrates the collective team’s contributions throughout the research study. Overall, the poster demonstrates how knowledge synthesis processes may need to be adapted on an ongoing basis to ensure that the results are meaningful to researchers and knowledge users who have different disciplinary and professional backgrounds., Background: Patients surviving critical care experience residual disabilities, with long-term consequences, challenging their return to pre-injury/illness roles. Occupational therapists (OTs) are experts in facilitating recovery from disabling conditions. However, the OT role is inconsistent and infrequent in many critical care settings and not clearly defined. To establish an OT niche on the critical care team and support best outcomes for patients, these shortfalls require in-depth, interdisciplinary exploration. To begin addressing this need, we designed this scoping review to systematically identify and explore reports describing the current and potential OT role in critical care. Methods: We searched MEDLINE, CINAHL, Web of Science, Scopus, Cochrane Library, ERIC, Social Science Citation Index, and SSRN from inception to November 2013 for all documents discussing the role of OT in critical care. We sought documents (original research (quantitative and qualitative), review articles, practice guidelines, editorials, commentaries) mentioning current or potential OT role(s) of activities involving the care of patients, their families and support of critical care staff, with no language restrictions. An interdisciplinary review team (three OTs, one physiotherapist (PT), one critical care methodologist) examined the citations to select relevant reports. Independently, in duplicate, pairs of review team members screened study titles, abstracts, and full text for eligibility. Similarly, an interdisciplinary team (three OTs and one PT) abstracted data independently in duplicate from included studies. Discrepancies at all review stages were resolved by consensus. Results: The initial search identified 32,711 citations; thus, practical considerations for managing our yield necessitated modification of our inclusion/exclusion criteria. To focus on the most pressing critical care needs, the review team collaborated to narrow our selection criteria to include citations that suggested a possible OT role only in direct patient care within the critical care setting focusing on interventions. Title screening by four reviewers (90 hrs) identified 3,628 abstracts for further review. Abstract review (37 hrs) identified 1,217 reports for full-text review. To date, 709 full-text documents have been retrieved, and 216 met the revised inclusion criteria. Four reviewers have abstracted data from 173 reports (57 hrs). Preliminary results suggest that reports on OT in critical care are limited in number; varied in document publication type, study design, and methodological quality; and, widely span traditional and emerging OT roles. Conclusions: The interdisciplinarity of the review and data abstraction teams have been instrumental in distilling the large volume of citations, defining key concepts, and collegially resolving conflicts to capture the current state and potential contributions of OT in critical care. Preliminary analysis suggests a need for further research into the effectiveness of existing OT roles in critical care (e.g., mobilization) and role expansion to support recovery from disability for patients during and following critical care, emphasizing cognitive and psychosocial services. This dynamic, iterative interdisciplinary process may serve as an exemplar of how other disciplines can describe their role in emerging aspects of health care., Rational: Lesbian, gay, bisexual, and transgender (LGBT) older adults are often described as a doubly invisible population – invisible as LGBT older persons in the heteronormative environment of social services and health, and invisible as elders within the LGBT community (Brotman, Ryan, & Cormier, 2003; de Vries & Blando, 2004). More likely to be without partners and without children, the primary caregivers of older adults, LGBT older adults look to friends and chosen family for care and support in later life — those same persons who are less likely to be socially groomed for such care and less likely to have participated in such care discussions (Adelman et al., 2006; MetLife, 2010; Wallace et al., 2011). When this network is unavailable, unrecognized, or unaccepted, higher rates of loneliness and isolation result leading to further exacerbation of serious and life-limiting conditions (Kuyper & Fokkema, 2010). Objectives: This project has three primary goals: (1) to understand and describe the issues involved in and the preparedness for aging and end-of-life planning among LGBT adults aged 60 and over; (2) to share knowledge and resources that will foster and encourage individual action and develop a greater sense of community; and (3) to provide a safe and supportive environment in which information about planning for aging and end-of-life can be accessed and lead to action. Method: The first component, currently in progress, entails four focus groups in five major cities across Canada. Three groups comprise LGBT older adults: (1) gay and bisexual men; (2) lesbians and bisexual women; and (3) transgender persons. The fourth group consists of local service providers and agencies that provide services to LGBT older adults. Following the focus groups, a town hall meeting will be held in each city at which themes from the focus groups, state-of-the-field research findings, and information about services for LGBT older adults will be presented. The final component of the project is the development of a pilot Web-based resource that will allow further knowledge transfer to the community. Discussion: By initiating and facilitating discussions about aging and end-of-life planning within the LGBT community, and by making knowledge available and easily accessible through a Web-based platform, LGBT older adults will be empowered and motivated to use the resource as a community building tool, enabling individual and communal planning and support in later life., Background: With the aging of the population and concomitant increases in the number of individuals with acute and chronic illnesses, understanding the patterns of health services use among the elderly at the end-of-life is increasingly important to Canada’s health-care system. Accordingly, our objective was to examine health services utilization at the end-of-life, with a focus on sex-based differences in health-care use. Methods: This population-based retrospective cohort study included elderly (≥ 65 years) residents of Ontario who died between April 1, 2004 and March 31, 2013. Vital status data was obtained from the Ontario Registered Person Database and this information was linked to several population-based administrative datasets to describe health-care use. Indicators of use included hospital and intensive care unit (ICU) admissions, emergency department visits, and physician visits. Descriptive statistics are reported to describe the study population. Results: The cohort included 764,081 decedents, 50.6% of whom were women and 46.1% died in hospital, with 22.5% of in-hospital deaths occurring in the ICU. Compared to men, women were older (mean 78.6 (14.6) vs. 73.2 (15.3) years), had fewer deaths occurring in hospital (43.8% vs. 48.5%), and fewer ICU admissions in the terminal hospital episode (29% vs. 34.2%). In the 6 months prior to death, 51.8% of decedents saw 10 or more physicians, with a lower proportion of women (48.7%) than men (55%) seeing 10 or more physicians. Women also had fewer emergency department visits (mean 1.7 (1.9) vs. 1.9 (2.2)), admissions to ICU (mean 0.2 (0.6) vs. 0.3 (0.7)), hospitalizations (1.1 (1.2) vs. 1.3 (1.3)), and fewer hospital days 13.8 (20.9) vs. 14.7 (21.5) days). Conclusion: This study highlights differences in health-care utilization between men and women at the end-of-life. Understanding the determinants of these differences will be informative to efforts aimed at improving the quality of end-of-life care for elderly Canadians., This study is part of a larger research project whose aim is to develop a Canadian nutrition care algorithm for hospitalized older adults; currently nutrition care is ad hoc, resulting in malnourished patients being undetected and untreated. The need for monitoring and communication tools that support algorithm implementation were identified in an environmental scan. This poster will present the process of developing and testing three tools including: a self-assessment of patient food intake; an audit of mealtime practices; and a standardized discharge communication for follow-up nutrition care. Development included review of literature for extant tools and key issues, modification of extant tools where possible or development of new tools with key user input. Tools will be tested in five diverse Canadian hospitals with 150 patients. Feasibility assessment will focus on ease of use and completion rate of tools. Interdisciplinary focus group at each hospital will be conducted for input on content validity and feasibility of implementation of tools. Criterion validity will be tested where possible. A detailed example of the development of one tool will be described., Background: Determining location of care is a difficult decision faced by many frail elderly persons. Moreover, it is challenging to establish the impact of location of care on frail elderly and caregivers’ health. Objective: To systematically review and critically appraise the evidence concerning health outcomes of location of care for elderly people and their caregivers. Methods: We conducted an umbrella review of systematic reviews guided by the Cochrane Handbook. We searched the Cochrane Effective Practice and Organisation of Care Group (EPOC), the Cochrane Rehabilitation and Related Therapies Field Database, EMBASE, CINAHL, PsycINFO, and MEDLINE. We determined eligible systematic reviews using the following PICO question: P: elderly people (65 and over) and/or their caregivers; I: location of their care; C: any comparison; and O: any health outcomes in clients and/or caregivers. Reviews in French, English, Spanish or Portuguese were eligible. Independent reviewers used the PICO question to screen citation eligibility in 5 stages: titles, abstracts, full texts, study quality (minimum score 5/11 on the AMSTAR quality measurement tool), and relevance to the review objectives. A third reviewer resolved discrepancies. We used descriptive analysis to synthesize the results. Results: Of 988 titles screened, 21 full texts were reviewed and four reviews were included. Systematic reviews were English publications from 2002 to 2010 conducted in Canada (n=1), United Kingdom (n=1), Belgium (n=1) and Sweden (n=1). One review was a Cochrane systematic review which did not comprise a meta-analysis. Two reviews comprised a meta-analysis. Sixty-seven studies were included across the four systematic reviews (range = 1–30). The locations of care included: home, community care program, and nursing home/institutional setting. Three studies examined the frail elderly and found no differences in health outcomes based on the elder’s dwelling location. One study showed that caregivers of elderly with dementia were more likely to be depressed compared to caregivers of elderly with other chronic diseases. The risk of depression increased with burden of care. Study quality was moderate, with two studies scoring 5/11 and two scoring 7/11 on the AMSTAR quality measurement tool. Conclusions: There is insufficient evidence to predict frail elderly health outcomes based on location of care. Therefore, the decision to stay at home or move to another location requires weighing personal importance of reasons for and against each option., Introduction: The emerging concept of frailty has been shown to predict postoperative risk in patients undergoing cardiac surgery. Therefore, it is critically important for the health-care team to identify strategies that will “de-frail” patients prior to surgery and optimize preoperative risk factors. Study 1: The purpose of this study was to prospectively examine the prevalence of frailty in patients undergoing cardiac surgery. In a cohort of 133 patients, 54% were classified as frail, according to the Modified Fried Criteria. Frailty was correlated with increased postoperative hospital length of stay (LOS), where frail patients had a median hospital LOS of 8 days compared to 6 days in non-frail patients (p 7 days compared to just 37% in non-frail, cardiac surgery patients (p, One component of our study consists of a clustered randomized control trial (RCT) to determine whether the use of the Carer Support Needs Assessment Tool (CSNAT) by home care nurses with the family caregivers of their patients improves the quality of life of said family caregivers. We will be testing the following 2 hypotheses in our RCT: The use of the CSNAT as a practice support tool intervention will 1) lead to improved family caregiver quality of life during the time prior to patients’ death and in bereavement, and 2) contribute to the following secondary outcomes in family caregivers during the time prior to patients’ death—enhanced perceived social support, improved preparedness to provide care, and reduced caregiver burden. We have adapted a model of caregiver burden to hypothesize the various concepts by which addressing support needs may contribute to family caregivers’ quality of life. Due to the complex nature of quantifying quality of life and the factors that contribute to quality of life for family caregivers, we needed to create a questionnaire that would address each concept in our hypothesized model—for example, burden, preparedness, overall quality of life, patient functionality. and symptoms. Developing an appropriate questionnaire for our outcomes measurement took considerable foresight and required that we address the following concerns: Constructs: We had to define the constructs within our model as they relate to family caregiver support needs and the quality of life of family caregivers.Measurement Tools: We had to investigate and select a number of appropriate, validated measures to use in order to measure our constructs (e.g., to address general quality of life we selected the Quality of Life in Life Threatening Illness—Family Carer Version (QOLLTI-F)). Appropriate authorization was obtained to utilize each of the measurement scales we had deemed most appropriate.Order of Tools: Considering the length of the final questionnaire, we needed to determine the most appropriate order for the measurement tools so as to ensure that we would obtain our primary outcome measures near the beginning, while still maintaining a natural flow between topics.Mode of Administration: As is the case with longitudinal outcome measures, we needed to assess what would be the best course of action to ensure that our data collection was as complete as possible over the entire data collection period. Our final measurement tool consists of various established family caregiver tools incorporated into one questionnaire. As this questionnaire will be longitudinal, we will be using an in-person interviewer administration mode with response cards to help with retention and data integrity. In some cases, we have adapted the family caregiver tools slightly to accommodate a change from the original self-administration mode to an interview administration., The overall objective of this research is to determine whether the learning resources promoted by the General Practice Services Committee (GPSC) Practice Support Program (PSP) End-of-Life (EOL) learning module can be incorporated into the electronic medical record (EMR) of primary care providers to improve the quality of palliative/EOL care delivered. This research intends to explore whether the palliative approach that is integrated into the EMR of primary care physicians as a set of electronic tools based on the GPSC EOL PSP module can enhance EOL care in ways that can be measurable, scalable, and sustainable. The GPSC EOL PSP learning module is considered the best practice approach to managing EOL patients: those enrolled in the BC Palliative Care Benefits Program or are currently at risk of dying due to a serious, life threatening illness within the next 12 months; and family members who have a relative who passed away within the last 12 months. This research has 4 stages over a 2-year period. Stage 1 is complete, where a small group of general practitioners (GPs) and medical office assistants (MOAs) were recruited to determine current EOL care practices. Stage 2 is complete, where EMR-supported tools based on the EOL PSP learning module were developed, based on feedback from GPs and MOAs. Stage 3 is in progress, to disseminate the EMR EOL Care Module widely to physicians across BC through live learning sessions and the project website. Stage 4 is in progress concurrently with Stage 3, with the evaluation and impact of the EMR EOL Care Module provided by means of time-series evaluation. By focusing on identification, assessment, and pro-active care planning of technology supports for EOL processes in primary care practices, more efficient use of health-care resources and improvements to EOL care are being addressed., The MOH&LTC’s report Living Longer, Living Well highlights a rapidly increasing need to care for seniors requiring complex care in nursing home (NH) settings. As the number of seniors rises, pressure increases on the care capacity in these organizations. The majority of these workers will be registered nursing and unregulated health-care staff. However, insufficient geriatric content in Canadian health-care education persists, leading to serious concerns that staff do not have adequate knowledge to assess, plan, provide, and document care. This deficit is especially acute in NH settings, with negative consequences for seniors. The Applied Simulated and Integrated Learning Approach (ASILA) Program is aimed to improve targeted clinical outcomes for seniors through the use of evidence-informed case simulations in the areas of frail seniors with cognitive and physical challenges. The ASILA Program is based on the use of Minimum Data Set (MDS) as a comprehensive assessment and quality improvement framework. This presentation will highlight the efforts made by the multi-disciplinary research team to develop, implement, and evaluate the ASILA Program on clinical care outcomes for frail seniors. Three evidence-informed simulated case scenarios addressing current deficits in the care of frail seniors will be discussed. These scenarios include the use of assessment scales to conduct a CGA and Clinical Action Protocols (CAPs) to facilitate care planning. In addition, a “train the trainer program” and a training and evaluation plan to integrate these scenarios for impactful learning will also be discussed. The implementation and research plan will be presented, focusing on select measures which will be used to collect health-care staff, resident, and organizational data. This work builds on leading practices in simulation education to develop inter-disciplinary and evidence informed training scenarios for health-care students and staff. This research will inform subsequent expansion of the ASILA Program for health-care education and training in NH settings across Canada. The ASILA Program has the potential to enhance care for frail seniors in NH settings, emphasizing quality of life and promoting best practices, all while working within a financial framework of accountability., Background: Advances in medical technologies are allowing patients with complex and terminal diseases to live longer, but this does not necessarily mean that treatment will restore health or improve quality of life. Advance care planning (ACP) is a method used for patients to express in advance their preferences, beliefs, and values for life-sustaining treatments at the end-of-life. With growing ethnocultural diversity in Canada, health-care providers are managing an increasing number of diverse beliefs/values that have significant impacts on the patient and family’s reaction to the dying process and the medical decisions they make. Medical decisions that are informed by cultural or religious beliefs are commonly associated with preferences for aggressive treatments, such as mechanical ventilation (MV) and hospitalization, at the end-of-life. How we manage ethnocultural beliefs/values in ACP is a significant indicator for the quality of care and quality of death that patients and families experience. Methods: The objectives for this study are: 1) understand methods used in ACP to manage ethnocultural beliefs/values for MV; 2) highlight challenges in ACP (organizational, material, systematic) that may hinder physicians’ or nurses’ ability to provide cross-cultural care; and 3) explore methods used to overcome perceived challenges. This qualitative study uses a semi-structured interview to explore methods used by physicians and nurses to set care plans for MV with patients and families from different ethnocultural backgrounds. Eight (8) participants (four physicians and four nurses) who engage in ACP were recruited from the following acute-care hospitals within the Ottawa region: l’Hôpital Montfort, Ottawa General Hospital, Saint-Vincent’s Hospital, Civic Hospital, Riverside Hospital. Interviews were audio-recorded and transcribed for content data analysis. Results: Three major themes emerged from the coded dataset of transcribed interviews: 1) goals of care across illness trajectories, 2) respecting beliefs, values, and wishes for care, and 3) cross-cultural support in ACP. Using a value-based approach in ACP is seen as an effective method for managing and interpreting diverse beliefs/values that impact decisions for MV. Physicians and nurses should be supported with more cross-cultural education and culturally competent skills for communicating and adjusting to different ethnocultural contexts. Knowledge from this study can be translated into evidence-based practice guidelines that facilitate meaningful ACP discussions, regardless of race or ethnicity. An ACP framework that is effective across cultures may have positive social, economic, and ethical implications that may serve as a promising tool for reducing burden at the end-of-life., Background: A palliative approach centres on improving the quality of life of persons with serious life-limiting illnesses and their families. Such an approach to care encompasses multidimensional aspects of health, with an upstream orientation on the needs of ill persons and their families. Objectives: This presentation addresses the complexities and highlights several key considerations in conducting research about a palliative approach to care for culturally diverse elderly persons with serious illness and their families. We report on lessons learnt during the early phase of our study regarding the challenge of conceptualizing a palliative approach in a way that is congruent with the cultural understandings of life-limiting illness of Chinese-speaking people who live in Canada. Methods: Multiple research methods, including literature synthesis, interviews, and focus groups, were employed to explore understandings of a palliative approach to care and quality of life outcomes for Chinese-speaking elderly people with life-limiting illness and their families. The literature synthesis is based on the search database of a comprehensive knowledge synthesis on a palliative approach by the iPANEL team (Initiative for a Palliative Approach in Nursing: Evidence and Leadership; www.ipanel.ca). Screening of this database revealed 14 documents that specifically focused on the care experience of the culturally diverse populations in the context of a palliative approach. An additional 22 articles were identified through subsequent backward and forward citation searches and are currently being screened for relevance. Participants for the interviews include seriously ill Chinese-speaking elderly persons and family support persons in British Columbia. The study is in the early phase of literature screening and interview participant recruitment. To date, 5 participants have been enrolled: 1 ill person and 4 family support persons have completed the interviews. The goal is to recruit a minimum of 5 ill persons and 5 family support persons for the interviews. Results and Discussion: Key issues that have emerged thus far include the conceptual clarification of a palliative approach and the contextualization of language in the culturally diverse populations. The preliminary review of the literature on the cultural dimension of a palliative approach reveals a challenge in defining a palliative approach in the cultural context of the diverse populations. The difficulty in recruiting Chinese-speaking dyads may be reflective of the cultural attitude towards death and dying, and the role of the family in coping with life-limiting illness. In recruiting Chinese-speaking participants for the study, the preference for hope instilling language may further distant participants from providing their views on a palliative approach to care for the dying. Notably, the culturally appropriate framing of a palliative approach will need to consider the tension between hope of living and acceptance of dying. Conclusions: This study seeks to contribute to the improvement of quality of care for the frail elderly persons and their families of culturally diverse backgrounds. With an increasing diverse population in Canada, the challenges in research on a palliative approach to care must be addressed in order to achieve the goals of culturally competent care for the frail elderly and their families., Objective: Informal caregivers of persons with dementia experience significant difficulties or “caregiver burden”, which has been associated with the quality of the caregiver and care-recipient relationship. Reminiscence Therapy (RT) is an intervention that may help improve the quality of this relationship and mitigate caregiver difficulties. In rural and remote communities, the high proportion of older adults with limited access to health services makes dementia care a challenge. This project will evaluate the effectiveness of an RT intervention for informal caregivers and assess the use of video conferencing as an accessible method of service delivery. The first objective of the project is to investigate the benefits of an RT intervention for caregivers of persons with dementia. A second objective is to contribute to the delivery of health services to older adults living in rural and remote areas by assessing RT delivered via video conferencing. Methods: Sixty-four informal caregivers of persons with dementia will be recruited to participate from the University of Saskatchewan Rural and Remote Memory Clinic. Participants will be randomly assigned to one of four groups: in-person RT, in-person active control, RT over Telehealth video conferencing, or active control over Telehealth. The RT intervention will be based on an empirically supported autobiographical memory activity involving the facilitated recall of positive memories involving the care-recipient. Measures of relationship quality, caregiver burden, and other outcome measures will be administered at pre, post, and follow-up. Hypothesis: It is expected that caregivers in the RT groups will demonstrate an increase in perceived quality of their relationship with the care-recipient, and a decrease in their perceived burden of caring. It is further anticipated that there will not be a significant difference in group outcomes between the in-person and Telehealth video conferencing delivery mediums. Relevance: This project will provide evidence of RT efficacy for improving caregiver/care-recipient relationships and reducing perceived burden of caring for persons with dementia. Further, it will add support for the use of video conferencing technology in the development of accessible services for those with limited access, especially in rural and remote areas., Almost 75% of residents die in their long-term care (LTC) home (Palliative Care Alliance, 2010). The Ontario Long-Term Care Homes Act (2010) states that all staff providing direct care to residents must receive training and re-training in the area of palliative care; however, little training is available and evaluation of education strategies is lacking. The need for high-quality, standardized, on-the-job training will increase over the next decade as LTC increasingly assumes a hospice-like function for frail seniors (Palliative Care Alliance, 2010). Effective and innovative educational strategies tailored for LTC staff that improve provision of palliative care and enhance team work are urgently needed. The objective of this educational research is to implement and evaluate simulation as an immersive experiential approach to teach palliative care to teams of LTC staff. Research questions: Can use of simulation improve the palliative care knowledge and skills of interdisciplinary LTC providers?Can use of simulation improve the self-perceived palliative care competence of interdisciplinary LTC providers?Can use of simulation promote interdisciplinary team-work in LTC homes?How does the using simulation positively and negatively impact the palliative care education experiences of interdisciplinary LTC providers? This research will evaluate the process and outcomes of a simulation palliative care training program with interdisciplinary LTC providers. Staff from 2 different LTC homes will participate in education using HFS as a pedagogical approach to gain skills in providing palliative care, caring communication, and teamwork. Four simulation training modules with accompanying resources will be developed and implemented: advanced care planning, teamwork, holistic care planning, and caring end-of-life communication. The process of learning and the qualitative experience of the participants will be evaluated through debriefing focus groups held at the end of each of the four simulation sessions. Outcomes will be evaluated by having participants complete pre and post surveys. Enhancing knowledge mobilization, the reach of this research will be expanded by inviting educators from Baycrest Long term Care Home and Elisabeth-Bruyere Residence to Thunder Bay to learn to replicate the simulation educational intervention in their LTC settings in Toronto and Ottawa. Through these collaborations, the findings of this research will benefit LTC homes throughout Ontario. This research is aligned with TVN’s mission to improve the care of the seriously ill elderly, while evaluating simulation as an educational strategy to address the palliative care training gap for health-care providers working in LTC. It will generate knowledge that can be used to: 1) advance the use of HFS in continuing interdisciplinary health-care education for LTC staff, 2) promote interdisciplinary teamwork in LTC, 3) advance educational research in LTC, and 4) improve the knowledge, skills, self-perceived competence, and teamwork of LTC home staff so they are better prepared to care for people who are dying and their families. This pilot project will generate evidence that will begin to determine the effectiveness of HFS to teach palliative and end-of-life care to interdisciplinary health-care providers and promote palliative care teamwork., Patient-reported outcome (PRO) measures are designed to provide important information to ensure that the needs and concerns relevant to the quality of life of patients are systematically assessed. Assessment of health and quality of life is critical to the provision of high-quality care that addresses the full range of and often complicated needs relevant to seriously ill elderly patients. This project is a review of research and other sources of information to establish consensus-based best practice guidelines using the Delphi Method for the selection and utilization of PRO instruments to assess the quality of life and inform the care of the seriously ill elderly patients. The purpose of this poster is to present the study protocol that describes the plan for this study. The present study consists of two stages. Stage I is a review of research and other sources of information to develop a large set of initial guidelines germane to the selection and use of PRO instruments for elderly patients. The standard approach to knowledge synthesis will be used. Evidence from various forms of knowledge from different sources will be synthesized. The recommendations of the Evidence for Policy and Practice Information and Coordinating Centre (EPPI-Centre) for knowledge synthesis will be followed. The EPPI-Reviewer software will be used to combine all documents into a common database, apply selection criteria corresponding to each of the review questions, conduct critical appraisals of relevant documents, establish and apply a code book to extract relevant information from each document, and facilitate the synthesis of findings. Stage II involves using the Delphi Method to generate consensus-based best practice guidelines. (The Delphi method is widely used for gathering data from participants within their area of expertise. The method is designed as a group communication process with an eye towards building consensus by conducting multiple rounds of surveys to collect information from a panel of experts.) Stakeholders, experts, and various health-care consumers, and advocacy and patient network group members will be invited to participate in the Delphi survey. A set of guidelines developed based on the knowledge synthesis from Stage I will be sent to the participants. Participants will be asked to rate the importance of each guideline for inclusion in the final set, provide feedback or a rationale for giving a guideline a high rating, and suggest possible additions to the list of guidelines. The list will be narrowed to include only the most highly rated guidelines, new ones will be added based on participant recommendations, and written comments about the guidelines will be summarized. The process will be repeated until consensus is reached. Having consensus-based best practice guidelines available will help ensure that the best PRO instruments are selected and utilized to assess and improve the quality of life of seriously ill elderly patients., The main objective of this study is to implement a mindfulness-based intervention (MI) to improve mood and quality of life for frail elderly and caregivers in long-term care (LTC). Depression is the most prevalent mood disorder among elderly in LTC and is also common in family caregivers. In addition, LTC staff working with elderly clients experience stress and burnout more than other personnel. We plan to implement a modification of Mindfulness-Based Cognitive Therapy (MBCT)—a group intervention that combines techniques from Mindfulness-Based Stress Reduction (MBSR) with Cognitive Behavioral Therapy (CBT). MBSR is a group program in which participants learn mindfulness mediation to decrease stress, anxiety, and suffering associated with various problems. CBT is a one-on-one approach for depression, in which patients learn to restructure irrational thought processes. MBCT has shown to be effective at preventing relapse in recurrently depressed individuals, as well as reducing symptoms of depression and anxiety. We hypothesize that our MI will: 1) improve depression and quality of life for frail elders and may also have a positive effect of daily functioning and physical health; 2) improve mood, stress, burden, and quality of life for caregivers and may also have a positive effect on physical health; and 3) improve mindfulness, self-compassion, and satisfaction with life in both groups. We plan to use a Randomized Controlled Trial consisting of two interventions: one MBCT intervention for frail elderly and one MBCT intervention for caregivers. The intervention will be 1.5 hours once per week for eight weeks. Questionnaires will be administered both before and after the MBCT interventions and waitlist period for all participants. The following scales will be completed by frail elders: Geriatric Depression Scale, Geriatric Quality of Life Questionnaire, and Frail Elderly Functional Assessment Questionnaire. The following scales will only be completed by caregiver participants: Beck Depression Inventory-II, Caregiver Strain Index, Zarit Burden Interview, and Quality of Life scale. All participants will complete the Depression, Anxiety and Stress Scale; Health Survey (SF-36) for physical and emotional health symptoms (a visual analogue to assess intensity and frequency of pain), Five Facet Scale for mindfulness; Self-Compassion Scale; and Satisfaction with Life Scale. Analyses will be conducted using Analysis of Covariance (ANCOVA) models with group (intervention or control) as the independent variable, the post-intervention score as the dependent variable and the pre-intervention score as the covariate. We predict greater change in the intervention group compared to the control group for all analyses in both frail elders and carers. By supporting frail elders and their caregivers through MBCT, we anticipate improvements in mental and physical health, stress, and quality of life. Importantly, reducing work-related stressors in caregivers may improve their quality of care for frail elderly, as lower stress levels in caregivers are related to increase quality of care. Because MBCT is a time-limited structured group program, it may be a cost-effective method by which to sustain the TVN’s strategic priority of improving outcomes and quality of care for frail elderly and supporting caregivers and families., Background: Advance care planning (ACP) is a process that can assist people to think about, talk about, and document their preferences for health care. Alberta Health Services (AHS) has developed ACP information materials to facilitate discussions among patients/families and health-care professionals (HCP). Currently, Alberta’s ACP information materials have not been empirically evaluated within medical contexts that provide services to seriously ill older patients. Study Aims: (1) establish a baseline understanding of how seriously ill older patients, families, and HCP interact with existing ACP information materials in four medical contexts (kidney clinics, palliative care, cancer clinics, and institution/facility living for older adults); (2) tailor refinements and intervention strategies to improve ACP information materials, HCP education, and discussion strategies to better reflect the needs of older patients; and (3) further tailor materials and discussion strategies to meet the needs of older patients in different medical contexts. Method: Conversation analysis (CA) is used to examine and evaluate discussions among HCP (e.g., physicians/nurse practitioners/nurses/social workers) and seriously ill older patients involving AHS’ ACP information materials. CA is the fine-grained qualitative analysis of interactions between people as a means of understanding how their talk results in actions and activities without directly asking (e.g., informing, criticizing). CA assists researchers in detecting and interpreting functional/dysfunctional communication practices. Data collection/analysis is being done in three phases. Phase 1: ACP discussions among HCP and seriously ill older patients/families are audio/video recorded in the participating medical contexts (a total of 30–35 ACP discussions). I examine how the design and content of the HCP’s talk using ACP information materials influences the patients’/families’ level of interaction and displays of understanding. Phase 2: Evidenced-based interaction principles derived from CA are used to illustrate and support possible revisions to the ACP tools and develop recommendations to enhance ACP discussions. HCP from each medical site are trained on how to use the new materials and discussion strategies to increase the effectiveness of their communication (30–35 intervention discussions will be recorded). The effectiveness of the new materials is evaluated. Phase 3: Feedback on using the new ACP information materials and HCP training tools is obtained from participating HCP. The intervention materials are revised based on findings from Phase 2 & 3. Preliminary Findings from Phase 1: Based on 22 recorded consultations, it has been determined that (1) very few of the patients/family members are familiar with the term ‘Advance Care Planning’; (2) there is little use of the existing ACP information materials by HCP; (3) patients receiving the existing ACP information materials display little interest in them; and (4) most of the HCP have developed their own discussion style that generally show good effectiveness. To assist with familiarity of the terminology associated with ACP, I have developed new ACP, Goals of Care Designations, and Green Sleeve icons and slogans. The new icons/slogans will be pilot tested with patients and family members attending kidney clinics in Edmonton. The pilot study will inform the development of the intervention materials used in Phase 2. This project is in progress. Final results available September 2015., Home-based rehabilitation services are part of Ontario’s home care strategy for safe hospital discharge and to reduce (re)hospitalization through prevention and maintenance. An estimated 78% of home care clients do not receive any rehab, wait times can be as long as 3 months, and the longest waiting is experienced by elderly with chronic disorders. Data on hospital utilization among elderly receiving home-based rehab and the impact of waiting for such services are sparse. These data are extremely important in Ontario where close to 60% of home care clients are elderly, over half are admitted post-hospital discharge, and the number awaiting long-term care placement at home is growing. Our study seeks to determine: How do wait times for home-based rehabilitation affect (a) emergency room use and (b) hospital (re)admission? Methods: The proposed project uses a retrospective cohort study design. The cohort includes individuals over the age of 65 who have been newly admitted to Ontario’s 14 Community Care Access Centres (CCAC) home care programs from 2009 to 2013. Data will be abstracted from province-wide datasets held at the Institute for Clinical Evaluative Sciences (ICES). The primary outcome is hospital utilization. Demographic information, medical historym and rates of hospitalization and emergency department visits will be analyzed. Survival analysis will be used to take account of the duration of the wait time to a hospital encounter (event). The analysis looks at the total time a client is at risk for a hospital encounter and allows us to determine: 1) if returning to hospital occurs later for clients who received rehab versus did not receive rehab; and 2) the impact that wait time for rehab has on time-to-event. The analysis also permits us to control for multiple potential confounders known to impact rehospitalization. Results: This provincial study builds upon a pilot study conducted in 2012–13. Results from the pilot were based on 1029 patients, ≥65 years of age, admitted to home care following a discharge from two hospitals in southeastern Ontario. The pilot found that home-based rehab was offered to 43.8% of these home care clients. Average wait times from home care admission to first rehab visit was 28 days for clients that were re-hospitalized compared to 13 days for those who were not. Survival analysis showed that physiotherapy was effective in delaying re-hospitalization, despite wait times of slightly over 3 weeks. Wait time for occupational therapy was over 4 weeks, and was associated with a high proportion re-hospitalized (37.4%). The majority of clients returning to hospital presented with pain, fever, dehydration, dyspnoea, pneumonia, nausea, polypharmacy, delirium, angina, COPD, and renal failure. Relevance: The study is an extensive examination of wait times for Ontario home-based rehabilitation and its impact on elderly clients. The survival analysis will include all clients over the age of 65, regardless of their assessed clinical and home care needs or length of stay on home care. This analytical strategy, study design, and inclusion criteria will provide results that are meaningful to decision makers at local, regional, and provincial levels when discussing resources, clinical pathways, and processes. Results delineated by diagnosis and case mix groupings will also inform physicians and rehabilitation therapists’ triage process and practice., Background: Health policy in Canada supports healthy aging at home and in the community. Specialized geriatric assessment services are generally centralized and frequently require frail seniors to travel for assessment and follow-up visits. Technology enabled interprofessional assessments and follow-up in the home or local community will enable more frail seniors to receive timely assessment, intervention, and follow-up by overcoming barriers. Timely comprehensive geriatric assessment has been demonstrated to support the development of holistic care plans that provide the best opportunity for seniors to maintain their independence and function. At the same time, older people are becoming the subjects of applied technology solutions, but may not have had the opportunity to influence the development of these technology solutions. An understanding of the ways in which older people currently view and use technology is required to ensure the needs and values of older people inform technology development and adoption. This understanding can also support the development and selection of technology solutions that optimize the potential for self-care among frail older people. Objectives: To explore the use and limits of technology to facilitate in-home geriatric assessment and follow-up/monitoring of community-dwelling frail seniors, including: Identification of available and emerging health technology options for both self and provider-led care for frail older peopleDevelop strategies to inform the selection and use of technology in the care of frail older peopleLearn from the experience of seniors, families and health-care professionals who use technology in health-care relationships to inform the design and modification of technological solutions Methods: In 2006, Ontario’s government implemented regionalized health-care services and created 14 Local Health Integration Networks (LHINs). Each LHIN is responsible for the planning, integration, and funding of specified health services in their region, including hospitals, community care, and home care. Similar to other regions in Canada, the number of seniors experiencing frailty (e.g., multiple co-morbidities, high health service utilization) is increasing in Ontario’s Central East LHIN. Data collection in phase one includes focus groups and interviews with seniors, technology designers, and decision makers, and a survey of health-care and social services workers in the Central East LHIN, to identify and evaluate technology options and approaches for home-based care of frail seniors. Results and Implications: We will report on the first stage of the study. Working collaboratively with field experts and others we have identified technology options for health assessment and monitoring. We have then gathered input about the process of design and the inclusion of the input of seniors in the design, decision-making, and selection of technology options. Ideas to enhance the inclusion of seniors are explored, as is the tension between the opportunities and limits of technology in the care of frail seniors. The evaluation of the technology and current decision-making approaches is considered and can inform health service design for community dwelling frail seniors., Depression is the most common mental illness among older adults and is more prevalent among those living in long-term care (LTC). Depression is undertreated, underdiagnosed and misdiagnosed in this population. The Resident Assessment Instrument-Minimum Data Set (RAI-MDS) 2.0 contains a depression rating scale (DRS) originally validated nearly 15 years ago. Guidelines exist for assessing and treating depression but the extent of their uptake is unknown. However, we do know that a consistent finding in clinical and health services research is a failure to translate research into practice. Facilitation is gaining recognition as a knowledge translation intervention but little empirical research exists on its effectiveness and none in this sector. The purpose of this project is to revalidate the DRS and evaluate feasibility and effectiveness of facilitation as an intervention to enhance depression guideline uptake by healthcare aides caring for elderly residents with depression in LTC in Alberta. The research involves 3 phases: I will conduct an environmental scan to understand depression screening and management practices and assess baseline state of guideline use with respect to engaging healthcare aides in managing depression. I will then revalidate the DRS in the RAI using the same approach as in the original validation.I will use Normalization Process Theory (NPT) and intervention mapping (IM) to develop a tailored, theory-informed facilitation intervention. NPT addresses processes by which new practices are operationalized in healthcare. It taps into the actual work routines and tacit knowledge base of workers, an important consideration for the healthcare aide group. IM involves conducting a needs assessment, creating objectives for change, planning for adoption and implementation of an organized programme, evaluating change and supporting sustainability. I will also work with care aides in focus groups to tailor the intervention to their work practices and identify potential barriers to implementation.I will evaluate the acceptability and feasibility of doing the facilitation intervention with healthcare aides using process evaluation. I will select a LTC facility with at least three resident care units and 6–8 care aides from each unit and perform the intervention with these groups. In this feasibility study I will also evaluate use of flowcharts to capture guideline uptake. The process evaluation will involve examining to what extent the programme is implemented as planned, evaluating reach, participant satisfaction, implementation of activities, intervention performance, and quality assurance. Data collected will include flowchart documentation, interviews, focus groups, and surveys. The appropriate approach to quantitative analysis of flowchart data and surveys will be determined. The qualitative data will be analyzed using the inductive approach of constant comparison. This research will add to our understanding about facilitation as an intervention to enhance the use of research. This will help us know if this strategy can be used with care aides as one tool to improve depression management, an important contribution to quality of life for this vulnerable population of older adults., Rational: Nursing staff provide the majority of direct care for institutionalized older adults with dementia and thus have the biggest impact on their quality of life. Understanding how nursing staff’s attitudes and perceptions of their residents is crucial because it directly affects quality of care delivered and the culture of care in residential care homes. Objective: This paper presents a systemic review of nursing staff perception and attitudes towards residents in residential care settings. The aim of this poster is to describe where the gaps in our knowledge and what future research needs to be conducted to further our understanding of attitudes of nursing staff in residential care settings. Method: Data Sources included Ageline, Medline, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, PubMed, and active researchers in this area from 1990 to present. Empirical studies will be included that explored perspectives or attitudes held by nursing staff of residents in long-term residential care settings. Conclusion: Preliminary findings suggest that social and cultural aspects of teamwork and staff morale have strong influences on perception of residents. Attempts to improve staff attitudes should focus on creating organizational cultures that promote high morale and collaboration of all members of the nursing staff., There is an increasing awareness and discussion of issues at the end of life, including the concept of advance care planning (ACP). ACP is a process through which older adults with capacity can plan in advance for their preference for care if they become incapable of making decisions for themselves. While ACP is important to all older adults, irrespective of age or health status, it is of particular salience for those with diagnosed cognitive impairment. The current study aims to provide the first step in understanding reasons cognitively impaired older adults choose to engage in aspects of ACP by exploring ACP as a multi-component complex process. The purpose is then to explore not only which aspects of ACP occur in families of cognitively impaired older adults, but also the reasons why these decisions are made. The specific research questions are: 1) When and how do cognitively impaired older adults and their families receive information about ACP and its relation to cognitive impairment? 2) In which aspects of the ACP process do they engage, and why? and 3)What is the role of ACP in family members’ perceptions of the deceased’s quality of death? Interpretive description (ID) will be used as the method of analysis in the current study as it addresses the limitations in traditional schools of qualitative analysis (Thorne, 2008). A key tenant of this approach involves grounding the research in both the literature as well as the practical knowledge gained from experience. The ID method focuses on practical applications, particularly the clinical utility of research to guide best practice. Family members of deceased older adults who were cognitively impaired prior to death will be recruited for one of four stages of data collection. In stage 1, 10 participants will engage in individual interviews with open-ended questions to address the research questions. Data collection and analysis will occur concurrently with the principle investigator immersing herself fully in the data and looking for broad themes as a first step in the analysis. These initial themes will be presented to two focus groups, each with 4–6 participants, who will provide feedback on these themes based on their experiences in order to illuminate aspects of this complex topic that may not have been explored through the initial individual interviews. Feedback from these focus groups will be used to create additional probes used in stage 3, which will consist of individual interviews with 10 new participants. Throughout this process, data analysis is inherently flexible, allowing for shifting of data construction and an openness to changing themes as new understandings of relationships are elicited. The final stage of data collection will involve 2 more focus groups (4–6 participants) where participants will be asked to discuss their reactions to the themes brought forward by the principle investigator to further refine these relationships. Finally, constant comparative analysis will be used to compare each identified theme with all the other themes to identify commonalities and patterns (Glaser & Strauss, 1967)., We all know an elderly friend or relative who has broken a hip or an arm after a fall on ice or snow. This winter was particularly treacherous in North America. Even the elderly who avoided a fall likely felt confined in their own homes for long stretches. Falls and the inactivity resulting from the fear of falling both lead to dramatic declines in the health of older adults each winter. At Toronto Rehab we are developing better footwear in WinterLab by testing on real ice and snow. We can tilt this lab to measure the maximum angle that someone can walk up, across, and down a wintery slope. The results show remarkable repeatability and can distinguish between the performance of footwear with much greater certainty than existing methods. Our results can be surprising. While most good winter footwear manages slopes up to about 7°, one undistinguished smooth boot enabled us to walk up and down 18° slopes on wet ice! The winter footwear slip resistance testing program at Toronto Rehabilitation Institute aims to reduce instances of slips and falls in older adults. Our objectives are to: improve winter footwear slip resistance standards;test, classify and develop an easy to understand labeling system for consumers so they can select the best performing footwear;develop new materials and designs for high performance winter footwear. Current winter footwear slip resistance standards rely on measuring the force required (coefficient of friction) to drag a fixture-mounted shoe across an ice surface. Our testing has shown that user-worn shoe testing based on real users walking up ice slopes is a more ecologically valid approach as it involves a subject’s natural gait cycle and biomechanics. This is particularly a concern when selecting winter footwear for older adults as their balance abilities and reaction times are severely impaired. We are also exploring new materials and design strategies to improve the slip resistance of winter footwear with the aim of developing universal footwear for indoor use on hard tile surfaces and outdoors on snow and ice. We have developed a new rubber compound that is a hybrid of a soft rubber and a hard fibrous phase, and which according to preliminary testing possesses a three times greater coefficient of friction on ice than other similar compounds. This material grips ice similar to metal cleats, but remains soft and flexible for use on hard tile indoor surfaces. Our work considers the design of optimal tread patterns on winter footwear, and we use 3D printing technology for fast and iterative slip resistance testing of evolving tread patterns. The knowledge generated from these activities will increase awareness regarding winter issues facing older adults and provide solutions to these issues through winter footwear testing and design. Addressing these issues is essential now more than ever due to our nation’s shifting demographics and the pressing need for older adults to remain physically active in all seasons as they age., Background: Health-care providers at Canadian long-term care (LTC) homes provide care to older adults with significant illnesses, and functional and cognitive decline. They need to be able to identify changes in residents’ health and functional statuses in order to promote comfort and provide appropriate interventions. The Palliative Performance Scale (PPS) (version 2) is a tool widely used by palliative care and other clinicians to assess and communicate the functional status of their patients, according to five key criteria. However, this tool has not been tested or evaluated in the LTC home setting. Objectives: To help determine the PPS’s suitability in the LTC home setting, the objectives of this project are to: 1) test the interrater reliability of the PPS between licensed nurses and personal support workers; 2) collect stakeholder feedback on the use of the PPS; and 3) develop and refine approaches to integrate the PPS assessment and educational components into an electronic documentation program. Methods: To learn more about the use of the PPS, a review of the academic literature was performed using five databases (PubMed, Web of Science, Cumulative Index to Nursing and Allied Health, Ageline and MEDLINE) with the key words, Palliative Performance Scale. To test the interrater reliability of the PPS, it was determined that (n = 5) personal support workers and (n = 5) licensed nurse raters will need to assess 52 residents’ PPS scores to obtain an intraclass correlation of .8. To obtain stakeholder feedback, using a qualitative descriptive approach, semi-structured interviews will be conducted with clinicians, family members, and residents. The interview questions will focus on learning about the PPS’s potential use in LTC home practice, and any facilitators and barriers to using the tool in this setting. To integrate the PPS into practice, key individuals from the LTC home setting who are responsible for overseeing the electronic charting and documentation will be invited to participate in a working group to develop and refine PPS policy and procedures. Preliminary Findings and Next Steps: A search of the literature returned 1020 articles published in English, between 1996 and August 2014. After accounting for duplicates, 633 articles were identified. Titles and abstracts were screened for an inclusion of the tool. Of the articles that included the PPS, the main themes in the literature included: using the PPS for survival or mortality prediction, evaluating psychometric properties, describing characteristics or personal factors of a study sample, and triggering palliative care interventions. Following clearance from McMaster University’s review board, the project will commence. Conclusions: The results will be important, if supported by the study, in encouraging the widespread, consistent use of the PPS in LTC homes. The use of the PPS will ultimately create opportunities to dialogue about palliative and end-of-life care interventions with dying residents and family members., WHAT: This project focuses on the creation of digital stories by older adults with mental illness and dementia and the impact of these stories on health-care providers. WHY: Ageism and stigma of growing old with mental illness continue to permeate society and the healthcare experience. Dominant (mis)conceptions about the abilities of older adults, in particular those living with mental illness and dementia, shape the experience of aging with mental illness. Digital storytelling is a person-centred process that builds on the values of maintaining personhood and preserving dignity—key tenets in the culture of person-centred care for older adults. Use of social-contact-based interventions has been identified as key ingredient in reducing stigma. Empowering older adults with serious mental illness, particularly older adults with dementia, to engage with technology and develop digital stories also challenges dominant concepts of ageism and stigma as it relates to aging with mental illness. HOW: Project Re•Vision is a mobile multi-media lab and expressive arts institute led by Dr. Carla Rice at the University of Guelph, dedicated to exploring ways that arts-informed research can work with communities to advance social inclusion and justice by challenging stereotypes. Project Re•Vision has successfully developed methodologies for accommodating people with diverse disabilities and difference including physical, mental, and intellectual difference, enabling them to tell their stories and impact others through digital media. Re•Visioning Aging builds on the success of Project Re•Vision by bringing arts-based research to seriously ill older adults and their families. This research will explore the value of digital stories developed by older adults with mental illness/dementia and understanding how they influence healthcare providers and trainees. Specifically we seek to answer the following questions: Does engagement with the digital storytelling process change older adults and provider perspectives on growing older with mental illness?Do changed perceptions influence clinical practice by enhancing the capacity of providers to communicate and share decision making with older adults?What is the potential of health providers’ engagement with digital stories to inform and enhance their attitudes, responses, and clinical competencies in interactions with those aging with mental illness? Is there a relationship between ageism and stigma?Can original arts-based digital stories be used to complement the education and training of providers and trainees working with older adults with mental illness?Can original arts-based digital change providers’ feelings towards the elderly or beliefs/attitudes about mental illness?, This research Fellowship will examine and evaluate Canada’s systems of laws governing caregiving leaves as relates to a very seriously ill elderly population. This research is important in determining the effectiveness of these laws in order to ensure that the seriously ill elderly population is provided with the option of informal family caregiving assistance where possible and appropriate. Laws associated with caregiving leaves have historically been available to family members or close relations on only a short-term and episodic basis, and are a mix of provincial and federal jurisdiction. They are often seen as confusing, and may not meet the needs of either the caregiver or care recipient. Canadian caregiving leave laws were not been developed with a Lifecourse perspective, nor an aging population in mind. Rather, what they reflect is a stop-gap support for short episodic leaves from paid work often to provide for acute care supports or to assist children, or to support a person within their last 26 weeks of life. This research will evaluate how effective, usable, and appropriate Canadian caregiving leave laws are for the modern reality of providing care to our increasingly oldest old, frailest frail, and seriously ill aging populations. It can no longer be assumed that, because an adult is very old and seriously ill, they will be at “end of life” within 26 weeks. Rather, it is the new reality that older people with significant health concerns are living longer and the current care leave laws may not fit the needs of Canadians. This interdisciplinary work will integrate research on law and policy, ethics, aging, geriatric care, home, and institutional care, as well as palliative care issues. The research will also consider issues of ethno-cultural and sociological issues associated with aging, care provision, and gender roles. Outcomes of this project will include knowledge mobilization tools and strategies for older adults, caregivers, and allied health professionals. A further key outcome will recommendations for law reform, as appropriate, to inform government and Canadian law reform commissions on possible changes to legislation and policy related to caregiving leaves., Background: Hip fractures are a common source of pain and related morbidity among the frail elderly. One technique that has been shown to adequately manage pain in this population is the femoral nerve block. However, it is not currently employed routinely in Alberta emergency departments. Objective: The first objective was to systematically review the recent literature around the use of femoral nerve blocks to manage acute pain among older adults with a hip fracture. The second objective was to survey physicians about the potential barriers to routinely performing femoral nerve blocks in the emergency department. Materials and Methods: Searches of MEDLINE, EMBASE, and the Cochrane Trials database were conducted between 2010 and 2014 to identify randomized control trials examining the use of femoral nerve blocks in the ED to manage acute hip fracture pain among older adults (65 years of age and older). The reference list of a previous systematic review published in 2011 was also searched. The results of the systematic review were used to inform the development of the barrier survey. The questions were structured using Michie’s twelve theoretical behaviour domains and the Behaviour Change Wheel. The survey was distributed to physician members of the Alberta Emergency and Bone & Joint Strategic Clinical Networks. Results: Seven randomized control trials were included in the review. Four studies employed a single femoral block, while three employed continuous (catheter placed) femoral blocks. All of the studies reported statistically significant reductions in pain. All but one study reported that patients treated with femoral nerve blocks consumed significantly less rescue analgesia. Finally, there were no significant adverse effects reported with the femoral block procedure, and multiple studies found a decreased risk of respiratory and cardiac events. Surveys are still being collected and evaluated. The results of the barrier survey will be mapped against the Behaviour Change Wheel to help determine the most effective knowledge translation strategies to employ to increase the use of femoral nerve blocks in Alberta emergency departments. Conclusions: Femoral nerve blocks appear to have benefits both in terms of decreasing pain and limiting the amount of systemic opiods administered to frail older adults experiencing a hip fracture. The results of this review and the barriers survey will help inform the development of knowledge translation strategies to increase the routine use of femoral nerve blocks., Background: Hip fractures in the elderly are a common problem associated with morbidity, mortality, and increased health-care costs. The hip fracture patients on the orthopedic service at Mount Sinai Hospital are complex and pose challenges to the surgical team to coordinate and manage their acute medical issues. The literature suggests that a co-management model with hospitalists or geriatricians may improve staff satisfaction and reduce costs. Therefore, a co-management clinical service was established to address gaps in care for the hip fracture patients. The objective of this study is to examine the effects of the hip fracture co-management service on patient outcomes, quality indicators, and appropriate resource utilization. Setting: Mount Sinai Hospital, an academic medical centre with orthopaedic inpatient units. Population: Geriatric patients admitted to MSH with hip fractures after 2011 with appropriate historical controls. Study Design: Retrospective, before-and-after cohort study. Data Collection: Covariate and outcome measures collected through electronic and paper chart reviews. Results: Preliminary data analysis demonstrates a positive impact on outcome measures of the co-management service. The average length of hospital stay for hip fracture patients decreased by 20% following the implementation of the co-management model of care. There was also a reduction in the in-hospital mortality rate and hospital acquired infection rate. The post-operative delirium rate was the same for both conditions. Preliminary analysis demonstrates a reduction in the time required for patients to get to the operating room and higher rates of osteoporosis treatment initiation post hip fracture. Important predictors of negative outcomes among elderly patients with hip fractures include advanced age, male gender, and co-morbid diseases. In this study, male patients had a longer hospital stay than female patients. Patients with increased co-morbidities and advanced age have a decreased chance of 10 year survival and a longer length of stay. A functional status score of 4 or below, which is indicative of moderate to severe functional impairment, correlates with increased length of stay. Conclusions: The preliminary results of the study are encouraging and suggest the intervention may improve patient outcomes and reduce post-operative complications. This novel model of care can has significant impact on improving healthcare efficiency and the quality of care of hip fracture patients. Implementation of this model has potential to improve coordination of care among health-care professionals and may be generalizable to other patient populations undergoing urgent procedures or surgeries., Background: Current literature provides evidence for the beneficial effects of physical and mental activities on cognitive functioning of older adults at risk of cognitive decline. In fact, according to existing epidemiologic studies, there is little dispute that type-2-diabetes (T2D) is linked to cognitive impairment. 2011 World Alzheimer report outlines the importance of providing routinely individualized cognitive stimulation programs as a part of care for older Canadians. Emerging health technologies, including mobile health (mHealth) via smartphones, have shown promise in extending the reach of preventive and management solutions for patients with cognitive impairment. Currently, however, there is a lack of consistency in the application and availability of cognitive training in geriatrics. This research group has developed the HealtheBrain smartphone application which is currently available on the Apple App store for iPod touch 4+, iPhone 3GS+, and iPad 2+. The HealtheBrain smartphone application aims to provide an easily accessible mind-motor exercise program known as Square-Stepping Exercise (SSE) developed by Shigematsu and Okura (2005). The SSE task uniquely challenges participants to utilize their memory and balancing skills as they watch, recognize, memorize, and executefollow step patterns demonstrated on a 4 by 10 square-patterned floor mat (in-person program) or diagram (smartphone application). Preliminary evidence indicates that the mind-motor exercise program leads to improvements in verbal learning and memory, as well as verbal fluency and overall global cognitive functioning, in community-dwelling older adults without dementia, diastolic blood pressure, and fitness (Gill et al., 2014). Objectives: The aim of this study is to develop, implement, and evaluate the HealtheBrain smartphone application. Methods: Two samples (7–8 participants in each) of community-dwelling T2D older adults who previously consisting of those who have completed a an previous aerobic and cognitive exercise study with our group (including both participants who are and and those who are not experienced with mind-motor exercise programs) will be recruited. Both samples of participants will be asked to use the HealtheBrain smartphone application for two weeks. Following this two-week period, participants will complete a 25-item questionnaire, intended to evaluate the feasibility, utility, value, and design of the HealtheBrain smartphone application. Bivariate zero-order Pearson correlations and independent sample t-tests will be performed on the pooled data to determine general linear relationships. Cronbach’s reliability alphas will be used to assess internal consistency of the questionnaire. Thematic analysis will be used to interpret participants’ responses to short answer questions. Anticipated Results: It is anticipated that the cognitive exercise smartphone application will receive positive feedback from the T2D patients. Additionally, the questionnaire will provide the investigators with valuable feedback about design features of the smartphone application. Significance: Findings from the questionnaire will establish grounds for a HealtheBrain smartphone application pilot study, which will determine the efficacy of mobile health technology in T2D as assessed by global cognitive functioning, specific cognitive domains (memory, reasoning, concentration and planning), mobility (balance, falls self-efficacy), and vascular outcomes. The smartphone application will extend the reach of the mind-motor exercise program to underserved populations in rural communities with limited transportation options and limited access to exercise programs. Overall, these studies will take us a step closer in building and implementing evidence-based mHealth mind-motor exercise mHealth programs to prevent life-limiting illnesses., Objectives: To determine: 1) compliance with use of validated delirium screening tools in hospitalized older patients; 2) use of non-pharmacological and pharmacological interventions for delirium management. Design: Retrospective chart review. Setting: Single tertiary care hospital. Participants: We included patients aged ≥ 65 years admitted to four medical units—Acute Care for the Elderly (ACE) unit, ICU, one general medicine unit, one orthopedic surgery unit for hip fractures— for ≥ 48 hours during seven time blocks between September 1, 2010 to October 31, 2013. Patients admitted or discharged from the unit outside of these time blocks and patients with documented palliative status were excluded. Measurements: Compliance with delirium screening was determined 1) within 24 hours of admission, or 2) at any point after the first 24 hours before discharge. This was used to calculate incidence of both delirium on admission, and hospital-acquired delirium. Further, use of nonpharmacological and pharmacological delirium practices were evaluated. Non-pharmacological practices included use of physical restraints, mobilization, and removal of devices, such as catheters. Pharmacological practices included changes in subject’s medication regimens, such as reduction of polypharmacy, initiation of medications used to manage delirium, and discontinuation of medications that are thought to contribute to delirium. Results: At the time of abstract writing, the study population (n = 315) consisted of a mean age ± standard deviation of 78 ± 8.6, 52.1% female. Delirium screening was completed for 60.6% of patients within the first 24 hours of hospital admission; 73.7% had delirium screening at any point after the first 24 hours before discharge; 82.5% of patients were screened at least once within 24 hours or after the first 24 hours. The average total screening compliance was calculated using number of days subjects were screened with a validated delirium screening tool, physician progress notes or consult notes, divided by total days admitted to the unit of interest, yielding a rate of 56.9%. Of the 315 subjects, 27.9% had a positive delirium screening at some point during their hospital stay. Of these, 69.3% developed delirium while in hospital; 30.7% were already delirious upon admission. The most common non-pharmacological practices used in patients who were screened positive for delirium were mobilization (64.8%), use of physical restraints (27.2%), and removal of urinary catheters (10.2%). Pharmacological practices most commonly initiated include use of antipsychotics (28.4%) and benzodiazepines (12.5%). Conclusions: An increase in delirium screening rates and a decrease in delirium incidence could be monitored as a quality of care indicator for hospitalized older patients. The results of this chart review indicate that there is room for improvement in terms of better optimization of screening to ensure early delirium detection and appropriate management throughout hospital stay in the older adult population., Background: Providing appropriate end of life care for all population groups requires health-care professionals to be culturally aware and have the ability to understand, appreciate, and interact with persons from cultures and/or belief systems other than their own. Unfortunately, this level of cultural safety does not occur for many indigenous peoples as they must leave their communities to receive end of life care in unfamiliar care systems. Purpose: For the purpose of this study, the results of previously completed qualitative studies were synthesized to enhance the overall depth and breadth of understanding of the diverse experiences of indigenous peoples at the end of life. Methods: This studied utilized the metasynthesis procedures outlined by Sandelowski and Barroso (2007) to synthesize the qualitative research studies on the end of life experiences of indigenous peoples. A total of 2255 articles were obtained; of those 18 articles fit the inclusion criteria. These 18 articles were appraised for quality using the Critical Appraisal Skills Program (CASP) scoring system and the classification of findings outlined by Sandelowski and Barroso (2007). SPSS was utilized to descriptively analyze the results of the CASP scores and study demographics. The reported findings from the chosen articles were entered into NVIVO 8 software for qualitative analysis. Synthesis of the findings was achieved using taxonomic analysis, constant target comparison, and reciprocal translation in conjunction with team meetings. Findings: A total of 447 individuals from Australia, Canada, Japan, New Zealand, and the United States participated in the included studies. Although diverse spiritual perspectives exist amongst indigenous peoples the relationship between the “inner being” and the body was viewed as the vital to health. As the pains of life were encountered, the “inner being” was set out of balance or fragmented. Although restoration of balance was attended to throughout life, at the end of life this became a priority. To prepare the “inner being”, three strategies were identified: healing, connecting, and protecting. It was through these preparations that individuals obtained what they viewed as important at the end of life which included: to be at peace, to be healed/renewed, to feel safe and comforted, and to feel strong for the journey ahead. Such preparations often occurred whilst receiving end of life care. This care was described to have the potential to both enable and retract from preparations at the end of life. The degree to which this care respected the indigenous person’s view of health and enabled their unique preparation for death, determined overall satisfaction and quality of life. Implications: The findings are clear for health-care providers and policy makers that end of life care must be restructured to better support indigenous peoples in their preparing of the “inner being” through healing, connecting, and protecting. These findings also contribute to closing literature gap on the end of life experiences of indigenous peoples. Future research may build on these findings by exploring the experiences other indigenous groups not represented here, such as those from the continent of Africa., Introduction: We sought to study whether muscle mass at admission to the intensive care unit (ICU) is predictive of overtaking among elderly critical care patients. Methods: 78 patients over the age of 65 admitted to the ICU at an academic hospital between April 2013 and May 2014 were included in the study. Inclusion criteria were if the patients were over the age of 65 at admission and had a computed tomography (CT) scan of the abdomen two days prior or seven days after admission. Exclusion criteria included presence neuromuscular disease or a CT scan of poor quality. Muscle area at the third lumbar vertebrae was determined by using a specialized computer program (Slice-O-Matic). This area is a validated measurement that corresponds with overall body muscle mass. Results: Muscle area is a predictor of mortality in the elderly ICU patient. The association between muscle area and mortality was significant before (p = .036) and after controlling for severity of illness (APACHE II score), age and sex (p = .033). Discussion: Low skeletal muscle mass during the early stages of critical illness is predictive of mortality in elderly critical care patients. This holds true after controlling for severity of illness, age, and sex., Introduction: Ventilator-associated pneumonia (VAP) is a lung infection that affects 10%–25% of patients in the Intensive Care Unit (ICU). PROSPECT (Probiotics: Prevention of Severe Pneumonia and Endotracheal Culture Trial: a Pilot Trial) is currently underway to assess the feasibility of a larger trial of probiotics to prevent VAP and other infections. In conjunction with the PROSPECT Pilot Trial, we conducted a survey of ICU pharmacists. Objectives: To assess Canadian ICU pharmacists’ attitudes toward the use of probiotics in critically ill patients; secondary objectives were to evaluate their knowledge and self-reported use of probiotics for critically ill patients. Methods: We surveyed pharmacists providing care to ICU patients in Canada. The survey instrument was rigorously designed according to previous guidelines. Following a literature review, a preliminary version of the survey was generated. This version was pre-tested by experts in the areas of survey development, natural health products, and/or critical care. Pilot and reliability tests of English and French versions of the survey were conducted by 5 ICU pharmacists (3 English and 2 French). Possible respondents were identified by telephoning inpatient pharmacies of all Canadian hospitals known to have ICUs. Of 356 total pharmacists identified, 9 were excluded due to participation in survey development, 12 could not be reached to obtain their email address, and 10 declined to provide one. Following an electronic announcement by the Canadian Society of Hospital Pharmacists, the final survey was distributed via email to 325 Canadian ICU pharmacists. The French version was sent to pharmacists in Quebec, and the English version to all others. Three waves of follow-up will occur via email at one, two, and three weeks after the first distribution. The survey will close after 5 weeks. Results: At the time of abstract writing (after the first follow-up email), 137 pharmacists had responded to the survey (42% response rate). Of these, 70% said probiotics were available in their institution, and another 6% indicated availability only under certain circumstances. 80% of respondents stated that they would “never” recommend probiotics for VAP prevention in critically ill patients, while 61% said they would “never” recommend them for prevention of C. difficile infection. 6% believed that probiotics are “definitely safe” for VAP prevention, while 34% were “unsure”. 56% of respondents accurately estimated the cost of a daily dose of probiotics as less than $5, and 65% indicated that they had used probiotics for at least one patient in the last year (in any formulation, for any purpose). However, 73% identified the “absence of written guidelines or protocol” as a barrier to usage of probiotics in their ICU practice. Conclusion: Preliminary survey results indicate that probiotics are available in most institutions and that the majority of Canadian ICU pharmacists have used probiotics for patients in the last year. However, most pharmacists do not recommend them routinely for prevention of VAP in critically ill patients., Background: Well-conducted clinical trials are essential for improving current standards of care and introducing new methods of therapy for critically ill patients. Previous research documented that older patients were less likely to be enrolled in critical care clinical trials (Cooke et al., 2010). The primary objective of this substudy was to determine if the consent rate for older adults (> 60 years) was different than younger adults in the TryCYCLE study (a prospective pilot study of the safety and feasibility of early cycle ergometry in mechanically ventilated (MV) adult patients). Our secondary objective was to determine if the consent rate was different for consent given by a patient versus a substitute decision maker (SDM). Methods: We analyzed data for the first 35 consent encounters in TryCYCLE at St. Joseph’s Healthcare, Hamilton. Patients were eligible for TryCYCLE if they were invasively MV for ≤ 4 days, within their first week of ICU admission and able to ambulate independently pre-hospital. Research personnel approached eligible critically ill patients or their SDM for informed consent. We collected demographic data on all eligible patients approached for consent and reasons for declining consent, and hypothesized there would be no difference in consent rates between older and younger adults. Additionally, we hypothesized that there would no difference in consent rates between consent given by patients and SDMs. We used Fisher’s exact test to determine if there was a significant difference in consent rates. Results: Between October 28, 2013 and July 25, 2014, we approached 35 eligible patients or their SDMs for informed consent. The mean (standard deviation) age of eligible patients was 66.9 (11.9) years, and 17 (48.6%) were female. Our overall consent rate was 31 (88.6%). The consent rate for older versus younger patients was 20 (83.3%) and 11 (100%), respectively (p = .285 for the difference). The consent rate for patients versus SDMs was 7 (100%) and 24 (85.7%), respectively (p = .562 for the difference). Reasons for declining consent included: concern for Achilles tendon rupture (n = 1), lack of interest by SDM (n = 1), impression that the patient would not enjoy cycling (n = 1), and unknown (n = 1). Conclusions: Based on preliminary data, we found no difference in the consent rates between older and younger critically ill adults for this early rehabilitation trial. Twenty percent of patients provided first person informed consent. We also found no difference in consent rates between patients and SDMs approached for this study. Our results demonstrate that older adults are equally as likely as younger adults to consent to an early in-bed cycling study for critically ill, mechanically ventilated adults. As this research program expands to a multi-centre randomized pilot study, our preliminary results underscore the feasibility of recruiting both older and younger critically ill patients to an early rehabilitation study., Background: Quality care at the end of life is about achieving the goals of the patient, as well as supporting caregivers. In Southeastern Ontario, two interventions—an advanced care planning tool and symptom response kits—were implemented to enhance and maintain quality care of terminally ill patients at home. These interventions are being evaluated to determine their impact on place of care and place of death. Additional evaluation is needed to determine family caregivers’ perceptions of these interventions in the context of publicly-funded home care services. Aim: To determine the most appropriate method of assessing the quality of palliative home care from the perspective of family caregivers. Methods: A scoping literature review was conducted using the York framework. 47 peer-reviewed articles were identified from the MEDLINE, CINAHL, EMBASE, and Health and Psychosocial Instruments databases. A numeric analysis of common approaches used to ascertain perceptions of palliative home care was performed by the first author. Themes emerging from the numeric analysis were then mapped onto the “Seven key benefits for individuals and families” identified in the Ontario Ministry of Health and Long-Term Care’s 2011 policy document, “Advancing High Quality, High Value Palliative Care in Ontario”. Gaps in the literature were identified. Results: 41 articles were published since 2000 and reflect a diversity of palliative care interventions delivered at home. Six studies were conducted in Canada; 4 in Ontario. 83% of the studies used qualitative approaches, relying primarily on face-to-face interviews with a small number of caregivers. More than two-thirds of studies took place before the patients died, of which only three included follow-up after death. Studies were typically broad in scope, asking questions about satisfaction, expectations, and positive and negative aspects of palliative home care. Of the seven benefits, “individual and/or family member engagement in care” and “keeping patients and families fully informed” were most commonly raised by patients and family caregivers. In contrast, the benefits of “inter-professional teams” and “consistency of staff/services” were rarely mentioned. Additional themes that did not map onto the seven benefits included staff competency, symptom control, and caregiver support (emotional and practical) pre- and post-death. Discussion: The methods used in assessing patients’/family caregivers’ perceptions of palliative home care varied, depending on the intervention under study and the level of detail sought. The nature of the intervention tended to guide the selection of particular benefits on which the evaluation was focused. The seven benefits identified by Ontario’s policy document do not fully encompass all that patients/caregivers value; other issues need to be included when evaluating palliative home care interventions. These preliminary results will be confirmed by having co-authors independently review selected papers. Conclusion: Evaluation of palliative home care interventions should include all seven benefits in addition to other important themes identified. The methods used should be adapted to the context, and should take into consideration relevant methodological challenges. When evaluating the two Southeastern Ontario interventions, we recommend developing a standardized, self-administered questionnaire for increased representativeness, followed by an in-depth, face-to-face interview guide for increased understanding., Population aging is placing extensive pressure on home care programs to provide the necessary services for complex care clients to remain in their homes and avoid institutionalization or hospitalization. Finding innovative and cost-effective ways of meeting the health-care needs of older adults and the health-care workers who support them is becoming a press-ingly urgent issue. Assistive in-home technologies, such as tools for fall prevention and medication management, have been demonstrated to positively affect health outcomes and the quality of life of autonomous older adults living in the community. This literature review identifies technologies that may improve home care of frail older adults, while reducing caregiver stress through comprehensive examination of current literature in the field of “gerontechnology.” Past research has demonstrated assistive technologies are beneficial in retaining elder independence while reducing risk of falls, medication errors, and caregiver burnout. The findings of this review highlight how technologies are currently integrated into home care and how the health-care system can better include these assistive tools in the care of community-dwelling older adults.

The opinions expressed in the abstracts are those of the authors and are not to be construed as the opinion of the publisher (Canadian Geriatrics Society) or the organizers of the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society. Although the publisher (Canadian Geriatrics Society) has made every effort to accurately reproduce the abstracts, the Canadian Geriatrics Society and the 32nd Annual Scientific Meeting of the Canadian Geriatrics Society assumes no responsibility and/or liability for any errors and/or omissions in any abstract as published., Objectives: To identify current practices and care gaps for elderly patients admitted following a hip fracture, and to characterize patients’ patterns of functional recovery over 1-year. Relevance Increased awareness of existing gaps and improving our understanding of patients’ recovery can help optimize patients’ outcomes. Methods: Forty community-dwelling participants with an osteoporotic hip fracture (≥ 65 years) were recruited and followed over 1 year. Patients were divided according to their pre-fracture mobility: low, medium, and high. Recovery was defined in two ways: “traditional definition” based on return to pre-fracture mobility, and “acceptable” based on ability to do stairs. Statistical analysis: Single-subject design approach for analyzing small samples was used to identify sources of variability in recovery over time. Results: Some gaps in services received during hospitalization and at the time of discharge were: (i) 63% had a surgical delay > 48 hours; (ii) > 75% had inadequate osteoporosis management; and (iii) only 35% had a home visit within 1 week of returning home. Using the traditional definition for recovery: 80%, 52%, 33% recovered from the low, medium, and high baseline groups, respectively; 40%, 43%, 33% maintained this recovery up to 1 year. Using the definition for acceptable recovery, 20%, 43%, 71% recovered, respectively, and 10%, 38%, 57% maintained the recovery. Patients generally lost functional improvement between 6–12 months, following waning of rehabilitation services. Conclusion: Despite the plethora of guidelines specifically for osteoporosis management following hip fracture, gaps exist in care practices across the continuum. The extent of recovery depended on the definition however, after initial improvement, the majority of patients deteriorated after 6-months. A booster rehabilitation program is indicated., The language of aging is burdened with history. In this presentation, I consider “the grey tsunami”: a charged metaphor that has been urgently deployed over the past decade to describe the socio-economic threats posed by population aging. As a research associate in geriatric medicine and a PhD candidate in English Literature, I apply methods of literary analysis to interpret “the grey tsunami” as a timely example of interdisciplinarity’s darker side: specifically, how the overlapping language and textual practices of popular journalism, health policy, and literature co-operate to engender an ideologically-loaded, ageist metaphor masquerading as self-evident fact. My paper presents a concise and synthetic overview of the veiled meanings implied by “the grey tsunami” by conducting close readings of this term as recently employed by influential health agencies and organizations (e.g., CIHR, Alzheimer Society of Canada). I propose that the implications of this contemporary metaphor can be traced back to the mid-nineteenth century, when Western medical advances first made possible the reality of an aging population. I show that the deepest anxieties about population aging actually took shape in numerous poems and novels of that period—by esteemed authors including Matthew Arnold, Alfred Tennyson, Charles Dickens, and Anthony Trollope—which depicted society as morbidly “burdened” by an unprecedented, overwhelming, elderly mass. By charting the as-yet unexamined conceptual history of “the grey tsunami”, I aim to demonstrate how literature and the humanities—often viewed as a preventive measure against societal ageism—can also serve to legitimize prejudice toward older persons., Background: Frailty is characterized by increased vulnerability for falls, fractures, institutionalization, and death. Several models for identifying frailty have been developed, including Fried’s widely accepted Frailty Phenotype Index (FPI). However, the FPI can be time-consuming and difficult to apply in clinical practice due to the requirement of hand grip and gait measurements. Alternatively, a nine-category Clinical Frailty Scale (CFS), ranging from 1 (“Very fit”) to 9 (“Severely Frail”), has been proposed based on clinical information and physical exam. The CFS, to date, has not been validated against the FPI. We aimed to test the agreement between the FPI and CFS in identifying seniors with frailty in the community. Methods: 109 community-dwelling seniors, aged ≥ 75, were classified as “not frail”, “pre-frail” or “frail” using the FPI. Subsequently, two clinicians, blinded from the first assessment, determined frailty status in each participant using the CFS and differences in scoring were resolved by consensus. Inter-rater reliability was assessed using kappa statistics. Gamma Correlation coefficients compared CFS frailty status to FPI components in individuals. Results: Analysis of kappa statistics showed a substantial agreement among raters in applying the CFS (κ = 0.76, 95% CI = 0.68, 0.84). The CFS was positively correlated with an increasing number of FPI frailty components., Objectives: The Vitamin D in Osteoporosis (ViDOS) study is a knowledge translation intervention to increase best practices for osteoporosis and fracture prevention in long-term care (LTC), particularly widespread use of vitamin D supplementation. Methods: ViDOS is a cluster randomized controlled trial underway in 40 LTC homes (n = 19 intervention, n = 21 control) across Ontario, Canada. Using baseline data on demographic, medications, and disease conditions collected from the pharmacy database, we evaluated vitamin D and calcium use for all residents in the study, and bisphosphonate use in high-risk residents (documented osteoporosis and/or a prior hip fracture). Results: 5,409 residents (71% women, mean age = 82.8 [SD 10.8]) were included. 87.5% of the homes are for-profit. The mean number of beds in the homes is 142 (range 43–378) with an average of six treating physicians per home. At baseline, 40% of all residents were taking Vitamin D (≥ 800 IU/day) and 33% were taking calcium (≥ 500 mg/day). Of 760 (14%) residents with documented osteoporosis, 62% were taking vitamin D and 51% were on a bisphosphonate. Of 351 (6.5%) residents with documented hip fracture, 58% were taking vitamin D ≥ 800 IU/day and 35% a bisphosphonate. Conclusions: At baseline, 60% of residents were not taking adequate amounts of vitamin D. Vitamin D and bisphosphonate use was higher in high-risk residents but was still sub-optimal. Identification of osteoporosis and fractures is essential to initiating appropriate treatment and preventing future fractures. Our analysis revealed a care gap in the recognition of residents with osteoporosis and prevalent hip fracture., Background: Aging is often associated with a gain in fat mass and loss of lean tissue, mainly muscle, which has been related to insulin resistance. Dietary protein intake is considered an easy approach to combat loss of muscle mass, but contrarily to plant source of proteins, animal proteins may increase the risk of insulin resistance. Objective: To elucidate the complex interrelationships of dietary protein intake, muscle mass, and insulin resistance. Methods: 441 non-diabetic, 68- to 82-year-old men and women of the Quebec Longitudinal Study NuAge with complete datasets. Muscle mass index (MMI; kg/height in m2) and percent body fat were derived from DXA and BIA. Insulin resistance was based on the HOMA-IR, physical activity on the PASE questionnaire, and protein intake and sources on three non-consecutive 24-h food recalls. Path analysis of a proposed model including age, sex, number of chronic diseases, and smoking served to identify if our theoretical causal pathway fitted with the data. Through several fit statistical indices, we attained a final model. Results: Significant, direct positive associations were observed for HOMA-IR with MMI (β = 0.42; 95% CI: 0.24; 0.6) and % body fat (β = 0.094; 95% CI: 0.07; 0.11), and for physical activity with muscle mass (β = 0.0028; 95% CI: 0.001; 0.004), but not for animal protein intake with MMI (β = 0.019; 95% CI: −0.006; 0.044) or HOMA-IR (β = 0.092; 95% CI: −0.03; 0.048). Significant, direct negative associations were observed for plant protein intake with MMI only (β = −0.068; 95% CI: −0.13; −0.003), and for physical activity with fat mass (β = −0.01; 95% CI: −0.021; 0.0). Significant, indirect associations were observed negatively for plant protein (xb = - 0.07; 95% CI: - 0.1; 0.0), and positively for animal protein (β = 0.0321; 95% CI: 0.01; 0.05) with HOMAIR mediated through MMI and fat mass. Our final model fitted with our data (Chi-Square = 4.83). Conclusions: Interestingly and contrarily to expectations, muscle mass and HOMA-IR were positively associated in these elderly participants. Results suggest that plant protein is beneficial for reducing insulin resistance but at the expense of muscle mass loss, whereas the reverse stands for animal protein. Physical activity has significant beneficial effects in body composition. These findings can shed some light on the directions to promote healthy aging through optimalization of protein diet and physical activity. (Supported by CIHR), Introduction: Mild cognitive impairment (MCI) is a heterogeneous condition affecting up to 40% of seniors. Almost a third with MCI will progress to dementia. Similarly, gait abnormalities, depressive symptoms, and executive dysfunction are commonly found in seniors, and this “triad” has been linked with brain ischemic lesions. To date, the presence of such a “triad” and its relationship with vascular risk factors (VRF) has not been described in MCI. We hypothesized that seniors with MCI who have high VRFs will be more likely to exhibit the “triad” of gait abnormalities, depressive symptoms, and executive dysfunction. Methods: Baseline data from 62 participants of the “Gait and Brain Study”, an ongoing prospective cohort of seniors with MCI at London, Ontario, was used for this project. Biannual assessments include executive function test (Clock Drawing and TMT B), quantitative gait analysis (velocity), and depression ratings (Geriatric Depression Scale), among other evaluations. VRFs were assessed at baseline using a modified Vascular Risk Factor Index which ranges from 1 to 7. Results: Forty-four percent of the participants had at least one VRF. There was a significant association between the number of VRFs and the presence of the triad (MANOVA, F(3,36) = 3.41, p = .025, controlled for age and sex). Conclusions: VRF were prevalent in our MCI cohort. VRFs were associated with the specified triad. A future prospective analysis of this cohort should elucidate causal mechanisms for this relationship. VRFs may play an important role in the development of cognitive, mobility, and mood dysfunction in people with MCI., Background & Objectives: Various explicit criteria exist for determining potentially inappropriate medications in older adults such as the Beers criteria. Our objective was to determine the nature and frequency of potentially inappropriate medications for patients admitted to Acute Care for Elders (ACE) units using modified Beers criteria, and the association with adverse outcomes with respects to patient mortality, readmission within 30 days, and length of stay. Methods: We prospectively studied consecutive patients 70 years or older admitted to the Acute Care for Elders (ACE) units at Vancouver General Hospital over two months. Detailed medication histories were obtained and outcomes data were tracked for each patient longitudinally. Results: A total of 168 consecutive patients were screened and 67 provided informed consent. An average of 6.2 prescription medications was used per patient. Of the total number of medications, 18 (7.4%) were deemed potentially inappropriate by modified Beers criteria, with 12 of 18 being considered to be of high severity for potential harm. For patients with Beers criteria medications, the median length of hospital stay was 15 days compared with 12 days in patients without Beers medications, despite similar frailty and co-morbidity indices. The mortality rate during hospitalization was 18.7% (3/16) among patients with Beer’s medications versus 9.8% (11/51) among those without. Conclusion: Inappropriate medications were used commonly in our cohort. Despite similar co-morbidity indices between groups, there was an association with a longer length of stay and increased mortality in patients with Beers criteria medications. Further outcomes-related studies are warranted to confirm the association we found., Introduction: The management of delirium includes a search for underlying acute medical illnesses, which may include urinary cultures. However, guidelines recommend only treating bacteriuria in the elderly if accompanied by urinary symptoms. This is based on RCTs showing no benefit in morbidity, mortality, or chronic urinary incontinence with routine screening or treatment of asymptomatic bactueruria, even in cognitively impaired individuals. The objectives of this study were to: (i) review the literature citing an association between urinary tract infections (UTIs) and delirium, and (ii) to look at the prevalence of treating asymptomatic UTI in a delirious medical in-patient population Methods: A MEDLINE search was conducted using the MeSH terms ‘urinary tract infection’, ‘bacteruria’ or ‘asymptomatic bacteruria’ AND either ‘delirium’, ‘confusion’ or ‘altered mental status’. Inclusion criteria included English articles, age > 65, and not undergoing a urological procedure. Data were used from a previously conducted prospective observational study of CAM-diagnosed delirium in consecutive medical in-patients. Data on signs and symptoms of infection, urinary symptoms, and whether a UTI was treated were collected from participants’ medical charts. Results: Studies (n = 65) relaying an association between delirium and UTIs were observational and lacked control groups. Preliminary results showed out of 315 delirious patients, 44% were treated for UTI but only 26% of treated patients had symptoms of a UTI or signs of an infection. Conclusions: Asymptomatic UTIs are often treated in delirious in-patients, despite a lack of good studies. This warrants further study., Introduction: TAVI decreases mortality and morbidity in older patients who are deemed inoperable or at high risk for surgical aortic valve replacement. Premorbid functional status and rates of geriatric-specific postoperative complications have not been well described. This study aimed to clarify these issues. Methods: Data collection occurred through the Division of Cardiology at St. Paul’s Hospital in Vancouver, Canada. Information on activities of daily living (ADLs), instrumental activities of daily living (IADLs), clinical frailty score (CFS), timed up and go (TUG), and a mini-mental state examination were collected prospectively by a study nurse. Patient charts were reviewed for medical co-morbidities, cardiac-specific metrics, pre-specified delirium criteria, complications, and discharge disposition. Results: Twenty-six cases were reviewed. The average patient age was 80 years and average Charlson Co-morbidity Index score was 3.5. Despite the advanced age and presence of significant co-morbidities, the incidence of delirium was low at 8% (2/26), with only 15.5% (4/26) receiving psychotropic medications during the hospitalization. All patients with available functional data were independent for ADLs at baseline (18/18), with 89% (16/18) requiring assistance with 2 IADLs or less. The mean scores on the CFS, TUG, and MMSE were 4, 12.8 seconds, and 27.9, respectively. Ninety-two percent (16/18) of patients were discharged home, with two patients going to a rehabilitation institution and eventually being discharged home. Conclusion: Appropriately selected older adults, with the functional and cognitive attributes noted above, appear to tolerate this procedure very well from a geriatrics point of view. Studies involving larger patient populations are warranted., Introduction: Socio-economic status is related to health both at the individual and country level. The health status of the older population of each country can be monitored by measuring its frailty status. Objectives: To examine the relationship between the Frailty Index (FI) and national economic indicators. Methods: 30,025 participants aged 50+ years (13,700 men, 16,325 women) from 12 countries (Austria, Belgium, Denmark, France, Germany, Greece, Israel, Italy, Netherlands, Spain, Sweden, Switzerland) which participated in the Survey of Health, Ageing and Retirement in Europe comprised the study sample. Following a standard procedure, an FI was constructed from 71 items. The economic indicators used for cross-country comparison were: gross domestic product (GDP), gross national income (GNI), health expenditure, and an inequality measure. Results: Across countries, the mean FI increased with age and was higher in women. Between countries, the mean FI ranged from 0.11 (Switzerland) to 0.21 (Israel). GDP, GNI, and health expenditure were negatively correlated with both the mean (r = GDP −0.85; GNI −0.86; health expenditure −0.86)., Introduction : Des travaux réalisés dans différents milieux de soins suggèrent que les personnes âgées qui sont atteintes de troubles cognitifs reçoivent des soins de moins bonne qualité. À partir d’une étude primaire évaluant la qualité des processus de soins offerts dans les UCDG du Québec, nous avons voulu vérifier si celle-ci était influencée par le statut cognitif. Matériel et méthode : Les dossiers médicaux de patients (n = 765) a dmis e n U CDG (n = 44) p our u ne c hute a vec traumatisme ont été étudiés. Le statut cognitif des patients (sans atteinte, n = 276; atteint, n = 489) a été déterminé par un gériatre. Deux dimensions de la qualité des soins, soit la globalité et la continuité informationnelle, ont été évaluées en mesurant l’écart entre les activités retrouvées au dossier et celles inclues dans deux grilles standardisées reflétant une prise en charge de qualité selon des données probantes et le jugement clinique multidisciplinaire consensuel. Des analyses de régression multiniveaux ont été effectuées afin de déterminer l’impact du statut cognitif sur la qualité des soins. Résultats : Les résultats pour la globalité des soins et la continuité informationnelle sont plus élevés chez les patients atteints (respectivement 4% (p < .001) et 2% (p = .054)). Ces dimensions de la qualité étant corrélées (Pearson, r = 0,391; p = .01), l’effet indépendant du statut cognitif sur la continuité n’est pas significatif. Conclusion : Les professionnels de la santé oeuvrant dans les UCDG dispensent un processus de soins de qualité égale ou même supérieure aux patients présentant des troubles cognitifs., Background: In response to challenges to recruiting older adults with Mild Cognitive Impairment (MCI) into a longitudinal study of on-road driving performance, we explored barriers and facilitators to their participation in driving studies. Methods: We conducted two focus group discussions with eight individuals with MCI. All participants held valid driver licenses and identified themselves as current drivers. The focus group discussions were audio recorded, transcribed, and analyzed according to standard qualitative coding techniques. Predominant themes were identified. Results: Primary barriers to driving research participation included the potential for punitive outcomes associated with poor performance on study on-road driving tests (e.g., mandatory reporting to participants’ physicians potentially leading to driver license removal), inherent biases associated with the on-road driving evaluation (e.g., inclusion of driving situations that the participant avoids), and a perceived lack of direct personal benefits. Research designs that offer participants with MCI the opportunity to receive training to improve their cognition, detailed feedback about their driving ability, and remediation for poor driving skills with an opportunity for an on-road re-test post-remediation were described as being facilitators of driving research participation. Conclusions: Driving study research designs that include on-road driving assessments that can result in negative outcomes such as potential license loss will likely fail in terms of recruitment of participants if they do not incorporate important elements that facilitate participation. These include offering driving remediation and follow-up on-road assessments to monitor progress. Participant recruitment can be maximized when the possibility of perceived biased and/or punitive outcomes are removed altogether., Background: The aging population challenges medical schools to improve geriatrics education to better prepare medical students for future practice. A fourth-ear geriatrics selective was planned as part of developing a comprehensive four-year undergraduate geriatric curriculum based on the Canadian Geriatric Society (CGS) competencies. Objectives: This survey aimed to identify medical students’ preferred methods of learning and content, in order to design an optimum geriatrics selective. Methods: All U of T medical students were invited to participate in an online survey consisting of 10 questions exploring preferred methods of teaching and content based on CGS competencies. Results: The response rate was 14.2% (n = 134). Most responders were female (73%), and were first, second, and third year students (33.3%, 31.1%, 24.2%); 46.7% were interested in geriatric medicine; 66% expressed interest in taking this selective due to demographic imperative; 56.6% preferred a two-week selective. Students showed interest in learning from staff physicians (93%), residents (87%), and interdisciplinary teams (76%). Preference was for bedside clinical education (94%), while less interest was shown in seminars (44%) or a manual (52%); in contrast, students favoured online resources (76%). Content areas preferred by students were biology of aging (97.1%), cognitive impairment (94.3%), health-care planning (93.4%), and medication management (88.7%). Least interest was shown in urinary incontinence (72.8%), adverse events of medications (76%), and transitions of care (80.2%). Conclusions: This survey provided insight into students’ preferences regarding a geriatrics selective. Students preferred clinical bedside experiences, taught by experienced clinicians, supported by online resources, with identified preferences for certain key content areas., Objective: Cognitive deficits are among the strongest predictors of function in younger adults with schizophrenia. The objective of this study is to assess the extent to which cognition also predicts functional abilities in older adults with schizophrenia. Methods: Community-dwelling individuals over the age of 50 who met DSM-IV TR criteria for a current diagnosis of schizophrenia (n = 76) and controls who did not meet criteria for a mental disorder (n = 34) were assessed with clinical interviews, neuropsychological tests, and functional measures. Cognitive ability was assessed using the MATRICS Consensus Cognitive Battery (MCCB). Functional competence was measured using the University of San Diego Performance Skills Assessment (UPSA), the Medication Management Ability Assessment (MMAA), the Performance Assessment of Self-Care Skills (PASS), and the Function and Disability Instrument (FDI). The schizophrenia and control groups were compared. Results: Demographic and baseline clinical, cognitive, and functional characteristics are reported for participants with schizophrenia and controls. The mean number of years of education was lower in the schizophrenia group than the control group. Participants with schizophrenia scored higher than controls on all clinical measures: the Positive and Negative Symptoms Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), Cumulative Illness Rating Scale for Geriatrics (CIRS-G), Simpson Angus Scale (SAS), and Subjective Well-Being on Neuroleptic Medications (SWN). Participants with schizophrenia also scored lower on all cognitive and functional measures. Conclusion: In future, analyses will be conducted to investigate relationships between cognitive and functional measures. Clinical measures will be controlled for as confounders to isolate the effect of cognition on real-life functional ability., Background: Since 1991, the Canadian Geriatrics Society has sponsored the biennial Summer Institute in Geriatrics (SIG) for Canadian medical students with the aim to improve awareness and encourage careers in geriatric medicine. However, the effectiveness of this program has not been evaluated. With recent fiscal constraints, it has been questioned whether there is ongoing merit in continuing the SIG. The objective of this study was to determine whether the SIG influences medical students to pursue careers in geriatric medicine, geriatric psychiatry, or care of the elderly and, if so, to what extent? Method: Past SIG participants were contacted by mail and invited to complete a survey containing questions about participant demographics, motivation for attending the Institute, residency training, influence of the SIG on career choice, ultimate career choice, and its perceived overall value. Results: Eighty-one physicians (54.4%) responded. Nineteen percent had current or planned careers in geriatrics disciplines, while 48% spent more than 50% of their time with adults over the age of 65. Seven participants are currently working as geriatricians, two as geriatric psychiatrists, and two as family doctors with care of the elderly training. Fifty-three percent were motivated to enroll in electives following the Institute, while 43% believed that the Institute influenced their career choice. All participants felt that the SIG improved their knowledge of geriatrics. Conclusions: Participants of the SIG do go on to have careers in geriatric disciplines. Those that do not still gain valuable knowledge that may be applied to the care of older adults in other disciplines. Participants provided several suggestions for how the Institute could be more effective at influencing career choice., There are urgent calls for care models that address the unique needs of geriatric patients, who are typically managed with several medications. Multiple-medication treatment regimens present many challenges for health professionals and patients. For health professionals, these challenges include those of reconciling the list of medications generated by multiple prescribers with the patient and often their caregiver(s) to ensure accuracy and completeness. For older patients, the challenges of understanding how to take multiple medications and the treatment burden imposed by complex medication regimens may result in poor adherence and poor health outcomes. Our objectives are to develop and assess new approaches to medication regimen reconciliation, consolidation, and simplification. Here, we present an interprofessional approach to medication reconciliation piloted in Project IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) for community-dwelling patients 65 years of age or older, with three or more chronic diseases and five or more long-term medications. A measure of medication regimen complexity (MRC), as the number of rules in the consolidated medication script, was also developed and validated in this study population. We present the protocol we developed for consolidating a medication list and reducing MRC, along with novel findings regarding the characteristics of medication regimens and associated issues for these older patients with multiple chronic conditions. These new approaches to medication management may be particularly useful in the person-centered care of the elderly., Transitions between health care settings are a high-risk period for care quality and threatened patient safety. This is especially significant for older persons with complex care needs, such as those with hip fracture or other musculoskeletal (MSK) disorders, as they often require care from multiple health professionals within and between care settings. To gain a better understanding of transitional care, we recruited older hip fracture patients from acute care and followed them as they moved through the health-care system. Participants were purposively sampled. At each transition, semi-structured interviews were conducted with the patients (N = 6) and members of their care network (N = 22). Transitions between hospital-based acute care and inpatient rehabilitation, as well as community-based home care and retirement living, were captured. Data were gathered and analyzed using a focused ethnographic approach. Facilitators and barriers of transitional care were identified from the perspective of patients, as well as their formal and informal caregivers. Important areas of interest that emerged included: continuity of care surrounding shift work and team-based care, insufficient time on behalf of the health-care providers to adequately communicate with their patients and each other, the impact of cultural competency on interactions within the care network, proactive strategies utilized by informal caregivers, and using health records to facilitate communication. A number of practical strategies for promoting successful transitions were also recommended by the participants., Delirium is an acute confusional state characterized by inattention, disorganized thinking, and perceptual disturbances. Previous research has shown that hospitalized elderly patients on a general medicine ward were more likely to develop incident delirium if they had baseline cognitive impairment, vision impairment, dehydration, and/or severe illness. Environmental factors likely play a role in delirium development. The primary study objective was to determine if room changes are associated with an increased incidence of delirium per patient days in elderly patients on a general medicine ward after controlling for baseline risk factors. Secondary objectives were (1) to determine if room changes increase the length of delirium in patients who had delirium at admission, (2) to determine if room changes increase length of hospital stay, and (3) to determine if bed-spacing and room characteristics affect these outcomes. Our study sample consists of patients 70 years of age or older who were admitted to the general medicine service at St. Michael’s Hospital between October 2009 and September 2010. A total of 1,384 patients met these criteria. A validated chart abstract abstraction technique was used to identify patients with delirium, and Decision Support data was used to identify room changes and bed spacing. So far, 1,354 patient charts have been abstracted. A total of 388 patients (28.7%) had delirium at admission, and 140 (14.5%) of the remaining patients developed delirium during their first week of hospital stay. We are expecting to complete data abstraction and analysis by the end of February 2012., Background: Women comprise the majority of the older population and have a greater burden of illness compared to men. This is evident in the home-care setting, where necessary services are provided to community-dwelling older adults. Whether the quality of these services differs between genders has not been examined. Objective: To determine if there are gender differences in home-care quality received by older individuals in Ontario and whether variations exist across planning regions. Methods: Retrospective cohort study using data from the Home Care Reporting System database using the RAI-HC Instrument. Study population: 119,795 Ontario home-care clients 65+ years receiving government-funded services from April 2009—March 2010. Home-care quality was assessed using validated indicators and risk-adjusted models developed by interRAI for decline in activities of daily living (ADL), cognitive decline, depressive symptoms, and pain control. For each indicator, unadjusted and risk-adjusted rates were calculated and stratified by gender. Results: All unadjusted quality indicators suggested gender differences. After risk-adjustment, 45.7% of women and 44% of men reported decline in ADLs; 50.8% of women and 50.5% of men reported cognitive decline; 11.9% of women and 11% of men reported depressive symptoms; 21.2% of women and 21.6% of men reported inadequate pain control. Rates varied 1.3- to 3.0-fold across planning regions after risk-adjustment. Conclusions: After risk-adjustment, no important gender differences exist in home-care quality. Differences in unadjusted rates between genders illustrate differences in health status and care needs. Regional variations in care quality across planning regions illustrate opportunities for improvement., Background: In Canada, 93% of older adults live at home and a substantial proportion of this population has complex and inter-related health and social problems. This sometimes renders them frail and homebound and poorly-served by predominantly office-based primary care delivery models. Several comprehensive and ongoing home-based primary care models have emerged internationally in order to address access-to-care deficiencies, postpone adverse health trajectories, and reduce overall costs for homebound elders. Objective: To identify the successful operational components of home-based primary care programs. Methods: We completed a systematic review of studies investigating home-based primary care programs for community-dwelling older adults that measured at least one of: hospitalizations, emergency department visits or long-term care admissions as an outcome of their intervention. Using the Cochrane, PubMed, and MEDLINE databases, 322 articles were identified and seven met our criteria for review. Results: The seven reviewed interventions were all based in the United States, with four emerging from the Veteran Affairs System. All seven programs demonstrated substantial effect on at least one of our inclusion outcomes, with four programs effecting two outcomes. All interventions were characterized by three common design principles: 1) house calls are made by the ongoing primary care provider, 2) the primary care provider leads an interprofessional care team, and 3) the program provides after-hours support. Conclusion: Specifically designed home-based primary care programs can substantially affect patient, caregiver, and systems outcomes. Adherence to the core design principles identified in this review could help guide the development and spread of these programs in Canada., Introduction: In Canada, 42% of cancer incidence and 59% of cancer mortality occur in persons aged ≥ 70 years. It has been reported that cancer is often under-treated in older patients due to co-morbidities, impaired functional status, and treatment toxicity. Objectives: The purpose of this ongoing study is to: 1) describe the health and functional status of the patient population referred to our Geriatric Oncology clinic, and 2) explore the reasons for referral and recommendations made. Methods: A chart review was conducted of 107 randomly selected patients who were seen in our clinic between 2006 and 2011. Data pertaining to demographic information, health, and functional status from the first visit were collected in a SPSS database. Health and functional status were assessed according to our Comprehensive Geriatric Oncology assessment consisting of co-morbidities, medications, functional status (ADLs, IADLs, ECOG), social support, cognition (MMSE Folstein, Montreal Cognitive Assessment test-MOCA), mood (Geriatric Depression Scale), mobility, nutritional status, and strength (grip strength by dynamometer). Descriptive techniques such as frequencies, means, and proportions were used for the statistical analysis. Results: In our sample of patients, lung, breast, and gynecological malignancies were the most common tumour sites. Average age of patients seen was 79 years old, and the majority of patients were referred for cognitive impairment (50.5%) and opinion on treatment plan (34.6%). As a result of our evaluations, we have uncovered and addressed previously undetected problems, such as mild cognitive impairment, dementia, polypharmacy, and mood disorders., Background: Given the growing proportion of older people, the prevention of cognitive decline is an important issue for patients, clinicians, and policy makers. There is significant interest in finding the “magic bullet” which will keep us cognitively intact for as long as possible. Objective: To complete a systematic review of the literature to determine the effectiveness of pharmacological therapies for preventing cognitive decline in healthy older adults and in those older adults with mild cognitive impairment. Methods: We searched Medline, EMBASE, and the Cochrane Central Register of Controlled Trials from date of onset to August 2011. No restrictions were placed on date of publication. Publications were excluded if they were not randomized control trials or systematic reviews, were not examining older adults (age > 65) with normal cognition or mild cognitive impairment, if they did not list adverse outcomes of their interventions, or if they were published in a language other than English. Two investigators independently completed study selection, quality assessment, and data abstraction. Quality assessment of articles was conducted using Cochrane Risk of Bias. Our initial search yielded 3,882 potential articles. An abstract review by two independent reviewers narrowed search results to 226 articles that met inclusion criteria. Further assessment of full-text articles resulted in 45 articles for data abstraction and analysis. Data synthesis is underway and will be completed by April 2012. Conclusions: While final results of the systematic review are currently pending, it is evident from our preliminary results that there are very few high-quality studies that demonstrate any successful interventions to prevent cognitive decline in older adults., Purpose: Few data are available regarding the utilisation of radiation therapy in patients aged 90 years and over. This study examines the utilisation of radiotherapy in this population. Methods: The clinical records of every nonagenarian referred at the Department of Radiation Oncology, CHUQ - L\’Hôtel-Dieu de Québec, between April 1, 2010 and March 31, were retrospectively reviewed. Results: Twenty-five nonagenarian patients with median age of 92 were seen in consultation. The majority had skin or rectal cancer. The tumors were early stage in seven patients, locoregionally advanced in five, recurrent in two and systemic in eleven. Six patients received radiation at more than one sites. 92% had their cancer pathologically proven and most of them in the same year as their referral in radiation oncology. Nine patients had a previous oncological surgery and none received chemotherapy. The intent of radiation treatment was definitive in six patients. Five treatments were not completed as planned. Polypharmacy, comorbidities, and dependance level for ADL and IADL were usually mentionned in the consultation report. Other geriatrics syndroms such as history of fall, cognitive impairments, depression or delirium were less frequently mentionned. Half of patients had a follow-up visit. Five patients had a complete response and nine had a partial response. Only five patients had toxicity; low grade dermatitis or diarrhea. Nine deaths occured, at a median time of two months. Conclusions: The current review showed that radiation therapy can be feasible and tolerable in nonagenerians. When applicable, definitive radiation therapy should also be considered., Background: Despite a looming demographic imperative, clinical rotations in geriatrics are not mandatory in North American undergraduate medical training. This is based on the rationing premise that, given curriculum time pressures, medical students can acquire geriatric competencies in clinical rotations with a significant number of older patients. We explored the clinical and teaching discussions regarding older patients on one such unit, the Internal Medicine Clinical Teaching Unit (CTU). Methods: Focusing on the admission case review and discharge summary, we asked: 1) What medical issues are emphasized when the CTU team cares for older patients? and 2) What geriatric core competencies are addressed? Using a multiple case study approach, over two separate 8-week periods we collected 19 cases of patients admitted to one of three CTUs. Case materials included transcripts of audio-recorded case reviews and de-identified patient discharge summaries. Results: 15 of the 19 patients were aged >65; these underwent inductive analysis for issues emphasized during review, and deductive analysis for geriatric content that could have been discussed according to Canadian undergraduate geriatric core competencies. Discussions focused narrowly on the patient’s chief complaint and the interpretation/correction of abnormal lab values. References to geriatric core competencies were infrequent, as was teaching regarding geriatric issues. Conclusion: While trainees regularly encounter patients with geriatric issues on CTU, these issues are rarely emphasized during case review. Similar findings are likely on other rotations where older patients are cared for, calling into question the suitability of current curricular rationing decisions pertaining to geriatrics teaching., Our health care system exists in “silos” of functions and services carefully marking out turfs. Patient safety, quality of experience, and consistent positive clinical outcomes will remain challenged in this fragmented system. Communication between the various system segments is often poor and creates confusion leading to mistakes and threatens consistency of care, especially for the most complex and vulnerable – our seniors. The North Perth Family Health Team, Listowel, Ontario serving a population of approximately 17,000 has created a model to support seniors and families with navigation and transition from sector to sector. A Nurse Practitioner, with specialized geriatric education, works closely with primary care physicians, consulting geriatrician, hospital, community agencies, and retirement homes by providing assessments where the senior is located. Regular visits are made to the local retirement homes every two weeks, the hospital weekly, a geriatric clinic with the consulting geriatrician monthly, and office and home visits as needed. Education is provided concurrently with these services, as part of chronic disease management. The patients’ electronic health record can be accessed in all of these settings to ensure that information is not duplicated and that documentation and communication can occur efficiently. This model of providing Complex Geriatric Care can be easily replicated in small Rural communities for enhanced efficiencies and concerted patient care., Background: Gait velocity is a strong identifier of physical frailty. However, it has been postulated that gait variability can be more sensitive to subtle impairments and may help in early frailty detection. Gait variability measures gait regulation, and high variability predicts falls, fractures, and cognitive decline even when gait velocity failed to do so. Thus, high gait variability may reflect an increased vulnerability in early stages before frailty is complete manifested. Associations of gait variability with frailty models which do not use gait velocity as a frailty component, have yet to be determined. Methods: Our sample included 106 community-dwelling older adults, aged ≥75. Frailty status was assessed using the 9-category Clinical Frailty Scale (CFS), a validated model which does not include the gait velocity criterion in identifying frailty. Quantitative gait variables were assessed under “usual” and “fast” pace using an electronic walkway. Linear regression analysis evaluated association between CFS levels and gait variability. Results: Frailty status ranged from 1 (“Very Fit”) through 6 (“Moderately Frail”). Increased frailty status was significantly associated with higher variability in stride length (p=0.023), stride width (p=0.015) at usual pace; and, higher variability in stride time (p=0.001), stride length (p=0.017) and stride width (p=0.019) at fast pace. Conclusion: High gait variability in several gait parameters is associated with frailty, even at early stages. Our findings help to explain the high vulnerability and risk of falls and fractures in community seniors with pre-frail and frailty status., Background: Disadvantaged seniors living in non-family situations in Toronto are more likely than seniors living in family situations to have less economic security, less social support, and less choice in housing. Seniors who live in poverty, and are precariously housed, are more likely to be chronically ill, to live with multiple illnesses, to have poor nutrition, high stress and loneliness, all of which are strongly associated with the determinant of health social exclusion. Methods: To understand how support services for income, housing, food security, social support, and health care mitigate the effects of social exclusion, we interviewed 15 male seniors at the Good Neighbours Club in downtown Toronto. The semi-structured interview is designed to assess barriers to, utility of, and perceived impact of support services available to disadvantaged seniors living in the central core of Southeast Toronto. Conclusion: Results suggest support services play a vital role in not only mitigating the effects of social exclusion, support services reduce the level of social isolation experienced by these seniors., Background: Considering the psychosocial factors at play, the management of elderly patients requires an interdisciplinary approach centered on the patient and his/her caregivers. An effective communication between the professionals is nevertheless an important asset in the client’s management. The Individualized Interdisciplinary Intervention Plan (IIIP) is a tool aimed at documenting and communicating information discussed during team meetings. Optimization of the IIIP is necessary to facilitate access to its information, to respect confidentiality and to integrate with existing computerized system. Objectives: To devise a computerized IIIP intent on optimizing quality of care and access to patient information. Methods: Modification of the pre-existing IIIP was done based on literature review, integration of the geriatric vital signs (AINÉES), the OPTIMAH (OPTIMisation des soins aux personnes Âgées à l’Hôpital) approach, and training in Project management using the Interprofessional Collaborative Approach. A demo session with team members of the two geriatric assessment units was organized prior to conducting a 6-month trial. A survey was created in order to gather feedback from users in both units. Results: An updated version of the IIIP was developed. Analysis of the survey is underway and the tool will be modified accordingly. Conclusions: The updated version of the computerized IIIP assures optimal management of elderly hospitalized patients and their caregivers. Not only is the IIIP accessible and easily integrated in existing computerized system, but it also respects the confidentiality code of conduct. It allows effective communication between interprofessional team members during current or future hospital stays, which is at the core of quality care., Objective: To study the long-term effects of glucocorticoids (GC) on fracture risk. Design: CaMos is an ongoing 10 year prospective cohort study. Population: Age and sex matched Canadian population who are non-institutionalized individuals and reside in nine CaMos study centers. Methods: Data from 2819 men and 6444 women were classified as current GC users and non-users. New fractures based on self-reports from an annually completed questionnaire included vertebral, hip, other (excluding hip, vertebral, toes, fingers, skull fractures) and any fracture (excluding toes, fingers, skull fractures). Multivariable survival analyses were conducted to examine the association between the time to new fracture and GC use. Hazard ratios and 95% confidence intervals (CI) were calculated. Results: The mean age, femoral neck T-score (standard deviation) and GC use at baseline of the cohort was 62.0 (13.3), −1.07 (1.03), and 128 (1. 4%), respectively. During the 10-year period, 130 (1.4%), 157 (1.7%), 869 (9.7%) and 1102 (11.9%) individuals developed a new osteoporotic vertebral, hip, other and any fracture. Ever taking GC for a minimum of one month in both men and women had a hazard ratio of 1.4 (95% CI: 1.0 −1.8), 1.9 (95% CI: 1.0–3.6), 0.97 (95% CI: 0.4–2.2),1.2 (95% CI: 0.9–1.6) for developing a new non-spine, hip, spine and any fracture as compared to those who never took GC, respectively. Conclusions: CaMos is the first prospective long-term study with data over 10 years showing that GC use is associated with higher incident fragility fractures., Introduction: Vitamin D is important in the management of osteoporosis and falls. Current Canadian guidelines recommend empiric supplementation (≥800 IU/day) for older adults. Before guideline publication, it was our practice to measure serum 25-hydroxyvitamin D levels (Vitamin D levels) on the first visit to our specialized falls clinic, serving adults aged ≥65 years. The extent to which this population would be undertreated by following the guidelines and delaying testing for 3–4 months after supplementation is currently not known. Methods: In this retrospective cross-sectional study, we determined the clinical benefit of a strategy of pre-emptive measurement of vitamin D levels. Chart reviews were conducted for 121 patients seen in the St. Paul’s Hospital Falls Clinic between January 2009 to November 2011. Baseline data, including fall risk, medications & supplements, laboratory testing and performance measures, were recorded. Results: 43 patients (35.2%) were taking ≥800IU of daily Vitamin D at their initial visit. Of the 94 patients who had Vitamin D levels measured, the average level was 80.4 nmol/L. Only 42 patients (44.7%) had sufficient Vitamin D levels (>75 nmol/L). Testing led to recommendations for dose adjustment for insufficient levels among 13 patients (13.8%), 5 of whom were previously on guideline-based supplementation doses. Conclusions: Many falls clinic patients are not taking adequate doses of Vitamin D and less than half of these patients have sufficient vitamin D levels. Preemptive testing led to correcting vitamin D insufficiency among a nearly 15% of patients in this high-risk population., Purpose: We present 2 case reports suggesting a possible association between delirium and swallowing deficits (or dysphagia) in older hospitalized adults. Method(s): Patient 1, a 96-year-old man, was previously highly functional without cognitive problems. He was admitted with pneumonia and developed delirium and new-onset dysphagia. Despite treatment of the patient’s pneumonia, the delirium was slow to recover, as was his dysphagia. Patient 2, a 78-year-old man with a history of dementia (likely alcohol related), was admitted with a fall and fractured humerus. The patient developed delirium and dysphagia while in hospital. Despite the patient’s persistent cognitive problems due to dementia, both his delirium and dysphagia resolved. Results: Both cases describe older adults with acute and chronic medical issues, delirium and dysphagia. In one case, persistence of delirium occurred concurrently with persistence of dysphagia, and, in the second case, improvement of dysphagia was associated with improved delirium symptoms. Conclusion: Delirium is a frequent problem for older hospitalized adults and is associated with a number of adverse outcomes as well as rising health-care expenditures. A potential association between delirium and dysphagia may be a very important consideration in the assessment, treatment, and prognoses of dysphagia. Although prior studies have reported associations between impaired ability to do activities of daily living and persistent delirium, a possible association between delirium and functional swallowing has not previously been reported. Further research into the relationship between delirium and swallowing deficits is necessary., Background: Slower gait is an early sign of cognitive decline in older adults. No studies have examined yet the brain morphometric substrate for slower gait in MCI. The purpose of this cross-sectional study was to determine whether gait speed was associated with lateral cerebral ventricle volume (LCVV), a measure of brain atrophy, and white matter lesions (WML) among older adults with MCI. Methods: Twenty community-dwellers with MCI, free of hydrocephalus, aged 76years [69/80] (median[25th/75th percentile]) (35% female) from the ‘Gait & Brain cohort study’ were included in this analysis. Gait speed was measured at usual pace with a 6 m electronic portable walkway (GAITRite). LCVV was quantified using semi-automated software from three-dimensional T1-weighted Magnetic Resonance Images. WML were visually rated on a 10-point scale from 0 to 9 (worst), and coded severe if grade was ≥2. LCVV, severe WML and age were used as covariables. Results: Median gait speed was 118.7 cm/s [104.4/131.3], and LCVV 39.9 mL [30.0/46.6] with no difference between right and left ventricles (p=0.052). Thirteen subjects (65%) had severe WML. Severe WML was associated with decreased gait speed (adjusted β=-17.94[95CI:-35.71;-0.16], p=0.048). LCVV was also inversely linearly associated with gait speed (adjusted β=-0.62 [95CI:-1.21;-0.03], p=0.041). More specifically, the enlargement of the left ventricle, unlike the right one, inversely correlated with decreased gait speed (p=0.002 and p=0.068, respectively). Conclusions: This study shows for the first time slower gait speed is associated with severe WML burden and left lateral ventricle enlargement in MCI, suggesting involvement of impaired sequential thinking in slowing gait during the early stages of dementia., Background: The predictive significance of hip fracture risk factors has been variably reported. This may at least in part be due to the effects of age. Objective: To determine the prevalence of validated risk factors for hip fracture in a relatively younger (60–80 years) and older (over 80 years) female age cohorts. Methods: Consecutive admissions of Caucasian females aged over 60 years presenting with the 1st osteoporotic hip fracture during a 24-month period were prospectively assessed. A group comparison was undertaken for the clinical risk factors used in the FRAX calculator, falls within 12 months, use of gait aid, dementia, neuromuscular disorders, usual residence, serum 25 (OH) D, current use of benzodiazepine and other baseline descriptive characteristics. Results: There were 83 and 90 patients in the ‘younger’ and ‘older’ age cohorts, respectively. Patients >80 yrs were more likely to have suffered a fall (57%, p=0.001), to use a gait aid (59%, p=0.001) and live in a hostel (28%, p=0.01). The prevalence of secondary causes of osteoporosis was greater (19%, p=0.048%) in the younger age cohort. There were no group differences for other risk factors. However, over 50% in each age cohort had a prior history of fracture and the mean 25 (OH) D in the younger and older age cohorts were 38+16.6 nmols/l and 34+18.6 nmols/l, respectively. Conclusion: The findings may have implications for the validity of fracture risk assessment tools that do not incorporate falls and/or other age associated hip fracture risk factors for stratifying hip fracture risk in the very old., Background: Although the principle goal of hip fracture management is a return to pre-event functional level, most survivors fail to regain their former autonomy. One of the most effective strategies to mitigate the fracture’s consequences is exercise. Purpose: To review the reported effect of an extended exercise rehabilitation program offered beyond the regular rehabilitation period on improving physical functioning for patients with hip fractures. Methods: Sources: The Cochrane Bone, Joint and Muscle Trauma Group, the Cochrane Central, PubMed, CINAHL, PEDro, EMBASE, and reference lists of articles were searched from inception to October, 2010. Study Selection: Included were all randomized controlled trials comparing extended exercise programs to usual care for community dwelling after hip fracture. Data Extraction and Synthesis: Two reviewers conducted each step independently. The data from included studies were summarized and then pooled estimates were calculated for nine functional outcomes. Results: Ten articles were included in the review and eight in the meta-analysis. The extended exercise program showed small–modest effect sizes which reached significance for knee-extension strength for affected and non-affected sides 0.46 (CI 95%: 0.2–0.6) and 0.45 (CI 95%: 0.16–0.74), respectively, balance 0.29 (CI 95%: 0.7–0.51), fast gait speed 0.52 (CI 95%: 0.18–0.85 p=0.002), and physical performance-based tests 0.53 (CI 95%: 0.27–0.78). Conclusions: To our knowledge this is the first meta-analysis to provide evidence that an extended exercise rehabilitation program for patients with hip fractures has a significant impact on various functional abilities. The focus of future research should go beyond just effectiveness and study cost-effectiveness of extended programs., Background: Sedentary behavior has been proposed as an independent cardiometabolic risk factor even in adults who are otherwise physically active through leisure-time recreational activities. Because little is known about the metabolic effects of sedentary behavior in seniors, we examined the relationship between sedentary behavior and cardiometabolic risk in physically active older adults. Methods: Enrollment is underway with 19/50 projected subjects currently included (mean age 73.1 years). Subjects were in good health and free of known diabetes. Activity levels were recorded with accelerometers worn continuously for 7 days. Blood pressure, waist circumference, body mass index (BMI), fasting glucose, lipids, HgbA1C and 2hr glucose tolerance were measured. Results: Time engaged in sedentary behavior was strongly positively correlated with triglycerides and BMI. Average amount of steps taken per day was strongly positively and negatively correlated to HDL and BMI respectively. All subjects met Canada Health guidelines for an active “fit” adult. Conclusion: Sedentary behavior is associated with adverse metabolic parameters in older adults, even those who are otherwise physically active and meet Canada Health guidelines for an active “fit” adult. Emphasizing activities that accumulate steps (eg: walking, light housework) may be a practical recommendation to reduce sedentary behavior in older adults., Background: Despite the importance of self-care, evidence suggests that people with heart failure (HF) do not consistently engage in such behaviours. One possible reason for poor self-care may be the presence of underlying and undetected mild cognitive deficits (MCD) Objective: This study is prospectively evaluating whether MCD measured with the MoCA in HF patients aged ≥60 years at hospital discharge is associated with impaired ability to self-care (measured with the Self-Care Heart Failure Index (SCHFI – 3 subscales: self-maintenance, self-management, self-confidence). Methods: Exclusion criteria: no caregiver, not English speaking, living in a long term care (LTC) facility, documented cognitive impairment, visual or hearing impairment, or life expectancy., Background: Failure to thrive (FTT) does not have an universally agreed definition in adults but is often used to describe a syndrome of global decline that occurs as an aggregate of frailty, cognitive impairment, and functional disability. The aim of this project was to better understand this population in an attempt to improve diagnosis and management. Objective: To explore characteristics and medical investigations commonly conducted among older adults with a diagnosis of FTT. Methods: Part 1: We searched Medline (Pubmed), Embase, and Cochrane databases from 1948 until 2011. Two investigators independently reviewed citations and then full-text articles. Inclusion criteria included published in English, population aged 65 or over, contained primary data, not a case report or case series. A summary of data was created and meta-analysis determined inappropriate. Part 2: Data from the local acute care electronic medical record for patients 65 years or older admitted with a diagnosis of FTT from January 2010 to January 2011 were reviewed. Several variables were analyzed that explored investigations in hospital. Results: The systematic review identified 62 citations. 46 full text articles were reviewed. 6 articles met inclusion criteria. All the 6 articles were cohort studies of small size. The local data revealed a cohort of 603 patients ranging in age from 65 to 104 years. The length of hospital stay varied from 0 to 106 days. Extensive investigations were ordered including CT, Echo and Ultrasound. A variety of medical specialists and allied health professionals were consulted during the patients’ hospitalizations., Objectives: Falls are well recognized to be associated with adverse health outcomes, especially when complicated by fracture. Falls are also more common in people who are frail and readily related to several items in the frailty phenotype. Less is known about the relationship between falls and frailty defined as deficits accumulation. Our objective was to investigate the relationship between falls, fractures, and frailty based on deficit accumulation. Methods: Design: Representative elderly cohort study with over 8 years of follow-up on mortality, recurrence falls and fractures. Setting: The Beijing Longitudinal Study of Aging (BLSA). Participants: 3257 Chinese people aged 55+ years at baseline. Measurements: A frailty index (FI) based on the accumulation of health deficits was constructed using 33 deficits, excluding falls and fractures. The rates of falls, fractures and death as a function of age and the level of FI were analyzed. Multivariable models evaluated the relationships between frailty and the risk of recurrent falls, fractures, and mortality adjusting for age, sex, and education. Self or informant reported fall and fracture data were verified against participants’ health records. Results: Of 3,257 participants at baseline (1992), 360 (11.1%) people reported a history of falls, and 238 (7.3%) people reported a history of fractures. 1155 people died over the eight-year follow-up. The FI was associated with an increased risk of recurrence falls (OR=1.54; 95% confidence interval (CI)=1.34–1.76), fractures (OR=1.07; 95% CI=0.94–1.22), and death (OR=1.50, 95% CI=1.41–1.60). The FI showed a significant effect on the proportional hazards in a multivariate Cox regression model (HR=1.29, 95% CI=1.25–1.33). When adjusted for the FI, neither falls nor fractures were associated with mortality. Conclusion: Falls and fractures were common in older Chinese adults, and associated with frailty. Only frailty was independently associated with death., Purpose: The primary purpose of this pilot study is to prospectively gather and evaluate patient characteristics, surgical outcomes and quality of life (QOL) outcomes of women with endometrial cancer undergoing robotic-assisted surgery. Methods: An unselected cohort of endometrial cancer patients, medically competent from the Jewish General Hospital were approached and offered robotic surgery. The da Vinci® Surgical System was used for the surgery. Results: From December 2007 to December 2009, 109 women underwent robotic-assisted surgery for their endometrial cancer. 68 women were under 70 years old and 41 were 70 years or older. 45 (69.2%) women under 70 experienced a post-operative pain level of 1 on a 7-point scale at one week post-surgery compared to 19 (48.7%) women 70 and older, p=0.037. At 3 weeks this trend persisted 47 (71.2%) compared to 20 (50.0%), p=0.028 respectively. 30 (46.2%) women under 70 experienced unusual urinary symptoms post-operatively compared to only 10 (25.6%) women 70 and older, χ2(1)=4.33, p=0.037. There was a significant effect of age on number of days required to resume typical activities. Older women resumed more rapidly to regular activities (8.4) than younger women (12.9), F (1, 87)=4.78, p=0.031. Conclusions: Elderly women undergoing robotic-assisted surgery for endometrial cancer experience less post-operative pain, less urinary symptoms and resume to their typical activities faster than younger women., Introduction : Les personnes âgées constituent une part toujours croissante de la population ayant recours aux hôpitaux. Haut lieu de technicité, le système hospitalier n’a pas été conçu en ayant en perspective les besoins spécifiques de cette clientèle. Les données s’accumulent pour démontrer que l’hôpital contribue souvent à une détérioration de leur état de santé par des modes de pratique mal adaptés. Les modèles de processus de soins efficaces existent mais ne sont pas appliqués. Objectif : Présenter le contenu du document : Cadre de référence sur l’Approche adaptée à la personne âgée en milieu hospitalier. Cet ouvrage sensibilise, guide et outille le personnel clinique et administratif des centres hospitaliers dans une démarche rigoureuse visant à prévenir le déclin fonctionnel iatrogène par des actions de prévention systématiques, individualisées et hiérarchisées. Méthodes : Une équipe de professionnels expérimentés s’est penchée sur cette problématique et propose des façons d’améliorer la qualité du séjour et des soins offerts aux personnes âgées en milieu hospitalier. Résultats : Le sujet est traité sous l’angle de la prévention et d’une meilleure gestion du delirium et du syndrome d’immobilisation. Un algorithme de soins cliniques est proposé dès l’arrivée, selon des interventions en paliers, déterminées par la condition physique initiale et la vulnérabilité face au système hospitalier. On propose des principes directeurs pour les organisations, des outils cliniques et d’implantation ainsi que des indicateurs de résultat. Conclusion : Le réseau hospitalier doit revoir en profondeur son fonctionnement afin de répondre adéquatement et sans délai aux besoins diversifiés des personnes âgées., Introduction : Le cadre de référence « Approche adaptée à la personne âgée en milieu hospitalier » est assorti d’outils cliniques pour faciliter son application. Ces fiches cliniques opérationnalisent la démarche clinique structurée et hiérarchisée de l’approche adaptée. Objectif : Présenter le contenu des 10 fiches théoriques et pratiques organisées selon trois paliers d’évaluation et d’interventions : systématiques et préventives, spécifiques et spécialisées, et traité sous trois angles : physique, psychosocial, environnement. Méthodes : Les fiches ont été rédigées par des cliniciens praticiens et enseignants d’expérience. Des experts de contenu ont été associés à la révision des fiches de même qu’une équipe d’infirmières oeuvrant elles-mêmes auprès des personnes âgées hospitalisées. Résultats : Chaque fiche théorique est organisée de la façon suivante: • présentation et définition de la dimension clinique ciblée; • éléments d’évaluation et d’intervention appropriés aux paliers systématique, spécifique et spécialisé; • bibliographie exhaustive suggérée; • annexes contenant des outils cliniques validés ou des suggestions du type trucs du métier. • fiche pratique-synthèse d’une page qui reprend avec concision les données stratégiques. Elle se présente sous forme de carnet et peut être gardée sur soi par l’intervenant et servir de ressourcement dans son travail au quotidien. Finalement, une fiche synthèse extrêmement concise résume les interventions essentielles systématiques pour les intervenants des urgences. Conclusion : Ces outils s’avèrent précieux pour soutenir les intervenants dans leurs actions quotidiennes auprès de la personne âgée hospitalisée., Introduction : Les soins aux personnes âgées sont une priorité inscrit dans la planification stratégique du MSSS du Québec. Le MSSS considère essentiel d’implanter l’AAPA et a mis sur pied une structure provinciale afin de soutenir les établissements du réseau dans ce changement important de pratiques. Objectif : Présenter la structure provinciale et les outils de reddition de compte qui accompagnent l’implantation de l’approche adaptée dans tous les établissements de courte durée du Québec. Méthode : Une coordination provinciale et régionale a été mise en place pour veiller à l’implantation de l’approche adaptée. Des éléments de l’approche sont intégrés dans les ententes de gestion des établissements qui doivent rendre compte de leurs progrès. Résultats : La structure est organisée comme suit: - Coordination provinciale par le MSSS: travail étroit avec les instituts de gériatrie de Montréal et Sherbrooke; conférences téléphoniques mensuelles avec les répondants régionaux; suivi personnalisé à l’occasion. - Coordination régionale: Répondant régional désigné; soutien aux établissements de sa région via des rencontres ou des suivis personnalisés. - Répondant local: organisation du déploiement dans son hôpital; planification des sessions de formation (avec les coaches); Des outils de reddition de compte (ententes de gestion, préalables, composantes), sont suivis rigoureusement. Conclusion : Cette structure et ces outils ont été mis en place dans toute la province afin de réussir l’adaptation du réseau hospitalier aux besoins de la personne âgée, Introduction : Afin de se donner des conditions gagnantes pour implanter l’approche adaptée, dans tous les hôpitaux du Québec, un programme de formation a été mis sur pied pour les intervenants du réseau de la santé. Il soutiendra l’instauration de nouvelles pratiques pour mieux répondre aux besoins des personnes âgées hospitalisées. Objectifs : Présenter le programme de formation qui s’adresse à tous les membres du personnel ainsi qu’aux gestionnaires des hôpitaux. Il comprend six modules de formation accompagnés d’activités de coaching qui permettent d’optimiser l’intégration des connaissances. Méthodes : Le programme de formation, basé sur l’Approche adaptée, est offert en ligne. Il a été créé par des experts cliniques et techno pédagogiques . Un comité d’experts a ensuite révisé les contenus qui ont été validés par des professionnels des établissements de santé avant d’être rendus disponibles à l’ensemble du réseau. Résultats : Les modules de formation touchent les thèmes suivants : introduction à l’approche adaptée à la personne âgée en milieu hospitalier, vieillissement normal et pathologique, adapter l’environnement, opérationnalisation de l’approche adaptée, le syndrome d’immobilisation, le delirium. Chaque module est accompagné d’un guide pour les coaches et de suggestions d’activités de coaching. Conclusion : Les modules de formation sont des outils polyvalents et conviviaux. Ils favorisent l’intégration de nouvelles connaissances et leur application au quotidien., Introduction : En centre de soins de longue durée, le maintien d’un état nutritionnel optimal peut s’avérer difficile. L’Hôpital Sainte-Anne (n=400 résidents et âge moyen= 90 ans; Ste-Anne de Bellevue, Québec) est un des rares établissements canadiens ayant choisi la pesée mensuelle et le suivi de l’indice de masse corporelle (IMC=Poids/Taille2) pour en faire une évaluation systématique et pratiquer une approche préventive. Cette initiative a été reconnue comme une pratique exemplaire par Agrément Canada (2011). L’IMC permet d’estimer le risque associé à un poids inadéquat. Un taux de mortalité plus faible est associé à un IMC >25 kg/m² chez les résidents institutionnalisés. Un IMC de 24 kg/m2 a été sélectionné comme norme optimale à l’Hôpital Sainte-Anne. Objectifs : 1) Utiliser l’IMC moyen de l’ensemble des résidents et des résidents dysphagiques comme indicateur de performance des interventions nutritionnelles pour les divers programmes d’intervention clinique; 2) Évaluer systématiquement l’efficacité des interventions nutritionnelles selon un protocole de pesée pré-établi. Méthodologie : Les résidents sont pesés mensuellement. Les changements de poids significatifs sont identifiés. Le résident et l’équipe de soins sont avisés de l’évolution de l’état nutritionnel, des problématiques associées et des changements au plan de soins nutritionnels. Les IMC individuels et moyens sont calculés. La conformité du protocole de pesée et la calibration de nos appareils sont évaluées régulièrement. Résultats : L’IMC global moyen et l’IMC des résidents dysphagiques sont 24.5 kg/m2 et 24.3 kg/m2, respectivement. Conclusion : Comme activité de dépistage, cette pratique permet de prendre rapidement en charge les états nutritionnels problématiques et aide à prévenir ou retarder l’apparition des conséquences fâcheuses de la dénutrition., Purpose: To assess the responsiveness of a variety of quality of life (QOL) measures in patients with Alzheimer’s disease (AD). Methods: We recruited 272 community-living AD patients and their caregivers. Patients with MMSE scores greater than 10 rated their QOL using the EQ-5D, Quality of Well-Being scale, a visual analogue scale and the QOL in AD (QOL-AD) instrument. Caregivers rated patient\’s QOL using these measures as well as the Health Utilities Index (HUI) and Short-Form-36. QOL and patients’ cognition, function and neuropsychiatric symptoms were assessed at baseline, 6, 12 and 24 months. We evaluated internal responsiveness using the standardized effect size and response mean and external responsiveness using ROC curves for the QOL measures based on a decline or no decline in a composite score based on the first principal component of the core dementia symptoms. Results: At baseline, patients’ mean age was 82.8, 50.2% were female and mean MMSE was 20.2. For patient self-ratings, the QOL measures did not exhibit meaningful responsiveness over time. For caregiver ratings of patient QOL: the internal responsiveness of the QOL measures at 12 and 24 months was small (0.12 to 0.28) and small to moderate (0.22 to 0.59), respectively; the external responsiveness at 12 and 24 months was greatest for the EQ-5D, QOL-AD and HUI, with areas under the ROC curves of 0.67 to 0.77. Conclusions: Over 24 months of follow-up, patient self-ratings of QOL did not exhibit meaningful responsiveness, while caregiver ratings of patient QOL with the QOL-AD, HUI and EQ-5D exhibited moderate responsiveness., Increasing incidence and prevalence of dementia and staff time constraints have created the need for an improved and streamlined system of care for dementia patients in primary care. The objective of this study was to develop a collaborative model of dementia care in partnership with and endorsed by staff members and stakeholders at a Primary Care Network (PCN) in Alberta. Phase 1 involved a retrospective chart review with Phase 2 involving focus groups and structured questionnaires that were distributed to staff members to assess their perspectives on dementia care. Phase 3 involved the creation of a preliminary care model for patients with dementia, followed by feedback on the model from staff members using consensus based methodology. Phase 4 of the project will focus on the implementation of the model in the PCN, with process and formative evaluation of the model planned. In this presentation, we provide a comprehensive overview of our model, components of the model, and resources that are foundational to successful implementation., Background: Falls are a common condition that had important impacts in elderly patients. Previous study suggested that falls lead to limitation of activities due to fear. Purpose: To report impacts of falls, expectations on Thai health-care system and fall events in falling elderly patients with chronic disease. Designs & Methods: Qualitative in-depth interviews, using an interview guide, were conducted with 18 participants who were referred from primary care clinic, geriatrics clinic and home health care unit. Content analysis was performed for analysis. Results: Falls were not found to be related to chronic disease in elderly patients. The most common reaction was fear, particularly fear of being dependent and burden to family members. Chronic pain was the most common illness developed after fall. Patients tended to be more careful, walking slowly, decrease activities, decrease traveling, and use gait aid more regularly. Most patients eventually told family member’s about their falls. Family’s reaction to patient’s fall included concern of patient’s condition, distrust, sarcastic comments. Doctors did not take falls into account by not asking patients about their falls. In addition, patient did not mention their falls events to doctors particularly, specialist doctors. Patients focused more on results of falls compared to causes of falls. Accident was the most common cause in fall event. Conclusion: Falls affected patients not only physical aspect, but also psychological status, behavior and their families. Health care providers should pay more attention to elicit causes of falls in elders., Background: Arthritis is largest contributor to disability in both Canada and the United States of America. Primary clinical features include pain and dysfunction. The effect of physical inactivity as a modifiable risk factor of arthritis is not clearly understood. Purpose: To elucidate the association between physical activity and arthritis in the Canadian population. Methods: Physical activity was evaluated in respondents with and without arthritis using a national health survey, the Canadian Community Health Survey 2007–2008 which consists of over 108,000 community-dwelling respondents 18 years or older. Respondents were asked a series of questions pertaining to physical activity over the past 3 months. Estimates of physical activity are obtained in terms of metabolic equivalent of task (METs). Logistic regression model was developed using demographic (age, gender, education, marital status) and behavioural (smoking, drinking, obesity) characteristics along with physical activity as potential risk factors for arthritis. Results: The prevalence of arthritis was 16.0%. The mean age for respondents with arthritis was 60.0 (SD=0.15) years with 40% being male. Mean Body Mass Index (BMI) was 27.0 (SD=0.06) Kg/m2 for respondents arthritis and 26.0 (SD=0.03) Kg/m2 for respondents without arthritis. The proportion of moderate and vigorous activities were significantly associated with having arthritis than those without arthritis (Moderate: OR 0.73, 95% CI 0.66–0.80; Vigorous: OR 0.80 95% CI 0.72–0.88). Conclusion: People with active lifestyle had a reduced likelihood of having arthritis; however, factors such as age and smoking can reduce the significance of physical activity in explaining arthritis., Background: Elder abuse is a growing problem in Canada that is underdiagnosed and overlooked by healthcare services with devastating consequences for older persons, such as increased morbidity and mortality, poor quality of life and loss of property and security. Objective: Examine the accuracy and precision of existing elder abuse screening tools to facilitate the introduction of more valid detection strategies for healthcare practitioners. Data Sources: We searched MEDLINE (1960–July 15, 2011), EMBASE (1980–July 15, 2011), PsycINFO (1984¬–July 15, 2011) and CINAHL (1982–July 15, 2011), plus gray literature, reference lists and review articles. Study Selection: Studies that included original data focusing on the accuracy and precision of instruments for screening of elder abuse, in which instruments were compared with a reference standard that included assessment by at least one expert. The subject of the screening assessment could be the patient, family member, caregiver, cohabitant and/or friend. Data Extraction: Study design, patient populations and settings, methods of assessment, and outcome measures were extracted, and a modified- QUADAS tool was applied to evaluate study quality. Two investigators independently completed each level of screening and data abstraction. Results: The literature search identified 5769 citations. Review of abstracts led to the retrieval of 83 full-text articles for assessment; 24 articles met inclusion criteria. Data synthesis is underway. Conclusion: Few studies provide data on screening tools that accurately and precisely identify elder abuse. Further research is needed to increase evidence-based knowledge on which healthcare practitioners may rely to improve identification of elder abuse., While much knowledge is gained from quantitative health research, illness itself is subjective. By appreciating the experience of failing health and its impact on outcomes for individual patients, it is hoped that healthcare providers will be able to practice more humanely and effectively. Falls are a common and serious health problem experienced by older persons. How they perceive and interpret the experience of falling can influence the long-term consequences of the event. Other than work done with fear of falling, to date this has not been rigorously studied. Our primary objective in this pilot study was to explore whether there was additional value in obtaining a patient’s narrative as part of the assessment of older persons who had fallen. We interviewed a convenience sample of 5 patients referred to the Calgary Fall Prevention Clinic (CFPC) using the Narrative Interview technique proposed by Jovchelovitch and Bauer. These narratives and the CFPC assessments underwent separate analyses for themes and patterns. Phenomena generated from narratives were determined through several readings of the transcript, using original audio recordings and field notes to help provide context. A comparison between phenomena found in the narrative analyses and the CFPC assessments was performed to highlight commonalities and gaps. Our findings will be presented to a focus group consisting of members of the CFPC who will discuss the potential usefulness of narratives in care planning for these patients. These deliberations will inform further research on the use of narratives in the assessment of patients referred to the CFPC., Purpose: Determine the prevalence of cognitive impairment in older cancer patients referred to a Geriatric Oncology clinic. Identify the type of cognitive impairment (dementia, mild cognitive impairment (MCI), cognitive changes related to cancer or its treatment). Methods: Ongoing study on data collected since 2006 for each patient visit in the Consultation service for senior oncology patient clinic at the Jewish general Hospital. A comprehensive assessment including data on demographics, comorbidities, functional status mood, mobility, nutritional status and level of energy is available. Cognition is evaluated with Mini Mental State Exam (MMSE), Montreal Cognitive Assessment test (MoCA) and neuropsychology in selected cases. Brain imaging is used when indicated. Descriptive techniques were used to analyze demographic data and diagnoses of cognitive impairment. Results: Preliminary analysis from November 1, 2006 to November 30, 2010 reveals a mean age of 79 years old (range 46–104) for a total of 240 referrals. 35% of these referrals were for cognitive impairment, our evaluations uncovered and addressed nearly 60% of cognitive impairments (dementia, MCI, cancer or cancer treated related cognitive changes) revealing a growing number of older patients with this issue. Conclusion: Findings from this study provide insight into the usefulness of having a formal cognitive screening evaluation pre and post cancer treatment of older cancer patients referred to an outpatient Geriatric Oncology clinic. Additional research is required to understand, prevent and treat cognitive impairement in older cancer patients, early recognition and identification is paramount., In preparation for the 2012 Canadian Consensus Conference on Dementia, background papers are being written on 8 topics in order to make recommendations for clinical practice. Rapidly Progressive Dementia (RPD) is an uncommon condition with numerous possible causes, for which there is no universally accepted definition. We conducted a systematic review to make recommendations about [1] definitions for RPD in (a) dementia developing in previously healthy individuals, and (b) individuals with an existing dementia who experience unusually rapid cognitive decline; [2] a logical diagnostic approach based upon the prevalence of conditions which cause RPD. The initial search identified over 900 articles. Each abstract was assessed for relevance (to [1] and [2] above) by two independent reviewers. If either reviewer deemed an article relevant or possibly relevant, it was fully reviewed for quality against pre-agreed criteria; if assessed of good quality, data were extracted. In the example of a report of a case series, a good article described patient population (and referral bias if any), diagnostic criteria for dementia, and definition of RPD. We describe the process of conducting the review, proposing criteria for standard definitions, and the iterative process leading to a recommended diagnostic approach., Background: Various methods are being used to ensure geriatric core competencies are being taught throughout Canadian medical schools. In 2011, the University of Saskatchewan (U of S) became the first Canadian medical school to incorporate a geriatric skills day (GSD) into the curriculum. The GSDs were based on the successful program created by the U of S’s Geriatric Interest Group. Methods: A full day GSD was held twice in Saskatoon and once in Regina, Saskatchewan. Interdisciplinary team members from both health regions facilitated interactive sessions on various geriatric competencies. The GSDs, accounting for 25% of the overall course mark, coordinated with the didactic geriatric lectures. In addition, an OSCE station, worth 20%, examined one of the skills taught. Student evaluations included rating their satisfaction with each session on a 5-point scale as well as pre- and post-assessments of students’ self-rated ability to perform 24 specific skills (on a 10-point scale). Results: 84 (98%) of the third-year medical students participated. The session evaluations (n=403) rated very high with a median rating of 5.0 on all questions. Student’s self-rated assessments of their ability to perform geriatric skills improved from median scores between 3–7/10 before to 8–9/10 after the GSD. Students also performed well on the OSCE station several weeks after the GSD. Conclusions: The geriatric skills day was well received by the medical students. The synergy created by combining didactic lectures with a skills day improved medical students confidence with their ability to perform specific geriatric skills., Introduction: The training of Specialist Geriatricians (SpGrtn) within Canada has not kept pace with the aging of the population over the last 15 years. The anticipated retirement of existing SpGrtns in Canada will exacerbate the shortfall for specialized geriatric services (SGS) across the country. Objectives: 1. To document the existing number of SpGrtns and practicing Care of the Elderly (CofE) trained Family Physicians practicing in SGS. 2. To project the anticipated number of SpGrtns that will retire over the next 15 and 30 years. 3. To calculate the ideal number of Geriatricians in Canada, based on published ratios.1,2 Methods: Using the ratio of 1.25 SpGrtns: 10,000 people 65+1 or 1 SpGrtns: 4,000 people 75+2 and 2006 Canadian Census data (low, med. and high pop. projections 65+ or 75+) over the next 30 years, the need for SpGrtns was identified. The anticipated retirement of present Canadian SpGrtns 40 years beyond their medical degree (MD) was determined. Results: In 2011, there were 256 SpGrtns in Canada and 93 CofE physicians. The calculated need in 2011 is 613 SpGrtns (1.25:10,000 65+) or 688 (1:4,000 75+). The calculated need for SpGrtns in 2026 is 969 (±27 (1.25:10,000 65+). Across Canada, 10 SpGrtns are trained annually (150 in 15 years). Over the next 15 years, 105 of the existing SpGrtns will have practiced 40 years beyond the date of their MD. Conclusions: In 2026 there will be 301 SpGrtns (256- 105+150) resulting in a shortfall of 668 SpGrtns (969–301) in Canada., Introduction: ‘Sitters’ have been used for some time for delirium. However, the specifics surrounding their use and involvement in patient care combined with their impact on delirium outcome is not known. Associated cost expenditure is considerable when compared to that for special care aides whom have considerably more training and experience, thus concerns have been raised about these sitters thus the reason for performing this chart review. Objective: The two objectives for this chart review are to review the current use of sitters in one of the local acute care hospitals, and the second was to assess the impact sitter use has on delirium outcomes. Method: A retrospective chart review was performed from the years April 1st 2009 to December 2010. 1252 charts in total were initially identified and reviewed, with 32 charts being included in the final analysis. Results: 32 charts documented the use of sitters. Two charts had client attendant forms completed. Sitters were hired for delirious and agitated patients. No information was provided about shift number, duration, activities performed or number of patients sitters were responsible for. The clinical impact sitter use had on delirium was assessed by looking at the complication rate (i.e., number of falls) and requirement for certain interventions (i.e., intravenous fluid (IVF)). Complication rate revealed 11 patients fell and 14 had a reduction in functional capacity. The intervention rate revealed 12 patients required IVF, three patients required artificial nutrition, 25 patients experienced sleep deprivation, 19 patient’s required pharmacological therapy and 11 patients required restraints., Background: There is increased mortality in older people following cold. This has been attributed to cardiovascular disease but others argue that cold alone is responsible. The effect of environmental cold on mortality for those in a protected environment remains unknown. This study examined whether elderly nursing home (NH) residents are protected from excess cold related mortality. Method: Weekly deaths of people >65 years old in Edmonton from 2000–2009 were obtained from Vital Statistics Canada. Corresponding weekly mean temperatures were obtained from the Weather Channel. Data were dichotomized into “NH” and “community” deaths. Results: There were 72629 deaths, 54516 of those >65 years old. Deaths in NH increased annually. Excess death related to cold was observed only for NH residents. Conclusions : The difference between deaths at the highest and lowest temperature deciles was statistically significant., Background Benign prostatic hyperplasia (BPH) with bladder outlet obstruction (BOO) can result in lower urinary tract symptoms (LUTS). Early, accurate diagnosis may reduce pain and complications. Objective: To systematically review the evidence on the diagnostic accuracy of office-based tests for BPH with BOO in males with LUTS. Methods: Search of MEDLINE and EMBASE (1950 to August 12, 2010), Cochrane Central Register of Controlled Trials via Ovid, and references of retrieved articles. Data selection: Prospective studies comparing at least one diagnostic test, feasible in a clinical setting and readily available to non-specialist clinicians, to the gold standard reference test, invasive urodynamics. Results: There were 6692 unique citations identified with 9 prospectively conducted studies (N=1217 patients) meeting inclusion criteria and describing use of 2 symptom questionnaires as well as individual symptom(s). The best constellation of symptoms suggesting BPH with BOO was ‘poor stream and frequency and/or nocturia’ (positive LR, 1.76; 95% CI, 1.17–2.64). The most useful symptom for which the absence made a diagnosis of BPH with BOO less likely, was nocturia (negative LR, 0.19, 95% CI, CI 0.05–0.79). The best symptom questionnaire to support or rule out a diagnosis of BPH with BOO was the International Prostatic Symptom Score (I-PSS) at a cut-off of 8 (summary positive LR, 1.34; 95% CI, 1.06–1.70; summary negative LR, 0.28, 95% CI, CI 0.12–0.70). Conclusions: Although urodynamic testing is the gold standard for diagnosis of BPH with BOO, symptoms obtained through history may be useful. The best evidence supports asking about nocturia, stream and frequency., “An Exploration of the Care of Older Adults in Acute NHS Trusts”, also focussed on nutrition, an area scrutinised by the media. The Council of Europe produced a “Resolution” – 10 characteristics of good nutritional care, from which the Nutritional Team of Southend Hospital created the Southend Universal Nutritional Screening (SUNS) Tool as a simple alternative to MUST (Malnutrition Universal Screening Tool), and introduced measures to improve patient nutrition. 3-part survey on inpatients (total = 83) across 4 wards:- two geriatric wards – one with a special interest in nutrition; an acute medical ward; a surgical ward where measures were not in place. Using the European guidelines, ward facilities were assessed, patient notes were audited, and patients provided their perspective. All wards had multiple dietary options. Not all implemented protected mealtimes. All patients were screened within 24 hours in Medicine, but only 63% of surgical patients. Many had a nutritional plan, although often not comprehensive, and few were re-screened within 1 week. Patients were satisfied with meals and nutritional services, but did not feel they had 24-hour access to food, or informed enough about nutritional care. There was no standardised screening across departments, although back-up pathways allowed unscreened patients to access nutritional services. Some low-risk patients (as identified by SUNS) developed complications so the tool requires adaptation to better identify at-risk patients. Weekly re-assessments need improving. These results reflect that a simple pathway for all departments across all hospitals would provide better patient care by moving the NHS towards national standardisation., Introduction : Puisque la prévalence de l’insuffisance cardiaque (IC) augmente avec l’âge, le fardeau de l’IC augmentera considérablement dans les prochaines années. L’objectif de la présente étude est de décrire les caractéristiques socio-démographiques et d’utilisation de soins de santé et de médicaments selon les groupes d’âge chez les individus âgés de 65 ans ou plus ayant eu un premier diagnostic d’IC entre 2000 et 2009 au Québec. Méthode : À partir des données de la Régie d’assurance médicaments du Québec (RAMQ), nous avons effectué une étude de cohorte incluant les individus âgés de 65 ans et plus recevant un diagnostic d’IC entre les années 2000 et 2009. Les caractéristiques étudiées sont celles se rapportant à l’utilisation des services de santé, de l’usage des médicaments et les caractéristiques socio-démographiques. Les analyses statistiques effectuées sont des moyennes, des médianes et des proportions. Résultats : Cette étude permet de comprendre les caractéristiques des individus âgés de 65 ans et plus souffrant d’IC afin de pouvoir appliquer les considérations soulevées par les lignes directrices., Background: By 2050, the proportion of seniors is estimated to increase to 27% from 14% currently. In 2011, there were only 238 Canadian specialists certified in Geriatric Medicine. Beyond the expansion of geriatric specialists, an improvement in physicians’ attitudes, knowledge and skills in geriatrics is important regardless of the specialty. Objectives: This study aimed to identify changes in attitudes of preclerkship University of Toronto (UofT) medical students towards geriatric care after participating in an interdisciplinary Geriatric Clinical Skills Day (GCSD) organized by UofT’s Geriatrics Interest Group.Methods. This was a before and after study. First and second year UofT medical students registered for the GCSD participated in this study. Method: A questionnaire, including the validated UCLA Geriatrics Attitudes Scale, was administered before and after the GCSD. Both a one-sample t-test and the signed rank non-parametric test were used to determine any changes in attitudes. Results: Of 19 study participants, four students did not complete the post-test questionnaire. 42.1% indicated an interest in Geriatric Medicine, 26.3% in Geriatric Psychiatry, and 63.2% in working with elderly patients. Both pre- and postmean scores were greater than 3 (neutral), indicating a positive attitude before and after the intervention (p0.11). Conclusions: There is an overall positive attitude towards geriatrics among study participants. However, a one day GCSD did not alter attitudes towards geriatric care. This small study warrants further investigation in a larger multicentred trial., Canada’s population is aging and research has shown that primary care physicians find it difficult to care for elderly patients. Canadian family physicians have appreciated need for geriatrics continuing medical education (CME) and based on the expert opinions of experienced care of the elderly family physicians, geriatric knowledge and skills felt necessary for a family physician caring for the elderly, were put into a curriculum based on the 5 weekend program style. The University of Toronto Department of Family & Community Medicine developed a 5 weekend leadership program in the mid 1990’s and this format allowed community physicians to train without giving up regular clinical time. The Five Weekend Care of the Elderly Certificate Course used discussion in small groups of four as per Malcolm Knowles’ theory of andragogy and adult learning. These discussions were directed carefully as per Dave Davis’ research on effective CME. Donald Schon’s theory of reflective practice shaped the course homework assignments. These homework assignments were created to allow immediate «reflection in action» with real life patient experiences and «reflection on action» later during presentation of their written essays to the entire class. Participants were asked to complete a survey regarding their self rated knowledge of curriculum topics before and after the course. The results showed improved family physician self-reported knowledge of the curriculum topics. Favourable response to small group discussion and debriefing of assignments showed that there is interest amongst family physicians to these types of interactive learning., Background: Carotid sinus hypersensitivity (CSH) is a common cause of fainting and falls in older adults and is diagnosed by carotid sinus massage (CSM). Previous work has suggested that age-related stiffening of blood vessels reduces afferent input from the carotid sinus leading to central upregulation of the overall arterial baroreflex response. A potential intevention to reduce carotid sinus hypersensitivity is aerobic training. Objective: We examined whether aerobic exercise could reverse carotid sinus hypersensitivity in older adults with Type 2 diabetes complicated by co-morbid hypertension and hyperlipidemia. Methods: 15 older adults (mean age 72.2±0.7) with diet-controlled or oral hypoglycemic-controlled Type 2 diabetes, hypertension, and hypercholesterolemia were recruited. Subjects were randomized to each of 2 groups: an aerobic group (AT, 3 months vigorous aerobic exercise), and a nonaerobic (NA, no aerobic exercise) group. Exercise sessions were supervised by a certified exercise trainer 3 times per week, and utilized a combination of cycle ergometers and treadmills. Arterial stiffness was measured using the Complior device. Results: Although aerobic exercise significantly increased arterial compliance as measured by both radial (p=0.005) and femoral (p=0.015) pulse wave velocity, there was no training effect on either the bradycardic (p=0.251) or vasodepressive (p=0.523) response to CSM. Conclusions: Although aerobic training can reverse arterial stiffness, there is no evidence for a corresponding reduction in carotid sinus hypersensitivity in older adults with diabetes., Background: Providing geriatric education to health science students becomes increasingly important as Canada’s population ages. The University of Saskatchewan’s Geriatric Interest Group (GIG) developed Geriatric Skills Days (GSD) to provide students additional opportunities to improve skills and knowledge in geriatric core competencies (GCCs). Methods: The GSDs, facilitated by the Geriatric Evaluation and Management Program’s interdisciplinary team, covered GCCs including comprehensive geriatric assessment, falls, polypharmacy, cognitive assessment, and functional assessment. Students rated satisfaction with each session (on a 5-point scale). In 2011, students also completed pre-post ratings (on a 10-point scale) of perceived ability to perform 11 skills. Results: Eighty health science students from seven different colleges attended GSDs. In the 2010 cohort, students felt the sessions had clear objectives, met those objectives, met their objectives as learners, provided enough time for discussion, and were well organized (all Mdn=5.0, N=151). We received 148 session evaluations from the 2011 cohort. Students agreed the sessions had clear objectives (Mdn=4.0) and met those objectives (Mdn=5.0); met their own objectives as learners (Mdn=5.0), provided enough time for discussion (Mdn=4.0), and were well organized (Mdn=5.0). Also in 2011, students’ (N=18) median self-rated ability to perform each skill ranged between 2 and 6 before the GSD (eight skills received scores of 2 or 3). Post-participation ratings increased markedly, with medians ranging between 7 and 9 (N=24). Conclusions: Participant responses were very positive to the GIG initiated GSD. This positive experience influenced the decision to incorporate a GSD into the College of Medicine’s 2011–2012 third-year curriculum., The Canadian Consensus Conference on Diagnosis and Treatment of Dementia in 2006 dealt with a wide range of topics in considerable depth. Many of those recommendations retain their relevance today. Since that time remarkable advances have occurred in the diagnosis of Alzheimer’s disease, including cerebral amyloid imaging and CSF studies of Abeta 42, and phosphorylated tau. Recent publications have attempted to redefine Alzheimer’s disease as a pathological entity which can now, perhaps, be identified by biomarkers ahead of any cognitive changes. However serious ethical dilemmas surround findings such as abnormal accumulations of cerebral amyloid, in normal or minimally symptomatic people. Should these promising but as yet unproven technologies be restricted to the research arena? How can we prevent premature “bleeding” into clinical practice before their benefits and risks can be adequately assessed? These and other dilemmas constitute the reasons for a new CCCD. The steering committee members are listed above. Background papers will be produced and posted to a website, where CCCD members can comment. Recommendations will be submitted for consensus prior to the Conference in Montreal in May. Dissemination will be actively managed through the Dementia Knowledge Translation Network. The CCCD will address the following topics: • Definitions (critique of recently published revised U.S. definitions) • Fluid biomarkers • Neuroimaging • Diagnostic approach to rapidly progressive dementia • Management of early onset dementia • Update on pharmacological treatment., Objectives: 1. To determine if frailty is associated with lower life satisfaction (LS); 2. To determine which domains of LS are influenced by frailty. Methods: Analysis of 1751 community-dwelling older adults (65+ years) from the Manitoba Study of Health and Aging. Measures: LS was measured using the Terrible-Delightful Scale. One item measures overall LS and was scored on a 7 point Likert-type scale. Satisfaction was also measured with individual domains: health, finances, family relations, friendships, housing, recreation activity, religion, self-esteem, and transportation. Satisfaction with employment and living partner were not considered because there were many missing responses. Frailty was determined by the Canadian Study of Health and Aging definition of frailty, and was categorized as no frailty; incontinence only; mild frailty; and moderate/severe frailty. Age, gender, education, marital status, and living arrangement were self-reported. Depressive symptoms were measured using the Centre for Epidemiologic Studies – Depression scale. Bivariate and multivariate linear regression models were conducted. Results and Conclusions: Most older adults, including frail older adults, were satisfied with life overall, and with most aspects of their lives. In bivariate analyses, frailty was associated with lower levels of LS overall (5.3 versus 4.9)., Purpose: To present the inspiring case of Ms. P who is a 103 year old lady we followed in our Geriatric Oncology clinic. Description: Ms. P. was 100 years old when she first walked into the clinic using her cane. She lived at home with her 105 year old sister, had a private caregiver for assistance with ADLs and IADLs and was not demented. She was diagnosed with left breast cancer in 1993, treated by local excision and hormonal therapy only. She was also known for bilateral hip surgery, one episode of pulmonary edema, osteoporosis and hypothyroidism. She presented in 2008 with local progression of disease over the left breast (painless red nodules and infiltration of the skin with minimal exudate). Investigations revealed no evidence of distant metastasis. In May 2009, she received radiotherapy for ulcerated skin nodules covering 70% of the breast and purulent discharge. She responded very well to treatment with complete resolution of the open wounds. However, the skin lesions recurred a few months later. In an attempt to control the disease while minimizing toxicity, she received a total of 4 monthly doses of Faslodex intramuscularly; this was discontinued because of side effects of anorexia and fatigue with arthralgias. In January 2011, she received a second course of palliative radiotherapy with good response. She passed away at home in October 2011. Our comprehensive evaluation and personalized interventions proved beneficial for this patient, who otherwise would not have received further treatment because of her advanced age., Background: Smoking is common in China, where the population is aging rapidly. This study evaluates the relationship between smoking and frailty and their joint impact on survival in older Chinese adults. Methods: Data come from the Beijing Longitudinal Study of Aging. Community-dwelling people (n=3257) aged 55+ years at baseline were followed between 1992–2007, during which time 51% died. A frailty index (FI) was constructed from 27 self-reported health deficits. Results and Conclusions: Nearly half (45.6%) of the participants reported smoking (66.8% men, 25.3% women). On average, male smokers were frailer (FI=0.18±0.15) than male nonsmokers (FI =0.14±0.10; p=0.030) and had an increased risk of death (risk ratio=1.66 age and education adjusted, 95% CI=1.46–1.88., Introduction : En 2003, quatre Réseaux Universitaire Intégrés de Santé (RUIS), établis autour des facultés de médecine et de leurs établissements de santé affiliés, ont été institués. Ils doivent mieux répondre aux enjeux socio-sanitaires actuels et futurs. À l’initiative de l’Institut universitaire de gériatrie de Montréal (IUGM), le RUIS de l’Université de Montréal a créé (2009), un comité de gériatrie. Objectifs : Favoriser les meilleures pratiques cliniques; proposer la mise en place de corridors de services pour les soins plus spécialisés; favoriser la concertation et complémentarité en recherche, enseignement, évaluation des technologies et prévention /promotion de la santé; être un leader auprès des instances universitaires et gouvernementales sur l’organisation des services de santé aux personnes âgées. Méthodologie : Processus de révision des services gériatriques spécialisés; inventaire du temps de formation universitaire consacré aux soins aux personnes âgées; inventaire des activités de prévention/promotion de la santé; élaboration d’un projet pilote de télépsychogériatrie auprès des partenaires de l’IUGM. Résultats : Une typologie des services gériatriques spécialisés a été définie. Le temps de formation obligatoire varie par discipline entre 0 % (service social) et 17% (médecine - psychiatrie), tandis que le travail auprès de la clientèle varie de 12% (orthophonie) à 61% (physiothérapie). Le répertoire en prévention/promotion a été complété ainsi que le projet pilote de télépsychogériatrie. Conclusion : Pour une meilleure coordination et intégration de ses composantes avec le réseau de première instance, le MSSS a instauré une table de gériatrie dans chacun des RUIS, fédérées au niveau national, Introduction : Le rôle des unités de courte durée gériatriques (UCDG) est d’offrir des soins spécialisés dans le continuum des soins et services de santé offerts à la personne âgée. Les professionnels de ces programmes doivent maintenir leurs compétences cliniques, et les gestionnaires mettre en place des processus organisationnels efficaces. Un besoin d’échange et d’actions spécifiques au niveau national a été exprimé par la majorité des responsables d’UCDG. Objectifs : Améliorer de façon continue la qualité des soins dans les services hospitaliers de gériatrie, généraliser de hauts standards de pratique afin d’y traiter des patients aux situations cliniques complexes et agir comme milieu de référence. Méthodes : 1) Création d’un comité exécutif composé de médecins et gestionnaires provenant des diverses régions du Québec; 2) Embauche d’une coordonnatrice; 3) Développement d’un site internet (www.rushgq.org) pour dépôt de documents et d’échanges via un forum de discussion. Résultats : 60% des centres hospitaliers ont adhéré au RUSGHQ. Les activités en cours sont : 1) Circonscrire la population cible des UCDG; 2) Harmoniser les mécanismes d’évaluation et d’intervention cliniques sur la base des meilleures pratiques; 3) Mettre à la disposition des membres une « boîte à outils » clinique et de gestion pertinente; 4) Établir les ratios de ressources professionnelles nécessaires à un fonctionnement optimal; 5) Offrir des activités de développement professionnel continu. Conclusion : Une communauté de pratique en gériatrie a été mise sur pied facilitant réflexions et apprentissages collectifs des professionnels de la santé et des gestionnaires travaillant en milieu hospitalier., Introduction: The Effective Management of Alzheimer’s disease (AD) By Treating pAtients and relieving Caregivers with Exelon* Patch (EMBRACE) is a prospective, observational, single-cohort, open-label, multicentre study with an 18-month treatment period. Study objectives were to evaluate the effectiveness of rivastigmine patch in patients with mild to moderate AD as measured by changes in cognition, daily function and behavior from baseline. Secondary outcome measure included the evaluation of the caregiver-reported compliance and treatment satisfaction. Results: A cohort of 1204 Canadian AD patients participated in this trial. Following results are for all evaluable patients (n=969) at the end of the study. The majority of patients were outpatients (80.5%) and treatment-naïve or “de novo” (69.4%). Mean baseline MMSE was 21.8 (95% CI: 21.5, 22.1). Mean change in MMSE from baseline to 18 months was −0.4 (95% CI: −0.7, −0.1). For subjects previously treated with oral cholinesterase inhibitor therapies, approximately 88% (122/139) of their caregivers preferred rivastigmine patch, citing ease of use and patient preference over previous medication as the two most common reasons. The most commonly reported category of adverse event in the safety population n=1204) was “Skin and subcutaneous tissue disorders” (9.3%) the most reported event being pruritus (4%). Conclusion: Final results of this registry demonstrate the effectiveness and good tolerability of rivastigmine patch in patients with AD. Cognitive function, as measured by MMSE, showed a relative stabilization over an 18 month time period. The benefit of rivastigmine patch treatment is further supported by the caregiver preference results.