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11. Rates of health services use among residents of retirement homes in Ontario: a population-based cohort study

Author

Manis, Derek R., Poss, Jeffrey W., Jones, Aaron, Rochon, Paula A., Bronskill, Susan E., Campitelli, Michael A., Perez, Richard, Stall, Nathan M., Rahim, Ahmad, Babe, Glenda, Tarride, Jean-Eric, Abelson, Julia, and Costa, Andrew P.

Subjects
Medical care -- Utilization, Aged patients -- Statistics -- Care and treatment, Nursing home patients -- Statistics -- Care and treatment, Health
Abstract

Background: Because there are no standardized reporting systems specific to residents of retirement homes in North America, little is known about the health of this distinct population of older adults. We evaluated rates of health services use by residents of retirement homes relative to those of residents of long-term care homes and other populations of older adults. Methods: We conducted a retrospective cohort study using population health administrative data from 2018 on adults 65 years or older in Ontario. We matched the postal codes of individuals to those of licensed retirement homes to identify residents of retirement homes. Outcomes included rates of hospital-based care and physician visits. Results: We identified 54 733 residents of 757 retirement homes (mean age 86.7 years, 69.0% female) and 2 354 385 residents of other settings. Compared to residents of long-term care homes, residents of retirement homes had significantly higher rates per 1000 person months of emergency department visits (10.62 v. 4.48, adjusted relative rate [RR] 2.61, 95% confidence interval [CI] 2.55 to 2.67), hospital admissions (5.42 v. 2.08, adjusted RR 2.77, 95% CI 2.71 to 2.82), alternate level of care (ALC) days (6.01 v. 2.96, adjusted RR 1.51, 95% CI 1.48 to 1.54), and specialist physician visits (6.27 v. 3.21, adjusted RR 1.64, 95% CI 1.61 to 1.68), but a significantly lower rate of primary care visits (16.71 v. 108.47, adjusted RR 0.13, 95% CI 0.13 to 0.14). Interpretation: Residents of retirement homes are a distinct population with higher rates of hospital-based care. Our findings can help to inform policy debates about the need for more coordinated primary and supportive health care in privately operated congregate care homes., In the continuum of care services and settings for older adults lies home care at one end and long-term care at the other. (1) Home care services may include, but [...]

Published
2022
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13. Facteurs de risque d'eclosion de SRAS-CoV-2 dans les residences pour atnes en Ontario, au Canada: etude de cohorte a l'echelle de la population

Author

Costa, Andrew P., Manis, Derek R., Jones, Aaron, Stall, Nathan M., Brown, Kevin A., Boscart, Veronique, Castellino, Adriane, Heckman, George A., Hillmer, Michael P., Ma, Chloe, Pham, Paul, Rais, Saad, Sinha, Samir K., and Poss, Jeffrey W.

Subjects
Infection, Dwellings, Housing, Health
Abstract

CONTEXTE : L'epidemiologie de l'infection au SRAS-CoV-2 dans les residences pour aines (offrant une aide a la vie autonome), est pour une bonne part inconnue. Nous avons etudie le lien entre les caracteristiques des residences et des communautes avoisinantes et le risque d'eclosion de SRAS-CoV-2 dans les residences pour aTnes depuis le debut de la premiere vague de la pandemie de COVID-19. METHODES : Nous avons procede a une etude de cohorte retrospective dans la population des residences pour aTnes certifiees en Ontario, au Canada, entre le 1er mars et le 18 decembre 2020. Notre parametre principal etait toute eclosion de SRAS-CoV-2 ([greater than or equal to] 1 cas confirme parmi les residents ou le personnel au moyen d'un test d'amplification des acides nucleiques). Nous avons utilise la methode des risques proportionnels avec predicteurs chronologiques pour modeliser les liens entre les caracteristiques des residences et des communautes avoisinantes et les eclosions de SRAS-CoV-2. RESULTATS : Notre cohorte a inclus l'ensemble des 770 residences privees pour aTnes (RPA) certifiees en Ontario qui hebergeaient 56 491 residents. On a denombre 273 (35,5 %) residences pour aines qui ont connu 1 eclosion de SRAS-CoV-2 ou plus; 1944 residents (3,5 %o) et 1101 employes (3,0 %o) ont contracte l'infection. Ces cas etaient inegalement distribues entre les residences. En effet, 2487 cas parmi les residents et le personnel (81,7 %o) sont survenus dans 77 residences (10 [degrees]%). Le rapport de risque ajuste d'une eclosion de SRAS-CoV-2 dans une residence a ete clairement associe aux etablissements qui avaient une grande capacite d'accueil, qui comportaient des unites de soins de longue duree, qui appartenaient a de plus grandes bannieres et offraient plusieurs services sur place, qui se trouvaient dans des regions marquees par une hausse de l'incidence regionale de SRAS-CoV-2 et ou la concentration ethnique a l'echelle de la communaute etait superieure. INTERPRETATION : Certaines caracteristiques facilement identifiables des residences pour aTnes sont associees de maniere independante aux eclosions de SRAS-CoV-2 et peuvent faciliter devaluation des risques et orienter la priorisation de la vaccination., Les adultes ages fragiles qui vivent dans des milieux de vie collectifs ont ete au centre de la pandemie de COVID-19 au Canada et ailleurs dans le monde (1,2). Les [...]

Published
2021
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15. Risk factors for outbreaks of SARS-CoV-2 infection at retirement homes in Ontario, Canada: a population-level cohort study

Author

Costa, Andrew P., Manis, Derek R., Jones, Aaron, Stall, Nathan M., Brown, Kevin A., Boscart, Veronique, Castellino, Adriane, Heckman, George A., Hillmer, Michael P., Ma, Chloe, Pham, Paul, Rais, Saad, Sinha, Samir K., and Poss, Jeffrey W.

Subjects
Ontario -- Health aspects, Epidemics -- Risk factors -- Statistics -- Canada, Assisted living facilities -- Health aspects -- Statistics, Health
Abstract

BACKGROUND: The epidemiology of SARS-CoV-2 infection in retirement homes (also known as assisted living facilities) is largely unknown. We examined the association between home-and community-level characteristics and the risk of outbreaks of SARS-CoV-2 infection in retirement homes since the beginning of the first wave of the COVID-19 pandemic. METHODS: We conducted a population-based, retrospective cohort study of licensed retirement homes in Ontario, Canada, from Mar. 1 to Dec. 18, 2020. Our primary outcome was an outbreak of SARS-CoV-2 infection ([greater than or equal to] 1 resident or staff case confirmed by validated nucleic acid amplification assay). We used time-dependent proportional hazards methods to model the associations between retirement home--and community-level characteristics and outbreaks of SARS-CoV-2 infection. RESULTS: Our cohort included all 770 licensed retirement homes in Ontario, which housed 56 491 residents. There were 273 (35.5%) retirement homes with 1 or more outbreaks of SARS-CoV-2 infection, involving 1944 (3.5%) residents and 1101 staff (3.0%). Cases of SARS-CoV-2 infection were distributed unevenly across retirement homes, with 2487 (81.7%) resident and staff cases occurring in 77 (10%) homes. The adjusted hazard of an outbreak of SARS-CoV-2 infection in a retirement home was positively associated with homes that had a large resident capacity, were co-located with a long-term care facility, were part of larger chains, offered many services onsite, saw increases in regional incidence of SARS-CoV-2 infection, and were located in a region with a higher community-level ethnic concentration. INTERPRETATION: Readily identifiable characteristics of retirement homes are independently associated with outbreaks of SARS-CoV-2 infection and can support risk identification and priority for vaccination., Frail older adults living in congregate care settings have been at the centre of the COVID-19 pandemic in Canada and internationally. (1,2) Long-term care facilities--whose residents are the congregate living [...]

Published
2021
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17. The association between frailty, long-term care home characteristics and COVID-19 mortality before and after SARS-CoV-2 vaccination: a retrospective cohort study.

Author

Dash, Darly, Mowbray, Fabrice I, Poss, Jeffrey W, Aryal, Komal, Stall, Nathan M, Hirdes, John P, Hillmer, Michael P, Heckman, George A, Bowdish, Dawn M E, Costa, Andrew P, and Jones, Aaron

Subjects
MORTALITY risk factors, FRAIL elderly, COVID-19, CONFIDENCE intervals, COVID-19 vaccines, MULTIPLE regression analysis, RETROSPECTIVE studies, NURSING care facilities, RISK assessment, PRE-tests & post-tests, DESCRIPTIVE statistics, RESIDENTIAL patterns, ODDS ratio, LONG-term health care, LONGITUDINAL method
Abstract

Background The relative contributions of long-term care (LTC) resident frailty and home-level characteristics on COVID-19 mortality has not been well studied. We examined the association between resident frailty and home-level characteristics with 30-day COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination in LTC. Methods We conducted a population-based retrospective cohort study of LTC residents with confirmed SARS-CoV-2 infection in Ontario, Canada. We used multi-level multivariable logistic regression to examine associations between 30-day COVID-19 mortality, the Hubbard Frailty Index (FI), and resident and home-level characteristics. We compared explanatory models before and after vaccine availability. Results There were 11,179 and 3,655 COVID-19 cases in the pre- and post-vaccine period, respectively. The 30-day COVID-19 mortality was 25.9 and 20.0% during the same periods. The median odds ratios for 30-day COVID-19 mortality between LTC homes were 1.50 (95% credible interval [CrI]: 1.41–1.65) and 1.62 (95% CrI: 1.46–1.96), respectively. In the pre-vaccine period, 30-day COVID-19 mortality was higher for males and those of greater age. For every 0.1 increase in the Hubbard FI, the odds of death were 1.49 (95% CI: 1.42–1.56) times higher. The association between frailty and mortality remained consistent in the post-vaccine period, but sex and age were partly attenuated. Despite the substantial home-level variation, no home-level characteristic examined was significantly associated with 30-day COVID-19 mortality during either period. Interpretation Frailty is consistently associated with COVID-19 mortality before and after the availability of SARS-CoV-2 vaccination. Home-level characteristics previously attributed to COVID-19 outcomes do not explain significant home-to-home variation in COVID-19 mortality. [ABSTRACT FROM AUTHOR]

Published
2023
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19. Comparing quality of care outcomes between assisted living and nursing homes before and during the COVID‐19 pandemic.

Author

Hoben, Matthias, Hogan, David B., Poss, Jeffrey W., Gruneir, Andrea, McGrail, Kim, Griffith, Lauren E., Chamberlain, Stephanie A., Estabrooks, Carole A., and Maxwell, Colleen J.

Subjects
MEDICAL quality control, EVALUATION of medical care, KEY performance indicators (Management), CONFIDENCE intervals, PAIN, CROSS-sectional method, CONGREGATE housing, NURSING care facilities, RISK assessment, COMPARATIVE studies, CLINICAL medicine, RESEARCH funding, MENTAL depression, COVID-19 pandemic, ANTIPSYCHOTIC agents
Abstract

Background: While assisted living (AL) and nursing home (NHs) residents in share vulnerabilities, AL provides fewer staffing resources and services. Research has largely neglected AL, especially during the COVID‐19 pandemic. Our study compared trends of practice‐sensitive, risk‐adjusted quality indicators between AL and NHs, and changes in these trends after the start of the pandemic. Methods: This repeated cross‐sectional study used population‐based resident data in Alberta, Canada. Using Resident Assessment Instrument data (01/2017–12/2021), we created quarterly cohorts, using each resident's latest assessment in each quarter. We applied validated inclusion/exclusion criteria and risk‐adjustments to create nine quality indicators and their 95% confidence intervals (CIs): potentially inappropriate antipsychotic use, pain, depressive symptoms, total dependency in late‐loss activities of daily living, physical restraint use, pressure ulcers, delirium, weight loss, urinary tract infections. Run charts compared quality indicators between AL and NHs over time and segmented regressions assessed whether these trends changed after the start of the pandemic. Results: Quarterly samples included 2015–2710 AL residents and 12,881–13,807 NH residents. Antipsychotic use (21%–26%), pain (20%–24%), and depressive symptoms (17%–25%) were most common in AL. In NHs, they were physical dependency (33%–36%), depressive symptoms (26%–32%), and antipsychotic use (17%–22%). Antipsychotic use and pain were consistently higher in AL. Depressive symptoms, physical dependency, physical restraint use, delirium, weight loss were consistently lower in AL. The most notable segmented regression findings were an increase in antipsychotic use during the pandemic in both settings (AL: change in slope = 0.6% [95% CI: 0.1%–1.0%], p = 0.0140; NHs: change in slope = 0.4% [95% CI: 0.3%–0.5%], p < 0.0001), and an increase in physical dependency in AL only (change in slope = 0.5% [95% CI: 0.1%–0.8%], p = 0.0222). Conclusions: QIs differed significantly between AL and NHs before and during the pandemic. Any changes implemented to address deficiencies in either setting need to account for these differences and require monitoring to assess their impact. [ABSTRACT FROM AUTHOR]

Published
2023
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21. The association between home care visits and same-day emergency department use: a case-crossover study

Author

Jones, Aaron, Schumacher, Connie, Bronskill, Susan E., Campitelli, Michael A., Poss, Jeffrey W., Seow, Hsien, and Costa, Andrew P.

Subjects
Home care -- Evaluation, Emergency medicine -- Evaluation, Health
Abstract

BACKGROUND: The extent to which home care visits contribute to the delay or avoidance of emergency department use is poorly characterized. We examined the association between home care visits and same-day emergency department use among patients receiving publicly funded home care. METHODS: We conducted a population-based case-crossover study among patients receiving publicly funded home care in the Hamilton-Niagara-Haldimand-Brant region of Ontario between January and December 2015. Within individuals, all days with emergency department visits after 5 pm were selected as cases and matched with control days from the pre vious week. The cohort was stratified according to whether patients had ongoing home care needs ('long stay') or short-term home care needs ('short stay'). We used conditional logistical regression to estimate the association between receiving a home care visit during the day and visiting the emergency department after 5 pm on the same day. RESULTS: A total of 4429 long-stay patients contributed 5893 emergency department visits, and 2836 short-stay patients contributed 3476 visits. Receiving a home care nursing visit was associated with an increased likelihood of visiting the emergency department after 5 pm on the same day in both long-stay (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.17-1.48) and short-stay patients (OR 1.22, 95% CI 1.07-1.39). Stronger associations were observed for less acute visits to the emergency department. No associations were observed for other types of home care visits. INTERPRETATION: Patients receiving home care were more likely to visit the emergency department during the evening on days they received a nursing visit. The mechanism of the association between home care visits and same-day emergency department use and the extent to which same-day emergency department visits could be prevented or diverted require additional investigation., Older adults are more likely to use the emergency department, have longer lengths of stay in the emergency department and are more likely to be admitted to hospital from the [...]

Published
2018
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22. Defining the Assisted Living Sector in Canada: An Environmental Scan

Author

Manis, Derek R., primary, Bronskill, Susan E., additional, Rochon, Paula A., additional, Sinha, Samir K., additional, Boscart, Veronique, additional, Tanuseputro, Peter, additional, Poss, Jeffrey W., additional, Rahim, Ahmad, additional, Tarride, Jean-Éric, additional, Abelson, Julia, additional, and Costa, Andrew P., additional

Published
2022
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28. Geriatric dementia care at Ontario Shores: A new model of care

Author

Viau, Katelynn, Yaddaden, Amel, Lussier, Maxime, Bier, Nathalie, Earle, Julie, Duff-Woskosky, Andra, Bartfay, Wally, Desai, Chaitali, Zavitz, Karen, Horsburgh, Sheri, Gamble, Brenda, Lee, Linda, Hillier, Loretta M., Patel, Tejal, Molnar, Frank, Clarke, Jo-Anne, Borrie, Michael, Cammer, Allison, Morgan, Debra, Whiting, Susan, de Vos, Maya, Henri-Bhargava, Alexandre, Votova, Kristine, Delmar, Paul, Kerchner, Geoffrey A, Wang, Guoqiao, Bateman, Randall, Klein, Gregory, Andjelkovic, Mirjana, Abi-Saab, Danielle, Bullain, Szofia, Montoya, Alonso, Fontoura, Paulo, Doody, Rachelle, Tai, Elaine, Harvey, David, Hofmann, Carsten, Ristic, Smiljana, Rehal, Sunita, Voyle, Nicola, Baudler, Monika, Verreault, Phylicia, Rousseau, François, Keller, Evelyn, Simard, Alexandra, Azouaou, Nassima, Jarboui, Manel, Talleria, Lorraine, Duguay, Johanne, Mérette, Chantale, Labbé, Annie, de Arco, Rossana Peredo Nunez, Yous, Marie-Lee, Ploeg, Jenny, Kaasalainen, Sharon, Martin, Lori Schindel, Palumbo, Mary Val, Rambur, Betty, McKenna, Lori, Voyer, Philippe, Allaire, Émilie, Li, Bing, Thaut, Michael, Yogaparan, Thirumagal, Shanmuganathan, Thirunathan, Vickneswaran, Anicha, Sriharan, Sruthy, DeMarco, Mari L., Hsiung, Ging-Yuek Robin, Best, John R., Chertkow, Howard, Gauthier, Serge, Karlawish, Jason, Feldman, Howard, Spaner, Caroline, Christie, Brian, Musteata, Stela, Gawryluk, Jodie, Hofer, Scott, Henri-Bhargava, Alex, Kenny, Rebecca, Elliot, Valerie, Kosteniuk, Julie, Chow, Amanda Froehlich, Bayly, Melanie, O’Connell, Megan E., Kortzman, August, O’Connell, Megan, Kirk, Andrew, Conn, David, Sokoloff, Lisa, Feldman, Sid, Chau, James, Moser, Andrea, Lingum, Navena, Gingrich, Shaen, Shaikh, Salma, Rabheru, Kiran, Cassidy, Keri-Leigh, Checkland, Claire, Parsons, Daria, Massie, Ariane S., Mitchell, Julie Spence, Aksenchuk, Sophia, Lindsay, Barbara, Howard, Maria, Shaw, Courtney, Armitage, Gerrard, Capstick, Andrea, McNeil, Heather, Holyoke, Paul, Vines, Chanile, Giosa, Justine, Khan, Bilal, Shultz, Mary, BEAUCHET, Olivier, Sekhon, Harmehr, Allali, Gilles, Montembeault, Maxime, Brodeur, Catherine, Macoir, Joël, Maxwell, Colleen, Maclagan, Laura, Campitelli, Michael, Yao, Shenzhen, Dharma, Christoffer, Sherin, Tracey, Hogan, David, Bronskill, Susan, Ivo, Jessica, Faisal, Sadaf, McDougall, Aidan, Bauer, Jillian, Pritchard, Sarah, Chang, Feng, Mehta, Deval, Syed, Ali, Carter, Caitlin, Sharma, Shaambhavi, Nagge, Jeff, Naglie, Gary, Stasiulis, Elaine, Yamin, Stephanie, Vrkljan, Brenda, Tuokko, Holly, Sanford, Sarah, Porter, Michelle, Polgar, Jan, Myers, Anita, Moorhouse, Paige, Mazer, Barbara, Marshall, Shawn, Gélinas, Isabelle, Crizzle, Alexander, Byszewski, Anna, Belchior, Patricia, Bédard, Michel, Rapoport, Mark, Minish, Duane, Yetman, Linda, Stephenson, Margaret, McCloskey, Rose, Agbaku, Mansa, Jarrett, Pamela, Cavanagh, Jennifer, Loncar, Adele, Demers, Vickie, Gobessi, Linda, Lodha, Vinay, Scerbe, Andrea, Astell, Arlene, DesRoches, Andrea, Panyavin, Ivan, Feltz, Nick, Wittich, Walter, Aubin, Gabrielle, Hogan, Mariah, Swaminathan, Swathi, Altschuler, Aviva, Murphy, Kelly, Guthrie, Dawn, Williams, Nicole, Campos, Jennifer, Mick, Paul, Orange, Joseph B., Pichora-Fuller, M. Kathleen, Savundranayagam, Marie Y., Phillips, Natalie A., Giroud, Nathalie, Pichora-Fuller, Kathy, Al-Yawer, Faisal, Rehan, Sana, Phillips, Natalie, Beauchet, Olivier, Niculescu, Iulia, Iaboni, Andrea, Quirt, Hannah, Penko, Marion, Tsokas, Mario, Marshall, Cecelia, Flint, Alastair, McGilton, Katherine, O’Connell, Megan E, Stewart, Norma J, Seitz, Dallas, Daku, Jean, Hack, Tracy, Hoium, Faye, Kennett-Russill, Deb, Sauter, Kristen, Holley, Joanna, Wimhurst, Christine, Katchaluba, Janet, Mitchell, Debbie, Severina, Elmira, Dallaire-Théroux, Caroline, Saikali, Stéphan, Duchesne, Simon, Sivananthan, Saskia, Mirza, Saira, Saeed, Usman, Knight, Jo, Ramirez, Joel, Stuss, Donald, Yu, Di, Swardfager, Walter, Keith, Julia, Nestor, Sean, Black, Sandra, Masellis, Mario, Joyal, Marilyne, Kotz, Sonja A., Lenglos, Christophe, Renauld, Emmanuelle, Wilson, Maximiliano A., Fecteau, Shirley, Appel, Lora, Kisonas, Erika, Appel, Eva, Bartlett, Deanna, Klein, Jennifer, Rosenberg, Jarred, Smith, Christopher, Ali, Suad, Narang, Tanya, Wiseman, Micaela, Ein, Natalie, Orchanian-Cheff, Ani, Rylett, Jane, Hogan, David B., Rockwood, Kenneth, Dixon, Roger, Sun, Winnie, Hawkins, Stacey A., Awde, Carolee, Kay, Kelly, Huntsbarger, Deana, Ferrier, Erin, Sourial, Nadia, Arsenault-Lapierre, Genevieve, McAiney, Carrie, Vedel, Isabelle, Ingram, K. Jennifer, Frank, Andrew, Sabra, Iman, Wallace, Bruce, Breau, Michael, Sweet, Lisa, Goubran, Rafiq, Knoefel, Frank, Goubran, Rafik, Stroulia, Eleni, Ault, Laura, Kecskemet, Judith, Guseva, Elena, Lungu, Ovidiu, Goldman, Sondra, Wilchesky, Machelle, Johri, Fozia, Turner, Angelese, Lavoie, Monica, Tang-Wai, David, Leonard, Carol, Graham, Naida L., Rochon, Elizabeth, Middleton, Laura, Herrmann, Nathan, Oh, Paul, Regan, Kayla, Bechard, Lauren, Lanctôt, Krista, Freeman, Shannon, Pettersen, Jacqueline, Tomasone, Jennifer, Dupuis, Sherry, Giangregorio, Lora, Ferris, Rebecca, Stultz, Tim, Mallard, Kirsten, Campbell, Elaine, Chatterjee, Atri, Mackenzie, Ian, Reinshagen, Veronica Hirsh, Ducharme, Blake, Mousavi, Ali, Gill, Sascha, Mouches, Pauline, Wang, Meng, Rajasheskar, Deepthi, MacMaster, Frank, Forkert, Nils, Smith, Eric, Ismail, Zahinoor, Varatharajah, Breni, Camicioli, Richard, Gee, Myrlene, Zwiers, Angela, Sekhon, Ramnik, Charlton, Anna, Arsenault-Lapierre, Geneviève, Ingram, Jennifer, Hawkins, Stacey, Mousavi, SeyedAli, Mackenzie, Ian R. A., Hirsh-Reinshagen, Veronica, Hsiung, Ging-Yuek. R., Gillingham, Susan M.E., Anderson, Nicole D., Alain, Claude, Georgievski, Georgi, Alfaro, Leonardo, McClenaghan, Meridith, Soares, Daniela, Matheson, Maureen, Stanoulis, Krisanne, Boyle, Daniel, Chau, Linh, Pelc, Jordan, Snash, Nadia, Byrne, Joanne, Elalouf, Karine, Alfaro, Andrea Urqueta, Johnson, Aaron, Marinier, Julie-Andrée, Kehayia, Eva, Gagné, Jean-Pierre, Murphy, Caitlin, Ellen, Ruth, Flowers, Brandi, Boulton, Karen Lee, Subotic, Arsenije, McCreary, Cheryl R., Nguyen, Amanda, Saad, Feryal, Alvarez, Ana, Beaudin, Andrew E, Pike, Bruce, Smith, Eric E, Hu, Sophie, Patten, Scott, Fick, Gordon, Sapkota, Shraddha, Mirza, Saira Saeed, Scott, Christopher J., Stuss, Donald T., Black, Sandra E., Le Blanc, Gabriella, Ducharme, Simon, Meilleur-Durand, Synthia, Lévesque, Marianne, St-Onge, Frédéric, Cunnane, Stephen, Villeneuve, Sylvia, Callahan, Brandy, Laforce, Robert, Cetin-Sahin, Deniz, Cummings, Greta G., Schuster, Tibor, Karanofsky, Mark, De Jesus, Belmir J., Cassani, Raymundo, Cecchi, Marco, Fadem, K. C., McGeown, William J., Falk, Tiago H., Chu, Charlene, Zdaniuk, Natalia, Wang, Rosalie, Ouellet, Marie-Christine, Cassivi-Joncas, Alison, Godard-Sebillotte, Claire, Rochette, Louis, Pelletier, Eric, Strumpf, Erin, Margo-Dermer, Eva, Silver, Hilah, Vafaei, Rod, Fok, Alice C, Hsiung, Ging-Yuek R., Ursenbach, Jake, Bethell, Jennifer, Neuman, Mark D, Bateman, Brian T, Hill, Andrea, Wunsch, Hannah, Ritchie, Kim, Cramm, Heidi, Aiken, Alice, Donnelly, Catherine, Goldie, Katie, Delara, Mahin, Ozzoude, Miracle, Varriano, Brenda, McLaughlin, Paula, Troyer, Angela, Bartha, Robert, Symons, Sean, Kwan, Donna, Tan, Brian, Swartz, Richard H., Saposnik, Gustavo, Tartaglia, Maria C., Ahuja, Manan, Siddhpuria, Shailee, Gormley, Jessica, Reppas, Christina, Wong, Eric, Lee, Justin, Patterson, Christopher, Walker, Jennifer, Warry, Wayne, Blind, Melissa, Allaby, Cheryl, Pitawanakwat, Karen, Zhao, Yantao, Lemieux, Andrine, Jacklin, Kristen, Crowshoe, Lindsay, Boehme, Gail, McKenna, Betty, Boyling, Elaine, Webkamigad, Sharlene, Bigeagle, Louise, Akan, Nicole, Wallace, Lindsay, Theou, Olga, Bennett, David, Darvesh, Sultan, Kirkland, Susan, Fisk, John, Andrew, Melissa, Cullen, Stephanie, Carroll, Susan, Mahon, Joel, Sarquis-Adamson, Yanina, Montero-Odasso, Manuel, Sharma, Nabina, Beaton, Derek, Roberts, Angela, Munoz, Doug, Swartz, Richard, Breen, David, Lang, Anthony, Fischer, COrrine, Fischer, Corrine, Kumar, Sanjeeve, Freedman, Morris, Finger, Elizabeth, Zinman, Lorne, Grimes, David A., Sunderland, Kelly M., Binns, Malcolm A., Strother, Stephen C., Mandzia, Jennifer, Orange, JB, Tartaglia, Carmela, El Shatshat, Amna, Rao, Praveen P.N., Teves, Julia, Bodkin, R Jack, Ho, Joanne M-W, Mehdizadeh, Sina, Dolatabadi, Elham, Ng, Kimberley-Dale, Arora, Twinkle, Jizmejian, Melody, Mansfield, Avril, Taati, Babak, Levy, Jake, Savard, Melissa, Pascoal, Tharick, Soucy, Jean-Paul, Rosa-Neto, Pedro, Martins, Felicia, Waller, Shannon, Flora, Parminder, Morland, Chris, Donovan, Steve, Fels, Deborah, Desai, Shital, Boger, Jennifer, Shashtri, Karan, Persaud, Deanna, Marashi, Sheida, Nedlund, Ann-Charlotte, Mäki-Petäjä-Leinonen, Anna, Nygård, Louise, Issakainen, Mervi, ryd, Charlotta, Pan, Yuhan, Joddrell, Phil, Dove, Erica, Owens, Hollis, Park, Elly, Liu, Lili, Kaufman, David, Simonian, Natalie, Chen, Ying, Sunderland, Kelly, Fraser, Julia, Swartz, Rick, Strother, Stephen, Legrand, Diego, Roberge, Pasquale, Vanasse, Alain, Bocti, Christian, Pirrie, Lorraine, Gray, Carolyn Steele, Nippak, Pria, Coughlan, Dave, Teselink, Johannes, Hermann, Nathan, Rasquinha, Fawn, Lanctot, Krista, Webber, Jodi, Woo, Kevin, Chamoun, Elicia, Coulombe, Valérie, Sellami, Leila, Paquette-Raynard, Emmanuelle, Gardner, Sandra, van Zon, Lorraine, Moy, Sally, Sidrak, Mariam, Sternhill, Janis, Feldman, Sidney, Karuza, Jurgis, Berall, Anna, Thomas, Neil, Mattek, Nora, Riley, Thomas, Reynolds, Christina, Marcoe, Jennifer, Sharma, Nicole, Kaye, Jeffrey, Jagtap, Shreya, Rotenberg, Shlomit, Vandermorris, Susan, Anderson, ND, Dawson, DR, Chater, Catherine, Soor, Jaspreet, Ji, Xiang, Koo, Morgan, Compagnone, Jordana, Kertes, Peter, Juby, Angela, Mager, Diana, Davis, Christopher, Jay, David, Blackburn, Toni, Brocks, Dion, Lee, Hyunwoo, Wiggermann, Vanessa, Rauscher, Alexander, Lam, Kevin, Tam, Roger, Popuri, Karteek, Beg, Mirza Faisal, Jacova, Claudia, Sossi, Vesna, Bindra, Jessica, Bouvier, Liziane, Monetta, Laura, Vitali, Paolo, Martel-Sauvageau, Vincent, Godin, Judith, McNeil, Shelly, McElhaney, Janet, Laughton, Thomas, Ho, Joanne, Tung, Jennifer, Dubé, Joseph B., Lin, Tianzhen, Best, Sarah, Truemner, Julia, Sargeant, Patricia L., Borrie, Michael J., Fogarty, Jennifer, Bassi, Nimi, Di Prospero, Cynthia, Whitehead, Victor, Pilon, Randi, Wong, Timothy, Elhayek, Nada, Dasgupta, Monidipa, Davis, Daniel, ORegan, Niamh, Kröger, Edeltraut, Furrer, Daniela, Wilcheski, Machelle, Morin, Michèle, Carmichael, Pierre-Hugues, Champoux, Nathalie, Monette, Johanne, Giguère, Anik, Aubin, Michèle, Durand, Pierre, Whiteside, Jena, Mele, Bria, Merrikh, Daria, Goodarzi, Zahra, Seary, Judith Anne, Bulley, Heather, Diciacca, Allison, Esseltine, Julia, Gaiger, Erin, Jankovic, Ivana, Mackenzie, Stephanie, McBride, Meghan, Knopp-Sihota, Jennifer A., Hoben, Mathias, Poss, Jeffrey W., Rachor, Geoffrey S., Estabrooks, Carole A., and Iroanyah, Ngozi

Subjects
Abstracts: Posters
Published
2020

29. Risk of Injury to Others: The Development of an Algorithm to Identify Children and Youth at High-Risk of Aggressive Behaviours

Author

Stewart, Shannon L., Celebre, Angela, Hirdes, John P., and Poss, Jeffrey W.

Subjects
Psychiatry, Psychiatry and Mental health, harm to others, physical aggression, interRAI, RC435-571, children and youth, mental health, Original Research
Abstract

Youth violence is considered one of the most preventable causes of morbidity and premature mortality. Various risk factors have previously been identified, however, there is presently a crucial need to develop effective decision-support tools in order to identify children and youth at increased risk for violence. The current study utilised data collected from the interRAI Child and Youth Mental Health Screener (ChYMH-S), within the province of Ontario, to develop and validate a methodology for the purpose of identifying young persons who were at greater risk of harm to others. Additional data from 59 mental health agencies validated the algorithm, and it was found to be a strong predictor of harmful behaviour toward others. The RIO algorithm provides a valuable decision-support tool with strong psychometric properties that may be used to identify young persons who exhibit signs or symptoms associated with increased likelihood of harm toward others, in order to provide early intervention efforts for these vulnerable youth, thereby reducing the likelihood of future aggressive behaviours.

Published
2022

32. Examining Health Service Rates Among Residents of Retirement Homes and Other Older Adult Populations in Ontario, Canada: A Population-Based Cohort Study

Author

Manis, Derek R., primary, Poss, Jeffrey W., additional, Jones, Aaron, additional, Rochon, Paula A., additional, Bronskill, Susan E., additional, Campitelli, Michael A., additional, Perez, Richard, additional, Stall, Nathan M., additional, Rahim, Ahmad, additional, Babe, Glenda, additional, Tarride, Jean-Éric, additional, Abelson, Julia, additional, and Costa, Andrew P., additional

Published
2021
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35. Additional file 1 of Do assisted living facilities that offer a dementia care program differ from those that do not? A population-level cross-sectional study in Ontario, Canada

Author

Manis, Derek R., Rahim, Ahmad, Poss, Jeffrey W., Bielska, Iwona A., Bronskill, Susan E., Tarride, Jean-Éric, Abelson, Julia, and Costa, Andrew P.

Abstract

Additional file 1: Supplemental Table S1. Detailed Descriptions of Exposures. Supplemental Table S2. RECORD Checklist.

Published
2021
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38. Risk factors for retirement home COVID-19 outbreaks in Ontario, Canada: A population-level cohort study

Author

Costa, Andrew P., primary, Manis, Derek R., additional, Jones, Aaron, additional, Stall, Nathan M., additional, Brown, Kevin A., additional, Boscart, Veronique, additional, Castellino, Adriane, additional, Heckman, George A., additional, Hillmer, Michael P., additional, Ma, Chloe, additional, Pham, Paul, additional, Rais, Saad, additional, Sinha, Samir K, additional, and Poss, Jeffrey W., additional

Published
2020
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39. Rates of health services use among residents of retirement homes in Ontario: a populationbased cohort study.

Author

Manis, Derek R., Poss, Jeffrey W., Jones, Aaron, Rochon, Paula A., Bronskill, Susan E., Campitelli, Michael A., Perez, Richard, Stall, Nathan M., Rahim, Ahmad, Babe, Glenda, Tarride, Jean-Éric, Abelson, Julia, and Costa, Andrew P.

Subjects
PHYSICIAN services utilization, MEDICAL care, OLDER people, COHORT analysis, RETIREMENT, POSTAL codes
Abstract

Background: Because there are no standardized reporting systems specific to residents of retirement homes in North America, little is known about the health of this distinct population of older adults. We evaluated rates of health services use by residents of retirement homes relative to those of residents of long-term care homes and other populations of older adults. Methods: We conducted a retrospective cohort study using population health administrative data from 2018 on adults 65 years or older in Ontario. We matched the postal codes of individuals to those of licensed retirement homes to identify residents of retirement homes. Outcomes included rates of hospital-based care and physician visits. Results: We identified 54 733 residents of 757 retirement homes (mean age 86.7 years, 69.0% female) and 2 354 385 residents of other settings. Compared to residents of long-term care homes, residents of retirement homes had significantly higher rates per 1000 person months of emergency department visits (10.62 v. 4.48, adjusted relative rate [RR] 2.61, 95% confidence interval [CI] 2.55 to 2.67), hospital admissions (5.42 v. 2.08, adjusted RR 2.77, 95% CI 2.71 to 2.82), alternate level of care (ALC) days (6.01 v. 2.96, adjusted RR 1.51, 95% CI 1.48 to 1.54), and specialist physician visits (6.27 v. 3.21, adjusted RR 1.64, 95% CI 1.61 to 1.68), but a significantly lower rate of primary care visits (16.71 v. 108.47, adjusted RR 0.13, 95% CI 0.13 to 0.14). Interpretation: Residents of retirement homes are a distinct population with higher rates of hospital-based care. Our findings can help to inform policy debates about the need for more coordinated primary and supportive health care in privately operated congregate care homes. [ABSTRACT FROM AUTHOR]

Published
2022
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42. Development and Validation of Caregiver Risk Evaluation (CaRE): A New Algorithm to Screen for Caregiver Burden.

Author

Guthrie, Dawn M., Williams, Nicole, Beach, Cheryl, Maxwell, Colleen J., Mills, Deborah, Mitchell, Lori, Reid, R. Colin, and Poss, Jeffrey W.

Abstract

Objective: The main objective was to develop a decision-support tool to assess the risk of caregiver burden, the Caregiver Risk Evaluation (CaRE) algorithm. Methods: Home care clients were assessed using the Resident Assessment Instrument for Home Care (RAI-HC). Their caregiver completed the 12-item Zarit Burden Interview (ZBI), the main dependent measure, which was linked to the RAI-HC. Results: In the sample (n = 344), 48% were aged 85+ years and 61.6% were female. The algorithm can be collapsed into four categories (low, moderate, high, and very high risk). Relative to the low-risk group, clients in the very high-risk group had an odds ratio of 5.16 (95% confidence interval: [2.05, 12.9]) for long-term care admission, after adjusting for client age, sex, and regional health authority. Discussion: The CaRE algorithm represents a new tool to be used by home care clinicians as they proactively plan for the needs of clients and their caregivers. [ABSTRACT FROM AUTHOR]

Published
2021
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48. Very Frequent Fallers and Future Fall Injury.

Author

Poss, Jeffrey W. and Hirdes, John P.

Subjects
INJURY risk factors, RISK factors of falling down, AGE distribution, EPIDEMIOLOGY, HOME care services, WOUNDS & injuries, HEAD injuries, INDEPENDENT living, ODDS ratio
Abstract

Objectives: To examine the relationship between falls history, especially those with frequent recent falls, and future injurious falls. Method: Resident Assessment Instrument for Home Care records of 167,162 home care recipients in Ontario, Canada, were linked to emergency department records recording an injurious fall. Diagnosis codes further informed the nature of the injuries. Results: Persons with a high number of recent falls tended to be younger, and more likely to have Parkinson’s or multiple sclerosis. Odds ratios for a future injurious fall, compared with zero recent falls, were as follows: 1.58 (1 fall), 1.91 (2 or 3 falls), 2.54 (4-8 falls), 3.07 (9 or more falls). Injuries among those with multiple recent falls were more likely to be head injuries with an open wound. Discussion: Persons reporting high number of recent falls were at the greatest risk of a future injurious fall and should receive the greatest attention in care planning. [ABSTRACT FROM AUTHOR]

Published
2016
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49. Opinion versus practice regarding the use of rehabilitation services in home care: an investigation using machine learning algorithms.

Author

Lu Cheng, Mu Zhu, Poss, Jeffrey W., Hirdes, John P., Glenny, Christine, Stolee, Paul, Cheng, Lu, and Zhu, Mu

Subjects
ALGORITHMS, DECISION making, HOME care services, MEDICAL informatics, REHABILITATION, RESEARCH funding, DATA mining, SYMPTOMS
Abstract

Background: Resources for home care rehabilitation are limited, and many home care clients who could benefit do not receive rehabilitation therapy. The interRAI Contact Assessment (CA) is a new screening instrument comprised of a subset of interRAI Home Care (HC) items, designed to be used as a preliminary assessment to identify which potential home care clients should be referred for a full assessment, or for services such as rehabilitation. We investigated which client characteristics are most relevant in predicting rehabilitation use in the full interRAI HC assessment.Methods: We applied two algorithms from machine learning and data mining - the LASSO and the random forest - to frequency matched interRAI HC and service utilization data for home care clients in Ontario, Canada.Results: Analyses confirmed the importance of functional decline and mobility variables in targeting rehabilitation services, but suggested that other items in use as potential predictors may be less relevant. Six of the most highly ranked items related to ambulation. Diagnosis of cancer was highly associated with decreased rehabilitation use; however, cognitive status was not.Conclusions: Inconsistencies between variables considered important for classifying clients who need rehabilitation and those identified in this study based on use may indicate a discrepancy in the client characteristics considered relevant in theory versus actual practice. [ABSTRACT FROM AUTHOR]

Published
2015
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50. Following the Epidemic Waves: Child and Youth Mental Health Assessments in Ontario Through Multiple Pandemic Waves.

Author

Stewart SL, Vasudeva AS, Van Dyke JN, and Poss JW

Abstract

Emerging studies across the globe are reporting the impact of COVID-19 and its related virus containment measures, such as school closures and social distancing, on the mental health presentations and service utilization of children and youth during the early stages of lockdowns in their respective countries. However, there remains a need for studies which examine the impact of COVID-19 on children and youth's mental health needs and service utilization across multiple waves of the pandemic. The present study used data from 35,162 interRAI Child and Youth Mental Health (ChYMH) assessments across 53 participating mental health agencies in Ontario, Canada, to assess the mental health presentations and referral trends of children and youth across the first two waves of the COVID-19 pandemic in the province. Wave 1 consisted of data from March to June 2020, with Wave 2 consisting of data from September 2020 to January 2021. Data from each wave were compared to each other and to the equivalent period one year prior. While assessment volumes declined during both pandemic waves, during the second wave, child and youth assessments in low-income neighborhoods declined more than those within high-income neighborhoods. There were changes in family stressors noted in both waves. Notably, the proportion of children exposed to domestic violence and recent parental stressors increased in both waves of the pandemic, whereas there were decreases noted in the proportion of parents expressing feelings of distress, anger, or depression and reporting recent family involvement with child protection services. When comparing the two waves, while depressive symptoms and recent self-injurious attempts were more prevalent in the second wave of the pandemic when compared to the first, a decrease was noted in the prevalence of disruptive/aggressive behaviors and risk of injury to others from Wave 1 to Wave 2. These findings highlight the multifaceted impact of multiple pandemic waves on children and youth's mental health needs and underscore the need for future research into factors impacting children and youth's access to mental health agencies during this time., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The handling editor JF declared a past coauthorship/collaboration with one of the authors SS., (Copyright © 2021 Stewart, Vasudeva, Van Dyke and Poss.)

Published
2021
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