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With increasing numbers of persons living with dementia and their higher rates of hospitalizations, it is necessary to ensure they receive appropriate and effective acute care; yet, acute care environments are often harmful for persons with dementia. There is a lack of dementia education for acute health care providers in Canada. Scotland presently delivers a dementia education program for health care providers, known as the Scottish National Dementia Champions Programme. The objective of this Policy and Practice Note is to present the collaborative work of Scottish experts and Canadian stakeholders to adapt the Dementia Champions Programme for use in Canada. This work to date includes: (a) an environmental scan of Canadian dementia education for acute health care providers; (b) key informant interviews; and, (c) findings from a two-day planning meeting. The results of this collaborative work can and are being used to inform the next steps to develop and pilot a Canadian dementia education program.

Background: The latest global figures show that 55 million persons lived with major neurocognitive disorders (MNCDs) worldwide in 2021. In Quebec, Canada, most of these older adults are cared for by family physicians in interdisciplinary primary care clinics such as family medicine groups (FMG). When a person has a MNCD, taking potentially inappropriate medications or polypharmacy (5 different medications or more) increases their vulnerability to serious adverse events. With the recent arrival of pharmacists working in FMGs and their expanded scope of practice and autonomy, new possibilities for optimizing older adults' pharmacotherapy are opening., Objective: This project aims to evaluate the impact of involving these pharmacists in the care trajectory of older adults living with MNCD, in an interdisciplinary collaboration with the FMG team, as well as home care nurses and physicians. Pharmacists will provide medication reviews, interventions, and recommendations to improve the pharmacotherapy and support offered to these patients and their caregivers., Methods: This 2-step mixed methods study will include a quasi-experimental controlled trial (step 1) and semistructured interviews (step 2). Older adults undergoing cognitive assessment, recently diagnosed with MNCD, or receiving care for this at home will be identified and recruited in FMGs in 2 Quebec regions. FMGs implementing the intervention will involve pharmacists in these patients' care trajectory. Training and regular mentoring will be offered to these FMGs, especially to pharmacists. In control FMGs, no FMG pharmacist will be involved with these patients, and usual care will be provided., Results: Medication use (including appropriateness) and burden, satisfaction of care received, and quality of life will be assessed at study beginning and after 6 months of follow-up and compared between groups. At the end of the intervention study, we will conduct semistructured interviews with FMG care team members (pharmacists, nurses, and physicians) who have experienced the intervention. We will ask about the feasibility of integrating the intervention into practice and their satisfaction with and their perception of the intervention's impacts for older adults and their families. We will assess the effect of improved pharmaceutical care for older adults with or at risk of MNCDs through the involvement of FMG pharmacists and a reorganization of pharmaceutical care., Conclusions: The inclusion of pharmacists in interdisciplinary care teams is recent and rising, strengthened by more substantial pharmacist practice roles. Results will inform the processes required to successfully involve pharmacists and implement developed tools and procedures transposable to other care settings to improve patient care., Trial Registration: ClinicalTrials.gov NCT04889794; https://clinicaltrials.gov/ct2/show/NCT04889794., International Registered Report Identifier (irrid): DERR1-10.2196/42577., (©Line Guénette, Edeltraut Kröger, Dylan Bonnan, Anne Maheu, Michèle Morin, Laurianne Bélanger, Isabelle Vedel, Machelle Wilchesky, Caroline Sirois, Etienne Durand, Yves Couturier, Nadia Sourial, Clémence Dallaire. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 17.11.2022.)

Objective: To develop a framework of population-based primary care quality indicators adapted to patients with dementia and to identify a subset of stakeholder-driven priority indicators., Design: Framework development was carried out through the selection of an initial framework based on a rapid review and identification of relevant indicators and enrichment based on existing dementia indicators and guidelines. Prioritization of indicators was carried out through a stakeholder survey., Setting: Ontario, Quebec, New Brunswick, and Saskatchewan., Participants: Stakeholders in community dementia care (N=109) including clinicians, patients, caregivers, decision makers, and managers., Main Outcome Measures: Primary care quality indicators., Results: The framework comprised 34 indicators across 8 domains of quality (access, integration, effective care, efficient care, equity, safety, population health, and patient-centred care). Access to a regular primary care provider, continuity of care, early-stage diagnosis, and access to home care were consistently rated as priorities. Equitable care was a specific priority among patients and caregivers; clinicians reported avoidable hospitalizations as among their priorities., Conclusion: A framework of indicators was established for persons with dementia that adds an important dimension to existing primary care and dementia quality indicators by providing primary care and population-based perspectives. This framework could set a foundation for the ongoing monitoring of primary care practices and policies for persons with dementia at a population level., (Copyright © 2022 the College of Family Physicians of Canada.)

Background: Older adults with major neurocognitive disorder (MNCD) are often exposed to polypharmacy. We aimed to assess the prescribing and discontinuation patterns of medications following diagnosis of MNCD among community-dwelling older adults., Methods: Using the Quebec Integrated Chronic Disease Surveillance System, we conducted a population-based cohort study comparing 1-year prediagnosis and postdiagnosis use of medications between a group of individuals older than 65 years newly diagnosed with MNCD in 2016-2017 and a control group without MNCD. The difference-in-difference method was used to estimate the prediagnosis and postdiagnosis variation in the number of medications prescribed and in the proportion of psychotropic and anticholinergic medication users., Results: In the MNCD group, the mean number of medications used (excluding Alzheimer disease treatments) increased by 1.25 in the year after the diagnosis. The respective increase was 0.45 in the control group, yielding an adjusted difference-in-differences of 0.81 (95% confidence interval: 0.74; 0.87) between groups. The adjusted difference-in-differences in the proportions of antipsychotic, antidepressant, and anticholinergic medication users was 13.2% (12.5; 13.9), 7.1% (6.5; 7.7), and 3.8% (3.1; 4.6), respectively., Conclusions: The medication burden among older adults tends to increase in the year following a diagnosis of MNCD. The use of antipsychotics and antidepressants may explain a part of the observed increase., Competing Interests: A.M. received a scholarship from the Centre d’excellence sur le vieillissement de Québec (CEVQ) and C.S. is the recipient of a Junior 2 research award from the Fonds de recherche du Québec—Santé (FRQS). The remaining authors declare no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Adolescents and young adults (AYAs) represent a unique population with distinct psycho-social risks and care needs. About 10% of AYAs live with chronic pain (CP) and transition to adult pain care between 16 and 25 years of age. These transitions in care happen simultaneously with other bio-psycho-social changes and require flexible multi-disciplinary support models. As it stands, transitional pain care appears suboptimal, fragmented, and opportunistic in Quebec (Canada). The objective of this Brief Report is, therefore, to present our study findings and propose a multi-disciplinary transitional framework vision applicable to AYAs living with CP. Data were collected using a sequential-consensual qualitative design with a longitudinal participatory component. The consecutive stages of this work included an exploratory stage, semi-structured interviews with primary care providers, and inter-disciplinary deliberative stakeholder consultation groups. The deductive inductive thematic approach and the three-level Health Care Transition Research Consortium's theoretical framework were used to analyze the data. A representative group of stakeholders discussed findings from the first two steps, made fifteen actionable recommendations and formulated their vision of a transitional pain care model that can be further adapted in other settings. The study results present important insights into various psycho-social factors associated with transitional pain care for AYAs., 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., (Copyright © 2022 Kudrina, Bartlett, Pagé, Shir, Tourian, Choinière and Vedel.)

Introduction: Telemedicine (TM) has been adopted by many health authorities to limit unnecessary exposure during COVID-19. Prior to the pandemic, TM was associated with improvement of quality of life of older patients, low hospital admissions and nursing home placement, and high overall patients' satisfaction due to convenience. However, older adults may face challenges to access TM, such as hearing, visual and cognitive decline, and limited access to Internet and devices. Ongoing vaccination campaigns and sanitary measures are keeping the pandemic under control, but new variants threaten public safety. Specific recommendations on TM use in high-risk populations, such as older adults, are therefore required., Methods and Analysis: To assess the challenges of TM use in the routine primary healthcare practice of older adults. The research objective is to examine the potential effect of TM; (1) to describe the evidence of TM, (2) to understand the patients, caregivers and clinicians' experiences with TM use and (3) to develop practice-based and evidence-based recommendations on effective use of TM. Multiphase design: (1) systematic mixed studies review on the evidence of TM use, (2) qualitative descriptive study on the experiences of the patients, caregivers and healthcare professionals. Recommendations will be proposed based on the integration of both studies. In accordance with PRISMA statement, the systematic mixed studies review will be conducted through multiple databases search: MEDLINE, PsycINFO, EMBASE, CINAHL, AgeLine, Cochrane Library., Population Studied: Community-dwelling 65 years and older adults using two-way synchronous TM by phone or video in a primary care setting. The qualitative descriptive study will include individual interviews with older adults from four McGill university affiliated primary care practices and focus groups with their healthcare professionals., Ethics and Dissemination: Ethics approval has been received. Results will inform healthcare professionals and policy-makers on sustainable use of TM in primary care for older adults., Prospero Registration Number: The review protocol has been recorded at the PROSPERO, CRD42021237686 (https://www.crd.york.ac.uk/prospero/., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Context: Dementia, characterized by a progressive decline in cognition, affects more than 50 million people globally. In 2020, the 5th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5) published up-to-date recommendations to guide the clinical management of persons living with dementia (PLWD) and their caregivers. However, primary care clinicians are not always up-to-date with current evidence as the information might be fragmented. Objective: To provide selected new and updated clinical guidance on the management of patients with dementia that are simple to use in a routine primary care practice. Study design: Recommendations were approved and graded based on the Appraisal of Guidelines for Research and Evaluation (AGREE II collaboration), GRADE, and a Delphi process. Setting: Working groups included experts from different backgrounds (primary care physicians, nurse practitioners and other primary care clinicians, neurologists, psychiatrists and geriatricians, researchers, knowledge translation experts, decisions makers, and PLWD and caregivers' representatives). The experts carried out systematic reviews, which guided the development of new recommendations for dementia care. Recommendations included: We summarize the most relevant CCCDTD5 recommendations for primary care clinicians Results: The relevant recommendations for primary care were focused on: a) risk reduction for the general population (nutrition, exercise, social engagement, education, and medication management), as well as for persons at risk of dementia (evaluation of hearing status and sleep, and cognitive training stimulation); b) screening and diagnosis of dementia, including the role of the informant, screening for patients at risk or with symptoms, use of cognitive tests and neuro-imaging, management of subjective cognitive decline); c) de-prescribing medications for dementia, including aspirin and cognitive enhancers; and d) non-pharmacological interventions for persons with dementia (exercise, cognitive stimulation therapy, psychoeducational interventions for caregivers, case management and dementia-friendly community/organizations). Conclusions: The development of recommendations for ongoing management of dementia is an iterative process as new evidence on interventions for dementia are published. The present recommendations are of importance for dementia care in a primary care setting as the entry point for PLWD into the health system., Competing Interests: Authors report none., (© 2021 Annals of Family Medicine, Inc.)

Importance: Persons with dementia and Parkinson disease (PD) are vulnerable to disruptions in health care and services., Objective: To examine changes in health service use among community-dwelling persons with dementia, persons with PD, and older adults without neurodegenerative disease during the first wave of the COVID-19 pandemic., Design Setting and Participants: Repeated cross-sectional analysis using population-based administrative data among community-dwelling persons with dementia, persons with PD, and adults 65 years and older at the start of each week from March 1 through the week of September 20, 2020 (pandemic period), and March 3 through the week of September 22, 2019 (historical period), in Ontario, Canada., Exposures: COVID-19 pandemic as of March 1, 2020., Main Outcomes and Measures: Main outcomes were weekly rates of emergency department visits, hospitalizations, nursing home admissions, home care, virtual and in-person physician visits, and all-cause mortality. Poisson regression models were used to calculate weekly rate ratios (RRs) with 95% CIs comparing pandemic weeks with historical levels., Results: Among those living in the community as of March 1, 2020, persons with dementia (n = 131 466; mean [SD] age, 80.1 [10.1] years) were older than persons with PD (n = 30 606; 73.7 [10.2] years) and older adults (n = 2 363 742; 74.0 [7.1] years). While all services experienced declines, the largest drops occurred in nursing home admissions (RR for dementia: 0.10; 95% CI, 0.07-0.15; RR for PD: 0.03; 95% CI, 0.00-0.21; RR for older adults: 0.11; 95% CI, 0.06-0.18) and emergency department visits (RR for dementia: 0.45; 95% CI, 0.41-0.48; RR for PD: 0.40; 95% CI, 0.34-0.48; RR for older adults: 0.45; 95% CI, 0.44-0.47). After the first wave, most services returned to historical levels except physician visits, which remained elevated (RR for dementia: 1.07; 95% CI, 1.05-1.09; RR for PD: 1.10, 95% CI, 1.06-1.13) and shifted toward virtual visits. Older adults continued to experience lower hospitalizations. All-cause mortality was elevated across cohorts., Conclusions and Relevance: In this population-based repeated cross-sectional study in Ontario, Canada, those with dementia, those with PD, and older adults sought hospital care far less than usual, were not admitted to nursing homes, and experienced excess mortality during the first wave of the pandemic. Most services returned to historical levels, but virtual physician visits remained a feature of care. While issues of equity and quality of care are still emerging among persons with neurodegenerative diseases, policies to support virtual care are necessary., Competing Interests: Conflict of Interest Disclosures: Dr Bronskill reported receiving grants from the Ontario Neurodegenerative Disease Research Initiative through the Ontario Brain Institute and Drs Bronskill and Vedel reported receiving a grant from the Canadian Institutes of Health Research (CIHR VR5-172692) during the conduct of the study. Dr Jones and Mr Harris reported postdoctoral and doctoral fellowships, respectively, from the Alzheimer Society of Canada during the conduct of the study. Dr Swartz reported receiving personal fees (administrative stipend) from the Ontario Brain Institute/Ontario Neurodegenerative Disease Research Initiative during the conduct of the study. No other disclosures were reported., (Copyright 2022 Bronskill SE et al. JAMA Health Forum.)

Background: The first imperative in producing the relevant and needed knowledge about major neurocognitive disorder (MNCD) is to identify people presenting with the condition adequately. To document potential disparities between administrative health databases and population-based surveys could help identify specific challenges in this population and methodological shortfalls., Objective: To describe and compare the characteristics of community-dwelling older adults according to four groups: 1) No MNCD; 2) Self-reported MNCD only; 3) MNCD in administrative health data only; 4) MNCD in both self-reported and administrative health data., Methods: This retrospective cohort study used the Care Trajectories-Enriched Data (TorSaDE) cohort, a linkage between five waves of the Canadian Community Health Survey (CCHS) and health administrative health data. We included older adults living in the community who participated in at least one cycle of the CCHS. We reported on positive and negative MNCD in self-reported versus administrative health data. We then compared groups' characteristics using chi-square tests and ANOVA., Results: The study cohort was composed of 25,125 older adults, of which 784 (3.1%) had MNCD. About 70% of people with an MNCD identified in administrative health data did not report it in the CCHS. The four groups present specific challenges related to the importance of perception, timely diagnosis, and the caregivers' roles in reporting health information., Conclusion: To a certain degree, both data sources fail to consider subgroups experiencing issues related to MNCD; studies like ours provide insight to understand their characteristics and needs better.

Purpose: Bisphosphonates are used to treat osteoporosis. Despite their benefits on bone mineral density (BMD) and fractures, they have shown adverse effects, sometimes severe, during chronic use. Taken for several years, they achieve long-term bone retention, making deprescribing feasible. This review aimed to synthesize evidence on the success and health outcomes of deprescribing of bisphosphonates in seniors, aged over 60 years., Methods: The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including articles in English, French, or German published before July 2020. Eligible studies included seniors having discontinued bisphosphonates and reported on health outcomes; some allowed meta-analyses on fracture risk., Results: The review included 9 RCTs and 9 cohort studies of moderate quality. Bisphosphonates were discontinued after 2 to 7 years of use, and BMD or fractures were assessed during follow-up of 0.5 to 5 years. A significant reduction in BMD after discontinuation was observed in 9 of 10 studies. Results on fracture risk after discontinuation are mitigated: 6 RCT extensions showed no increase in the risk of any osteoporotic fractures after discontinuation. Meta-analyses including 4 RCTs showed an increased odds ratio of vertebral fractures of 2.04 (95% CI, 1.39-2.99) among discontinuers. Results from 2 large cohort studies showed no increased risks of any osteoporotic or vertebral fractures, while 2 studies found increased fracture risks., Conclusion: Bisphosphonates have successfully been discontinued low overall fracture risk after at least 3 years of use, but a risk for decreased BMD and increased vertebral fractures remained., (© 2021. International Osteoporosis Foundation and National Osteoporosis Foundation.)

Background: Whether avoidable hospitalizations in community-dwelling persons with dementia have decreased during primary care reforms is unknown., Methods: We described the prevalence and trends in avoidable hospitalizations in population-based repeated yearly cohorts of 192,144 community-dwelling persons with incident dementia (Quebec, 2000-2015) in the context of a province-wide primary care reform, using the provincial health administrative database., Results: Trends in both types of Ambulatory Care Sensitive Condition (ACSC) hospitalization (general and older population) and 30-day readmission rates remained constant with average rates per 100 person-years: 20.5 (19.9-21.1), 31.7 (31.0-32.4), 20.6 (20.1-21.2), respectively. Rates of delayed hospital discharge (i.e., alternate level of care (ALC) hospitalizations) decreased from 23.8 (21.1-26.9) to 17.9 (16.1-20.1) (relative change -24.6%)., Conclusions: These figures shed light on the importance of the phenomenon, its lack of improvement for most outcomes over the years, and the need to develop evidence-based policies to prevent avoidable hospitalizations in this vulnerable population., Competing Interests: CONFLICT OF INTEREST DISCLOSURES The authors declare that no conflicts of interest exist., (© 2021 Author(s). Published by the Canadian Geriatrics Society.)

Context: The Canadian reality of dementia care may be complicated by the cultural diversity of patients and their informal caregivers., Objectives: To what extent do needs differ between Canadian- and foreign-born patients and caregivers? What are their experiences with the illness in primary care case management?, Methods: Mixed methods, sequential explanatory design (a cross-sectional study, followed by a qualitative descriptive study), involving 15 pairs of patients and caregivers., Results: Foreign-born patients had more needs compared to their Canadian-born counterparts. Foreign-born caregivers reported more stress, more problems, and increased need for services. However, the reported experiences of Canadian- vs. foreign-born individuals were similar., Conclusion: The results remain hypothesis-generating. The present pilot illustrated the suitability of mixed methods to this area of study, which deserves further investigation to better serve all members of a population already vulnerable by age and disease., Competing Interests: CONFLICT OF INTEREST DISCLOSURES The authors declare that no conflicts of interest exist., (© 2021 Author(s). Published by the Canadian Geriatrics Society.)

Our study objective was to develop and validate a questionnaire assessing the knowledge, attitude, and practice (KAP) of family physicians regarding dementia care and dementia strategies in Canada. Using a multistage process with a panel of experts, we developed and distributed an 83-item questionnaire to 542 eligible family physicians in 42 interdisciplinary primary care teams participating in the Quebec Alzheimer Plan implementation. Altogether, 369 physicians (68%) returned questionnaires. Median item-specific non-response rate was 0.8 per cent (0.3%-8.1%). Exploratory factor analyses and scale correlation supported the questionnaire validity. The final questionnaire contained five factors and 31 items. The KAP questionnaire has proved to be a reliable instrument for assessing the KAP of family physicians regarding dementia care and dementia strategies. This questionnaire provides researchers, clinicians, managers, and decision-makers with a tool to assess an intervention, a program, or a policy change implemented in primary health care for patients with dementia.

Introduction: Current pharmacological therapies for dementia have limited efficacy. Thus it is important to provide recommendations on individual and community-based psychosocial and non-pharmacological interventions for persons living with dementia (PLWDs) and their caregivers., Methods: Phase 1: A systematic review for developing recommendations on psychosocial and non-pharmacological interventions at the individual and community level for PLWDs and their caregivers. Phase 2: Rating of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. Phase 3: Delphi process (>50 dementia experts) for approving recommendations by the 5 th Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD5)., Results: The CCCDTD5 approved the following recommendations: Exercise (1B) and group cognitive stimulation for PLWDs (2B), psychosocial and psychoeducational interventions for caregivers (2C), development of dementia friendly organization and communities (2C), and case management for PLWDs (2B)., Discussion: The CCCDTD5 provides for the first time, evidence-based recommendations on psychosocial and non-pharmacological interventions for PLWDs and their caregivers that can inform evidence-based policies for PLWDs in Canada., Competing Interests: HB is a member of the advisory board for Nutricia Australia. The other authors report no conflicts of interest., (© 2020 The Authors. Alzheimer's & Dementia: Translational Research & Clinical Interventions published by Wiley Periodicals, Inc. on behalf of Alzheimer's Association.)

There is a growing recognition among oncologists that older patients differ from other cancer patients. Older patients present age-specific issues affecting the prevention and management of their cancer. Over the years, this has led to the development of the discipline of geriatric oncology, which is the set of practices elaborated to evaluate, treat, follow-up and rehabilitate the population of older cancer patients. Geriatric oncology is still struggling to establish itself in healthcare settings managing older cancer patients. Efforts are currently being made to make it a recognized medical specialty. Health policy makers have to have a grasp of the evolution of this discipline because it concerns a fast growing segment of the cancer patient population. To shed light on the literature about this field, we undertook a scoping review in which we identified relevant studies; charted the data from the selected studies, collated, summarized and reported the results. From 2043 references initially identified, we included 92 articles in our scoping review and extracted data from 88 articles. The included articles were classified into three major categories, namely Advancing the discipline, Organization of care and Nursing and support services for patient and their caregivers. This review affords researchers and policy makers a foundation to help conduct many other conversations on each theme and sub-theme., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Since 1989, four Canadian Consensus Conferences on the Diagnosis and Treatment of Dementia (CCCDTD) have provided evidence-based dementia guidelines for Canadian clinicians and researchers. We present the results of the 5th CCCDTD, which convened in October 2019, to address topics chosen by the steering committee to reflect advances in the field, and build on previous guidelines. Topics included: (1) utility of the National Institute on Aging research framework for clinical Alzheimer's disease (AD) diagnosis; (2) updating diagnostic criteria for vascular cognitive impairment, and its management; (3) dementia case finding and detection; (4) neuroimaging and fluid biomarkers in diagnosis; (5) use of non-cognitive markers of dementia for better dementia detection; (6) risk reduction/prevention; (7) psychosocial and non-pharmacological interventions; and (8) deprescription of medications used to treat dementia. We hope the guidelines are useful for clinicians, researchers, policy makers, and the lay public, to inform a current and evidence-based approach to dementia., (© 2020 the Alzheimer's Association.)

Purpose: Despite evidence on the benefits of case management for the care of patients with complex needs in primary care, implementing the program-necessary to achieve its benefits-has been challenging worldwide. Evidence on factors affecting implementation remains disparate. Accordingly, the objective of this systematic review was to identify barriers to and facilitators of case management, from the perspectives of health care professionals, in primary care settings around the world., Methods: We conducted a systematic review and thematic synthesis of qualitative findings. In collaboration with 2 librarians, we searched 3 electronic databases (MEDLINE, CINAHL, EMBASE) for studies related to factors affecting case management function in primary care. Two researchers screened titles, abstracts, and full texts for inclusion, then assessed included studies for quality. Results from included studies were synthesized by thematic synthesis, and a framework was developed., Results: Of 1,640 unique records identified, 22 studies, originating from 6 countries, met the inclusion criteria. We identified 9 barriers and facilitators: family context; policy and available resources; physician buy-in and understanding of the case manager role; relationship building; team communication practices; autonomy of case managers; training in technology; relationships with patients; and time pressure and workload. We describe these factors, then present a framework demonstrating the relationships among them., Conclusions: Our study's findings show that multiple factors influence case management implementation. These findings have implications for researchers, clinicians, and policy makers who strive to implement or reform case management programs in local or larger primary care settings., (© 2020 Annals of Family Medicine, Inc.)

Competing Interests: Competing interests: Nadia Sourial is financially supported by a Canadian Institutes of Health Research — Vanier Canada Graduate Scholarship.

Objective: The mixed methods appraisal tool (MMAT) was developed for critically appraising different study designs. This study aimed to improve the content validity of three of the five categories of studies in the MMAT by identifying relevant methodological criteria for appraising the quality of qualitative, survey, and mixed methods studies., Study Design and Setting: First, we performed a literature review to identify critical appraisal tools and extract methodological criteria. Second, we conducted a two-round modified e-Delphi technique. We asked three method-specific panels of experts to rate the relevance of each criterion on a five-point Likert scale., Results: A total of 383 criteria were extracted from 18 critical appraisal tools and a literature review on the quality of mixed methods studies, and 60 were retained. In the first and second rounds of the e-Delphi, 73 and 56 experts participated, respectively. Consensus was reached for six qualitative criteria, eight survey criteria, and seven mixed methods criteria. These results led to modifications of eight of the 11 MMAT (version 2011) criteria. Specifically, we reformulated two criteria, replaced four, and removed two. Moreover, we added six new criteria., Conclusion: Results of this study led to improve the content validity of this tool, revise it, and propose a new version (MMAT version 2018)., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Background Medication non-adherence may lead to poor therapeutic outcomes. Cognitive functions deteriorate with age, contributing to decreased adherence. Interventions have been tested to improve adherence in seniors with cognitive impairment or Alzheimer disease (AD), but high-quality systematic reviews are lacking. It remains unclear which interventions are promising. Objectives We conducted a systematic review to identify, describe, and evaluate interventions aimed at improving medication adherence among seniors with any type of cognitive impairment. Methods Following NICE guidance, databases and websites were searched using combinations of controlled and free vocabulary. All adherence-enhancing interventions and study designs were considered. Studies had to include community dwelling seniors, aged 65 years or older, with cognitive impairment, receiving at least one medication for a chronic condition, and an adherence measure. Study characteristics and methodological quality were assessed. Results We identified 13 interventions, including six RCTs. Two studies were of poor, nine of low/medium and two of high quality. Seven studies had sample sizes below 50 and six interventions focused on adherence to AD medication. Six interventions tested a behavioral, four a medication oriented, two an educational and one a multi-faceted approach. Studies rarely assessed therapeutic outcomes. All but one intervention showed improved adherence. Conclusion Three medium quality studies showed better adherence with patches than with pills for AD treatment. Promising interventions used educational or reminding strategies, including one high quality RCT. Nine studies were of low/moderate quality. High quality RCTs using a theoretical framework for intervention selection are needed to identify strategies for improved adherence in these seniors.

Purpose The purpose of this paper of inter-professional networks is to analyze the evolution of relationships between professional groups enacting new forms of collaboration to address clinical imperatives. Design/methodology/approach This paper uses a case study based on semi-structured interviews with physicians and nurses, document analysis and informal discussions. Findings This study documents how two inter-professional networks were developed through professional agency. The findings show that the means by which networks are developed influence the form of collaboration therein. One of the networks developed from day-to-day, immediately relevant, exchange, for patient care. The other one developed from more formal and infrequent research and training exchanges that were seen as less decisive in facilitating patient care. The latter resulted in a loosely knit network based on a small number of ad hoc referrals while the other resulted in a tightly knit network based on frequent referrals and advice seeking. Practical implications Developing inter-professional networks likely require a sustained phase of interpersonal contacts characterized by persuasion, knowledge sharing, skill demonstration and trust building from less powerful professional groups to obtain buy-in from more powerful professional groups. The nature of the collaboration in any resulting network depends largely on the nature of these initial contacts. Originality/value The literature on inter-professional healthcare networks focusses on mandated networks such as NHS managed care networks. There is a lack of research on inter-professional networks that emerged from the bottom up at the initiative of healthcare professionals in response to clinical imperatives. This study looks at some forms of collaboration that these "grass-root" initiatives engender and how they are consolidated.

Objective: To revise diagnostic strategies for Alzheimer disease (AD), update recommendations on symptomatic treatment of dementia, and provide an approach to rapidly progressive and early-onset dementias., Composition of the Committee: Experts and delegates representing relevant disciplines from diverse regions across Canada discussed and agreed upon revisions to the 2006 guidelines., Methods: The GRADE (grading of recommendations, assessment, development, and evaluation) system was used to evaluate consensus on recommendations, which was defined as when 80% or more of participants voted for the recommendation. Evidence grades are reported where possible., Report: Important for FPs, despite advances in liquid biomarkers and neuroimaging, the diagnosis of dementia in Canada remains fundamentally clinical. New core clinical criteria for the diagnosis of AD now recognize less common, non-amnestic forms. Early-onset dementia, a rare but important condition, should prompt referral to specialists with access to genetic counselors. Rapidly progressive dementia, poorly defined in the literature, is described to facilitate detection of this rare but important condition. There are new expanded indications for cholinesterase inhibitors beyond AD, as well as guidelines for their discontinuation, which had not been previously described. New evidence regarding use of memantine, antidepressants, and other psychotropic medications in dementia care is presented., Conclusion: Several recommendations from the Fourth Canadian Consensus Conference on the Diagnosis and Treatment of Dementia are relevant to FPs. For guidelines to remain useful, family physicians should participate in all stages of the ongoing development process, including topic selection., (Copyright© the College of Family Physicians of Canada.)

Introduction: A single entry point for the elderly is important for the integration of services and for standardizing needs assessment processes. The role of a single entry point role is to refer older persons to the appropriate social and/or health services. The purpose of this paper is to describe the relationships between institutional partners and their use of the single entry point in a gerontological network., Methods: The gerontological network "Ancrage" is one of the first integrated care models with a single entry point to be implemented in France. The contact assessment tool known as CHIP (Community Hospital Intake Profile) is used to assess the needs of elderly people living at home and to make referrals. The data collected included all the requests made by partners at the single entry point over the course of one year (2008)., Results: A total of 303 requests were submitted to the single entry point by all partners (i.e. health and social professionals). These requests came from primary care professionals (68.3%), notably family physicians (29.3%). The needs of elderly people varied according to the type of requester. Most of those involved were directed toward the gerontological network (59.2%) and had more complex needs (no support from an informal caregiver and more difficulties in performing daily activities)., Conclusion: A single entry point is designed to involve all institutional partners and to meet the needs of the elderly. The level of involvement among physicians is high, and elderly people directed toward the gerontological network have the most complex clinical needs.

The increase in the number of elderly people requires a reorganization of patient care based on integrated networks of healthcare and community services. These services enable patients to remain at home, thus avoiding the significant costs incurred as a result of long hospital stays and numerous visits to emergency departments. Despite the interest of policy-makers in integrated services, the real impact of gerontological networks remains unknown. This study aims to investigate healthcare professionals' perceptions of the links between the various actors involved in older patient care (professionals, health services and community services) and to examine the perceived impact of a gerontological network among a range of different actors. The qualitative study conducted as part of this research examined the Parisian gerontological network Ancrage and its partners based on three main data sources: Ancrage documentation; interviews with 40 healthcare professionals; and observations (inter-service meetings and case management meetings). The data were analyzed using qualitative research methods. Data analysis highlighted three characteristics: the central role of the general practitioner, who remains responsible for the trajectory of care; the relevance of the geriatrician's interventions in the case of severely dependent patients and the assessment of older patients' needs; and the interface between hospitals, general practitioners and homecare professionals. Healthcare professionals highlighted improvements in patients' transition between home and hospital. Two particular areas for improvement emerged from the data. The relationship between the case manager and general practitioners was found to be akin to a delegation of homecare responsibilities and has little impact on practices and relationships between actors. In addition, although geriatricians are gaining in legitimacy, collaboration with general practitioners remains limited.