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Optimizing heath care services for seniors in emergency departments (ED) is a core component of the “Senior Friendly Hospital Approach” being implemented in Quebec. We measured the availability of geriatric expertise in Quebec EDs and its relationship with ED characteristics such as university affiliation, number of stretchers, and geographical location. We surveyed (2013–2014) head nurses and head physicians at 116 adult, non-psychiatric Quebec EDs. We defined high level of availability in the three following components of geriatric expertise: 1) geriatric care coordinatioN = a designated clinician coordinating the care of older adults available every day; 2) multidisciplinarity = 4 or 5 different nonmedical professionals, i.e., specialized nurse, social worker, occupational therapist, physiotherapist, and pharmacist, available almost always/often (nurse-reported); and 3) geriatric consultation = a specialist or a general practitioner specialized in geriatrics available almost always/often (physician-reported). We performed descriptive analyses and Fisher’s exact test. Among participating EDs (N = 83), 73 (88%) nurses and 67 (81%) physicians participated in the survey. 18% of EDs had high level of geriatric care coordination, 41% provided high level of multidisciplinarity, and 33% received high level of geriatric consultation. We found that EDs that had greater number of stretchers were more likely to have high level of geriatric care coordination (p < .05) and consultation (p < .001). EDs in metropolitan areas were also more likely to receive high level of geriatric consultation (p < .01). High level of multidisciplinarity was not associated with any ED characteristics. 2/5 of Quebec EDs provide high level of multidisciplinarity varying in their characteristics, whereas smaller and non-metropolitan EDs lack geriatric care coordination and consultation. There is a need for reorganisation and finding innovative ways to use existing human resources in Quebec EDs., Background: Use of potentially inappropriate medication (PIMs) in the hospitalized elderly can lead to adverse drug events, and contribute to geriatric syndromes. PIMs are frequently prescribed to elderly hospitalized patients, indicating the need to develop strategies to reduce their use. Objectives: To assess 1) the applicability of a pharmacist-physician intervention model to reduce the use of high-risk medications and 2) the clinical relevance of the alerts generated by a computerized alert system (CAS). Methods: The study was conducted in patients aged 65 or older admitted to a teaching hospital between April and June 2014. In the intervention model, the pharmacist determined the clinical relevance of the CAS alerts, analyzed the patient’s pharmacotherapy, and elaborated a geriatric pharmacotherapeutic plan to be discussed with the treating physician. The alerts were based on the Beers criteria. The main outcome was the change rate, defined as the number of patient-days with a change in at least one medication out of the total number of patient-days with at least one intervention. Results: The CAS identified 200 patient-days with at least one alert. In 149 patient-days, at least one alert was judged to be clinically relevant for a positive predictive value of 74.5%. The change rate was 77.7%. The most frequent changes were drug discontinuation (40.9%), and dose reduction (31.1%). The most frequently targeted drug classes were bone resorption inhibitors (20.2%), antiemetics (18.1%), benzodiazepines (13.0%), antidepressants (11.9%), antipsychotics (9.8%), and opiate agonists (7.8%). The inpatient geriatric consultation team was involved in 42 (22.3%) of the 188 included hospitalizations. Conclusion: The intervention model reduced high-risk medication use in hospitalized older patients, most of whom, otherwise, did not have a comprehensive geriatric assessment., The GAI was recently developed to address the need of a screening test that is simple, brief, and tailors to an older adult healthy and clinical population while minimizing items assessing somatic symptoms (Pachana et al., 2007). The purpose of this study is to assess the psychometric properties of the GAI as a tool to measure severity of anxiety symptoms among geriatric outpatients. Participants (N = 190) were recruited from two geriatric outpatient clinics at the McGill University Health Centre (MUHC). The 20-item GAI was administered in English or French. The data were analyzed via the Rasch analysis (RUMM2030) to examine unidimensionality of the construct being measured and assess individual item fit. Unidimensionality was confirmed by good fit of all the GAI items to the Rasch model with no significant item-trait interaction. There were no residual correlations of items above 0.3 observed. The 20-item GAI hierarchy ranged a span of 3.61 logits with the least severe anxiety symptom as “think of myself as worrier” to the most severe anxiety symptom as “feel great knot in stomach.” Standard error for item estimates ranged from 0.21 to 0.43. Person separation index was 0.71 when excluding individuals who did not report anxiety symptoms (38.4%). GAI items appropriately capture the anxiety construct. Even though in our sample GAI does not allow fine discrimination among individuals with similar severity of anxiety symptoms, this may be due to the development of the GAI as a screening test. All 20 GAI items represent a unidimensional anxiety construct, hence the GAI is a valid measure to assess geriatric outpatients’ anxiety symptomatology., Population aging is a global phenomenon that creates challenges in the care of the elderly population may be jeopardized in their cognitive health. The objective of this study was to delineate the cognition of registered elderly caregivers in a family-USF Health Unit in an area of high social vulnerability. The sample consisted of 73 elderly caregivers, over the age of 60. The interviews were conducted in the homes of elderly people in previously scheduled days and times. The instruments used for data collection were a sociodemographic questionnaire, The Addenbrooke’s Cognitive Examination Revised (ACE-R), and Mini-Mental State Examination (MMSE). Of the 73 elderly caregivers 58 (73.45%) were females and 15 (20.54%) were male, with a mean age of 70.35 (± 8.50) years and average schooling of 2.31 years. Regarding cognitive assessment, the average total points in the ACE-R was 49.58 (± 18.11) and MMSE 19.9 (± 4.6). The average scores on the ACE-R were: Attention/orientation 11.84 (± 3.15) points; Memory 10.45 (± 6.05); Verbal fluency 4.32 (± 2.84); Language 14.9 (± 5.7); and spatial Viso 8.02 (± 3.63). Of the elderly, 39 (53.42%) did not have changes in cognition according to the MMSE, using education by cohort note. In females 48.27% had cognitive impairment and in males 40% of the elderly. There are few studies that bring the design of cognition of the elderly in a highly vulnerable population, showing the need to study this further. We conclude that low educational level, the advanced age of the caregiver and the percentage of caregivers with cognitive impairment signs are worrying factors in the elderly, highly vulnerable population., Identification of the risk of recurrent falls is complex in older adults. The aim of this study was to examine the efficiency of three artificial neural networks (ANNs): multilayer perceptron (MLP), modified MLP, and neuroevolution of augmenting topologies (NEAT) for the classification of recurrent fallers and non-recurrent fallers using a set of clinical characteristics corresponding to risk factors of falls measured among community-dwelling older adults. Based on a cross-sectional design, 3,289 community-dwelling volunteers aged 65 and older were recruited. Age, gender, body mass index (BMI), number of drugs daily taken, use of psychoactive drugs, diphosphonate, calcium, vitamin D supplements, and walking aid, fear of falling, distance vision score, Timed Up&Go (TUG) score, lower-limb proprioception, handgrip strength, depressive symptoms, cognitive disorders, and history of falls were recorded. Participants were separated into 2 groups based on the number of falls occurred over the past year: ≤ 1 fall and ≥ 2 falls. In addition, total population was separated into training and testing subgroups for ANNs analyses. Among 3,289 participants, 18.9% (N = 622) were recurrent fallers. NEAT using 15 clinical characteristics (i.e., use of walking aid, fear of falling, use of calcium, depression, use of vitamin D supplements, female, cognitive disorders, BMI < 21kg/m2, number of drugs daily taken > 4, vision score < 8, use of psychoactive drugs, lower-limb proprioception score ≤ 5, TUG score > 9 seconds, handgrip strength score ≤ 29(N), and age ≥ 75 years) showed the best efficiency for recurrent fallers identification: sensitivity (80.42%), specificity (92.54%), positive predictive value (84.38), negative predictive value (90.34), accuracy (88.39) and Cohen’s kappa (0.74) compared to MLP and modified MLP. Our results show that NEAT and modified MLP are both efficient ANNs for the identification of recurrent fallers, the most effective ANN being NEAT. NEAT using a set of 15 clinical characteristics was an efficient ANN for the identification of recurrent fallers in older community-dwellers., Fear of falling (FOF) and increased gait variability are independent markers of gait instability. There is a complex interplay between them. The purposes of this study were 1) to perform a qualitative analysis of all published studies on FOF-related changes in gait variability through a systematic review, and 2) to quantitatively synthesize FOF-related changes in gait variability. A systematic Medline literature search was conducted on May 2014 using the Medical Subject Heading (MeSH) terms “Fear” OR “fear of falling” combined with “Accidental Falls” AND “Gait” OR “Gait Apraxia” OR “Gait Ataxia” OR “Gait disorders, Neurologic” OR “Gait assessment” OR “Functional gait assessment” AND “Self efficacy” OR “Self confidence” AND “Aged” OR “Aged, 80 and over.” Systematic review and fixed-effects meta-analysis using an inverse-variance method were performed. Of the 2184 selected studies, 10 observational studies (including 5 cross-sectional studies, 4 prospective cohort studies and one case-control study) met the selection criteria. All were of good quality. The number of participants ranged from 52 to 1,307 older community-dwellers (26.2 to 85.0% women). The meta-analysis was performed on 10 studies with a total of 999 cases and 4,502 controls. In one study, the higher limits of the effect size’s confidence interval (CI) were lower than zero. In the remaining studies, the higher limits of the CI were positive. The summary random effect size of 0.29 [95% CI: 0.13; 0.45] was significant, albeit of small magnitude, and indicated that gait variability was overall 0.29 SD higher in FOF cases compared to controls. This systematic review and meta-analysis shows that FOF is associated with a small significant increase in gait variability (i.e., worst performance of gait). In addition, mixed results of qualitative analysis suggest that this association may be influenced by other covariables that should be taken into account when examining it. Our findings show that FOF is associated with a statistically significant, albeit of small magnitude, increase in gait variability., Behavioural and psychological symptoms of dementia (BPSD) are common among older adults with dementia in long-term care (LTC) facilities. There is controversy regarding the prevalence of different manifestations of BPSD across the stages of dementia. This study examined the prevalence of BPSD in LTC in urban Nova Scotia. We also aimed to create a profile of different components of BPSD across the spectrum of dementia severity. LTC chart reviews were conducted between September 1, 2011, and January 31st, 2012, using a Comprehensive Geriatric Assessment (CGA) tool adapted for Long-Term Care: the LTC-CGA. A total of 269 LTC residents from 10 LTC facilities (LTCF) in Halifax, Nova Scotia with documented cognitive status were included, of whom 199 had a diagnosis of dementia. Group comparison of demographic variables, cognition (assessed using the Mini-Mental State Examination), BPSD symptoms, and function in Activities of Daily Living (ADLs) were performed across stages of dementia severity. BPSD were present in 76.9% of 199 residents with dementia, and a similar behavior pattern without physical aggression was also reported in up to 45% without a dementia diagnosis. The prevalence of psychological symptoms increased only slightly with dementia severity (28%, 31%, and 32% for mild, moderate, and severe, respectively), and were in fact most prevalent among those without dementia (36%; p < .001). Behavioural symptoms did increase with severity of cognitive impairment (p < .001). BPSD are highly prevalent among residents of LTC facilities in Nova Scotia. In contrast to often-held views that BPSD are a manifestation of severe dementia, here BPSD appeared to be prevalent across the spectrum of dementia severity, and many behavioral and psychological clusters were indeed identified in residents without a documented diagnosis of dementia., To identify the predictors of outcomes of elderly patients admitted to a slow-stream, low-intensity, long-duration inpatient rehabilitation (SSR) program after an acute hospitalization because they were unable to tolerate traditional inpatient rehabilitation. Prospective cohort study with assessments conducted on admission and discharge. 104 patients above age 60 admitted between September 2011 and December 2012 to Baycrest’s 30-bed SSR Unit in Toronto, Ontario. Admission assessments included motor Functional Independence Measure (FIM), Montreal Cognitive Assessment (MoCA), grip strength, ability to ambulate, Berg Balance Scale, Older American Resources and Services Activities of Daily Living (OARS ADL) based on functional status prior to the hospitalization, Short Form Health Survey (SF-12), Confusion Assessment Method (CAM), Patient Health Questionnaire (PHQ-9), and Comprehensive Geriatric Assessment Frailty Index (CGA-FI). Discharge outcomes included change in motor FIM from admission to discharge, residential status at discharge, and length of stay. Univariate and multivariate analyses were performed. Mean age was 81.6 ± 8.4 years and 68.3% were females. Mean length of SSR stay was 82.5 ± 26.4 days. Mean change in motor FIM from admission to discharge was 21.0 ± 12.2 (p < .001). Higher MoCA, higher Berg, lower CGA-FI and lower motor FIM at admission showed significant association with greater improvements in motor FIM. Lower CGA-FI was associated with returning to previous living situation. No significant predictors of lengths of stay were found in the multivariable analyses. Lower frailty scores, higher cognitive function, lower falls risk, and lower functional independence scores at admission were associated with greater improvements in motor FIM. Lower frailty scores on admission was associated with greater likelihood of returning to previous living situation. Admission frailty scores were strong predictors of outcomes for patients admitted to SSR., Twitter is a microblogging platform that overcomes physical barriers, allows unrestricted participation, and enables interactive discussions. Twitter-based journal clubs have demonstrated growth, sustainability, and worldwide communication, using a hashtag(#) to trend journal club participation. To date, there is no reported Twitter-based geriatric medicine journal club. We describe the first five months of #GeriMedJC. @GeriMedJC moderates #GeriMedJC, a monthly 26-hour asynchronous journal club that complements the live, 1-hour, traditional-format geriatric medicine journal club based at the University of Toronto. Growth metrics including number of tweets, number of participants, tweet amplification, and impressions were obtained from Symplur. Thematic analysis of tweets was performed to categorize content into areas of clinical practice, medical education, health policy, and critical appraisal. In the first five months, @GeriMedJC has grown 217 followers, including 30%, 25%, and 16% from the U.K., Canada, and U.S.A., respectively. Most followers were physicians (35%), with two-thirds representing geriatricians. There was an increase in all growth metrics for the first few months with a mean of 83 tweets, 36 retweets, 16 participants, and 34,750 impressions per journal club session. The content of tweets were most relevant to clinical practice, medical education, critical appraisal, and health policy in 39%, 18%, 16% and 4% of tweets, respectively. There has been a steady increase in growth metrics for #GeriMedJC with demonstrated discussion in areas of clinical practice, medical education, critical appraisal, and health policy. #GeriMedJC is another example of using Twitter to engage international and interprofessional appraisal of medical literature. Future directions include demonstrating sustainability and analyzing factors associated with the growth of #GeriMedJC., Urodynamics (UD) refers to a broad range of investigations of lower urinary tract function such as bladder diaries and post-void residual measurement as well as invasive procedures such as multi-channel cystometry. According to the 5th International Consultation on Incontinence, the level of evidence supporting UD in the in frail older persons is weak. To assess the body of evidence, a scoping study was conducted by searching OVID Medline, OVID Embase, Cochrane Central Register of Controlled Trials, CINAHL, and Web of Science. The search was limited to English studies of patients > 18 years old, published from 1965 to November 18, 2014. A total of 10,246 abstracts meeting the search criteria were found; studies included bladder diaries, the pad test, post-void residuals, uroflowmetry, filling and voiding cystometry, and abdominal leak point pressure measurement. Studies involving the frail elderly were few but some themes emerged: non-invasive UD (bladder diaries and pad tests) were found useful prior to treatment and to assess treatment response. Post-void residual measurement and uroflowmetry showed benefit in preventing urinary retention when performed prior to initiation of pharmacological therapy or invasive urological procedures. Voiding cystometry was of benefit to both male and female older adults prior to surgery and in the assessment of postsurgical incontinence. UD was well-tolerated by the geriatric population. Based on current evidence, both non-invasive and invasive UD can be considered in selected elderly patients to guide treatment decisions, especially when considering surgical intervention. More research is needed in deciding which elderly patients will benefit from UD investigation., The aims of this study were 1) to confirm that combinations of brief geriatric assessment (BGA) items were significant risk factors for prolonged LHS among geriatric patients hospitalized in acute-care medical units after their admission to the emergency department (ED); and 2) to determine whether these combinations of BGA items could be used as a prognostic tool of prolonged LHS. Based on a prospective observational cohort design, 1,254 inpatients (mean age ± standard deviation, 84.9 ± 5.9 years; 59.3% female) recruited upon their admission to ED and discharged in acute-care medical units of Angers University Hospital, France, were selected in this study. At baseline assessment, a BGA was performed and included the following 6 items: age > 85 years, male gender, polypharmacy (i.e., ≥ 5 drugs per day), use of home-help services, history of falls in previous 6 months and temporal disorientation (i.e., inability to give the month and/or year). The LHS in acute care medical units was prospectively calculated in number of days using the hospital registry. Area under receiver operating characteristic (ROC) curves of prolonged LHS of different combinations of BGA items ranged from .50 to .57. Cox regression models revealed that combinations defining a high risk of prolonged LHS, identified from ROC curves, were significant risk factors for prolonged LHS (hazard ratio > 1.16 with p > .010). Kaplan-Meier distributions of discharge showed that inpatients classified in high-risk group of prolonged LHS were discharged later than those in low-risk group (p < .003). Prognostic value for prolonged LHS of all combinations was poor with sensitivity under 77%, a high variation of specificity (from 26.6 to 97.4) and a low likelihood ratio of positive test under 5.6. Our results show that combinations of BGA items were significant risk factors for prolonged LHS in geriatric patients admitted to ED and discharged to acute-care medical units. However, the prognostic value for prolonged LHS of these combinations of BGA items was poor, whatever the BGA items or their combinations used. Combinations of 6-item BGA tool were significant risk factors for prolonged LHS but their prognostic value was poor in the studied sample of older inpatients., Fragility fracture risk assessment tools are increasingly being used to inform treatment decisions. Three commonly used tools are FRAX, Garvan, and Qfracture. However, these tools produce different results for 10-year risks of sustaining major osteoporotic fractures and hip fractures and potentially may lead to different treatment decisions. The aim of this study was to evaluate if employing these different tools with their associated guidelines would impact on the decision to treat or not in a group of postmenopausal women. Clinicians used a questionnaire to collect information to populate the 3 tools in patients attending osteoporosis clinics and the 10-year fracture risks were calculated. For FRAX (UK), the National Osteoporosis Guideline Group (NOGG) age-related treatment thresholds were used, and for Garvan and Qfracture, a set 20% threshold was used to determine the need for intervention. 90 women (mean age 69.5 ± 12.9 years) were studied. FRAX recommended treatment in 45.6% (95% CI = 35.3–55.9%; N = 41) versus 71.7% (95% CI = 61.7–80.5%; N = 64) in Garvan and 40% (95% CI = 29.9–50.1%; N = 36) in Qfracture. There was substantial discordance in treatment recommendation between the groups with only 17.8% (N = 16) of patients having the recommendation to treat by all three tools. Compared to FRAX-NOGG (UK), employing the Garvan tool (20% threshold) significantly over-treated and the Qfracture tool (20% threshold) tended to undertreat and there was substantial misclassification on whether or not to treat between the three groups. Clinicians should be aware that choosing one fracture risk assessment tool over another (with associated treatment guidelines) may strongly influence their treatment decisions., Understanding how and why dementia occurs is key to understanding its prevention and management. Recently, standard laboratory values have been used together as an index to identify adverse outcomes in the presence of frailty. We sought to investigate whether this laboratory frailty index (the FI-Lab) was associated with a diagnosis of dementia. A secondary analysis was done of a prospective cohort study consisting of community and institutionally dwelling individuals aged 65 and older. The FI-Lab was created from laboratory tests used in the first clinical examination of the Canadian Study of Health and Ageing. Univariate and multivariate logistic regression for a diagnosis of dementia at five years was performed to identify any association with the FI-Lab. Of 1,013 patients, 467 were alive at follow-up, of whom 391 (83.7%) had a follow-up diagnostic evaluation. Those 76 missing diagnosis had similar demographics to the study group. In univariate analysis, the FI-Lab (mean 0.25) was significantly associated with a diagnosis of dementia (p = .003). In multivariate analysis the FI-Lab remained significant (p = .019). Combining the FI-Clinical and FI-Lab the FI-Combined (p < .001), education (p = .002), age (p = .019) and sex (p = .032) were all predictive of dementia. Sex was not significantly associated with a dementia diagnosis. A standard laboratory index (FI-Lab), modelled after the frailty index, was associated with a future diagnosis of dementia. The FI-Lab did not include any classical dementia biomarkers. This contributes further to the possibility that dementia most often occurs in those who are frail. This further supports the potential mechanism to dementia being an impaired neurocognitive repair process. Standard laboratory tests, when combined, are able to identify individuals who are at increased risk of dementia., Among hospitalized older adults, delirium is a common complication of acute illness and contributes significantly to patient morbidity and mortality. The aim of our study was to investigate the incidence of delirium among older adults admitted to the Clinical Teaching Unit (CTU) in the Royal University Hospital in Saskatoon, the factors associated with development of delirium, and subsequent management practices. This information will provide us with an opportunity to develop delirium prevention, diagnosis, and management strategies. A chart review of 170 patients over the age of 70 at admission to the CTU was completed. A validated chart review tool was used to diagnose delirium from patient charts. Delirium diagnosis was defined as a recorded diagnosis of delirium or a documentation of “mental status change” or “acute/fluctuating” along with at least one other key term documentation (acute onset, agitation, disorganized thinking, disorientation, hallucinations, inappropriate behaviour, inattention). The delirium rate in the sample was 30.8%, (95% CI: [21.9%, 39.7%]). Delirium management ranged from non-pharmacologic interventions such as reorientation and reassurance, to invasive strategies such as physical or chemical restraint (predominantly haloperidol). Management techniques were applied inconsistently when delirium was present. This project has demonstrated a significant presence of delirium within the CTU, with variable management strategies. Although delirium was commonly encountered, physician documentation of delirium within the chart was rare. Furthermore, benzodiazepines were occasionally used as a first-line management tool, in contrast to the Choosing Wisely Canada guidelines. Management of delirium requires appropriate recognition and coordinated strategies for appropriate intervention. Recognizing the significant burden of delirium on the health-care system bears important implications for health resource planning and improved patient outcomes, particularly among vulnerable elderly populations., Influenza results in over 200,000 hospitalizations and 36,000 deaths per year in the United States. Ninety percent of influenza-related deaths occur in those older than 65. In order to appropriately advise the public and direct future vaccination strategies and research, the Canadian Immunization Research Network’s Serious Outcomes Surveillance (SOS) Network calculates vaccine effectiveness by monitoring the annual burden of influenza illness resulting in hospitalization. Surveillance for influenza is conducted at 15 SOS Network sites across Canada. All patients aged 16 years or older admitted with possible influenza (e.g., acute respiratory illness, fever) received a nasopharyngeal swab testing for influenza via reverse-transcriptase PCR or viral culture. Viral strain, vaccination status, intensive care admission, and death were recorded and compared among confirmed cases and test-negative controls. Interim data for the 2014/15 influenza season indicate: A poor match between the circulating virus and vaccine strain, with poor vaccine effectiveness in all age groups (e.g. −25.4% (90% CI: −65, 4.6) for those older than 65);69% of hospitalized cases are older than 75 years;11% required intensive care; 8% associated mortality. One of the defining features of aging is declining immune function. Age-related changes in T-cell function result in lessened ability of elderly people, especially those who are frail, to mount a protective immune response. Given the lack of vaccine effectiveness in a mismatch year and the high associated mortality in the elderly population, multiple strategies such as biomarkers for vaccine response, high-dose vaccines, and vaccine adjuvants need to be explored to mitigate adverse outcomes in future influenza outbreaks. Further research into frailty-informed assessments of vaccine responsiveness is imperative to reduce influenza-related morbidity and mortality., A thorough falls assessment can successfully reduce future events and injuries in elderly patients presenting to hospital with a fall. However, the frequency with which patients receive such an assessment is not clear. We sought to characterize the management of elderly patients presenting to the ED with a fall. Records from a single large tertiary care center ED between 2003 and 2014 were searched. A random sample of 96 charts, describing visits for a “fall” in individuals ≥ 65 years, were selected. Charts were reviewed using a detailed pre-specified data abstraction form documenting fall management. Of the 96 patients, mean age was 78.2 years (SD ± 8.53), and 61.5% were women. Most (42.8%) lived at home with family, 11.5% lived alone, and 16.6% lived in nursing homes or assisted living. Fall-related injuries were common with 54.2% sustaining a new fracture. In terms of falls assessment, only 2% patient charts had documentation of the presumed etiology of their fall. Orthostatic vital signs were performed in 1% of patients, 1% had a visual assessment, 3% underwent assessment of cognition, and 3% had a medication review. Following assessment, 69.7% of patients were discharged from the ED and 25% of patients were admitted to home hospital (4.1% transferred elsewhere, 1% died in ED). Of those discharged, 29% of patients did not have follow-up arranged, 28% were referred for community supports, and 14% were discharged with a new walking device. Two (2.2%) were started on Vitamin D and calcium, and 1% on a bisphosphonate. Very few elderly patients presenting to the ED with a fall received a proper falls assessment or treatment plan. These results suggest a significant care gap and highlight an area of opportunity for future quality improvement., Frailty is a multicausal syndrome including weight loss, exhaustion, and lack of strength and mobility, which puts older adults at risk for adverse outcomes including falls, hospitalization, and death. High burden in caregivers of older adults is associated with physical and psychiatric morbidities. Limited research suggests a relationship between frailty in older adults and their caregivers’ self-reported burden. This study analyzed the relationship between frailty in older adults attending a geriatric outpatient clinic and their caregivers’ self-reported burden. The study population consisted of 50 older adults attending an outpatient geriatric clinic in 2013 and 2014 accompanied by a caregiver. Participants’ degree of frailty was evaluated using the Fried Frail Scale (FFS). Independence in activities of daily living was assessed using the Katz Index. Patient charts were reviewed for prior diagnosis of dementia. Caregivers’ self-reported burden was evaluated using the Short Zarit Burden Interview (ZBI). Multivariable linear regression was performed with ZBI score as the dependent variable, and age, gender, dementia, Katz Index, and frailty status as independent variables. Caregivers of frail (FFS ≥ 3; N = 21) patients had a mean ZBI score of 19.4 (SD = 11.3). Caregivers of non-frail (FFS < 3; N = 29) subjects had a mean ZBI score of 13.6 (SD = 8.4). Frailty and prior diagnosis of dementia significantly predicted caregiver burden. Age, Katz Index, and gender did not significantly predict caregiver burden. Caregivers of frail older adults attending a geriatric outpatient clinic reported a significantly higher level of burden than caregivers of non-frail patients. Prior diagnosis of dementia was a significant predictor of caregiver burden. Further examination of the relationship between frailty and caregiver burden is warranted., Older adults with functional impairment are cared for by physiatrists in rehabilitation. With the aging population, acquiring geriatric-related competencies will be essential. Literature is limited on geriatric learning needs in physiatry but suggests that education is suboptimal. To develop a geriatric rehabilitation curriculum, a needs assessment was conducted to understand comfort level of geriatric-related competencies and resident learning needs in physiatry residents, physiatrists, and key informants (KI). A mixed methods approach was taken. Physiatry residents at the University of Toronto were invited to participate in a questionnaire and focus group. Physiatrists in Ontario were invited to complete a questionnaire and participate in follow-up one-on-one inter views. KIs were purposively selected to participate in both surveys. Questionnaires assessed comfort level (0 very uncomfortable, 5 very comfortable) on geriatric-related competencies. Focus groups and interviews explored learning experiences and needs in geriatrics rehabilitation. Descriptive statistics were used to analyze questionnaires. NVivo software was used for qualitative analysis within a grounded theory approach. Eighteen (87%) residents and 27 (21%) physiatrists completed the questionnaire. More than 50% of residents were somewhat to very uncomfortable on geriatric topics such as age-related pharmacokinetics and dynamics, pain management, frailty, physiology of aging, and depression. Physiatrists identified similar topics in addition to cognitive impairment (including delirium), medication management, and end-of-life care. Initial qualitative analysis sheds further light on these identified learning needs; in particular, how applicability can be enhanced in the post acute care setting. A large proportion of physicians in physiatry do not feel comfortable on core geriatric-related competencies, which were similarly identified as learning needs by physicians in physiatry. Initial insights may provide educators with an understanding on how to improve geriatric education in physiatry., Biological aging is a stochastic process that can be characterized by the number of health deficits individuals accumulate (i.e., their frailty index). As people with HIV exhibit excess risk for multiple age-related health problems, they might age differently than people without HIV. Secondary analysis of four-year follow-up data from the Italian Modena HIV Metabolic Clinic cohort (MHMC; N = 963; mean age 46.8 ± 7.1 years; 29% women) and the Italian sample of the general community-based Survey of Health, Ageing and Retirement in Europe (SHARE; N = 1,391; mean age 65.7 ± 8.8 years; 56% women). Health state was quantified as the number of deficits accumulated out of 31 health variables, selected separately in each cohort. Multistate transition modelling provided probabilities of health state changes, including death. In both cohorts, mean deficit count at four years follow-up showed a similar, linear relationship with deficit count at baseline; MHMC consistently had smaller standard deviations in deficit counts at follow-up. Mortality was 3.0% in MHMC and 7.7% in SHARE. Adjusted for baseline deficit count, age, and gender, MHMC participants had more deficits at follow-up than SHARE participants (RR 1.28, 95% CI 1.22–1.35), but mortality differences were non-significant (OR 0.85, 0.45–1.61). Adjusted mean deficits at follow-up were 8.25 (7.99–8.52) in MHMC and 6.87 (6.66–7.07) in SHARE (p < .001). Despite differences between cohorts (e.g., HIV clinic vs. community-based, age and gender distributions) and in the health variables making up the frailty indices, HIV-positive MHMC participants and general population SHARE participants demonstrated similar patterns of deficit accumulation. MHMC participants generally accumulated more deficits and exhibited greater homogeneity in outcomes. People with HIV appear to age in patterns similar to the general population, but experience poorer and less variable outcomes over four years., Anticholinergic drug therapy may worsen cognitive performance and is particularly concerning when prescribed to older adults with dementia. Care provided by multiple physicians may contribute to this inappropriate prescribing. We explored the association between the number of unique physicians providing care and anticholinergic drug burden among older persons newly initiated on cholinesterase inhibitor therapy for the management of dementia. A population-based cross-sectional study of community and long-term care dwelling older adults with dementia in Ontario. The number of unique physicians providing care and anticholinergic drug burden using the Anticholinergic Risk Scale (ARS) were measured within the prior year. We identified 79,067 community-dwelling older adults and 12,113 LTC residents newly dispensed cholinesterase inhibitors. In the community (mean age 81.0 years, 60.8% women), individuals saw an average of 8 unique physicians in the prior year. The odds of high anticholinergic drug burden (ARS score of ≥ 2) increased by 24% for every 5 additional physicians providing care (adjusted odds ratio, 1.24; 95% confidence interval, 1.21–1.26). Female sex, low-income status, previous hospitalization, and higher comorbidity score were also associated with high anticholinergic drug burden. In LTC (mean age 84.3 years, 67.2% women) individuals saw an average of 10 unique physicians in the prior year. Relative to the community setting, the anticholinergic drug burden based on the number of physicians providing care was similar but attenuated in LTC. Among older adults with dementia newly dispensed cholinesterase inhibitor drug therapy, a greater number of physicians providing care was associated with higher anticholinergic drug burden scores. Improved communication amongst physicians, and a medication review prior to prescribing a new drug therapy, as suggested by Choosing Wisely, are important strategies to improve prescribing quality., Older adults who become ill often demonstrate impairments in mobility and balance. Such impairments are more common in frail adults, and independently are associated with death. Even so, little work has related frailty to recovery time, which was our objective here. This is a secondary analysis of a cohort study of 409 older adult inpatients at a Canadian teaching hospital (mean age = 81 ± 7 standard deviation, 64% women). Frailty was measured using a frailty index based on a comprehensive geriatric assessment (FI-CGA), at baseline (two weeks prior to admission; mean 0.31 ± 0.10), and on admission (mean 0.40 ± 0.10). Mobility and balance was quantified using the Hierarchic Assessment of Balance and Mobility (HABAM). Recovery was measured as the difference in HABAM scores between discharge and admission. The odds of no or incomplete recovery increased by 1.06 (95% confidence interval: 1.01–1.11) for each 0.1 increment in the baseline FI-CGA. Recovery was similarly dependent on age, but independent of mobility scores on admission. Frailer patients showed longer recovery times, especially with an increase in FI-CGA scores between baseline and admission (r = 0.35, p < .001). Recovery time was independent of age. Recovery has been shown to be dependent both on severity of illness and baseline level of frailty. Tracking mobility and balance can help providers, patients, and families understand the course of acute illness in older adults. Frailer patients are at a greater risk of incomplete recovery from impaired mobility and balance. Further work into how frailty and illness severity together impact recovery — perhaps through a measure that combines the two — is needed., Studies suggested that antipsychotic-induced weight gain is not as much of a concern in the elderly compared to the younger population. Part 1 of this study was to determine whether atypical antipsychotics induced weight change in elderly patients with various psychiatric diagnoses. Part 2 was to identify whether certain antipsychotics induced weight change in elderly patients. In Part 1, a retrospective chart review was done on 115 geriatric inpatients. After exclusion, patients were divided into four groups: control (N = 17), new treatment (N = 18), long-term treatment (N = 13), and medication switch groups (N = 8). In Part 2, a medication review was performed on 169 geriatric inpatients. After exclusion, patients were divided into three groups: aripiprazole (N = 18), olanzapine (N = 49), and risperidone (N = 57). Body weights were obtained at two different time points. No significant weight change was observed among the control (1.5 kg), new treatment (0.8 kg), long-term treatment (−0.3 kg), and medication switch (1.9 kg) groups. No significant weight change was observed between patients with and without dementia (0.8 and 1.1 kg, respectively). The weight change in the aripiprazole group (−2.0 kg; −2.30% from baseline) was significantly different from the weight change in the olanzapine group (0.7 kg; +1.87% from baseline; p < .05), but not from the risperidone group (−0.4 kg; −0.45% from baseline). Clinically significant weight gain (> 7% increase in body weight) occurred in 14.3% of the olanzapine patients, a percentage significantly higher than the 3.5% in the risperidone group. Although antipsychotics generally caused no weight change in the elderly population, aripiprazole and olanzapine were associated with significant weight loss and weight gain, respectively. Prospective trials are needed to confirm whether aripiprazole and olanzapine cause weight change in the elderly population., Background: As no widely accepted screening tool that predicts patient rehabilitation outcomes on a Geriatric Rehabilitation Unit (GRU) exists, determination of those who will benefit from admission and how to maximize rehabilitation gains remains challenging. Objective: Does pre-morbid frailty, as assessed with the 9-point clinical frailty scale (CFS), predict rehabilitation outcomes? Methods: A retrospective chart review was conducted on all patients admitted to Parkwood Institute’s GRU between September 2013 and May 2014. CFS scores were assigned retrospectively based on pre-morbid health and functional status data recorded in the patient’s chart. Rehabilitation outcomes, including Relative Functional Gain (RFG), and Relative Functional Efficiency (RFE) were calculated. Results: Ninety-six (41.4%) of the 232 GRU patients were male and 44% had experienced a lower-extremity fracture. Mean age was 82.8 years (range: 59 to 96), mean CFS on admission was 4.9 (range: 1–7), mean FIM on admission was 69.9 (range: 20–109), mean RFG was 0.43 (range: −0.21 to 0.88), and mean RFE was 0.02 (range: −0.01 to 0.10). Regression modeling that included physical health (Charlson comorbidity index [CCI], BMI, use of gait aids, Braden score, MMSE, number of admission medications), emotional health (geriatric depression scale), and demographic variables (age, sex, education, presence of extended family, living alone) suggested that CFS score accounted for 19.7% of RFG variability. An additional 17.6% of the RFG variability was explained by the combination of CCI, MMSE, Braden Score, education, and lack of extended family. Conclusion: Of all measures considered, pre-morbid CFS score was the strongest predictor of patient rehabilitation outcomes., The Queen’s Geriatric Interest Group (QGIG) is a student-run initiative aimed at fostering interest in geriatric medicine. Pre-clerkship observerships have been documented as valuable methods for increasing exposure and interest in a given specialty. QGIG leaders collaborated with the Division of Geriatric Medicine to arrange observerships at St. Mary’s of the Lake Hospital. Participants were paired with a preceptor for a four-hour weekend observership on an inpatient geriatric rehabilitation unit. Participants were asked to complete surveys before and after the observership, which consisted of: (1) internally-developed Likert scale questions assessing students’ experiences and interest in geriatric medicine; (2) University of California Los Angeles – Geriatric Attitudes Scale (UCLA-GAS); and (3) narrative feedback. Forty-two students participated in the program between October 2013 and May 2014. Twenty-seven participants completed the pre-observership survey (response rate 64%), and 22 completed the post-observership survey (response rate 52%). All participants found the process of setting up the observership easy. The majority (72.7%) described the experience as leading to positive changes in their attitude toward geriatric medicine and 54.5% felt that it stimulated their interest in the specialty. No statistically significant change in UCLA-GAS scores was detected (p = .35). All participants agreed that the program should continue, and 90% stated that they would participate again. Despite the lack of a statistically significant difference in attitudes, the observership program was positively received by students. They enjoyed learning about the specialty, working with the preceptor and patients, the opportunity to practise clinical skills, the ease of setting up the observership and the pace of geriatric medicine. Structured pre-clerkship observerships may be a feasible method for increasing exposure to geriatric medicine., Delirium is a frequent complication among hospitalized elderly patients and is associated with poor outcomes. Many predictive models have been elaborated to identify patients at risk of developing delirium, but none of them have been validated in a geriatric assessment unit (GAU). We sought to determine the prevalence, incidence, and effects of delirium in a GAU and to validate Inouye’s predictive model for delirium in this population. We conducted a retrospective study of consecutive admissions in a GAU at Saint-Luc Hospital (Centre Hospitalier de l’Université de Montréal) between March and December 2012. Delirium risk was assessed by using Inouye’s predictive model, which is based on four risk factors at admission: visual impairment, severe illness, cognitive impairment, and high blood urea nitrogen/creatinine ratio. Delirium cases were diagnosed with the DSM-IV-TR criteria. One hundred thirty-six patients were included. The mean age was 85.6 ± 5.7 years old; 64% were women. Thirty-eight patients were diagnosed with delirium at arrival (prevalence 27.9%); 16 patients developed delirium during their hospitalization (incidence 16.7%). New-onset delirium was associated with prolonged hospital stay (46.1 ± 20.4 days vs. 28.2 ± 23.7 days, p < .005) and increased mortality (18.8% vs. 5.0%, p < .05). Application of the predictive model did not succeed in stratifying risk of delirium within this population (low risk: RR 1.0, intermediate risk: RR 0.97, high risk: RR 1.94; chi-square test for trend: p = .248). Delirium is common in our GAU and is associated with prolonged length of stay and increased mortality. Application of Inouye’s predictive model, validated previously in an elderly population hospitalized on a medical ward, did not predict accurately the occurrence of delirium in a GAU population., The “Pain Assessment Checklist for Seniors with Limited Ability to Communicate” (PACSLAC) is considered by many as the reference tool to assess pain in seniors who have difficulty communicating. Despite its excellent psychometric qualities, clinicians often report that the high number of items of the PACSLAC hampers its use in clinical setting. (1) To evaluate the relationship between two short assessment scales (the revised version of the PASCLAC [PACSLAC-II] and the Pain in Advanced Dementia [PAINAD]) and the original version of the PACSLAC; (2) to compare the administration times of the three tools. 46 residents in long-term care (mean age = 83 ± 10 yrs.) with dementia and difficulty to communicate were observed during transfer or mobilization (two potentially painful procedures) by three independent evaluators. Each of them used a different assessment tool (PACSLAC, PACSLAC-II, or PAINAD; randomly assigned). Correlational analyses were used to determine the relationship between the PACSLAC and PACSLAC-II and between the PACSLAC and PAINAD; an ANOVA was used to compare the administration times for the three tools. The PACSLAC-II and PAINAD were both moderately correlated with the PACSLAC (r = 0.63 and r = 0.65; all p values < .001). The mean administration times for the PACSLAC-II (96 ± 22 sec.) and PAINAD (63 ± 10 sec.) were significantly lower than that for the PACSLAC (135 ± 29 sec.; all p values < .001). Our results suggest that the PACSLAC-II and PAINAD can both be used to quickly assess pain in individuals with dementia. However, given the moderate association observed and the relatively small differences in administration time, we believe that the original version of the PACSLAC should be preferred when possible., Despite a rapidly aging population, there remains a shortage of geriatric specialists throughout the world. The factors associated with psychiatric residents’ interest in geriatric psychiatry had not been previously examined in a nationally-representative sample. This was an online survey of 226 Canadian psychiatry residents (24.3% response rate). The main outcome was interest in becoming a geriatric psychiatrist. Bivariate and multivariate analyses were performed to better understand what demographic, educational, and vocational variables were associated with interest in becoming a geriatric psychiatrist. A number of respondents had an interest in becoming a geriatric psychiatrist (29.0%, N = 60), in doing a geriatric psychiatry fellowship (20.3 %, N = 42), or in doing geriatric psychiatry as a part of the clinical practice (60.0%, N = 124). Demographic characteristics (e.g., age, gender, ethnicity) did not correlate with interest in geriatric psychiatry. The variables most robustly associated with interest in geriatric psychiatry were: 1) completion of geriatric psychiatry rotation(s) before 3rd year of residency (OR 5.13 [95% CI: 1.23–21.4]); 2) comfort working with geriatric patients and their families (OR 18.6 [95% CI: 2.09–165.3]); 3) positive experiences caring for older adults prior to medical school (OR 12.4 [95% CI: 1.07–144.5]); and 4) the presence of annual conferences in the resident’s field of interest (OR 4.50 [95% CI: 1.12–18.2]). Exposing medical students to clinical geriatric psychiatry rotations that increase comfort in working with older adults may help improve recruitment of geriatric specialists. This poster will describe the protocol of a proposed randomized trial exposing medical students to geriatric psychiatry during clerkship psychiatry rotations., Polypharmacy and multimorbidity are common among older people in long-term care facilities (LTCFs). This is associated with increased hospitalizations, adverse drug events, drug interactions, and cognitive impairment. Reducing polypharmacy may reduce adverse events and improve resident quality of life. Deprescribing refers to cessation of medications after consideration of therapeutic goals, benefits and risks, and medical ethics. The purpose of the study was to rank factors which general practitioners (GPs), nurses, pharmacists, and residents perceive are most important when deciding whether or not medications should be deprescribed. Discipline-specific groups of GPs (N = 13), nurses (N = 6), pharmacists (N = 9) and residents/representatives (N = 6) associated with LTCFs were conducted in South Australia. Nominal group technique was used to discuss, explore, and rank factors each discipline perceived as important when deciding whether or not to deprescribe medications. Participants identified a wide range of factors with considerable overlap between disciplines; however, no two disciplines ranked factors in the same order. The highest ranked factors for each discipline were: GPs — evidence for deprescribing; communication with family/residentNurses — GP receptivity to deprescribing; nurses ability to advocate for residents;Pharmacists — clinical appropriateness of therapy for individual residents; identifying a resident’s goal of care; andResidents — residents well-being; poor continuity of nursing staff. The results corresponded with published frameworks for GP and patient-identified factors. This study extends those frameworks to include nurses and pharmacists. Furthermore, factors were prioritized, providing guidance for practice and future research. Multiple factors that influence deprescribing decisions in LTCFs were identified, with each discipline having different priorities. The factors important to each discipline need to be considered in the design of deprescribing interventions in this setting., Polypharmacy and multimorbidity are common among older people in long-term care facilities (LTCFs). Polypharmacy has been associated with increased hospitalizations, adverse drug events, drug interactions and cognitive impairment. Reducing polypharmacy may reduce adverse events and improve quality of life. Deprescribing refers to cessation of medications after consideration of therapeutic goals, benefits and risks, and medical ethics. The purpose of the study was to rank factors that metropolitan and regional multidisciplinary groups (comprising general practitioners [GPs], nurses, pharmacists, and residents’ representatives) consider most important when deciding whether or not medications should be deprescribed in the LTCF setting. Multidisciplinary groups were convened in metropolitan and regional South Australia. Using nominal group technique, the groups discussed, explored, and ranked factors they perceived important for deprescribing. The metropolitan group ranked “adequacy of a resident’s medical and medication history” as the most important factor. The regional group ranked “identifying a resident’s goal of care” the most important factor. Both metropolitan and regional groups ranked the “structure of the health system” as an important factor impacting their decision to deprescribe. Both groups identified factors relating to interdisciplinary cohesiveness as important, with the metropolitan group ranking these factors more highly. Previous research involving GPs found a perceived “lack of evidence” for deprescribing. We discovered all health-care practitioners felt this was important. Addressing the range of factors identified may improve deprescribing success in LTCFs. Patient-centred factors were the most important overall. However, the structure of the health system had a considerable impact on the decision to deprescribe. Metropolitan and regional multidisciplinary groups prioritized different factors. This suggests that for deprescribing to be effective, local factors should be taken into account while implementing a patient-centred, multifaceted approach., Avoiding unnecessary emergency room transfers (ERTs) is recognized as an opportunity to improve health outcomes for elderly residents living in long-term care facilities (LTCFs). Prior research has identified improved communication between health-care professionals as a means of lowering ERT rates, but few studies have assessed nurses’ perceptions and use of communication tools following their implementation. As such, this investigation sought to: (1) evaluate nursing use of a modified communication tool implemented in a LTCF to reduce unnecessary ERTs; and (2) explore nursing attitudes towards this tool post-implementation. This study employed a mixed-methods approach. Intensity of communication tool use was established using chart abstraction and electronic institutional records. Semi-structured interviews were conducted with registered nurses in a Montreal LTCF currently implementing the tool. Of the 29 nurses who participated in the study (91% response rate), 11 had used the tool in 60% or more of transfer cases (high-intensity users), 8 had used the tool in approximately 50% of cases (mid-intensity users), and 10 had used the tool in less than 40% of cases (low-intensity users). More experienced nurses (>10 years) tended to be low/middle users, while newer nurses tended to be more frequent users. Overall, nurses found the communication tool especially helpful for surveillance purposes, but tedious to complete during time-sensitive emergencies. Observed differences in tool use may stem from nurses’ confidence in their ability to effectively manage emergency situations. Nurses with less experience may also be more likely to adhere to protocols, in general. ERT rates are a common benchmark for LTCF quality improvement. Given the potential applicability of nursing communication tools to other facilities, understanding how users perceive and use such tools may prove useful for future program implementations., Elder abuse (EA) is a social phenomenon with important health implications, particularly in long-term care (LTC). Residents of LTC institutions are at high risk of EA due to their physical and mental frailties, increased dependency and vulnerability, and social isolation. Despite this, studies of EA detection and prevalence have largely neglected institutionalized seniors and seniors with cognitive impairment (CI). EA screening instruments are also not suitable for these populations. As such, the objectives of this study are: (1) to identify how an existing, rapidly administered, EA screening instrument (Elder Abuse Suspicion Index) may be adapted to reflect the realities of institution-living (including residents with CI); (2) to create a LTC version of this tool informed by expert panel recommendations; and (3) to pilot the use of this newly modified instrument within a sample of LTC residents. A mixed-methods design will be employed. Recommendations for tool modification will be obtained from a carefully selected Delphi panel of twelve health-care professionals with experience in LTC and/or EA. The revised EA screening tool will then be administered to 75 consenting residents with varying degrees of CI. Data from the Delphi panel questionnaires will be analyzed to identify common and conflicting viewpoints. Once the tool has been modified to reflect group consensus, content validity will be determined using specificity, sensitivity, and positive and negative predictive value metrics. In targeting the early detection of EA in a previously untested, vulnerable population, this analysis will begin to generate insight on EA prevention measures in LTC. The rapid detection of at-risk, institutionalized seniors may lead to an institutional response at the earliest sign of suspicion, resulting in improved health outcomes for this population., Heart Failure (HF) patients often experience a poor prognosis, evidenced by frequent hospitalizations and limited survival. Appropriate management of HF is contingent on an accurate diagnosis. Part of the physical examination for suspected/worsening HF is assessing JVP and this can be a difficult, often underutilized maneuver. The Venous 1000 is a non-invasive, commercially available device providing a JVP measure and waveform. Our aim in this study is to assess the usability, perceived barriers, and acceptability of the device in the primary and long-term care (LTC) setting by physicians and registered nursing staff. An exploratory, ethnographic design was utilized and data were collected through four focus-group interviews. Participants were presented with a training module and had an opportunity to use the device on a test subject. Two research assistants independently coded the transcripts. Initial results indicate a high degree of acceptability and usability, despite difficulty in locating the fourth intercostal and interpreting the JVP. Barriers include resident behavior, interprofessional communication/structure, perceived adequacy with current clinical skills, and a belief that HF patients were appropriately diagnosed despite rarely measuring JVP. There is an evident lack of utility of JVP despite its having a role in the Canadian Cardiovascular Society Guidelines for diagnosing Heart Failure. The device appears best suited for long-term care and utilized by nursing staff due to the nature of physician availability and lack of diagnostic investigative tests. Educational initiatives are needed for nursing staff and physicians and our findings can help direct development of future technological devices and their implementation in these settings. This device has tremendous potential to help establish new-onset or worsening Heart Failure by providing a jugular venous pressure measurement and waveform., Patient selection for surgical oncologic treatment is a challenge, particularly with elderly patients. The purpose of this study was to compare patient’s characteristics with geriatrician recommendation as fit or non-fit for surgery and to identify baseline characteristics associated with adverse immediate postoperative outcomes. We conducted a retrospective study of patients seen in our geriatric oncology clinic before an elective surgical intervention for gastrointestinal cancer between 2010 and 2014. Patients were referred by surgeons or oncologists. Clinical and geriatric assessment variables and postoperative data were collected by chart review. Univariate analyses were used to identify baseline patient’s characteristics associated with decision prior to surgery and with postoperative outcomes (length of hospital stay and discharge status). Forty-four patients were included (14 had hepatic metastasis of a colorectal cancer, 13 had rectal cancer, 7 had pancreatic adenocarcinoma, 3 had colon cancer, and 7 had other types). Median age was 80.1 years (70–89). Nine patients (20.5%) were advised against surgery; they were more dependent for IADLs (p = .003), had lower grip strength (p = .003) and lower gait speed (p = .029). Twenty-three patients were operated. The median hospital stay was 10 days. Eighteen patients (78%) had complications: 13 minors and 5 majors, including 1 death. Seven patients had delirium. Falls in the last 6 months (p = .022) and polypharmacy (p = .043) were associated with prolonged hospital stay. Eight patients (36%) were discharged in rehabilitation or convalescent unit: they had lower grip strength (p = .019). Low grip strength is associated with postoperative discharge in convalescent or rehabilitation unit in our study. A prospective study is needed to confirm the results. Low gait speed and grip strength seem to influence preoperative decisions in our geriatric oncology clinic., The Web allows access to people with dementia and their care partners who can provide information about important symptoms that might otherwise receive little attention. Verbal repetition in dementia is common, troubling, and little studied. The objectives were to see how often and at which stage verbal repetition was tracked in an online list of symptoms, how it related to other symptoms, and whether frequency was less in patients on a cholinesterase inhibitor. Verbal repetition data came from the DGI Clinical website. Care partners of people with dementia selected symptoms for tracking from a 60-item SymptomGuide. Of 1,665 respondents, 895 reported a dementia diagnosis, in whom verbal repetition was identified as a target symptom in 267. Compared to those in whom verbal repetition was not targeted, those in whom it was were more often women (70% vs 60%, p < .01) and more likely to have mild dementia (43% vs 22%, p < .01). When reported, verbal repetition was associated with symptoms of irritability, frustration, misplacing objects, and impaired recent memory. The most common descriptions were repeating the same questions about upcoming events (98%) or the same stories at successive encounters (94%). Verbal repetition was reported occurring 10 times/day in patients treated with a cholinesterase inhibitor vs 20/day in those not treated. Verbal repetition can be seen at all stages of dementia, but most commonly is targeted to track treatment in the mild stages. Repetitive questioning about upcoming events was the most frequent symptom. Treatment with a cholinesterase inhibitor was associated with reports of fewer episodes of verbal repetition. Verbal repetition is a commonly targeted symptom in the mild stages of dementia that might respond to treatment., Goals-of-care discussions occur between patients, family members, and clinicians to establish decisions about plans of care, including the use or non-use of life-sustaining treatments. In previous studies, learners have reported insufficient training in end-of-life communication, but most studies have focused on development or evaluation of specific educational interventions. The objective of this study was to explore senior medical students’ experiences with goals-of-care discussions, specifically 1) whether real-life informal training reinforces or subverts formal training, 2) what behaviours are role-modelled by residents or staff physicians, and 3) whether students are observed or receive feedback on their discussions. We conducted one-on-one, semi-structured interviews with consecutive McMaster University medical students who responded to our study invitation during or after their Internal Medicine clerkship. We analyzed a subset of interview transcripts in triplicate, using conventional content analysis to develop a consensus list of codes and organize them into meaningful themes. Data were analyzed concurrently with data collection to inform further interviews. To date, we have completed coding and analysis of 5 interviews. Preliminary data suggest that students 1) believe goals of care discussions are important, 2) conduct discussions independently after observing residents, 3) feel uncomfortable conducting these discussions, 4) are not observed and do not receive feedback on their discussions, and 5) perceive significant differences between their formal and informal training. Medical students have identified significant educational gaps around goals-of-care discussions. Despite lack of experience and supervision, they routinely conduct these discussions, raising concerns about the quality of decisions made based upon these conversations. Our findings suggest medical students need improved education on goals-of-care discussions. This may be achieved through adoption of a competency-based curriculum., A non-pharmacologic, family-delivered intervention directed at modifying delirium risk factors was found to prevent delirium in Chile. The feasibility of doing a similar delirium prevention intervention was tested in a pilot study at the London Health Sciences Centre (LHSC). Eligible participants were free of delirium on admission and were community-dwelling seniors (≥ 70 years of age) consecutively admitted to the medical units. Patient-caregiver dyads were randomized (stratified by age and known dementia diagnosis) to receive a delirium prevention pamphlet (with a bedside explanation of ways to prevent delirium) or a general health brochure (placebo). Caregivers were asked to complete a survey and maintain a log of the time spent visiting the patient. The Confusion Assessment Method was used for delirium diagnosis. Out of 146 eligible patient-caregiver dyads, 79 (54.1%) agreed to participate (67 of 146 eligible caregivers either refused or were unavailable to participate). Five patients (6.7%) became delirious in hospital: 2 patients (5.1%) in the placebo group and 3 patients (7.5%) in the intervention. Surveys were returned by 52 (66%) caregivers. Challenges caregivers faced were parking costs and the overall time required (average of 5.6 hours per day were spent by caregivers). Caregivers did not find the study difficult to participate in (mean score 1.9 on 1 to 5 Likert scale; in the intervention group, mean score 1.8), and 51 of 52 (98.1%) of respondents found the overall experience at least somewhat rewarding. Although 45.9% of caregivers were not interested in participating in this study, those who did participate found it to be a rewarding experience. A family-delivered delirium prevention intervention may be another way to decrease delirium., There are anecdotal and case reports of the development or worsening of Parkinsonian symptoms after the initiation of androgen deprivation therapy (ADT) in men with prostate cancer. Medical castration using gonadotropin-releasing hormone (GnRH) agonists (e.g., goserelin, leuprolide) results in approximately 90% reductions in circulating testosterone, and reduction of estradiol levels by 80–90%. Literature from animals and humans suggests that androgens and estrogens have important effects on the nigrostriatal dopaminergic system but their relative contributions, and how those are influenced by androgen deprivation, is uncertain. This is a propensity-matched cohort study using linked administrative databases at the Institute for Clinical and Evaluative Sciences (ICES) and the Ontario Cancer Registry (OCR). We will compare men with prostate cancer receiving at least 6 months of ADT with those not receiving ADT. A separate non-matched cohort including all men who receive ADT will be examined to determine if the duration of ADT has an effect on the risk of developing PD. Primary outcome: New diagnosis of Parkinson’s — We will identify men who receive a new diagnosis of Parkinson’s disease if they received one hospital discharge or two physician outpatient service claims with the following ICD codes: G20.X (ICD-10) or 332.0 (ICD-9). Statistical Analysis: For the primary outcome, Cox proportional hazards models will be used based on the groups defined. Unadjusted and then adjusted hazard ratios will be calculated, along with 95% confidence intervals, using the following covariates: total duration of ADT, age, history of stroke. Results and analysis anticipated to be available by March 2015, and ready for presentation at CGS in April., Background: Parkinson’s disease is a neurodegenerative disorder which is very prevalent in older individuals. Depression is a common non-motor symptom of Parkinson’s disease (PD), with an estimated prevalence of 35%. However, the detection of depression can be challenging in this population. Objective: To examine the diagnostic accuracy of depression screening tools for case-finding in adult outpatients with Parkinson’s Disease (PD), as compared with psychiatric diagnosis based on DSM or ICD criterion. Methods: We conducted a literature search of MEDLINE, PsychINFO, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews from database inception until October 28, 2014. All citations, full text articles, quality assessments, data extraction, and analysis were independently examined by two authors. Study eligibility criteria were diagnostic accuracy studies involving adults with PD in an outpatient setting that validated a depression screening tool compared to a gold standard interview (DSM or ICD). Meta-analysis of results was completed where feasible. Results: From a total of 7,196 citations 21 studies were included, which incorporated 15 tools. Prevalence of depression pooled from 17 unique study populations was 29.4% (95% CI 23.3, 35.5). We were able to perform meta-regression analysis for three screening tools. The GDS-15 (N = 6 studies) had a pooled sensitivity of 0.85 (95% CI 0.78, 0.90) and specificity of 0.86 (95% CI 0.81, 0.89). The BDI-I/Ia (N = 4 studies) had a pooled sensitivity of 0.79 (95% CI 0.68, 0.90) and specificity of 0.85 (95% CI 0.79, 0.96). The MADRS (N = 4 studies) had a pooled sensitivity of 0.74 (95% CI 0.6, 0.83) and specificity of 0.93 (95% CI 0.85, 0.97). Discussions: Screening tools for depression case-finding assist clinicians to identify patients who require further assessment. These tools are not diagnostic, but use of accurate tools may help facilitate appropriate use of specialty mental health services. Conclusions: There are many validated tools available to screen for depression in PD. Based on the current evidence, the GDS-15 is an accurate tool to use for depression case-finding in PD patients, which is also favourable from a logistical standpoint given its ease of use, absence of copyright protection, and lack of overlapping questions with PD symptomatology., The MoCA is widely used for Mild Cognitive Impairment (MCI) screening in elderly individuals. Memory is assessed by a free recall of 5 words, which is done after two trials of repetition. Providing category or multiple-choice cues is optional. Using Rasch analysis, we investigated whether scoring the two trials of repetition, cued and multiple-choice recall improves MoCA’s psychometric properties and ability to distinguish among three groups: No Cognitive Impairment (NCI), MCI, and Alzheimer’s Disease (AD). People with NCI (N = 35), MCI (N = 197), and AD (N = 122), who were administered MoCA in the course of normal clinical care, were selected from a geriatric database. Rasch analysis was performed using two new scoring methods, which were compared to the original scoring: 1) each word for both repetition and recall was scored separately; 2) items Repeat1, Repeat2, RecallFree, RecallCue and RecallMultipleChoice each reflected performance on the set of 5 words. Significant difference between the mean ability values of the groups was observed for original and both new scoring methods (NCI > MCI > Dementia, p < .0001, one-way ANOVA). Separation of AD and MCI was better (smaller overlap and higher difference in mean values) than separation of MCI and NCI groups. Although new scoring methods equally improved sensitivity to distinguish persons by their ability at the individual level (Person Separation Index 0.86 for both new vs. 0.84 for original scoring), they negatively affected separation of the groups. Original and both new scoring methods allow better discrimination of AD vs. MCI than NCI vs. MCI. Observed difference among the three groups proves MoCA’s discriminant validity. Measuring and screening properties of the same tool can be affected in opposite ways while introducing changes in scoring., Late-Life Depression (LLD) affects 3–5% of older Canadians. Unfortunately, it is inadequately treated with antidepressants, necessitating additional treatment options. Various mind-body therapies are being embraced by patients as they are considered safe and potentially effective. Sahaj Samadhi, a form of Automatic Self-Transcending Meditation (ASTM), may offer particular benefit in LLD. We are conducting a large single-centre, single-blind, longitudinal randomized controlled naturalistic trial to determine if ASTM improves depressed mood, anxiety, and quality of life in patients with LLD (N = 96). Patients with LLD are randomized either to ASTM plus treatment as usual (TAU) or TAU alone. ASTM training, provided by certified teachers from the Art of Living Foundation, is administered for four consecutive days (120 minutes per day) in the first week, followed by 60-minute sessions in each of the 11 subsequent weeks. Participants are assessed at baseline (week 0), and 4, 8, and 12 weeks into the study. With 25 patients (ASTM=11; TAU=14) having completed the 12 weeks of monitoring, we found that ASTM led to improvement in Hamilton Depression (HAM-D 17) scores from 15.5 at baseline to 8.5 at week 12 (p < .001) with 7 of 11 treated patients achieving remission with a score below 8. A significant (p = .006) clinical improvement was also noted using the Clinical Global Impression (CGI) scale, and Geriatric Depression Scale (GDS) scores improved from a mean of 9.3 to 6.2 (p = .03). In comparison, subjects in the TAU group showed no significant differences in scores over time (p > .05) other than a worsening on CGI (p = .02). Upon study completion, if ASTM continues to show effectiveness, it could be readily adapted into routine clinical care and delivered in a range of settings at relatively little cost., Adherence to catheter guidelines is poor and may be a particular problem in emergency departments (ED). We aimed to describe catheter insertion practice in the ED of an urban Western Canadian hospital to inform a catheter reduction strategy. Prospective convenience sample of adult patients catheterised in the ED. Data on patient demographics, diagnosis, indications and perceptions of catheter appropriateness from char t review and interviews. Appropriateness was determined by the research team using current guidelines. Beliefs regarding catheterisation were collected by surveys. Of 150 cases of catheterisation, 62.7% occurred in patients over 65, 43.3% had a written order and 5.3% a documented reason. Based on guidelines, 58.7% were deemed inappropriate. Nurses identified more than one reason in most cases, with close monitoring of urine output for critically ill patients cited in 42.2%. Of the inappropriate cases, 24.7% occurred in non-critically ill patients, 24% to manage urinary incontinence, 19.3% for mobility impairment, and 18% for confusion/dementia. Survey data revealed 96.7% of physicians and nurses perceived close monitoring of urine output for critically ill patients an appropriate indication. Both groups viewed gross haematuria (56% and 77.2% respectively) and stroke (32% and 55.9% respectively) as appropriate indications. There was likely a difference in understanding of the phase “critically ill,” a frequent nurse-identified reason. Of concern is the large proportion catheter insertions designed to manage urinary incontinence, mobility, or cognitive deficits. Current guideline criteria do not address gross haematuria and stroke, which nurses and physicians identified as appropriate indications. Current practice guidelines provide only general indications for appropriate catheter use and there is a need for novel knowledge translation strategies within the ED environment to encourage appropriate catheter use., ApoE genotype, serum plasmalogen (PlsEtn) levels, and biomarkers of reverse cholesterol transport (RCT) have been shown to be associated with cognition in elderly persons. Using a community-based sample of 904 well-characterized elderly persons from the Rush University Religious Orders Study and Memory and Aging Project, the relationships between ApoE genotype, serum PlsEtn, triglycerides (TAG), cholesterol (CHO), HDL and the CHO/HDL ratio (HDLr) levels on cognition were measured. Effects of serum PlsEtn status was assessed using a quantitative PlsEtn Biosynthesis Value (PBV) that was generated for each person by combining the relative serum levels of three key PlsEtn species. ApoE allele effects were assessed by combining four allele combinations into one of three genotype groups (ε2 = ε2ε3, ε3 = ε3 ε3, ε4 = ε3ε4 + ε4ε4). Using a base model that corrected for age, education, and gender we assessed the effects of each variable independently and collectively on cognition. When all variables were considered, only PBV (coef = 0.606, p < .0001), ApoE (ε3 = ref.); ε2 (coef = 0.156, p = .007) ε4 (coef = −0.236, p < .0001), and HDLr (coef = −0.534, p = .015) remained significantly associated with cognition. PBV and ApoE did not interact with each other. Both ApoE (coef = 0.173, p = .02) and PBV (coef = 0.226, p = .004) interacted with HDLr. No effect of gender was observed. The different ApoE alleles have different cholesterol efflux capacities with ε2>ε3>ε4. Increasing membrane concentration of DHA-PlsEtn increases cholesterol efflux. The ratio of total cholesterol to HDL is a measure of RCT capacity. These data suggest that low RCT capacity may be a common underlying mechanism associated with lower cognition. Metabolic and genetic mechanisms affecting RCT have a negative effect on cognition in the elderly., Family caregivers are often overwhelmed by the stresses of caregiving, conflicting with other demands like work and childcare, resulting in deterioration of their health. Caregivers, thus, require support to ensure that they can continue to provide care, while maintaining their own well-being. However, there is a gap between what is known to help caregivers and what is available. This study will determine the strengths, gaps, and barriers to the provision of caregiver supports, including resource utilization and costs, and research priorities. A CIHR-funded conference was held in Edmonton on April 14–15, 2014. On Day 1, the conference brought together over 120 researchers, health-care providers, community organizations, government, and caregivers to discuss ways to understand and support family caregivers of seniors. On Day 2, 76 participants focused on research needs for caregivers of seniors with complex needs. NVivo was utilized to support ethnographic thematic analysis. On Day 1, barrier/gaps were identified: caregiving involves managing a multitude of tasks impacting caregivers’ ability to tend to their own personal needs; changing roles and obligations; inadequate communication and information; scattered resources; need for system navigation; negative economic impact; and lack of supportive policies. On Day 2, initial research priorities were identified: defining caregivers; timing and type of support; ‘Goals of Care’ for caregivers; enhanced case management; system navigation supports; impactful change and funding models; and knowledge exchange strategies. A 5-year research program was proposed with two key priorities: a longitudinal study of caregivers and their needs, and an economic cost analysis. There’s a need for centralization and navigation of resources with enhanced case management, goals of care for caregivers, education for health-care professionals and caregivers, and the development of provincial frameworks and policies., Older people at an increased risk of adverse health outcomes compared with others their own age are said to be frail. How best to assess frailty in acutely ill older adults is disputed. In this observational cohort study, patients from the emergency department were evaluated using routine tests, and a standardized comprehensive geriatric assessment (CGA). We compared a frailty index based on a CGA (FI-CGA) with one constructed from clinical and laboratory data (FI-Lab) to determine which was better at predicting the risk of death. Consecutive older adults (aged 65+) were enrolled and followed for at least 6 months. The FI-CGA was comprised of 55 items and the FI-Lab, which included clinical, laboratory, and ECG data, was comprised of 24 items. Kaplan-Meier plots were done to illustrate the event curves by frailty status. Predictive validity for 6-month mortality was tested by Cox proportional hazards analysis. Of 438 participants, 109 (55 men and 54 women) died during 6-month follow-up. Mean FI scores in the least frail group were 0.151 ± 0.033 using the FI-CGA vs. 0.148 ± 0.043 using the FI-Lab, and 0.653 ± 0.048 (FI-CGA) vs. 0.660 ± 0.037 (FI-Lab) in the frailest group. Mortality increased significantly as the frailty scores increased, both for FI-CGA and FI-Lab. An age- and gender-adjusted model showed a clear dose-response relationship of the FI with mortality. The hazard ratios for FI-Lab and FI-CGA were 1.553 (1.334 to 1.808) and 1.380 (1.186 to 1.605), respectively. The impact on the discriminative ability of combining both FIs was modest: the area under the receiver operating characteristic (ROC) curve was 0.653 for the FI-CGA, 0.663 for the FI-Lab and 0.690 for the combined FI. Frailty can be screened using either the standard FI (FI-CGA) or routinely collected laboratory and clinical data (FI-Lab). Both of FI-CGA and FI-Lab, singly or jointly, could identify acutely ill older patients at increased risk of death. Compared with the traditional method for calculating the FI (FI-CGA), the novel FI-Lab, based on routine clinical data and laboratory data, was more easily collected for clinicians and requires minimal participation by patients. Therefore the novel FI-Lab may be more suitable to measure frailty in patients with serious conditions. Further evaluation of this approach in clinical settings is encouraged., Time spent in moderate-to-vigorous activity (MT) in young adults is the best predictor of daily caloric expenditure (CE); conversely CE is best predicted in older adults by time spent in light activity (LT). Some studies have suggested that increasing MT in older adults has no impact on CE due to a compensatory increase in daily sedentary time (ST). We examined highly active older adults to examine the biggest contributors to energy expenditure in this population. 54 community-dwelling men and women > 65 years of age (mean 71.5 years) were enrolled in this cross-sectional observational study. All were members of the Senior’s Whistler Ski Team and all met current Canadian guidelines for physical activity. Activity levels (ST, LT, and MT per day) were recorded with accelerometers worn continuously for 7 days. CE was measured using accelerometry, galvanic skin response, skin temperature, and heat flux (SenseWear armband). Significant variables were then entered into a stepwise multivariate linear model containing activity levels, age and gender. The average proportion of time spent at a sedentary activity level each day was 72%. The main predictors of higher CE were time spent in moderate-to-vigorous activity (MT, Standardized β, 0.360 ± 0.086, p < .001) and male gender (Standardized β, 1.421 ± 0.171, p < .001). A model containing only MT and gender explained 66 percent of the variation in CE. An increase in MT by one minute per day was associated with an additional 13 calories expended in physical activity. The relationship between activity intensity and CE in athletic seniors is similar to that observed in young adults. Active older adults still spend a substantial proportion of the day engaged in sedentary behaviours., For the person with dementia (PWD), the loss of driving privilege is often worse than a diagnosis of cancer. Physicians in Canada are placed in a position where they are legally responsible and liable to report unfit drivers. Skills such as empathy, clear communication, referral to resources, and follow-up are crucial. In some cases the discussion is “rushed” within the context of multiple medical issues, leaving the PWD and caregivers with a strong emotional reaction and lack of information. We developed a module (1.5–2 hrs) containing background material on issues specific to dementia and driving, communication strategies, links to resources, and representative video clips. Two videos were produced (demonstrating the less and more ideal), simulating real-life disclosure and management of emotionally charged discussion that often ensue. The videos were pilot tested at a CME event for Family Physicians, using an adapted form of the Calgary Cambridge Communication scale, to ensure validity. The module was then presented to postgraduate trainees at an academic half day. A pre- and post-test was administered to evaluate the effectiveness of the module. Using the adapted Calgary Cambridge Communication Scale, validity was established regarding accurate demonstration of contrasting communication styles of the two videos. Results from pre and post survey of the module demonstrated that confidence increased (p < .0001), as well as comfort and willingness in discussing the subject. This project involved the development and evaluation of a module which demonstrated positive impact on health professionals’ attitude for communication on driving cessation with PWD. This module can to add to teaching methods around the topic of driving and dementia, such as lectures and workshops., Enoxaparin is used for anticoagulation usually without requirements and capability for laboratory monitoring. Its dosage in severe chronic renal disease needs to be reduced. However, its dosage in the elderly is not required to be lowered. This raises concerns since the elderly could have rapidly fluctuating renal functions which require immediate adjustments in drug dosage. We will report a case of spontaneous retroperitoneal hemorrhage in an elderly on dose-appropriate enoxaparin. Case Report: An 81-year-old lady with chronic renal failure was admitted for diagnostics on falls/pain. She also had a pulmonary embolism four months prior to admission for which she had been treated and maintained on enoxaparin (1 mg/kg subcutaneously b.i.d.). Her other medications included aspirin. On admission, her laboratory results were consistent with chronic renal failure and anemia. During hospitalization, she developed vomiting, diarrhea, and melena. Abdominal CT scan showed a large retroperitoneal hematoma. We aggressively managed the ensuing hypotension and acute renal failure. We also discontinued enoxaparin and aspirin. Supportive care was provided in the intensive care unit until her renal function recovered. Low-molecular-weight heparin (LMWH; e.g., enoxaparin) is frequently prescribed in geriatric patients. It is preferred over unfractionated heparin because LMWH does not need coagulation monitoring, is administered with ease, and is associated with decreased hospitalization cost. However, the use of enoxaparin in the elderly population poses some safety concerns. When the elderly patient is stable, enoxaparin dosing could be maximally effective; but the same dosing could rapidly become harmful when kidney function deteriorates. With vigilance, the dose could be decreased immediately during compromised renal functions; however, the risk of thrombosis would consequently increase. The safety of enoxaparin in the elderly needs to be established., Current estimates of the prevalence of late-life depression (LLD) in Canada have been found to be as high as 16% and are expected to increase further as we face a more aged population. Evidence has shown that LLD is associated with a three-fold increased risk of cardiovascular disease, which may be mediated by autonomic dysfunction. Further complicating this relationship is the adverse effect some antidepressants have on autonomic tone. Therefore the aim of this study is to assess the cardiovascular benefits of a category of meditation referred to as automatic self-transcending meditation (ASTM) in LLD. We present preliminary results (N = 20) from an ongoing single-centre, single-blind, longitudinal RCT assessing the effects of a 12-week augmentation program of ASTM vs. treatment as usual (TAU) on heart rate variability (HRV), an autonomic parameter. Participants between 60 and 85 years of age with an Axis I diagnosis of mild to moderate LLD were randomized to the ASTM (N = 9) or TAU (N = 11) study arms. ASTM training was administered on four consecutive days (2hrs/day), followed by weekly 1hr follow up sessions for 11 subsequent weeks. ECGs were completed at baseline (week 0) and post-intervention (week 12). Thus far, the findings are promising; although only approaching significance at the current sample size, paired t-tests identify improvements in low-frequency HRV with ASTM training (p = .06) as compared to TAU (p = .6). These preliminary results suggest that ASTM may improve autonomic tone in LLD. The study is ongoing (target N = 96) and will require further analysis. If the results continue to show the effectiveness of ASTM in improving autonomic parameters, such a treatment could be readily adapted into routine clinical care., Primary care memory clinics (PCMCs) are being established in Ontario to enhance system capacity for dementia care and efficient integration with specialized services. Preliminary evaluations are favourable, though variability in documentation of the physical examination (PE) suggests the need for Quality Indicators (QI) specific to this domain. While dementia diagnostic guidelines recommend PE, opinion varies regarding which manoeuvres are essential. PCMC physicians and affiliated specialists were surveyed to rate the importance of PE manoeuvres as essential, discretionary, or unnecessary to the diagnostic process. Participants were asked to identify who should perform specific PE manoeuvers. Ninety surveys were completed (78/112 PCMC physicians, 9/23 specialists, and 3 unspecified). Most considered the assessment of orthostatic vital signs as essential and the responsibility of allied health professionals. Assessment of nutritional state and hygiene was deemed essential and the responsibility of referring or PCMC physicians. General PE manoeuvers were considered discretionary or unnecessary, and the responsibility of referring physicians. Gait assessments was considered essential. Specialists were significantly more likely than PCMC physicians to consider examination for facial asymmetry, extra-ocular movements, and pyramidal and extrapyramidal signs as essential. General PE was considered the purview of the referring physician. Specialists considered most neurological examination manoeuvres the purview of PCMC physicians, who generally considered these the responsibility of referring physicians. Time constraints were cited as important barriers to PE. This study identified PE manoeuvers considered important to the assessment of patients referred to a PCMC. A tiered approach to the PE of patients seen in PCMCs may be warranted, based on a shared understanding of roles and responsibilities of clinicians involved, and considering potential training requirements., Geriatrics is an increasingly challenging field of practice in which there are limited opportunities for continuing education. The Geriatric Certificate Program was developed for practising regulated and unregulated health-care providers to build capacity related to geriatric assessment, behaviour management, and geriatric best practices. This study provides a preliminary evaluation of this program, examining impact on self-reported changes in knowledge, skills, and competence. All graduates completed an on-line evaluation survey upon completing program requirements. A total of 189 individuals are registered in the program, including nurses (30%), allied health professionals (19%), other regulated professionals (7%), unregulated health professionals (19%), and physicians (3%). Twenty individuals have graduated to date; 16 completed a survey. Mean ratings (5-point scale) reflect that the program was very relevant to clinical practice (4.1 ± .72) and very useful in enhancing clinical practice (4.1 ± .62). The majority of graduates (75%) reported that they are now more competent and more comfortable in providing geriatric care; 94% reported that the quality of care they provide has improved (69%, “much improved”; 25% “improved”). The program impacted the acquisition of new knowledge (81%) and skills (75%) “very much” or “to a great extent.” Self-reported knowledge transfer included increased use of standardized tools, use of evidence-based strategies for managing responsive behaviours, and more comprehensive care planning. Program and travel costs in the absence of financial support from employers was identified as challenge. This program provides a significant opportunity for increasing capacity in core competencies to advance the use of best practices for geriatric care across disciplines. This program will develop a workforce that is better prepared and supported to meet the needs of the aging population., Universal vitamin D supplementation is not desirable. The determination of serum vitamin D status remains yet much more expensive than corrective supplementation. To rationalize health costs, our objective was to develop and to test a clinical diagnostic tool for the identification of older community-dwellers with hypovitaminosis D without using a blood test. A total of 1,924 community-dwelling volunteers aged ≥ 65 years without vitamin D supplements were recruited in this cross-sectional study. A set of clinical variables (age, gender, living alone, individual deprivation, body mass index, undernutrition, polymorbidity, number of drugs used daily, psychoactive drugs, biphosphonates, strontium, calcium supplements, falls, fear of falling, vertebral fractures, Timed Up&Go test, walking aids, lower-limb proprioception, handgrip strength, visual acuity, wearing glasses, cognitive disorders, sad mood) was recorded from standardized questionnaires and medical examination at the time of serum 25-hydroxyvitamin D(25OHD) measurement. Hypovitaminosis D was defined as serum 25OHD ≤ 75nmol/L, ≤ 50nmol/L or ≤ 25nmol/L. The whole sample was separated into training and testing subsets to design, validate and test an artificial neural network (multilayer perceptron, MLP). In total, 1,729 participants (89.9%) had 25OHD ≤ 75nmol/L, 1,288 (66.9%) had 25OHD ≤ 50nmol/L, and 525 (27.2%) had 25OHD ≤ 25nmol/L. MLP using 16 clinical variables was able to diagnose hypovitaminosis D ≤ 75nmol/L with accuracy = 96.3%, area under curve (AUC) = 0.938, and κ = 79.3 indicating almost perfect agreement. It was also able to diagnose hypovitaminosis D ≤ 50nmol/L with accuracy = 81.5, AUC = 0.867 and κ = 57.8 (moderate agreement); and hypovitaminosis D ≤ 25nmol/L with accuracy = 82.5, AUC = 0.385 and κ = 55.0 (moderate agreement). We developed an algorithm able to detect, from 16 clinical variables, hypovitaminosis D with almost perfect agreement among older community-dwellers taking no vitamin D supplements. Such an inexpensive tool will undoubtedly help clinicians in decisions to supplement their patients without routinely resorting to an expensive blood test., Although delirium is a common and serious geriatric syndrome among the elderly, it is often unrecognized. Prevalence of delirium in community-dwelling older adults over 85 years of age is approximately 14%. The goal of this pilot study was to increase knowledge of delirium in community-dwelling elderly and their caregivers. Multiple strategies were used in the aim of increasing knowledge on delirium. First, an educational pamphlet was developed and made available to elderly persons and their families. In addition, a 20-minute PowerPoint presentation was presented to small groups, with follow-up discussion. A pre and post test measuring knowledge levels was administered in order to measure impact. A brief survey was also conducted to obtain feedback on the quality and understanding of the content. A total of three presentations were given with 16 participants, mean age of 53 years. A total of 12 questions were administered in the pre and post test questionnaire. Overall, participants scored higher on the post test. Feedback from participants revealed that they found the presentation and pamphlet useful in learning about delirium, especially since many participants had no previous knowledge on the subject. The pilot study revealed that community-dwelling elders and their caregivers were not familiar with delirium. They described gaining valuable knowledge and felt the teaching methods were helpful. To further our understanding of the impact of these interventions, this pilot project will be continued in the community by 4th year pharmacy stduents with a larger group of participants. The results support the need for education among family members and caregivers in the community setting. Focus should be on the prevention, identification, and management of delirium., Our recent data have shown that eyecare services offered to older institutionalized seniors with dementia are not optimal. We present here the development of a visual acuity (VA) screening tool aimed at improving eyecare services for those individuals. Some two decades ago, the World Health Organization developed a tool to screen VA in individuals from developing countries. The tool comprised tumbling E’s presented on plastic cards. Researchers have since used this tool for screening VA in older institutionalized seniors, including those with dementia, even if it has never been validated in dementia. We have therefore developed a new tool that will be presented at this meeting. Testing is currently being performed in volunteer institutionalized seniors ≥ 65 y.o. with cognitive impairment. The tool has been developed on a retinal-display iPad to provide repeatable, high-resolution, high contrast optotypes. It contains 3 kinds of optotypes (letters, numbers, tumbling E’s), 4 symbols per optotype and 3 levels of VA. It allows testing of each eye at 2 working distances and gives the time taken for each test. Each symbol is displayed one at a time in the centre of the screen, from the largest to the smallest one, in a random sequence for each target size. This new tool is successfully being used in older institutionalized seniors with mild to severe dementia. Its application for that population has therefore been shown feasible. Within a year, we will have collected enough data to determine if the tool is valid for that population. If the tool is valid, then long-term care units will benefit from a VA screening tool to help determine those residents most needing an oculovisual examination., Neuropsychiatric symptoms (NPS) are behavioural and non-cognitive manifestations of dementia that are highly prevalent among residents in long-term care (LTC), increasing costs and burden of care for this vulnerable population. A common clinical phenomenon observed among people with dementia is “sundowning syndrome,” or the emergence or exacerbation of NPS in the late afternoon, evening, or at night. Very few studies, however, have assessed NPS prevalence in LTC residents with dementia as a function of time of day. Frequency and severity of NPS were assessed over a 2-week period using the Neuropsychiatric Inventory – Nursing Home version. NPS information for 97 LTC residents with dementia was obtained from frontline nursing staff providing their direct care during the day, evening, and night shifts. A total of 238 staff interviews were conducted, and complete triad data (across all shifts) was obtained for 59 residents. NPS prevalence was 66.1%, 71.2%, and 42.4% during day, evening, and night, respectively. Agitation/aggression and irritability were the most prevalent symptoms, even after accounting for sleep dysregulation. The percentage of residents exhibiting more than four NPS increased significantly from 13.6% (day) to 20.34% (evening) (p < .01), suggesting the presence of sundowning syndrome. Although depression was prevalent in about 15% of residents at all times of day, its presence was significantly associated with anxiety (all times), aggression/agitation (day and evening), irritability (day), and delusions and hallucinations (night). Sundowning syndrome manifests itself as an increase in the number of NPS observed within a given resident rather than as an increase in overall NPS prevalence. Depression is strongly associated with multiple NPS. Our results highlight the importance of considering time of day when evaluating NPS in LTC residents., In 2011, Alzheimer’s disease (AD) and dementia affected 747,000 Canadian seniors (65+). Estimates of the prevalence or incidence of dementia are frequently based on the Canadian Study of Health and Aging (CSHA, 1991–2001). However, administrative data are increasingly used for the surveillance of chronic diseases, including AD/dementia, and may add new insight into care trajectories. The present study identified a Quebec cohort of AD/dementia cases using linked health administrative data. This study used data linked at the Institut national de santé publique du Québec provided from 3 sources: 1) the RAMQ medical and pharmaceutical services and the registered users’ files, 2) the MED-ECHO hospital discharge file and 3) the death registry. AD/dementia cases were identified using three definitions with different combinations of ICD dementia-related diagnostic codes from physicians or hospital discharge, with or without pharmacy claims for 4 dementia medications. Two of these definitions were validated by the Public Health Agency of Canada and one will be used for further surveilance. Estimates were age-standardized. The study included 1.3 million persons aged 65+. In 2011–12, 6.8% to 10% among them were identified as cases, depending on the definition. Prevalence was 15% to 18% higher among women than men and rose exponentially in older age groups. About 1% to 2.5% of persons aged 65 to 69 years were identified as cases, compared to 27% to 35% for people 85+ years. Incidence rates varied between 16.5 and 21.7 per 1,000 person-years depending on the case definition. In this study, highest incidence rates were measured in 2006–07 for all case definitions. In Quebec data, physician claims were the main source for case ascertainment, followed by hospital data. The observed measures of prevalence and incidence are below those that can be extrapolated from the CSHA and Canadian demographics, possibly due to underreporting in administrative data. Different data sources for incidence and prevalence estimates are used in Canada and their interpretation can be challenging. Ongoing surveillance from health administrative data in Quebec is feasible and useful for research, policy, and program guidance., Certain drugs have been linked to adverse events and poor outcomes in the elderly. These drugs, called Potentially Inappropriate Medications (PIM) by the American Geriatrics Society, should be avoided in the elderly population, through treatment with safer drugs and/or nondrug approaches. In this study, we will determine the (1) prevalence of PIM use among patients referred for comprehensive geriatric assessments; (2) most common PIMs used; (3) extent comprehensive geriatric assessments addressed PIM use. Design: This was a cross-sectional study involving chart reviews of 200 patients (65 years and older) seen for Comprehensive Geriatric Assessments at the Glenrose Rehabilitation Hospital in 2012–2013. Procedure: We reviewed the use of PIMs, as defined by the 2012 American Geriatrics Society Updated Beers Criteria. Specifically, we noted the use of Medications to Avoid in Older Adults Regardless of Disease or Conditions (Group 1) and Medications Considered Potentially Inappropriate When Used in Older Adults with Certain Diseases or Syndromes (Group 2). The patients had a mean age of 79 ± 8 years. The prevalence of PIM use was 49.5% (N = 98). For Group-1 medications, 45.5% (N = 91) of patients used at least one PIM. For Group-2 medications, 31% (N = 62) of patients used at least one PIM. The most common Group-1 PIMs used were Zopiclone, Benzodiazepines, and pain medications. The most common Group-2 PIMs used were Benzodiazepines, Zopiclone and Selective Serotonin Reuptake Inhibitors. Of the 98 patients who used PIMs, 48% (N = 47) had their medications stopped, tapered, adjusted, decreased, or reviewed as a result of Comprehensive Geriatric Assessments. The 2012 Beers Criteria is a useful guideline for safe drug use and monitoring in the elderly. PIM use in the elderly is common and needs to be addressed., Long-term care (LTC) residents have high acute-care utilization rates and face elevated risks when transitioning between LTC and acute care. The objective of this study was to evaluate the initial implementation of components of the Interventions to Reduce Acute Care Transfers (INTERACT) program as part of an innovative strategy to improve the capacity of staff to handle acute change in LTC residents and reduce potentially preventable emergency department (ED) visits and hospitalizations from Baycrest. INTERACT is a quality improvement program to improve the identification, evaluation and communication of changes in LTC residents’ status. The initial implementation methods included primarily education and reminders. The evaluation used a mixed-methods approach including electronic health record reviews, audits of communication tools, tracking of ED visit and hospitalization rates, and surveys and focus groups. Preliminary findings reveal that initial implementation methods have not resulted in sustained changes in practice. Survey data collected at the onset of implementation indicated that one-third of the LTC units were in the pre-contemplation phase of change and two-thirds of the units were in the contemplation phase of change. Focus group data from point of care staff noted that the communication tools were too time-consuming and did not facilitate the preferred communication. In addition, multiple barriers have been encountered in measuring potentially preventable ED visits and hospitalizations. Our findings indicate that education and reminders alone are not sufficient for implementing sustained changes in practice related to better identifying and managing changes in status in LTC residents. To ensure greater success in implementing capacity building strategies in LTC, future efforts will focus on driving forces for change such as urgency for change, aligning with organizational systems and strategies, and committed change agents., Nursing home (NH) residents with severe dementia often receive multiple medications. With disease progression care goals shift from curative or preventive to comfort care and consequently medications have to be reviewed, adjusted, or discontinued, because of reduced life-expectancy or changes in their harm-benefit ratio. Few studies evaluated interventions to achieve this goal. The objective of this pilot study was to evaluate the feasibility of an inter-professional intervention to optimise medication use in NH residents with severe dementia. Based on a literature review and a multidisciplinary Delphi panel, lists of mostly, sometimes, or rarely appropriate medications and elements of successful interventions were identified. The lists were tailored for a NH pilot study. Between April and November 2014 a 4-month intervention was led in 3 NH in Quebec, Canada. The families of participating residents received an information leaflet on optimal medication use in severe dementia. Nurses, pharmacists, and physicians of the NH participated in two 90-minute continuous education (CE) sessions. For each participant the pharmacist performed a medication review using the lists and then discussed recommendations with nurses and physicians. A study nurse observed comfort and agitation levels of participants using the Cohen-Mansfield and the PACSLAC-F scales during the study period. 93 residents were eligible and 48 participated; 7 residents died before or during follow-up and 41 were observed over 4 months. 38 health professionals participated in the CE sessions. Medication lists were well accepted and the study nurse was present at the discussions about medication changes. Families’ and health professionals’ comments provide opportunities to improve information material and the tailored lists. Some changes in medication use were observed but levels of agitation and comfort did not change noticeably. An interdisciplinary NH intervention to optimise medication use in residents with severe dementia is feasible. The three NH in Quebec City were interested in opportunities and tools facilitating improved medication use. Results from the pilot study need to be repeated in a larger trial and education or information to families should be a focus of the study. A literature review and an expert consensus provided the elements for a feasable intervention to optimize medication use. A cluster randomized trial should validate medication outcomes, generalizability, and patient or family outcomes of this intervention., Background: Programs for preventing functional decline in the elderly hospitalized in acute care facilities are suggested in the literature and in clinical guidebooks. In general, they are poorly detailed and primarily involve physiotherapists. Rehabilitation professionals affiliated with the IUGM GAU have developed a physical reconditioning program (SPRINT) that can be adapted to the functional profile of patients admitted to GAU. This program has 4 different levels and includes ad-lib repetitions of motor activities prescribed after an evaluation of functional capabilities, ranging from transfer to a chair (level 1) to walking (level 4). The program engages the patient and enlists the contribution of medical personnel and natural caregivers with daily interactions with the patient. Purpose: Collect preliminary information on the implementation process of SPRINT in order to determine the conditions necessary for rolling out SPRINT to GAU. Methods: The project, currently under way, will last one year at the IUGM GAU and includes 4 stages: preparation, pre-intervention, intervention, and post-intervention. Results: Amongst the 47 patients admitted to the GAU to date, 18 patients (61% women) accepted to participate. They were aged 80.5 ± 8.2 years, had an MMSE score of 26.4 ± 3.4 and participated in SPRINT for 19.1 ± 9.3 days. Only SPRINT levels 2 and 3 were prescribed to recruited patients. Patients did an average of 0.1 to 4.1 exercises/day. Exercises were done with a nurse (49%), a doctor (21%), or alone by the participant (18%); natural caregivers only participated in 4% of cases. Conclustions: Qualitative data concerning factors that facilitated and perceived barriers will be collected and analysed to facilitate the successful implementation of the intervention., Although associated with adverse drug events in the elderly, prescribing cascades are often not recognized in clinical practice. The objective of this prescribing cascade game was engage students in learning how to prevent, detect, and understand prescribing cascades. This activity was part of a 3-credit course in the geriatrics pharmacotherapy course at the Faculty of Pharmacy at the University of Montreal. Four different prescribing cascades that were detected in clinical practice were used. Each cascade contained four elements (medication–side effect– medication–side effect). Students were divided into 16 groups with two students per group. Each group selected one card on which one of the elements was written: either the name of a medication, or a side effect. All 16 groups were then asked to work together to reconstruct the four different prescribing cascades. Once all four elements of the four prescribing cascades were identified, they were asked to explain how these cascades took place. A 5-point Liker scale was used to evaluate the perception of the students regarding this activity. 32 students participated in the game. It took 15 minutes for the students to get organized and reconstruct the four prescribing cascades. In general, students appreciated this activity. The majority mentioned that having to find the different element of the cascade raised their awareness concerning the detection of future cascade. This activity was used to understand, apply, and retain information on prescribing cascades. Students actively participated in this activity. They were able to discover the four different elements of their respective cascade and to explain them using ptharmacokinetics, pharmacology, and pharmacodynamics principles. The prescribing cascade game was received positively by the students. It will now be part of the geriatrics pharmacotherapy course., Internet use among older adults has the potential for significant social and health outcomes. However, few senior-focused and senior-friendly training opportunities exist. The purpose of this study was to evaluate the feasibility of delivering a senior-friendly tablet training program and its impact on tablet ownership, sustained use, and confidence over time. Twelve seniors completed the iLearn iLive Well tablet training program (six 2-hour weekly sessions) to teach participants how to operate a tablet including e-mail and internet use; availability and use of apps; and viewing, taking, and sending photographs. Participants completed pre- and post-program surveys, session reaction surveys, and 3-month follow-up interviews to assess sustained use of learned skills. All of the sessions were well received with most of the sessions being rated as “very good” or “excellent” by over 67% of participants. At follow-up 8 of 11 interviewed participants reported that they had purchased a tablet, 63% reported using it more frequently since the end of the training program, and 88% reported being more confident in their ability to use the tablet in comparison to before the program. As a result of their tablet use, participants reported being in greater contact with friends and family than they would have been otherwise, being better informed of current affairs, being able to access to information more easily, and having a great sense of satisfaction with learning new things. One-to-one mentorship, senior-friendly training manual, learning strategies, environment, and previous computer experience facilitated their tablet learning. Identified learning barriers were mostly program-specific and modifiable. This senior-focused tablet training program facilitated sustained tablet use. Future studies will examine the impact of this program on perceived social isolation, loneliness, and attitudes towards computers., Anorexia in the elderly often cause weight loss, therefore it is regarded as a important starting point of frailty syndrome, which is considered as a critical point on the pathway to disability and mortality. Korea is entering an aging society at the fastest speed in the world, but the prevalence and risk factors of anorexia in the Korean elderly have not been investigated. A total of 170 men and women (30 from nursing homes, 140 from out-patient clinics) older than 60 years were recruited in this study. We evaluated the appetite with a Simplified Nutritional Appetite Questionnaire (SNAQ) and defined the anorexia subjects as those whose SNAQ score was less than 14. We also performed a comprehensive geriatric evaluation including the measurement of anthropometric data; the medical, drug, and social history; cognitive function with the Korean version of the mini mental state examination (K-MMSE); activity of daily living (ADL); the Geriatric depression scale (GDS); and the Mini-nutritional assessment (MNA). The prevalence of anorexia was 50% in nursing home residents and 45% in ambulatory elderly patients. Comparing with non-anorexic subjects, the anorexic subjects showed lower K-MMSE score (24.7 ± 5.33 vs 26.4 ± 4.01, p = .026) and MNA score (10.2 ± 2.90 vs 11.4 ± 2.59, p = .004) and more frequently expressed gastrointestinal symptom such as diarrhea (8.0% vs 1.1%, p = .046). We could not show statistical significant relationship between the anorexia and body mass index, calf circumference, Cumulative Illness Rating Scale, the number of medications, ADL and GDS score, residual teeth number and social support factors. Logistic regression analyses showed that the MMSE score was independently related to the anorexia (p = .005). The prevalence of anorexia in our study was higher than the results in the other countries, and this result may be due to the high prevalence of polypharmacy. The average number of medications in this study was 4.9 ± 3.70. Because the study population was not selected by random sampling, the results of this study could not represent the anorexia prevalence of the general Korean elderly population. We showed a high prevalence of anorexia in the Korean elderly. Because the SNAQ is regarded as the early detection tool of malnutrition and weight loss, further prospective studies are essential to determine the long-term consequences of the anorexia assessed with SNAQ., Physicians play a key role in DMCA. However, many do not feel prepared based on their residency training. They, thus, often require additional training once in practice. To address this need, we developed and administered an interactive DMCA Workshop to familiarize physicians with a DMCA model, including concepts of capacity, the protocol, documents, and case studies. In this study, we will determine the effect of the DMCA Workshop on physicians’ confidence and comfort with decision-making capacity assessments. Design: This study used a pre-test-post-test design. We administered a questionnaire before and after the Workshop. The questionnaire asked participants to rate their agreement (4-point Likert-type scale) on 15 statements regarding awareness, confidence, and understanding of core concepts of capacity. Participants: All physicians who attended three workshops in 2014. Intervention: A 3-hour DMCA Workshop accredited by the College of Family Physicians Canada. There were 54 participants with an average age of 47 years. There was a significant improvement (p < .001, Sign Test) in the post- compared to the pre-workshop ratings for all the items. The highest positive differences were seen for awareness of legislative acts, understanding a trigger, problem-solving techniques, standardized approach, and knowledge and skill-set in regards to capacity assessments. Among the participants, those without prior DMCA training exhibited the largest change in pre- versus post-workshop ratings (p < .05). The results indicate that the information provided in the workshops is valuable for physicians regardless of years worked in the current setting. The pattern of findings provides important feedback on modifications to delivering future workshops. This study has shown that a DMCA Workshop was effective in training Family Physicians. The next step is to customize the Workshop to Family Physicians’ needs., The Regroupement des Unités de Courte Durée Gériatriques et des Services Hospitaliers de gériatrie du Québec (RUSHGQ) is a geriatric community of practice that includes health-care professionals and managers from 51 of the 61 Quebec hospitals with Geriatric Assessment Units (GAU). The RUSHGQ established a work sub-committee composed of doctors and pharmacists throughout Quebec with the purpose of establishing guidelines for medication management in GAU. Doctors and pharmacists with experience in GAU have prepared, using evidence-based data and consensus decisions, a user guide on appropriate medication management for health-care professionals in GAU. To date, the covered drug classes are: statins, antihypertensives, direct oral anticoagulants, sedatives/hypnotics, antidepressants/psychotropic drugs, as well as medications for urinary incontinence Six workgroups composed of GAU doctors and pharmacists were formed to cover each of the themes; each workgroup was headed by a doctor considered by his/her peers to be a theme expert. This iterative work lasted 12 months. The guidelines begin with a general section detailing pharmacokinetic and pharmacological changes linked to aging, specific precautions and the notion of deprescribing, which must be considered when prescribing medications to patients admitted to GAU. The typical profile of GAU patients has been described in previous work by the RUSHGQ: ≥ 80 years old with multiple acute and chronic conditions and polymedicated. Then, specific information sheets are presented which include: (1) a summary of the indications of the medication of interest; (2) usage guidelines adapted to the geriatric population; (3) clinical cases integrating the presented concepts. Appendixes provide complimentary tools. Prescribing guidelines presently covering 6 different themes were elaborated by expert clinicians in order to maintain/propagate good practices in medication management in GAU., The Geriatric Rehabilitation Program at UHN facilitates the transitions of older adults from the acute care setting to home. Participation and progress in rehabilitation is hampered at times by complications related to bowel function. The patient population includes patients with multiple co-morbidities including those with end-stage renal disease receiving hemodialysis. In order to better understand the prevalence of bowel-related concerns on the unit, a chart audit was conducted revealing approximately fifty percent of the patient population met the criteria for constipation as per the Rome III classification system. A review of current practices on the unit and existing documentation revealed opportunities for improvement. The unit leadership, consisting of the Clinical Nurse Specialist, Advance Practice Nurse Educator, and Program Service Manager, developed a multi-faceted strategy to enhance the interprofessional team’s ability to optimize the bowel health of patients. Components of our strategy included: implementing nursing interventions to enhance healthy bowel function, introducing the Bristol stool chart for assessment, patient education, evaluation of interventions, and team communication as well practice supports at the bedside. Members of the interprofessional team contributed updates on best practices and participated in educational sessions with the nurses to enrich the dialogue and assist with translation to practice. Evaluation of this important initiative included auditing documentation, communication at team rounds, and prevalence of constipation post-implementation. Optimizing Bowel Health was a significant clinical and educational initiative that improved the interprofessional team’s ability to monitor, document, and discuss priority concerns related to bowel function. This is especially important in a rehab setting where complications often lead to decreased participation, interruptions in therapy, and decreased quality of life experiences for patients. The results demonstrated enhanced documentation, interprofessional communication, and reduction in rates of constipation., Older people living in nursing homes (NH) in Hong Kong have significant mortality. Their preference of place of death and the factors affecting their decision have not been explored. This study examined the preference of place of death and the predictors in older people living in NH. A cross-sectional quantitative study by face-to-face interview in 20 NH selected by convenience sampling. A structured questionnaire was employed to collect information about attitudes of older people towards end-of-life (EOL) issues and preferences for place of death. NH residents aged ≥ 65 with Abbreviated Mental Test (AMT) Score ≥ 6 and ability to communicate in Cantonese were recruited. AMT, Barthel Index (20) and Chinese version of the European Quality of Life-5 Dimensions (EQ - 5D) for quality of life assessment were collected. The attitudes toward EOL issues (AEOLI) were examined using a validated translated questionnaire. 317 NH residents (248 women and 69 men) aged 65 to 99 (mean ± SD) 84 ± 6.6 were recruited. Most residents (N = 310, 97.8%) viewed NH as their own home. There were 216 (68.1%) who wished to pass away in NH. NH residents who preferred receiving care in hospital if they were severely ill without hope of recovery were less likely to wish to die in NH (odds 0.49, CI 0.3 to 0.81, p = .005). Those who agreed physician-assisted suicide if they were severely ill without hope of recovery were likely to wish to die in RCHE (odds 1.95, CI 1.07 to 3.56, p = .029). EOL services should be enhanced in NH in Hong Kong. Further studies are recommended to examine the attitudes towards dying in place in family members, NH staff and local public. Many older Chinese people in Hong Kong viewed NH as their own home. More than two-thirds of NH residents wished to die in NH., Suicidal ideation is a public health issue that has a significant impact at the individual, family, community, and societal levels. This study aimed to examine the association between filial piety and suicidal ideation among U.S. Chinese older adults. Guided by a community-based participatory research approach, 3,159 community-dwelling Chinese older adults in the Greater Chicago area were interviewed in person 2011–2013. Independent variables were expectations and receipt of filial piety from the older adult’s perspective. Dependent variables were suicidal ideation in the last 2 weeks and last 12 months. Logistic regression analyses were performed. Of the 3,159 participants interviewed, 58.9% were female and the mean age was 72.8 years. After adjusting for age, sex, education, income, medical comorbidities, and depressive symptoms, lower receipt of filial piety was associated with increased risk for 2-week suicidal ideation (OR 1.07, 95% CI 1.03–1.11) and 12-month suicidal ideation (OR 1.07, 95% CI 1.04–1.11). The lowest tertiles of filial piety receipt was associated with greater risk for 2-week suicidal ideation (OR 1.95, 95% CI 1.12–3.38) and 12-month suicidal ideation (OR 2.17, 95% CI 1.35–3.48). However, no statistically significant associations were found between filial piety expectations and suicidal ideation in the last 2 weeks or in the last 12 months. This study suggests that filial piety receipt is an important risk factor for suicidal ideation among U.S. Chinese older adults. However, future longitudinal studies are needed to quantify the temporal association between filial piety and suicidal ideation., Prevalence of sarcopenia increases with age. Sarcopenia is associated with higher rates of drug side effects, hospital-acquired infections and functional decline. Sarcopenia subtypes are defined by the European Working Group of Sarcopenia in Older People (EWGSOP), based on presence/absence of low muscle mass, plus/minus low muscle strength or low performance. Participants are independently mobile, community-dwelling seniors. Baseline assessments included dual energy Xray absorptiometry (DXA) body composition (BC) analysis, grip strength (dynamometer), and gait speed (10 metre walk test). BC provided appendicular lean mass/height2 (aLM/ht2) and percentage body fat. Data evaluated per EWGSOP guidelines. Low grip strength and gait speed, with normal aLM/ht2 were classified as “weak,” to differentiate them from normal. Prescaropenics had only low aLM/ht2, sarcopenics had low aLM/ht2 plus one abnormal level in one of the other parameters, and severe sarcopenics had abnormal levels in all parameters. Obesity was defined by DXA BC percentage fat of > 40% (women), > 28% (men). 39 participants were evaluated: 32 women, 7 men; average age 75.9 years (67–90); average MoCA 25.5. EWGSOP classification of the 32 women: 9 normal; 2 presarcopenia; 2 presarcopenic obesity; 1 sarcopenia; 1 severe sarcopenia; 1 severe sarcopenic obesity; 3 sarcopenic obesity; 10 obese; 1 normal “weak”; 2 obese “weak.” Of the 7 men: 2 normal; 1 sarcopenia; 3 sarcopenic obesity; and 1 obese. The subgroups were comparable for age. Baseline BMI was 27.5 (18.8–37.5) and BMI did not discriminate the body types. In these independent, highly functioning seniors, there was a surprising diversity of body composition. BMI alone was of no use in classifying body type. The EWGSOP classification is useful to stratify an outwardly homogenous group of seniors., Polypharmacy is becoming increasingly prevalent in our aging population, due to the need to treat various disease states that may develop with age. Geriatric polypharmacy has been correlated with a significant patient safety issue, due to its association with higher likelihood of nursing home placements, morbidity, hospitalization, and death. Primary care teams represent the first point of contact, and are well positioned to address this phenomenon. The purpose of this project was to develop an automated medication review process in high-risk patients (defined as those 75 years of age or older and on 7 medications or more) by optimizing collaborative process with a clinical pharmacist and taking advantage of the capabilities of the electronic medical record (EMR). Patients were identified via a search on the EMR and flagged for a medication review. An optimal process for referral and communication between providers was developed using an iterative approach, taking into consideration feedback from the team members and patient reactions. Data were also collected on the types of pharmacist interventions and the types of medications changed. We developed a process using electronic messaging and coordinated MD-pharmacist visits. The total number of medications per patient was reduced, and the medications were adjusted based on the current geriatric literature. Patients were more likely to agree to a face-to-face meeting if the idea was introduced by their regular provider. Co-ordination of pharmacist and MD appointments led to more efficient implementation of pharmacist recommendations. Inferentially, by optimizing polypharmacy, harms of negative clinical outcomes would be reduced. Using EMR capabilities, a workable and sustainable process for performing geriatric polypharmacy reviews in the primary care setting was developed, and can easily be disseminated to other sites., Case Report: 97-year-old female presented with two painful ulcers on her left foot. One of the ulcers was determined to be an osteomyelitis. 3 months into treatment of these non-healing, painful wounds, she developed a third painful wound on her left calf. Her wounds treated with topical dressings and antibiotics. Pain required multiple opiods with limited success. Seen by vascular surgery 6 months into treatment. Problem determined to be angiosomal. Treated with angioplasty. Ankle brachial ratio was increased from 0.28 to 0.57. Rapid healing over next few months ensued. Two years later, patient is walking around the nursing home. Vascular surgery consultation with computed tomography angiogram should be considered earlier in treatment to decrease morbidity, improve quality of life, and lessen pain symptoms. Advanced age is not a reason to not consider consultation., St. Mary’s General Hospital has been awarded a demonstration project for the development of a Geriatric Medically Complex Clinic (GMCC). BRIDGES, based out of the University of Toronto, has been engaged for project evaluation. Geriatric patients with conditions such as dementia, cognitive decline, delirium, falls, fractures, multiple co-morbidities (CHF, COPD and diabetes), and chronic pain can be compounded by cognitive decline, caregiver stress, frailty, and polypharmacy. When geriatric patients have suboptimal care or are unable to access traditional primary care providers, they will resort to crisis teams and emergency departments (EDs), presenting a significant cost to the health system. For the ED the GMCC specifically targets those who have suboptimal access/utilization of traditional primary care providers and sees the patient within 72 hours. The GMCC has partnered the community to ensure urgent referrals are also seen within 72 hours. The GMCC team follows patients through their point of referral (i.e., ED, community, or hospital stay), with the guidance and support of geriatric medicine specialists or primary care practitioner. The team provides a focused comprehensive assessment and targeted inter-professional intervention, intensive case management across the spectrum of care, and facilitation of successful transitional care from hospital to the community. For those who are unable to leave their homes, management of chronic diseases through partnership with Primary Care supports the patient in the community, providing patient-centered care across the continuum. Through the use of an inter-professional team, patients/caregivers will have system navigation regarding health-care options, and access to timely community supports/services to manage their health-care needs. The goal is to improve patient outcomes, access community supports to successfully manage in the community post a hospital interaction, and reduce health-care costs., The objective of this study was to evaluate the family composition of elderly caregivers that were identified in the Basic Health Unit localized in an area of high social vulnerability. Seventy-three elderly caregivers participated in the study. Collection took place from May to October 2014. The genograms were made through interviews in their homes. All ethical principles were observed. The mean age was 70.35 years (SD ± 8.5), 58 elderly women and 15 men. Mean education was 2.3 years. We found the average of three people per household and 5.53 children per individual. Most seniors reported normal bonding with family. The average income of the elderly was 0.93 minimum wage and average family income was 2.3 minimum wage. The genogram is a good tool to investigate characteristics and familial relations, revealing the interviewed’s non-verbal language; however, these relationships change over time. Most of the patients reported normal bonding with family. The genogram has proved an effective tool for assessing the family structure of the elderly in a Basic Health Unit and can be used as a mechanism to improve services planning to this population., Due to the growing number of individuals suffering from dementia, many will require acute hospital care as other indirectly related conditions appear throughout the course of the disorder. Significant concerns have been raised about the provision of quality care. Understanding their experiences is therefore essential. As part of a larger-scale study, semi-structured interviews were conducted with caregivers and people with dementia dyads after acute hospitalization. Data were analyzed using qualitative content analysis. Twenty-nine participants including 25 family caregivers and 4 caregivers/people-with-dementia dyads experienced hospitalization and commented primarily on the negative experience. Despite the importance of caregiver involvement, and evidence of caregiver burden, they commented they were rarely included in care plans and lacked support. Continuity of care was said to be affected by absent communication amongst health-care team members. The acute hospital process and environment were perceived as not supportive of dementia person-centred care principles, with reports of poor staff knowledge and recognition of the disorder. The three important themes from this study — the importance of caregivers, communication challenges, and how the processes/environment of the acute hospital is not an ideal place for a person with dementia — raise important issues about care provision. These findings are supported by prior research that states that the acute-care hospital is not adapted to care for people with dementia. Reports of acute-care hospital experiences of people with dementia and their caregivers provide insights about gaps in care delivery. These findings can influence the development of further initiatives for care improvement., The Consortium pour l’identification précoce de la Maladie d’Alzheimer – Québec (CIMA-Q) aims for earlier diagnosis of Alzheimer’s disease, before the dementia stage, and to better understand its causes, in order to develop effective therapies and identify at-risk populations. The clinical cohort group adapted or developed clinical assessment tools to evaluate both global and cognitive health status, as well as to identify health and lifestyle related risk factors, both at the start of the study and over time. This questionnaire had to be completed in under 2.5 hours, and needed to be useful to evaluate both healthy and cognitively impaired elderly individuals. Longitudinal studies of aging and Alzheimer’s were consulted as well as Cognition Clinics evaluation tools in order to determine themes that are most commonly assessed. Final selection was made by a team of experts (clinicians from memory clinics across Quebec). Within each topic, most commonly used/best questions and questionnaires were evaluated by the team of experts. When possible, a validated questionnaire was used, in order to make comparisons with other studies possible. Questions were created and adapted if a validated questionnaire could not be found. Three different tools were created, both in French and in English: (1) a telephone screening interview (15 minutes), (2) a participant evaluation (2.5 hours), and (3) an informant questionnaire (15 minutes). All were piloted in a group of elderly volunteers. Fifteen validated questionnaires are included, such as the MoCA, a telephone MMSE, functional autonomy scales, and a depression scale. The CIMA-Q clinical assessment tools can be used to evaluate both cognitively-impaired and non-impaired participants. The inclusion of validated questionnaires should permit comparisons with previous and future longitudinal studies., To provide an evidence base to support the use of safe and appropriate yoga instruction and yoga therapy for an aging population including geriatric and palliative care clients. This presentations will share the benefits of yoga postures, breath work, mindfulness, and meditation on the physiological, biochemical, psychological, and spiritual health and well-being of geriatric populations. A review of the current research on the benefits of yoga therapy practices for addressing common physical diseases and the effects of sedentary lifestyles for aging populations including geriatric and palliative care patients will be presented. Specific recommendations for health concerns & conditions such as: Alzheimer’s, dementia, COPD (Chronic Obstructive Pulmonary Disease), cardiac rehab, anxiety, depression, cardiovascular disease, chronic lower respiratory disease, diabetes, cancer, injuries from accidents, joint pain, hearing loss, vision impairmentIntegrative care for palliative care patientsBest practices for geriatric and palliative care patientsPsychological issuesSpirituality for aging The implications of this research for integrating yoga, breathing exercises, laughter yoga, spirituality, mindfulness and meditation into existing geriatric health-care programs. The current research provides a strong evidence base for incorporating yoga and yoga therapy into geriatric health and wellness programs to support the aging population in maintaining physical health, biochemical and psychological health, and well-being., The literature indicates that delirium is increasing in incidence in the acute medically ill patient. The prevalence of delirium ranges from 6% to 56% in hospital settings and costs upwards of 17 million dollars/year. There are many risk factors known to contribute to delirium, resulting in the complexity of identifying, assessing, and managing a patient that develops delirium. Hospital-acquired delirium is a concern for the geriatric population. The evidence states that the development of delirium influences a patient’s hospital course, increasing length of stay, and is associated with poor long-term physical functional and cognitive outcomes. Moreover, psychological distress to family and care givers is significant. Several studies have shown gaps in health-care professionals’ knowledge, skills, and comfort regarding management of delirium, including inconsistent use of screening instruments and poor adherence to management protocols. The management can be complex, requiring the collective expertise of the interprofessional team. To address delirium issues this poster was created to improve understanding of various types of delirium as well as to highlight prevention and management strategies. Delirium was made a focus at UHN and the poster was developed to summarize UHN’s initiatives. These included: Identifying risk factors and causes of deliriumDiscussing measures for delirium preventionExplaining assessment and management of patients with deliriumDemonstrating the use of CAM assessmentDiscussing CAM assessment and interventions documentationDelirium Prevention and ManagementResultsThe Communication StrategyTools and policiesEducation The poster promoted awareness for staff about delirium and promoted the UHN initiative (see “Conclusions”). The literature indicates that 40% of delirium can be prevented. It is clear that interprofessional education regarding identification, prevention and management is paramount to reduce the risk of delirium development and associated long-term deleterious outcomes., While most clinicians acknowledge that opioid analgesia can be an important component of ED pain management, it is well documented that ED opioid administration and prescribing is influenced by age, with older patients being less likely to receive opioids than younger patients. Retrospective char t review involving three rural emergency departments and one urban emergency department studying a total of 92 patient visits at the rural sites and 193 patient visits at the urban site. Information describing the emergency department visit and administration of analgesia in the emergency department was abstracted. 12% of rural patients and 32% of urban patients received opioid analgesia from the time of triage to discharge from the emergency department (p = .0003 for comparison). However, after adjusting for possible confounders, rurality was not associated with a decreased likelihood of opioid administration (odds ratio, 0.722; 95% CI, 0.291–1.791). 10% of rural patients and 24% of urban patients received acetaminophen (p = .0038 for comparison), while 14% of rural patients and 8% of urban patients received a non-steroidal anti-inflammatory drug (NSAID) (p = .0918 for comparison). The overall rate of opioid administration was low in both settings. Interestingly, the rate of acetaminophen administration was even lower in both settings, and the rate of NSAID administration was higher than that of opioid administration in the rural settings combined. Clinical practice guidelines for treating pain in the elderly state that acetaminophen is generally considered to be the first-line pharmacological treatment, and that NSAIDs should be used cautiously due to their side effect profile. Rurality did not influence emergency department administration of opioids to elderly patients in pain after adjusting for possible confounders., Patients with dementia and their caregivers express different needs such as coping with memory loss, information on the disease, emotional support. As a key intervention of the Alzheimer Plan of Quebec, case management (CM) has been implemented in Family Medicine Groups (FMGs) to address their needs. The purpose of this study is to identify the needs of the patient-caregiver dyad and if CM meets their expectations. A systematic mixed studies review was conducted to integrate the results from studies with diverse designs (quantitative, qualitative, mixed methods studies) on needs of the dyad and CM, published in English or French up to 2014. CM comprises case finding, assessment, care planning, and monitoring and includes a family physican working with a case manager. Two reviewers selected title/abstract, full-texts, and appraised quality (using the Mixed Methods Appraisal Tool) independently. Synthesis (a sequential explanatory design): (i) development of the categories of needs based on the deductive approach; (ii) identification of the needs that CM targets to address; (iii) juxtaposition of the needs of the dyad to the needs that CM targets to improve. 54 studies were included; 8 studies concern CM. Four main categories of needs were identified: needs for information and knowledge, needs to maintain normality, caregiver needs, and access to care. Overall CM effectively addresses the needs of the dyad living in the community. Impact of CM on access to care (e.g., access to trained family physicians) is not studied. This study highlighted a knowledge gap on the impact of CM on access to care. These results will guide the conduit of experimental study on the needs of the dyad receiving care within CM implemented in FMGs of Quebec., Patients who have sustained fragility fractures remain at high risk for future fracture without appropriate bone-protective interventions. The goal of our investigation was to examine the rate of bisphosphonate prescription within three months of discharge from hospital among patients with fragility fracture of the hip admitted to the Orthopedic Service at the Royal University Hospital, in Saskatoon. The data from this study will inform future interventions tailored to improve secondary prevention of fragility fractures in Saskatchewan. A chart review of 114 patients over the age of fifty with a fracture of the hip was completed. Patients whose mechanism of injury was not consistent with fragility fracture were excluded, along with those receiving treatment with bisphosphonates at admission, or creatinine clearance less than 35 mL/min. Data were matched with the provincial Pharmaceutical Information Program (PIP) to assess for prescription of bone protective therapy within three months of discharge. Five patients received prescriptions for bisphosphonate therapy (7%, 95% CI: [1%, 13%]), and 70 of the eligible patients did not receive treatment (93%, 95% CI [87%, 99%]). A total of 23 patients were precluded from receiving bisphosphonate therapy, and an additional 16 patients presented with fragility fracture of the hip while on bisphosphonate treatment. These findings reveal an identifiable care gap in the secondary prevention of fragility fracture of the hip in Saskatchewan. Patients who have sustained fragility fractures are at risk of adverse outcomes including loss of function and decreased quality of life. Further study to improve the management of this cohort is under way. We have begun a knowledge translation intervention, supplementing discharge summaries with information to identify patients in need of treatment and further follow-up to prevent future fragility fracture., Ambulatory care is a key component of geriatric medicine subspecialty training but currently there are no standardized core competencies in this domain. The goal of this project is to develop a set of competencies for geriatric ambulatory medicine that are essential for the geriatric subspecialty residents to master by the end of their curriculum to become independent in their professional practice, offer the best care possible, and respond to the increasing demand for the ambulatory care of older patients. We are completing a multiphase project including an environmental scan, modified Delphi, and an in-person meeting with relevant experts to develop the list of core competencies. In the first phase, we identified 151 core competencies from the current literature and lists provided by 7 geriatric program directors in Canada. They were divided into six domains (medical expert, manager, collaborator, communicator, scholar, and professional). The modified Delphi is under way and we expect 38 leaders in geriatric medicine to participate in the surveys. At the time of the 2015 CGS Annual General Meeting, data from the Delphi will be available and competencies that should definitively be included or eliminated from the final list will be identified. Competencies with discordant results will be compiled and presented for discussion during the experts meeting. The final goal of this project is to produce an exhaustive and concise list of competencies that cover the essential aspects of ambulatory care for elderly. We are hoping to create a valid and useful tool to develop ambulatory geriatrics training curricula and to emphasize skills specific to ambulatory medicine., Elderly with advancing chronic heart failure (CHF) experience high levels of morbidity and mortality, similar to patients with common cancers. There is a gap in optimal quality of care and the real experiences for these patients. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health-care services that are poorly coordinated and offer fragmented care. There is evidence that these poor experiences and the lack of understanding of their preferences could be improved to a large extent by simple organizational and process improvement rather than complex clinical mechanisms. This study examines patient, carer, and professional perspectives on current management of advanced HF and barriers and facilitators to improved care. Qualitative study involving semi-structured interviews and focus groups with advanced HF patients (N = 20), carers (N = 20), and professionals (N = 30–40). Some questions are testing the knowledge, others attitude, opinion, and experience. The questionnaires for the one-on-one interviews are different from the focus group interviews. A conversational style of communication, starting the questionnaire with an introductory statement and a non-threatening and open-ended easy question to warm up is used. The literature highlights that little progress is being made to improve care experiences for those with advanced HF. Even in the terminal stages, patients and caregivers are heavily and unnecessarily burdened by health-care services that are poorly coordinated and offer fragmented care. There is evidence that these poor experiences could be improved to a large extent by simple organizational rather than complex clinical mechanisms. We will discuss the result of this study and provide recommendations., Health care has entered an era of complexity. Patients often suffer from multiple comorbidities, and the growing cohort of elderly patients present with medical, psychiatric, functional, and social complexity. There is growing recognition that the ability to handle complex cases is a critical physician competency which should be developed in trainees. We aim to explore how medical trainees conceptualize clinical complexity, how well-prepared they feel to handle complexity, and how complex encounters influence residency selection. In this qualitative study, to date, 13 participants (12 3rd-year students in their 11–12th month of clerkship and 1 4th-year elective student) engaged in a two-part interview process. First, students drew two rich pictures that represented complex clinical scenarios: one exciting, and one frustrating, overwhelming, or uncomfortable. Second, the pictures were used to guide a semi-structured interview. Interview transcripts were coded, compared, and analyzed using constructivist grounded theory principles. Preliminary emerging categories for how trainees conceptualize complexity include role certainty, perceptions of learning, and belonging. These suggest the notion of active engagement as a key process influencing how clinical complexity is perceived; when actively engaged, students described the case as complex and exciting versus complex and frustrating. Active engagement may also influence residency selection as feelings on complexity and mentorship appear to be connected when describing specialty preferences. Preliminary results suggest that the social process of learning, in relation to feelings of engagement, is a strong determinant of how medical trainees experience complex patients and the choices that result from these encounters. Medical students must be trained to handle complex cases. Future direction for this study includes recruitment of additional participants, and further exploration on trainees’ preparedness for clinical complexity and how the pre-clinical curriculum can better support the development of this competency., The recent Royal College of Physicians and Surgeons report highlighted areas of medicine that are over-serviced, but also emphasized those that are under-serviced, including geriatric medicine. The goal of this project was to develop a multimedia podcast template that would inform medical students about various career choices. Geriatric Medicine served as the prototype podcast. A needs assessment was done by surveying existing resources (CaRMS, AAMC, AFMC, CFMS) and conducting an online survey of medical students. Based on these results, a list of interview questions was developed for this video podcast. A Sony camcorder was used for recording interviews in Ottawa while Skype and ScreenFlow were used to interview and record physicians and residents nation-wide. Interviews were conducted with physicians and residents working in Geriatrics. Relevant links and resources were added to the podcast. It is now housed on the CGS website and the TOH Department of Medicine webpage. As well, the CFMS and AAMC plan to add it to their websites. The podcast was evaluated by medical students via a questionnaire. Using a podcast framework to educate trainees on career choices is a novel idea. The results from this project may be used as a template for other postgraduate training programs and this podcast may be used to raise awareness of Geriatrics as a career choice. Podcasts are a novel multimedia approach for demonstrating career opportunities to medical students, when considering residency training options., Delirium is an acute confusional state that is most commonly seen in older adults and is a predictor of poor outcomes. Despite being a quality of care indicator, evidence shows that delirium is often unrecognized. This limits the possibility of timely management. The objectives of this study are to determine the rates of delirium screening at MSH and to identify barriers and the needs of health-care professionals to better facilitate daily delirium screening. We conducted a retrospective chart review of adults 65 years or older admitted to one of four units — Acute Care for the Elderly, ICU, general medicine unit, and orthopedic surgery — between September 2010 and October 2013. The survey consists of 4 sections: Demographics, Delirium, Delirium Screening, and Education & Resources, to be administered to health-care professionals at MSH that screen for delirium in the above-mentioned study subjects. The survey was developed in 4 phases: Item Generation, Item Reduction, Question Formatting, and Validation. At the time of abstract writing (465 charts), the rate of total compliance with daily delirium screening was 60%, the rate of screening within 24 hours of hospital admission was 62%, and the rate of hospital-acquired delirium was 19%. The survey was in the validation phase and to be distributed to staff in March 2015. We hypothesize that many of the perceived barriers identified will be possible to target through the availability of resources, and that identifying the needs of health-care professionals will allow future resources to be appropriately chosen to enable improved screening rates. This approach will allow more cases of delirium to be identified and opportunely managed at MSH to reduce negative outcomes., In older adults with Mild Cognitive Impairment (MCI), a precursor to dementia, deficits in cognition can have negative impacts on well-being and quality of life. Research has shown depression increases risk of cognitive decline. Among the elderly, those who live alone are at risk of developing depressive symptoms. There is a lack of information from relevant literature on whether individuals with MCI are at risk for further cognitive deterioration depending on their relationships (marriage and/or companionship) and living arrangement (alone/with a partner). This study is to investigate the effect of relationship status and living arrangement on memory and cognition, and whether depression mediates these effects in the elderly population diagnosed with MCI. Data from the ongoing “Gait and Brain Study” cohort will be used to assess forty older adults with MCI who live alone, and forty with MCI who live with a partner. The Mini Mental State Examination (MMSE) will be used to assess cognition and depressive symptoms will be assessed using the Geriatric Depression Scale (GDS) every six months over a 2-year period. This study is in its preliminary stages; results are pending. We expect that individuals who live alone, in comparison to individuals living with a partner, will demonstrate greater declines in cognitive function, as evidenced by lower MMSE scores, and will experience greater depressive symptoms, represented by higher GDS scores. There is currently a lack of understanding whether relationship status and living arrangement, mediated by depression, affect cognitive function in individuals with MCI. This study may provide insight into possible social and psychological risk factors, further contributing to cognitive decline, that need to be addressed in the care of older adults with MCI., The McGill Centre of Excellence on Aging and Chronic Diseases (CEViMaC) aims to design a needs analysis questionnaire that can measure the performance gaps between the current situation and an ideal situation in terms of coordination of health care and services for seniors with multiple chronic diseases in the McGill Réseau Universitaire Intégré de Santé (RUIS McGill). This research project represents an important procedure as it will guide the CEViMaC in providing appropriate clinical support to health organizations within RUIS McGill. The Kaufman methodology of needs analysis at the strategic level and a conceptual framework of health-care coordination were selected to guide the questionnaire’s design process. A scoping review was performed to identify strategic plans of relevant health-care organizations: pertinent goals of coordination were analyzed and converted into items for the questionnaire. The measurement scale and the basic visual design of the questionnaire were based from similar research studies. Finally, qualitative interviews with a sample of health-care professionals were conducted to test the questionnaire. According to the interviewees, the visual design and the measurement scale were intuitive, and the items reflected broadly their professional concerns. However, some instructions and questions lacked coherence and contained inaccurate terminology. Additionally, the completion of the questions required a considerable amount of time. Reformulating the instructions and the questions, and arranging thematically the sequence of questions, are necessary to facilitate comprehension. Otherwise, the number of questions should be reduced to ensure a favorable response rate. A team of suitable experts, further interviews, and adjustments are needed to improve the measurement tool in addressing adequately the dimensions of care and service coordination. Use of incentives should be explored to boost response rate upon the questionnaire’s official launch., Low life satisfaction (LS) predicts poor outcomes and may predict dementia. We sought to determine if LS predicts dementia over a five-year period in older adults with normal cognition at baseline. Secondary analysis of a population-based cohort study of 1,751 older adults, with initial assessment in 1991 and follow-up five years later; 1,028 were cognitively intact at time 1, and alive and had complete data at time 2 when 96 were diagnosed with dementia. Measures were age, gender, and education, which were self-reported. LS was assessed using the Terrible-Delightful scale, which measures overall LS and aspects of LS (e.g., health, finances, friendships) using separate 7-point scales. Cognition was assessed using the modified Mini-mental State Examination (3MS) and a clinical exam for those scoring < 78. Cognitive status was categorized as intact, dementia, or Cognitive Impairment, No Dementia (CIND). Analyses were adjusted for age, gender and education. There were few cognitively intact people at time 1 with low LS. Overall LS predicted death, dementia, and CIND five years later. Those with low overall LS were more likely to die than to develop dementia. In logistic regression models, the unadjusted Odds Ratio (OR; 95% confidence interval) for dementia at time 2 was 0.72 (0.55, 0.95) per point on the LS scale, with the adjusted OR 0.68 (0.50, 0.93). However, no individual domain of LS predicted dementia, although the competing risk from mortality was high for some items. The risk of death exceed the risk of dementia over the five-year interval. A basic global measure of LS predicts dementia over a five-year period in older adults without cognitive impairment. No individual aspect of LS predicted dementia., Cardiovascular disease, related risk factors, and falls are all well-known predictors of cognitive decline in older adults. In a longitudinal study assessing cardiovascular health, cognition, balance, and dual-task walking, we evaluated baseline differences in balance outcomes and neuropsychological assessments to see if poor balance and poor cognition were associated with individuals who have poor cardiovascular health. The Cardiac group (CG, N = 23) included individuals with ≥ two cardiovascular risk factors and coronary patients. Healthy group (HG, N = 16) included individuals with < two risk factors. Mean age: HG 64.7 years old SD 4.3 years, CG 69.9 years old SD 4.9 years. The Montreal Cognitive Assessment (MoCA) was measured prior to balance assessment. Ten-second balance assessment were performed using a Matscan platform and included two eyes-open conditions (bipedal and unipedal). Initial comparisons of center of pressure measures between groups revealed significant differences in several measures (mean velocity [MV], mediolateral velocity [MLV]). After controlling for age and sex differences between groups, a mixed ANOVA (group by balance condition) revealed significant interactions in MV and MLV, such that CG performed more poorly than HG in the unipedal conditions (MV: p = .04, MLV: p = .02) with no significant differences in the bipedal conditions (MV: p = .86, MLV: p = .628). MLV also negatively correlated with MoCA scores in the whole sample (p = .05). This study suggests that CG have poorer balance control than HG. Simple tests with a balance platform reveal differences that identify at risk groups and relate to lower MOCA scores. Early assessments of balance status can help to identify older individuals at risk of cognitive decline, allowing early intervention to prevent falls and further cognitive decline., Speed of information processing can be affected in Mild Cognitive Impairment (MCI) and may play a role in activities such as driving. Electroencephalography (EEG) may have a role in assessing cognition, because it measures current changes to the level of milliseconds. In cognitive testing, the EEG signal is averaged to yield a waveform termed an “event-related potential” (ERP). This study compares the results of traditional cognitive testing and ERP n-back testing in patients with MCI and healthy controls (HC). Thirteen MCI patients were recruited from the Bruyère Memory Program, and 9 HCs were recruited from the general population. Cognition was tested using the MoCA, RBANS, and Trails A & B. EEGs were measured using NeuroScan NuAmps 4.3 and analysed using Brain Analyzer 2.0. Participants performed n-back cognitive tests to elicit working memory relevant ERPs. There were significant differences between clinical test results of MCI and HC groups; e.g., mean Trails B time for MCI was 173.5 seconds compared to 76.4 seconds in the HC (p < .001). In addition, the HC group had more correct responses and responded more quickly than the MCI patients in all 3 n-back conditions (p < .003). There was also a significant delay in the P200 component at midline and left hemisphere centro-posterior electrodes in MCI patients when compared to HC (p < .04). This MCI group performed less well on traditional cognitive testing, was slower, and made more mistakes in the n-back testing, and showed a significant delay in the P200 component compared to healthy older controls. Further work will be required to clarify the role of ERP in measuring decreases in speed of processing in older adults with cognitive impairment., The current practice to monitor mobility is periodic clinical assessment. Technology is now available that would allow continuous monitoring. The purpose of this study was to track mobility changes in 25 community-dwelling, frail older adults over one year, with the ultimate goal being the early detection of mobility decline. Clinical measures, including Timed Up & Go (TUG) and gait speed, were taken monthly for frail older adults living in the community. Under-mattress pressure-sensitive mat (S4 Sensors Inc.) data were collected continuously over the same time period and analyzed with custom-designed software. Among the first 15 participants, data were collected over an average period of 10 months. Of these participants, there were 8 that showed a clinically meaningful decline, 3 that showed a meaningful improvement and 4 that showed stability in mobility using the clinical measures. Data from an 85-year-old male, with a history of cerebrovascular accidents, will be presented. Over the period June 2013 to May 2014, he went from using a cane to requiring a wheeled walker, his gait speed dropped from 0.70 to 0.47 m/s and his TUG increased from 23.9 to 37.7 s. This will be compared to changes in sum of pressures and centre of pressure velocity magnitude data extracted from the mat. Distinct changes in data analyzed by the pressure-sensitive mat were associated with functional decline in the case presented. Further data analyses are ongoing to determine whether continuous monitoring of bed mobility can facilitate the early detection of mobility decline. To our knowledge, this is the first time that bed transfer data has been measured continuously over a year in frail, community-dwelling older adults., Introduction: Increasing numbers of primary care memory clinics (PCMCs) are being established in Ontario to provide much-needed system capacity for dementia care and efficient integration with specialty services. There is a need for routine integration of standardized quality indicators (QI) into PCMC care processes to ensure high-quality care. The purpose of this project was to develop consensus on the most relevant QIs for PCMCs to promote quality care and program fidelity and sustainability. Methods: A Delphi survey of PCMC clinicians and specialists was used to develop consensus on QIs for use in PCMCs. A list of QIs was identified through a systematic literature review. Survey participants were asked to rate the QIs according to their importance and feasibility in PCMCs. Mean ratings determined relative rankings of importance. Two survey rounds were conducted involving 179 and 88 participants, respectively. QIs ranked below a pre-specified threshold or not readily measurable in a primary care setting were eliminated. Results: Consensus was reached on 18 QIs. These included criteria for referrals to specialists; assessment, reassessment, and documentation requirements for diagnoses of mild cognitive impairment and dementia; criteria for diagnostic testing; medication reviews; discussing the risks and benefits of cholinesterase inhibitors and of antipsychotics; use of stroke prophylaxis in the presence of vascular risk factors; assessment for safety risks; counselling on driving risks and fitness to drive assessment; and advanced care planning, including identification of substitute-decision makers. Conclusions: A set of QIs for PCMCs has been identified. These indicators will form the basis of a quality assurance framework to enhance primary and collaborative care and that can be used in further studies to evaluate the quality of dementia care models in primary care., Vitamin D is involved in brain physiology and lower-extremity function. We investigated spectroscopy in a cohort of older adults to explore the hypothesis that lower vitamin D status was associated with impaired neuronal function in caudal primary motor cortex (cPMC) measured by proton magnetic resonance spectroscopic imaging. Twenty Caucasian community-dwellers (mean ± standard deviation, 74.6 ± 6.2 years; 35.0% female) from the “Gait and Brain Study” were included in this analysis. Ratio of N-acetyl-aspartate to creatine (NAA/Cr), a marker of neuronal function, was calculated in cPMC. Participants were categorized according to mean NAA/Cr. Lower vitamin D status was defined as serum 25-hydroxyvitamin D (25OHD) concentration < 75 nmol/L. Age, gender, number of comorbidities, vascular risk, cognition, gait performance, vitamin D supplements, undernourishment, cPMC thickness, white matter hyperintensities grade, ser um parathyroid hormone concentration, and season of evaluation were used as potential confounders. Compared to participants with high NAA/Cr (N = 11), those with low NAA/Cr (i.e., reduced neuronal function) had lower serum 25OHD concentration (p = .044) and more frequently lower vitamin D status (p = .038). Lower vitamin D status was cross-sectionally associated with a decrease in NAA/Cr after adjustment for clinical characteristics (beta = −0.41, p = .047), neuroimaging measures (beta = −0.47, p = .032) and serum measures (beta = −0.45, p = .046). Lower vitamin D status was associated with reduced neuronal function in cPMC. These novel findings need to be replicated in larger and preferably longitudinal cohorts. They contribute to explain the pathophysiology of gait disorders in older adults with lower vitamin D status, and provide a scientific base for vitamin D replacement trials., Everyday situations in which attention is divided (e.g., walking and thinking) can put older adults at risk for accidents and falls. In order to prevent falls and provide early interventions for cognitive-motor declines, additional research targeting neural contributions during dual-task walking is needed. This study assessed behavioural and neural changes during dual-task walking. Younger (YA; N = 19) and older adults (OA; N = 14) walked on a treadmill at a self-selected pace while performing an n-back task with two difficulty levels (1- & 2-back). Using a blocked design, changes in oxy- (HbO) and deoxy-hemoglobin (HbR) during single (ST: walk) and dual task (DT: walk+n-back) were acquired from 28 channels placed on the prefrontal cortex (PFC). Within each group and channel, a task by difficulty ANOVA was conducted. For HbO, a significant task effect (ST < DT) was found in 5 channels in YA and 7 channels in OA (p values < .028). For HbR, task effects (ST < DT) were found in 17/28 channels for the YA and 24/28 channels for the OA (p values < .045). In four channels (left hemisphere), a significant task by difficulty interaction was found in the YA, in which the HbR concentration change in the 2-back DT was lower than the change in the 1-back DT, a finding not present in the OA. Both groups demonstrate changes in cerebral oxygenation during dual-task walking, with OA demonstrating these effects in more channels than YA. YA may have benefited from dual-task exposure as they have less activity in the harder dual-task condition. These findings help clarify neural contributions to dual-task walking and can be used to inform intervention work on falls and cognitive-motor declines in aging., While research has demonstrated cognitive impairment is a risk factor for functional decline and may affect rehabilitation compared to the cognitively intact, the characteristics that lead to rehabilitation success in people with dementia has not been evaluated. Our objective was to determine factors associated with functional gains among older adults with dementia during inpatient geriatric rehabilitation. Retrospective cohort study: Consecutive subjects admitted to an inpatient geriatric rehabilitation unit with a dementia diagnosis (N = 175, age 83.1 ± 7.2 y, 55.4% female) had mobility, cognitive and demographic data collected at admission and discharge. The Functional Independence Measure motor function (FIM-motor) subscale was used to estimate level of mobility. Gain in motor function was the difference between FIM-motor scores at admission and discharge. Multivariable linear regression evaluated the association between cognitive and demographic factors on mobility gains. Functional gains were smaller with increasing care among pre-admission residence settings. The mean gain in mobility was 48.9% for “home without services,” 44.6% for “home with services,” 38.0% for “assisted living,” and −4.9% for “residential care.” In regression analysis, compared to “home without services,” average FIM-motor gains were lower by 4 points for “home with services” (p = .042), 5.6 points for “assisted living” (p = .029) and 23.2 points for “residential care” (p < .001). No other demographic or cognitive factors were associated with mobility gains. Only pre-admission place of residence was associated with mobility gains. More research is needed on the link between pre-admission function and loss of function on rehabilitation gains to refine positive prognostic factors associated with residence setting. Age, MMSE, gender, comorbidities, and mobility aid use were not associated with mobility gains and should not be absolute contraindications for access to inpatient rehabilitation., Speed of information processing can be affected in Mild Cognitive Impairment (MCI) and may play a role in activities such as driving. Electroencephalography (EEG) may have a role in assessing cognition, because it measures current changes to the level of milliseconds. In cognitive testing, the EEG signal is averaged to yield a waveform termed an “event-related potential” (ERP). This study compares the results of traditional cognitive testing and ERP n-back testing in patients with MCI and healthy controls (HC). Thirteen MCI patients were recruited from the Bruyère Memory Program, and 9 HCs were recruited from the general population. Cognition was tested using the MoCA, RBANS, and Trails A & B. EEGs were measured using NeuroScan NuAmps 4.3 and analysed using Brain Analyzer 2.0. Participants performed n-back cognitive tests to elicit working memory relevant ERPs. There were significant differences between clinical test results of MCI and HC groups, e.g., mean Trails B time for MCI was 173.5 seconds compared to 76.4 seconds in the HC (p < .001). In addition, the HC group had more correct responses and responded more quickly than the MCI patients in all 3 n-back conditions (p < .003). There was also a significant delay in the P200 component at midline and left hemisphere centro-posterior electrodes in MCI patients when compared to HC (p < .04).This MCI group performed less well on traditional cognitive testing, was slower and made more mistakes in the n-back testing, and showed a significant delay in the P200 component compared to healthy older controls. Further work will be required to clarify the role of ERP in measuring decreases in speed of processing in older adults with cognitive impairment., Age-normative hearing loss is linked with reduced cognitive functioning, mobility decline, and increased falls risk in older adults. This study examined age-related differences in allocation of cognitive resources between concurrent walking and listening tasks. Seventeen younger and twelve older adults with normal hearing participated. Three sentences (1 target, 2 maskers) were played simultaneously from different locations (left, center, right) in a virtual-reality street crossing scene. Target location probability (100% versus < 75%) was varied. Participants reported the number and colour in the target sentences. Gait during self-paced treadmill walking was assessed with motion capture system using active markers positioned on the head, sternum, sacrum, and feet. There were 3 conditions: walking, listening, and walking while listening. Key dependent measures were listening accuracy, head and trunk position, and stride time variability. Word recognition accuracy was significantly worse in (a) older than younger adults, (b) dual- than single-task, and (c) less predictable location probability. Preliminary kinematic analysis suggests increased peak trunk pitch, head pitch, and peak head roll rotation in older adults compared to younger adults. Older adults showed decreased head roll, peak head roll, and peak trunk pitch rotation from single-task walking to dual-task conditions but there was no such decrease in younger adults. Stride time variability (coefficient of variation) was greater in older adults under dual-task conditions than single-task walking while younger adults showed no trend. Listening performance in old age is particularly hampered when concurrently walking and when the signal location becomes less predictable. Furthermore, older adults’ gait variability worsened when simultaneously listening. The findings suggest that listening challenges affect mobility and provide early evidence to explain the link between age-related hearing loss and gait adaptations., After a mild traumatic brain injury (mTBI), individuals frequently experience balance problems associated with sensory processing disorders. Pediatric research has shown that compression vests improved anxiety in children with the disorder. However, a significant gap exists in literature regarding the application of compression vests in adult injury populations. The purpose of this study is to measure whether the vest improves gait and if it can improve mobility and aspects of cognition. Twenty-eight mTBI participants will complete the Rivermead post-concussion symptoms questionnaire (measure of anxiety) and cognitive testing, acting as their own controls performing a series of walking tests under four dual-task conditions. The dual-task conditions will consist of walking while performing a cognitive task with and without the compression vest. Cognitive testing includes the MoCA, to assess global cognition, and Trail Making to assess executive function (EF). Gait variability (GV) will be collected as a measure of gait performance. Participants will be wearing over-sized shirts to keep assessors blind to weighted vest condition. There will be a one week wash-out period. We expect that gait performance, specifically GV, under-dual task conditions will improve using the weighted compression vest — a mechanism that can be related to reducing anxiety and improving EF. This study may provide evidence that weighted compression vests can improve patients’ gait performance, allowing them to better navigate in daily environments. If gait improves using the compression vest, it may suggest that GV is sensitive to brain function. This study may contribute to recommending the use of compression vests for older adults to improve gait performance., Low executive function is associated with gait dysfunction in older adults. However, little is known about the neural basis underlying this association. We aim to investigate the relationship between regional cerebral metabolic rates of glucose (rCMRglc) and executive / gait functions in healthy community-dwelling older women. One-hundred and forty-five older women (mean age [SD], 69.6 [6.6] years) who have normal global cognitive function (MMSE > 26) underwent positron emission tomography using [F-18]fluorodeoxyglucose (FDG-PET) to assess brain activity at rest. Within 6 months before and after the FDG-PET, TMT-A, TMT-B and maximum gait indices (speed, step length, and cadence) were measured. The difference in time between TMT-A and TMT-B was calculated for a measure of executive function (ΔTMT). Associations between variables were examined using multiple linear regression analyses adjusted for demographic variables and comorbidity. Lower ΔTMT was associated with poor performance in maximum gait speed and cadence, independent of covariates. For the cerebral glucose metabolism, both lower ΔTMT and lower maximum gait indices (speed and cadence) were associated with lower rCMRglc in the posterior cingulate and the primary sensorimotor cortices. The present study in healthy older adults suggests that the known relationship between low executive function and gait dysfunction in seniors may be explained by reduced metabolic activity in the posterior cingulate and the primary sensorimotor cortices. Assessing the neural activity in these brain areas may be helpful for identifying older adults at higher risk of experiencing mobility disability, falls and progressive MCI or dementia. The posterior cingulate and the primary sensorimotor cortex may play important roles in both executive and gait controls., In Parkinson’s disease (PD), deficits in executive functions (EF) have been linked to impaired gait. Current research has suggested that exercise may be effective to treat cognitive deficits in PD. However, it remains unknown how changes in cognition might influence gait in PD. This study aimed to investigate the effects of an aerobic and a Parkinson’s-specific goal-based exercise on EF and gait in PD and whether changes in cognition and gait as a result of exercise are associated or independent. Forty-eight PD participants were randomized into an aerobic (N = 23) or a goal-based (N = 25) exercise group and attended 1-hour sessions 3×/week for 12 weeks. EF (Digit Span, Stroop Test, and Trail Making Test) and gait (single and dual tasks) were assessed pre and post exercise. A group by time interaction for the Stroop interference condition approached significance (p = .056), revealing that only the aerobic group performed better in this condition at post-test. In addition, all participants performed the Trail’s part A faster after exercise (p = .009). An interaction between time, walking task, and group for step time variability neared significance (p = .058), demonstrating that, while goal-based exercise decreased variability in the single-task, aerobic exercise decreased variability in the dual-task condition at post-test. Participants decreased step time, increased cadence and step width after exercise, only in the dual-task condition (p < .05). Negative correlations showed that more points in the digit span forward were associated with reduced step time (aerobic: r = −0.41; goal-based: r = −0.48) and double support (aerobic: r = −0.50) variability during dual-task. This is the first study to demonstrate that exercise-related changes in EF may influence gait in PD. This influence occurs primarily during dual-task and is dependent on the measure of EF., Cardiovascular disease, related risk factors, and falls are all well-known predictors of cognitive decline in older adults. In a longitudinal study assessing cardiovascular health, cognition, balance, and dual-task walking, we evaluated baseline differences in balance outcomes and neuropsychological assessments to see if poor balance and poor cognition was associated with individuals who have poor cardiovascular health. The Cardiac group (CG, N = 23) included individuals with ≥ two cardiovascular risk factors and coronary patients. The Healthy group (HG, N = 16) included individuals with < two risk factors. Mean age : HG 64.7 years old SD 4.3 years, CG 69.9 years old SD 4.9 years. The Montreal Cognitive Assessment (MoCA) was measured prior to balance assessment. Ten-second balance assessments were performed using a Matscan platform and included two eyes-open conditions (bipedal and unipedal). Initial comparisons of center of pressure measures between groups revealed significant differences in several measures (mean velocity [MV], mediolateral velocity [MLV]). After controlling for age and sex differences between groups, a mixed ANOVA (group by balance condition) revealed significant interactions in MV and MLV, such that CG performed more poorly than HG in the unipedal conditions (MV: p = .04, MLV: p = .02) with no significant differences in the bipedal conditions (MV: p =.86, MLV: p = .628). MLV also negatively correlated with MoCA scores in the whole sample (p = .05). This study suggests that CG have poorer balance control than HG. Simple tests with a balance platform reveal differences that identify at-risk groups and relate to lower MOCA scores. Early assessments of balance status can help to identify older individuals at risk of cognitive decline, allowing early intervention to prevent falls and further cognitive decline., Several studies have reported benefits of exercise interventions and cognitive training on cognitive performance in older adults, but the effect of combining both interventions has rarely been studied. 136 healthy older adults were randomly assigned to one of the 4 combinations: 1) aerobic training and dual-task training; 2) aerobic training and placebo computer; 3) stretching training and dual-task training; 4) stretching training and placebo computer. Dual-task performance benefits were assessed. Analyses compared percentage of change among groups in transfer dual-task conditions in three trial types: single-pure trials, single-mixed, and dual-task trials. Results showed larger change in dual-mixed than in single-mixed trials, but only for the groups that completed the dual-task training (vs. placebo computer), with no substantial difference between aerobic and stretching exercise. Improvement in other task conditions was equivalent among all groups. Results of this study suggest that both dual-task computer training combined with aerobic or stretching can help improve the ability to maintain multiple stimulus-response alternatives. This specific skill is essential when it comes to concurrently performing multiple tasks. Moreover, these combined interventions also lead to functional improvement in balance and gait, but do not seem to have a synergetic effect, which could be partly explained by a reduced training volume due to the combination of multiple training. These results further support the benefits of dual-task training on attentional control, and suggest equivalent effect of aerobic and stretching exercise on dual-task performance.

Background/Purpose: As of 2011, approximately 747,000 Canadians suffer from some form of dementia; Alzheimer’s disease (AD) is one such form. AD is a neurodegenerative disease characterized by significant neuronal death. Neuronal death has been associated with two pathophysiological features: 1) neurofibrillary tangles within the neurons, and 2) amyloid beta plaque formation between neurons. Excessive production of these two features is manifested by severe cognitive impairment. One of the most extensively researched compounds, associated with these characteristics, is the amino acid, homocysteine, which has been found to be higher in blood plasma concentrations in patients with AD compared to healthy counterparts. Folate, vitamin B12, and vitamin B6 have been effective in reducing plasma homocysteine and this reduction has been associated with a reduction in amyloid beta and tau phosphorylation. However, this reduction in homocysteine has not resulted in improved cognitive performance. More recently, research focus has shifted to the universal methyl donor, S-adenosylmethionine (SAM), as a dietary supplement to treat both the pathophysiological features and cognitive impairment of the disease in mice and has shown promising results in alleviating both domains of the disease. Methods: Here, a meta-analysis was conducted to evaluate the effect size for Y maze performance between two groups of mice, one receiving a SAM supplemented diet and the other group receiving a non-SAM supplemented diet. A thorough literature review was conducted and all studies that met the inclusion criteria were included in the analysis. For each study, both groups of mice were fed a folate and vitamin E deficient diet for 1 month with or without SAM supplementation. Results & Conclusion: The results of four mouse studies demonstrated a significant effect of SAM supplementation on cognitive performance as measured by the percent of spontaneous alternations made in the Y maze, thus illustrating the utility of this supplement in research concerning mental health., Objectives: To identify primary care doctors knowledge, practices, and obstacles with regard to the diagnosis and management of dementia. Methods: Standardized questionnaires covering knowledge, practices, and obstacles were distributed among a random sample of primary care doctors in Kathmandu, Nepal. 380 physicians responded (response rate = 89%). Results: Knowledge of practitioners with regard to the diagnosis and management of dementia was unsatisfactory. Diagnosis and management barriers are presented with regard to GP factors, patient factors, systemic factors, and carer factors. Discussion: Specifically, the results address the following issues: time, communicating the diagnosis, negative views of dementia, difficulty diagnosing early stage dementia, acceptability of specialists and responsibility for extra issues, knowledge of dementia and ageing, less awareness of declining abilities and diminished resources to handle care, not specified guidelines, poor awareness of epidemiology, and less confidence to advise. Conclusions: Demographic changes mean that dementia will represent a significant problem in the future. The following paper outlines the problems and solutions that the Nepalese medical community needs to adopt to deal effectively with its diagnosis, care, and management., Background: As the number of individuals with dementia grows, we are seeing associated caregiving challenges. In one program for persons with dementia, involving caregivers in the creation of an individual’s life story is an important step in the development of a person-centred approach to care by identifying important life events and their meaning. This narrative contributes to individualized interventions for care. At the same time, the use of technology and ‘simulated presence’ is being explored with some caregivers as an additional intervention. Objective: This poster will demonstrate how ‘simulated presence’ can be an effective strategy to engage family or other significant caregivers and the interprofessional team in provision of a truly person-centred approach to care. Methods: Clients and caregivers are involved in creation of a life story when the client is first admitted to the program. Caregivers are also invited to participate in making audio-tapes where they provide reassurance or narration of care steps. These audio recordings are played during care, in order to redirect or engage the person with dementia. Elements of the person’s life story, as well as how to implement ‘simulated presence’, are integrated into a behavioural intervention plan. Several of these situations have been videotaped and caregivers have viewed the videos and participated in individual interviews, to learn about their perspectives on the use of ‘simulated presence’ in the care of their family member. Results: Videotapes of care when ‘simulated presence’ is part of the intervention demonstrate engagement of the person and a reduction in unwanted behaviour. The impact on care providers is also evident. With simulated presence, the number of staff required to provide care has been observed to be fewer than without this intervention. Interviews with family reveal a variety of themes. While they may have doubts about their ability to contribute to care, or about the effectiveness of ‘simulated presence’ for their family member, they are eager to participate in finding solutions to reduce responsive behaviours. Over time, observing changes in their family member’s behaviour and feeling like their participation has an impact on client care, can be reassuring and rewarding. Conclusions: Simulated Presence therapy is an intervention which uses recordings of a client’s family members to be played during care or at other times when responsive behaviours occur. This can be a meaningful way to engage caregivers and to enhance care for persons with dementia. Consideration should be given to who may or may not be appropriate for such an approach, and future research is warranted to further explore this unique element of a person-centred approach to care for persons with dementia., Background: Assessment of quality of life (QoL) of long-term care (LTC) residents presents significant challenges. People with dementia (PwD) may be unable to comprehend information being sought, lack insight into their own experiences, and be unable to formulate responses that express their perceptions of their own QoL. Yet they have been shown to be able to respond to such questions. Further, the perspectives of people with higher levels of cognition may not be well-served by instruments based predominantly on observation of behaviours and non-verbal indicators. Evaluation of the outcomes of care measures and performance improvement interventions is therefore challenging. A method of reliable and valid assessment of QoL of LTC residents is needed that is responsive to changes in clinical status, clinically feasible, an indicator of quality of care and performance, and a valid research measure. Objective: To compare and contrast selected measures of QoL of LTC residents in people with cognitive impairment levels ranging from none to severe dementia. This pilot study assessed the feasibility of a proposed protocol. Method: Instruments validated to assess QoL in PwD were compared and contrasted for validity and feasibility across levels of cognition in LTC settings. Seven instruments were selected for further evaluation. Twelve resident/staff member dyads were randomly selected and stratified based on cognitive status of residents (unimpaired, mild, moderate, severe impairment). All seven tools were administered to staff members. Two instruments were designed to be administered directly to PwD. Mini-Mental State Examinations were administered to residents. Semi-structured interviews were conducted in which resident and staff member participants evaluated the instruments in terms of representativeness of their concepts of QoL, formats of instrument items, relevance, and clinical feasibility. Preliminary qualitative analysis (open coding) was conducted. Results: Internal instrument consistencies ranged from Cronbach’s α = 0.678–0.914 (one outlier 0.039). Further quantitative analysis will be conducted on the subsequent full sample. In interviews, residents and staff members reported that instruments addressed all relevant domains; no omissions were identified. Both residents and staff members asked for clarification of various items within the scales. Preferences were expressed for scales with emphasis on observable behaviours and simplicity. Number of response options was not a determining criterion. Discrepancies were identified between residents’ self-evaluations and staff evaluations. Duration of caregiver data collection ranged from 31–66 minutes for testing and 5–23 minutes for interviews. Duration of data collection with residents was 15–33 minutes and 3–12 minutes, respectively. Residents with no, mild, and moderate impairment were able to complete the two instruments administered directly to them; none of the three severely impaired residents was able to complete the instruments. Caregivers commented that they found the data collection process to be long. Conclusions: Findings validated the feasibility of the proposed methodology. The number of instruments was reduced. Understanding of concepts and use of instruments was problematic. No single instrument was deemed appropriate across the cognitive range. Preliminary findings identify the need for a simple instrument in language easily understood by residents and staff with clearly expressed items based on objective observation of behaviours., Background/objectives: Low socioeconomic status (SES) has consistently been shown to increase the risk of developing Alzheimer’s disease (AD) and other dementias. Not surprisingly, a few studies have also linked low SES with an increased risk of mild cognitive impairment (MCI), a brain syndrome that often precedes dementia. However, it is not known what the relationship of SES is to the initial clinical presentation to a memory disorders clinic. We hypothesized that lower SES can lead to delayed medical attention and disease diagnosis and greater clinical severity at time of diagnosis, and be associated with reduced use of cognitive enhancers. Methods: Data from 127 AD and 135 MCI patients seen at a memory disorders clinic based in a large urban centre were analyzed retrospectively. We examined the relationship between SES and 1) the diagnosis of either AD or MCI; 2) the age of patients when they present to clinic; 3) objective cognitive tests using the Mini-Mental State Exam (MMSE) and Behavioural Neurology Assessment (BNA) to indicate clinical severity; and 4) the use of cognitive enhancers in patients with AD. SES was measured using the Hollingshead 2-factor index of social position, which is a linear scale from 11 to 77 that incorporates educational and occupational attainments, and is negatively correlated with SES. Upper and middle class (scores of 11–43) were compared with lower class (scores of 44–77) individuals. Results: AD patients had significantly lower SES than MCI patients (p < .001). Low SES was also associated with a greater age at initial time of diagnosis (U = 6006.5, p = .027). Among patients with MCI, those with low SES performed worse on the BNA than their higher SES counterparts after correcting for age (high SES: 91.4 ± 10.8; low SES: 82.4 ± 14.1; p = .005), although there was no effect of SES on the less comprehensive MMSE. SES did not affect cognitive scores in patients with AD. Lastly, the use of cognitive enhancers among AD patients was associated with higher SES (p < .001, r = 0.842). Conclusions: Individuals with lower SES presented more frequently with established dementia, while higher SES individuals presented more frequently with MCI. This, combined with the greater age found among low SES individuals, could indicate that low SES may lead to delayed referral to memory disorders clinics and delayed diagnosis of AD. Furthermore, higher SES is associated with better cognitive functioning in MCI patients and increased use of cognitive enhancers in AD patients, possibly because low SES patients come in too late to benefit from treatment. This has broad health policy implications in terms of developing strategies to engage patients with low SES in the early stages of dementia, perhaps through better identification of patients at the primary care level., Background: Home oxygen therapy is prescribed to people with various health conditions including lung and heart diseases, such as Chronic Obstructive Pulmonary Disease (COPD) and heart failure. Managing the use of oxygen can be difficult in patients with dementia who have cognitive and functional losses. Hypoxia can exacerbate confusion and worsen behavioural symptoms. Patients with cognitive impairment often have great difficulty to learn and remember how to use unfamiliar oxygen equipment properly. Mortality and readmission rate are high in this group of patients. The burden of symptoms significantly affects quality of life and health status of patients and caregivers. Older people with dementia who have medical co-morbidities require careful attention to minimize behavioural consequences and improve quality of life. Clinical management of these patients differs from the younger population and care professionals must adjust their management strategies to accommodate their special needs. Aim: Despite the fact that provision of home oxygen therapy is required by some older adults with cognitive impairment or dementia, there is no literature which describes the specific challenges and offers guidance to the provision of oxygen therapy. This study aims to explore the main issues associated with preparing older patients going home with oxygen therapy by inquiring the care providers’ perspective. Method: A total of 10 participants, including Physician, Respiratory Therapist, Physiotherapists, Occupational Therapist, Nursing and Social Work, participated in two focus groups. The participants from one group work in a local community hospital; the others work in the community sector. The focus group discussions were one hour each. The discussions were audio-taped and transcribed verbatim. Thematic analysis was undertaken to identify important themes and subthemes to reveal the challenges and specific areas for improvement. Results: Three broad themes emerged as main issues associated with preparing patients going home with oxygen. The first theme, ‘Education’, explored subthemes of Knowledge, Resources, and Barriers. For care providers in hospital, knowledge of equipment available in the community is needed to select appropriate equipment to meet varying needs of patients. The biggest barrier is patient-related factors including decreased cognition, visual and physical deficits, and language barriers that affect the learning ability of patients. Under the second theme, ‘Safety’, there were subthemes that considered environmental challenges and equipment. Participants reported high risk for falls due to long oxygen tubing in their homes and the manoeuvring of equipment. Other hazards include smoking, fire risks with gas stoves, and inappropriate levels of oxygen. The third theme, ‘Discharge Process’, discussed the subthemes of team collaboration, time limit, and home oxygen assessment. Participants consistently highlighted the importance of effective communication of information about patient’s cognitive, physical, and functional abilities, as well as safety issues to community teams. Conclusion: This study demonstrates that there is a need to improve current processes in order to provide patient-centred, safe, and efficient home oxygen therapy to geriatric patients, particularly to the group with cognitive impairment/dementia. Careful attention and adaptations are required to meet the special needs of this vulnerable population., Background: Environmental interventions are an untapped source of therapeutic potential. Given the fact that we have a burgeoning older population with dementia in acute hospitals, there can be great patient benefits and potential cost savings of utilizing environmental strategies to promote safe recovery, reduce loss of function, and avoid adverse events. Older adults with dementia have decreased ability to cope with environmental stressors; they are more sensitive to the impacts of environmental features. Research suggests that an environment that is safe, warm, and familiar not only supports cognitive and functional needs of older people with dementia, but may also contribute to improving quality and safety of care in patients of all ages. However, research on effective environmental interventions in the acute setting to support patients with dementia is lacking. Aim: Our study aims to: 1) provide a review of the literature to identify relevant evidence-based environmental interventions that may contribute to positive experience in older adults in acute hospitals, and 2) investigate the physical environment of a geriatric psychiatry unit in a community hospital to understand how physical environment may play a role in meeting needs of patients with dementia or other mental health needs. Method: We conducted a focused ethnography method on a 16-bed geriatric psychiatry unit in a community hospital. We began with a review of literature, an environmental scan, and a survey of 18 staff from different disciplines, including nurses, occupational therapists, and care aides. These guided our subsequent focused observations and interviews with patients and families. The sample included 7 patients (four of whom were diagnosed with dementia and three with depression/schizoaffective disorder), and 4 family members. We used purposive sampling to ensure we had a variety of patients with different behavioural symptoms and functional and psychosocial needs. A thematic analysis was conducted. Results: Our results demonstrate that physical environment plays an important role in impacting the hospitalization experience of older adults with dementia or other mental health needs and their families. The four inter-related themes of environmental qualities central in promoting healing and coping are: therapeutic; supportive in functional independence; facilitative in social connections; and personal safety. Therapeutic means the unit offers pockets of home-like environment and provides quality sensory stimulations. Supportive of functional independence refers to the environmental features that make it easy for older adults to use the bathroom, wash, groom, mobilize, locate places/rooms, and store personal belongings. Facilitative of social connection indicates the provision of safe and comfortable social spaces for patient, family, and staff to interact/engage in meaningful activities. The feeling of personal safety involves having staff in close proximity and minimizing disruptions (e.g., physical or verbal) from confused patients. Conclusion: The evidence indicates that physical environment plays an important role in making hospitals safe and supportive of healing for older adults with dementia and other mental health needs. Patients’ and families’ perspectives provide us with a better understanding of current challenges of the hospital environment and assist in identifying specific priorities and interventions to make improvement., Background: Alzheimer’s disease (AD) and depression share many common pathological features — for example, decrease in the number of synapses. The synapse forms an important communication unit between neurons to maintain neuronal viability and sustain whole brain functioning. Actin is the main cytoskeleton that forms the architecture of the synapse. Polymerization and depolymerization of actin allow actin filaments to constantly remodel and maintain synaptic plasticity. Furthermore, synaptic vesicle proteins involved in the docking and fusion of the vesicles to the membranes allowing for neurotransmitter release, including synaptophysin and synaptotagmin, are also important in maintaining synaptic function. Abnormalities in synaptic and cytoskeletal proteins have been observed in both depression and AD. Objectives: To investigate morphological and protein changes in the synapse after treatments with oligomeric beta-amyloid and corticosterone. Methods: 14-day-old hippocampal primary-cultured neurons were treated with either oligomeric beta-amyloid or corticosterone separately for 24 or 48 hours. Neurons were transfected with beta-actin to observe synaptic morphological changes. Immunocytochemical analysis was used to investigate changes in the vesicle proteins synaptophysin and synaptotagmin in neurons. FM4-64 dye was used to investigate functional changes. All of the above were imaged by multiphoton microscopy. Results: After treatments with oligomeric beta-amyloid or corticosterone, changes in beta-actin morphology were observed. Rod shaped actin began to form within the cell body, and also along and at the ends of dendrites. Oligomeric beta-amyloid significantly reduced the expressions of synaptic vesicle proteins, whereas corticosterone induced aggregation of these proteins. FM4-64 dye showed that the function of the neurons was compromised; more specifically, exocytosis appeared to be abnormal in the amyloid- or corticosterone-treated synapses. Conclusions: Our results show that both oligomeric beta-amyloid and corticosterone affect presynaptic vesicle proteins, cytoskeletons, and neuronal functioning. This may help to explain the decrease in dendritic spine number and dendritic regression observed in depression and AD. Moreover, such resulting neurodysfunction likely forms the basis of cognitive impairment seen in depressed and demented individuals., Background/Objectives: It is well established that persons with Alzheimer’s disease and their family care partners may hold differing views on how the disease has impacted various aspects of their lives. For example, previous research has identified discrepancies in care partner/receiver perceptions of depression, diagnosis, pain, values and care preferences, quality of life, and everyday functioning. One domain that has not been closely examined, yet which contributes to all other aspects of daily functioning, is a person’s ability to communicate. The present exploratory study investigated family care partner/receiver perceptions of the care receiver’s communication abilities in daily life. Methods: Seven participant dyads (care partner/receiver) were interviewed separately using the CLIMAT interview scale. Questions were asked regarding the care receiver’s abilities across four major domains: Social, Everyday Functioning, Cognitive, and Behavioural. The care partner and receiver interview data were transcribed and imported into Atlas-ti for coding. Open coding was undertaken to identify participants’ recurring comments and themes related to language and communication abilities, such as word-finding difficulty, repeating oneself, comprehension, initiating conversation, and engaging in social interaction. These themes were further analyzed to determine whether there were discrepancies between the care partner’s and receiver’s perceptions of functioning in each domain. Results: The results indicate that discrepancies were most apparent in describing the care receiver’s abilities to have meaningful conversations about recent events and to engage in social interaction outside the home. The differing views reflected care receivers’ underestimation of the impact of AD on their communication functioning. Possible sources of the diverging care partner/receiver perceptions include awareness and/or protection of self and others, and attitudes about the functional impact of AD. Conclusions: The differing views of care partners and receivers point to the need for them to have more open and ongoing dialogue about changes in communication ability and their potential impact on interpersonal interactions and quality of social life., Background: Preventing falls among older adults remains a focus of health professionals. While fall prevention and injury reduction initiatives involve many excellent, evidence-based strategies, these same strategies are not always applicable within a dementia population. Recent trends at a geriatric hospital reveal an increase in falls with critical injury with clients who have dementia and also exhibit responsive behaviours. This relationship between falls and behaviour indicates a need to explore possible interventions aimed at this population specifically. Clients who exhibit responsive behaviour often have underlying neurological conditions which may make traditional falls prevention strategies ineffective, as they are not aimed at the strengths of the client. Methods: As part of a larger Falls Prevention Initiative, a geriatric hospital implemented a three-month pilot project on two specific units involving strategies that were developed with a focus on the unique characteristics of each population. On one behavioural dementia unit, two falls prevention strategies: consistent, universal provision of hip protectors and a visual tracking of falls and falls with critical injury, were implemented for a three-month period. Results: Preliminary results from this pilot indicate that there have been zero falls with critical injury during the three-month period, and the average rate of falls is no different from the average falls rate observed during the past year. A visual tracking system, located in a lounge area in front of the care station, has been available for staff, clients, and families to observe and follow. Different team members were required to take on the duty of tracking falls, encouraging interprofessional accountability. Use of hip protectors was offered to all clients; however, many barriers arose to limit family members and staff from continuously implementing wearing of hip protectors over the course of the pilot project. Some examples of barriers include hip protectors limiting clients’ abilities to toilet themselves, clients exhibiting behaviours which may limit the effectiveness of hip protectors (e.g., disrobing, fidgeting, etc.), and having hip protectors contribute to responsive behaviours (e.g., restlessness). Conclusions: The pilot project has so far been successful, in that there have been no falls with critical injury observed on the unit and the number of falls has been regularly below the annual average. Having one universal strategy (hip protectors) has not been sustainable on this unit, due to individual differences within the patient population. The visual management strategy has engaged staff and families. While there is a trend in the number of falls in people who exhibit responsive behaviours, falls strategies need to be individualized as this population is highly heterogeneous. Taking a team approach, including team conferences and implementing collaborative interventions, helps to minimize the risk associated with falls in this population., Background: Older adults identify themselves by what they do and the activities that structure their lives (Laliberte-Rudman D, et al. 1997). People with dementia maintain this need for engagement, but are often unable to communicate their needs. A lack of attention to individual care needs may trigger responsive behaviours. The lack of coordination between care settings may exacerbate client’s behaviours when they move between care settings (Coleman EA. 2003). Methods: A geriatric hospital aimed to identify critical components of a process and develop a prototype to ease care setting transitions of patients with severe cognitive impairment and behavioural issues. A pilot project on the behavioural neurology inpatient unit in collaboration with the hospital’s Innovation, Technology, and Design Lab explored use of video communication across care settings. To showcase six clients’ engagement to subsequent care providers, videos were created of each client, depicting personhood, behaviour mitigation, and approach to care. A participatory action framework, based on the knowledge to action cycle was utilized (Graham ID. 2006). Focus groups were held with care providers at the discharge destination. Results: A thematic analysis was completed by the behavioural neurology unit and the Innovation, Technology and Design Lab which revealed three themes: 1) Video communication is valued as a medium for sharing client information; 2) Communication needs to be catered towards the discharge destinations, considering workload, culture, and accessibility; and 3) Staff value preserving client identities, through maintaining daily routines, incorporating their life story, and building connections with clients. Conclusions: The current process and lack of individualized care plans leave clients with unmet needs and decreases engagement. Care facilities value video, so long as it is tailored to the needs of the care setting and highlights the shared goal of preserving the client’s occupational identity. Enhancing communication through video technology is one strategy to help ease care transitions and support continuous meaningful engagement. Next steps include activating a Cloud—a portal that will allow staff in other institutions to access client information securely and enable better communication across settings., Background: Apathy and depression, two of the most prevalent behavioural disturbances in Alzheimer’s disease (AD), often contribute to decline in quality of life for patients and their caregivers. Symptoms of apathy and depression may be difficult to assess, particularly as cognition deteriorates. Our team developed the Visual Attention Scanning Technology (VAST), an eye-tracker which enables real-time measurements of attention patterns towards competing visual stimuli. Previous results suggest that VAST has the ability to distinguish between depressed patients without dementia and healthy controls. Using VAST in the AD population for the first time, we explored an objective method of assessing symptoms of apathy and depression that does not rely on patient verbal skills or caregiver reports. Methods: This is a cross-sectional study of patients with mild to moderate AD (NINCDS-ADRDA criteria; Mini-Mental Status Examination, MMSE). Participants were screened for significant depression (DSM-IV-TR; Neuropsychiatric Inventory, NPI depression, and apathy (NPI apathy). On a computer screen, participants were presented a series of 16 slides, containing 4 images of different themes (2 neutral, 1 social, 1 dysphoric), interspersed with filler slides. Patients were allowed 10.5 seconds to view each slide for a total test time of 20 minutes. Interest was measured using the number of fixations within specific images on a slide. Groups were compared using analysis of variance (ANOVA) and associations were determined using Pearson correlation coefficients. Results: Of the 37 AD patients (19 females, age =77.1±8.7, MMSE = 22.1±3.5) included in this preliminary analysis, 19 had neuropsychiatric symptoms (NPS, 12 significant apathy, 7 significant depression) and 18 had neither of these symptoms (non-NPS). These patients had comparable age, though depressed patients scored lower on MMSE compared with apathetic and non-NPS patients. There was a significant difference in number of fixations on social images between groups (F2,34 = 4.01, p = .027); specifically, apathetic patients were less interested in social images compared with non-NPS. No statistical significance was found between groups for dysphoric images (F2,34 = 0.35, p = .707). Higher apathy scores on the NPI were significantly correlated with decreased number of fixations on social images (r = 0.42, p = .009, n = 37). Conclusions: These preliminary findings suggest that interest in social stimuli using VAST can distinguish AD patients with different behavioural disturbances and is associated with severity of apathy. The results of this study will begin the development of a non-invasive and novel objective tool for evaluating apathy and depression severity in AD, which might also be a useful biomarker for predicting and monitoring treatment response., Background: Cholinesterase inhibitors (ChEIs) are considered the first line treatment for symptoms of Alzheimer’s disease (AD). Despite their modest efficacy, lack of data regarding long-term use, and potential for side effects, patients with moderate to severe AD on ChEIs tend to remain on these medications for long periods of time and often until death. This warrants the investigation of predictors of response to discontinuation of ChEI therapy to determine if, and for whom, it is appropriate. Methods: Institutionalized patients with moderate to severe AD (Mini-Mental Status Exam 2 years ChEI use were randomized, double-blind to ChEI continuation or placebo (with 2-week taper) for 8 weeks. Vitals: weight (kg), Clinician’s Global Impression (CGI), neuropsychiatric symptoms (Neuropsychiatric Inventory/Nursing Home Version [NPI-NH]), cognition (Severe Impairment Battery [SIB] and the MMSE), and safety (standardized symptom checklist) were monitored biweekly. Demographic and clinical characteristics were investigated at baseline. Results: To date, 25 patients (72% male, mean age 87.9±3.0, mean MMSE 6.8±5.2, mean NPI 17.6±13.6, mean CGI 3.8±0.7 at baseline) have been enrolled. Based on un-blinded results, patients were classified into two groups to determine whether baseline measures of vitals (blood pressure, pulse rate), weight, cognition (MMSE and SIB), and behaviour (NPI) were objective predictors of change in CGI status. When patients were grouped based on CGI status at study endpoint, a total of 8 (32%) patients worsened, while 16 (64%) showed no change and 1 (4%) had improvement. Preliminary data indicates that vitals (χ2 (3) = 4.642, R2 = .169, p =.200), weight (χ2 (1) = .864, R2 = .034, p =.343), cognition (χ2 (2) =.586, R2 = .023, p =.746), and behaviour (χ2 (1) =1.239, R2 = .048, p =.266) were not associated with CGI change in binary logistic regression models. As well, there were no predictors of change in behaviour (NPI) and cognition (MMSE and SIB). Conclusion: Thus far, there have been no baseline predictors of worsening. Once the recruitment goal of 60 patients is met and study treatment allocation revealed, placebo and ChEI continuation groups will be compared and predictors of response will be determined. Further assessment of predictors of improvement following ChEI discontinuation will provide data for guidelines for ChEI discontinuation., Background: Gait and cognition are interrelated. However, it is still unknown if there is a “motor signature” associated with cognitive dysfunction. Previous studies assessing older people with normal cognition, mild cognitive impairment (MCI), and with dementia have found that executive dysfunction is consistently associated with a slower gait. However, associations between episodic memory dysfunction and gait performance are inconsistent, and it is unknown if memory dysfunction, which is cardinal sign in MCI, is specifically associated with the gait disturbances seen in MCI. Objective: To determine whether gait performance in older adults with MCI differs based on their cognitive subtyping classification: amnestic type (aMCI) or non-amnestic type (na-MCI). Methods: Older adults (≥ 65 years) with MCI from the “Gait and Brain Study” were included in this analysis. Global cognition was evaluated using the MMSE and the MoCA. Specific cognitive domains were evaluated using a battery of neurocognitive tests: Trail Making Tests A and B, Rey Auditory Verbal Learning Test, Digit Span Test, and Letter Number Sequence Test. Gait performance was evaluated with the GaitRITE mat under usual and dual-task walking conditions (walking while naming animals out loud and walking while doing serials subtractions by 7). Participants were divided in aMCI and naMCI based on their episodic memory assessment performance. The relationship between cognitive group (aMCI vs. na-MCI) and gait variables was evaluated with linear regression modeling. Results: Sixty-four participants, mean age 77±6 years and 57.6% female were included. Forty-three were aMCI and 21 were na-MCI. Groups were similar in age, co-morbidities, level of physical activity, and history of previous falls. aMCI participants walked slower than na-MCI (98.5 vs. 112.1 cm/sec, p < .001). Multivariable linear regression, adjusted for age, gender, and executive function, demonstrate the aMCI group was significantly associated with gait dysfunction under dual-task testing and had a higher gait variability (p < .001), indicative of a more unstable gait pattern. Conclusions: Memory dysfunction, specifically episodic memory impairment, was associated with poor gait performance, particularly under dual-task test conditions. Associations were maintained even after adjustments for potential confounders in the multivariate logistic regression. Our findings suggest that there is a motor signature in aMCI characterized by slowing gait under dual-tasking and higher variability, which seems to be independent of executive dysfunction., Background: Extensive research in behavioural neuroscience has established that the hippocampus and the medial temporal lobe (MTL) systems are required to form new long-term declarative memory until slow consolidation processes allow neocortical networks to represent memory independently. Sharon et al. (2011; PNAS) demonstrated an important exception to this well-established theory by showing that adults with severe MTL amnesia were able to acquire novel arbitrary associations through Fast Mapping (FM). During FM, the meaning of new words and concepts is inferred by exclusion, and durable novel associations are incidentally formed. FM is most apparent during early childhood’s exuberant learning phase, but is also available to adults. Age-related changes commonly involve explicit memory decline that is correlated with hippocampal dysfunction. FM has never been tested in older individuals or neurodegenerative disorders. Objectives: Examine older adults’ ability to learn through FM, and the impact of dementia on such learning. Methods: Healthy older adults (OA), mild cognitive impairment (MCI), and Alzheimer’s disease (AD) patients performed an FM task. On each trial, participants saw pictures of two items—an unknown (e.g., umbretta) and a well-known (e.g., duck) item. They had to make a perceptual decision (e.g., “Is the umbretta’s beak purple?”) that required an inference about the association between novel labels and novel items. Sixteen new items were incidentally encoded in this way. Memory was tested using a 3-alternative-choice associative recognition task after 10 minutes and again after 1 week. A matched Explicit Encoding (EE) task was also used in which participants were simply asked to “remember the Caracara”, and testing was the same. Results: Similar to previous studies with young and middle-aged adults, OA perform better on EE than FM, but in addition they displayed moderate reductions in FM performance. AD and MCI patients demonstrated equivalent performance to OA when tested after 10 minutes following FM encoding, despite significant impairment on the EE task. By contrast, when tested after a week, FM gains were lost in AD, but not in OA or MCI. Brain behaviour correlations in AD and MCI patients showed that EE scores were correlated with hippocampal volumes and with clinical tests of episodic memory. By contrast, FM scores were correlated with neocortical regions such as ATL and specific frontal and parietal regions, and with semantic memory tasks. Conclusions: Our study concurs with that of Sharon and colleagues, that MCI and AD patients were able to learn new associations through FM despite an impaired episodic memory system. However, AD patients also demonstrated accelerated forgetting over a week. Interestingly, the pattern of correlations with brain volumes suggests FM is less sensitive to hippocampal atrophy and more sensitive to anterior and posterior neocortical degeneration that is also part of AD. These findings are in line with previous patient research that demonstrated learning through FM depends on the ATL probably due to its role in representing semantic associative networks. The data are consistent with the idea that acquisition of semantic information through FM and EE rely on distinct neural systems., Background: Dementia is a major predictor of the need for long-term home care and becomes increasingly common with greater age. Retirement living is an alternative residential option available to seniors that offers some support (e.g., cleaning, cooking, medical support) but is independent of provincial health services. Retirement living may facilitate physical and social activity among older adults by reducing health, social, and environmental barriers. Since regular physical activity is associated with slower cognitive decline, an increase in physical activity in retirement living may slow cognitive decline with age. Objective: The objective of this study is to (1) quantify changes in physical activity over the transition from community living to retirement living, and (2) describe the association between these changes and cognitive function. Methods: Older adults living in and on the wait-lists for retirement living were recruited for this study. Physical activity was assessed objectively with a tri-axial actigraph activity monitor and was self-reported using the CHAMPS questionnaire. Cognitive function was assessed using the MoCA and a 30 minute cognitive battery based on the vascular cognitive impairment harmonization standards, which assess cognitive domains including memory, executive function, and attention. Current residents participated in one assessment in which they reported current and past (prior to retirement living) physical activity; current activity was objectively measured. Wait-list participants reported physical activity and had both physical activity and cognitive function measured prior to and after their transition to retirement living. Discussion: Physical activity in retirement living will be compared to physical activity in the community using paired t-tests. The relationship between physical activity changes and cognitive function will be assessed with correlational analysis. Results: Sixty-seven percent of current residents increased weekly participation in purposeful exercise (e.g., aerobic classes, use of fitness equipment in the facility, and walking groups). Four residents reported beginning purposeful exercise activities only after the transition to retirement living. Conversely, the frequency of physical activity related to activities of daily living decreased among all residents. At this time, 10 wait-list residents have completed pre-transition assessments and will have post-transition assessments completed in the fall. These results will also be presented at the Canadian Dementia Conference. Conclusion: This study investigates the impact of a residential choice and alternative health care option (retirement living) on physical activity patterns and cognitive function. It is possible that this alternative care model may improve physical activity and thereby decrease cognitive decline and dementia among older Canadians., Background: In 2038, there will be 257,800 new cases of Alzheimer’s disease or a related dementia in Canada, equaling 756 million hours of informal care, and a projected economic burden of $153 billion for that year (Rising Tide: The Impact of Dementia on Canadian Society, 2009). The aging of the Canadian population has heightened the potential environmental, social, and economic impacts on those with dementia. Objectives: This paper focuses on the relationship between individuals with dementia and their environments. Specifically, it concentrates on improving quality of life for those with dementia and increasing the capacity of the existing urban spaces through safety, sense of community, equality of access and opportunity, and enabling independence. Discussion: The impact of public spaces on those affected by dementia is often overlooked in the academic literature and, more seriously, in public policy formulation. To help address the shortage of material on dementia-friendly public spaces, a review of the literature on dementia-friendly communities is included to produce recommendations for “best practices” addressing dementia, with special emphasis on dementia-friendly public environments. The paper then employs Penny McCourt’s ‘Dementia Policy Lens Toolkit’ to assess the new ‘dementia-friendly’ approaches in York, England in the context of the identified “best practices”. Addressing the questions: “How can we make our urban public spaces more dementia-friendly?’’ and ‘’What are the health implications of ‘dementia-friendly’ urban spaces?’’, the paper concludes with recommendations on implementing these best-practices in Canadian settings., Background: Recent prospective studies have shown that high Aβ amyloid is associated with a faster rate of memory decline in healthy older adults and adults with mild cognitive impairment (MCI). However, because these studies were conducted over shorter durations (i.e., 18 months), longer prospective studies are required to determine if Aβ-related memory decline is unremitting. Methods: Healthy older adults (n = 177), and adults with MCI (n = 48) underwent positron emission tomography (PET) neuroimaging using Pittsburgh Compound B (PiB) for Aβ amyloid, APOE ε4 genotyping, and cognitive assessment using Cognigram as part of their baseline assessment in the Australian Imaging, Biomarkers, and Lifestyle (AIBL) study. Cognitive function was reassessed 18 and 36 months later. Results: Compared to healthy older adults with low Aβ amyloid, healthy older adults and adults with MCI with high Aβ amyloid showed a moderate decline across 36 months on the Cognigram learning working memory composite. In contrast, adults with MCI and low Aβ amyloid showed a slight improvement on the Cognigram learning/working memory and psychomotor/attention composites across the 36 months. APOE ε4 carriage did not moderate the relationship between Aβ amyloid and cognitive decline. Conclusions: The results of this study suggest that in healthy older adults, high Aβ amyloid most likely indicates that AD-related neurodegeneration has begun. They also support the hypothesis that adults with MCI and high Aβ amyloid is indicative of incipient AD, while MCI with low Aβ amyloid may reflect the presence of other neurodegenerative or psychiatric processes. Once commenced, the rate of decline in cognitive function remains constant across the preclinical and prodromal stages of AD. Finally, the results indicate the sensitivity of the Cognigram learning and working memory composite to the effects of Aβ amyloid in non-demented adults., Background: Prospective studies show that in healthy older adults and adults with mild cognitive impairment (MCI), high levels of Aβ amyloid are associated with cognitive decline and more rapid progression to the next clinical disease stage. However, as yet single cognitive assessments or cognitive screening has not been able to differentiate non-demented individuals with low and high Aβ amyloid. Methods: Healthy older adults (n = 288) and adults with amnestic MCI (n = 56) enrolled in the Australian Imaging, Biomarkers and Lifestyle (AIBL) study, underwent positron emission tomography (PET) neuroimaging using Pittsburgh Compound B (PiB) for Aβ amyloid, and completed the Cognigram cognitive screen. Results: In healthy adults, performance on the attention/psychomotor function (d = 0.16) and learning working memory (d = 0.23) composites were equivalent between low and high Aβ amyloid groups. In MCI, performance on the attention/psychomotor function composite was equivalent between low and high Aβ amyloid groups (d = 0.21); however, performance on the learning working memory composite was significantly worse in the MCI high amyloid group compared to the MCI low Aβ amyloid group (d = 0.69). Conclusions: The data indicate that in MCI high Aβ is associated with more severe impairment in learning and working memory. In MCI, Aβ amyloid levels do not influence attention and psychomotor function. In healthy adults, cognitive screening is not sensitive to elevated amyloid levels. These data suggest that prospective cognitive screening may be necessary to identify high Aβ amyloid in healthy adults. However, in MCI more severe memory impairment can indicate that Aβ amyloid levels are abnormally high., Introduction: The objective of this study was to determine the role of music in promoting an enhanced brain reserve capacity in Franz Schubert and Maurice Ravel, two professional musicians who suffered from neurological disorders. Methods: We consulted medical journals, reports, historical reviews, memoirs, and books written in English describing the life of each composer, the progression of their disease, and its effects on their musical faculties. Results: Schubert suffered from a brain infection, most likely tertiary syphilis. In 1822, he experienced hair loss, skin rashes, ulcers in the mouth and throat, bone pain, and headaches—all characteristics of second stage syphilis. During this time however, Schubert composed numerous pieces, including “Die Schöne Müllerin”, which was written while being treated in the hospital. In the final year of his life, Schubert’s disease progressed to a tertiary phase where his brain was affected, resulting in chronic headaches, dizziness, paranoia, memory deficits, and eventually delirium. Despite the cognitive and physical deterioration, Schubert’s musical composition output remained intact with the completion of his last three piano sonatas just weeks before his death. In fact, Schubert was reported to have made corrections to Part II of his piece “Winterreise” a day before he died. Likewise, Ravel first exhibited symptoms of primary progressive aphasia with underlying corticobasal degeneration as early as 1927, about the same time as he composed his famous work, Bolero. His motor and cognitive deterioration accelerated following 1932 due to a car accident. Like Schubert, despite the onset of his cognitive decline, Ravel composed numerous works including his last two piano sonatas from 1929–1931 and “Don Quichotte à Dulcinée” a year after his car accident. Although his apraxia restricted him from composing music into the last couple of years of his life, his memoirs explicitly indicate that his musical sensibility was preserved. In describing his opera, “Jeanne d’Arc”, he claimed to have had so much music rushing into his head, but no way of physically expressing it. Likewise, Ravel retained the ability to remember his own music and identified errors in the performance of his work by other musicians. Conclusion: The literature on the preservation of musical competency in famous artists affected by various brain diseases such as frontotemporal dementia and Alzheimer’s disease is supported by our review on the musical integrity in Schubert and Ravel. We raise the hypothesis that the neural pathways recruited in composing and understanding music at a professional level are separate from those used in daily activities. These networks are unique in that they are resistant to neurodegenerative diseases. Therefore, music may serve as another basis for enhanced brain reserve capacity in artists., Background: Behavioural and psychiatric symptoms of dementia (BPSD) may disable a patient from performing activities independently; the reverse may be true in that losing independence may affect mood and behaviour. The purpose of this study is to investigate the association between function and severity of neuropsychiatric disturbance in the context of dementia. Methods: We analyzed data from a longitudinal study of caregiver informants responding to the Functional Rating Scale (FRS), Clinical Dementia Rating Scale modified for frontotemporal dementia (CDR-FTLD), Frontal Behavioural Inventory (FBI), and Neuropsychiatric Inventory (NPI). Participants granted 2–3 telephone sessions separated by at least one year. We performed bivariate correlations for the FRS and CDR-FTLD against the behavioural inventories and compared patterns among 3 subtypes of dementia and Mild Cognitive Impairment (MCI) who converted to Alzheimer’s disease (AD). Results: The dataset includes 20 sessions regarding 9 MCI converters, 194 sessions for 94 AD patients, 63 sessions for 28 behavioural variant frontotemporal dementia (bvFTD) patients, and 32 sessions for 14 primary progressive aphasia (PPA). For the total sample, we found positive correlations for FRS and FBI: r from .682 to .870, p < .01; CDR-FTLD and FBI: r ranging from .734 to .876, p < .01; FRS and NPI: r from .425 to .605, p < .05; CDR-FTLD and NPI; r from .442 to .544, p < .05. Among diagnostic groups, MCI converters showed the highest r values for all pairings of 4 instruments. Conclusion: This study indicates links between functional ability and severity of neuropsychiatric symptoms across several types of cognitive impairment. Further study will explore causality in the association, as well as seeking the relative roles of additional covariates, such as educational level or duration of illness., Background: Neuropsychiatric symptoms (NPS) are common in patients with dementia including Alzheimer’s disease (AD), vascular dementia (VaD), and mixed AD and VaD. The most common NPS encountered in dementia are apathy, irritability, agitation, depression, delusions, hallucinations, anxiety, disinhibition, and eating abnormalities (Cummings JL; 1997). These symptoms contribute to patients’ distress, caregiver burden and institutionalization. Different neurode-generative diseases may be associated with certain NPS, thus impacting treatment and care. Moreover, frontal lobe injury is often associated with development of NPS (Damasio A. In: Clinical Neuropsychology. 1993; Oxford University Press). Objectives: The aim of this study was to compare NPS in patients with AD, VaD and mixed AD and VaD, and to evaluate the differences in incidence of NPS in relation to frontal white matter hyperintensities (WMH). Methods: This was a retrospective chart review of 510 patients who presented to the Toronto Western Hospital Memory Clinic with cognitive complaints. Ninety-three patients with AD (McKhann GM, et al.; 2011), 34 patients with VaD, unrelated to stroke (Gorelick PB, et al.; 2011), and 54 patients with mixed AD and VaD who had a Neuropsychiatric Inventory (Cummings JL; 1997) score or data on NPS were included in the study. Binary logistic regression was used to determine whether diagnosis was associated with specific NPS. Left and right frontal WMH on the FLAIR images were manually segmented and their volumes calculated. One-way ANOVA tests were used to determine the relationship between NPS and the volumes of frontal WMH. Results: There were no significant differences in gender, education or MMSE (AD 21.7; VaD 23.8; mixed 23.8) between patients with AD, VaD, and mixed, but there was a significant difference in age with mixed being older (mixed 82.3±6.6, AD 76.6±10.2; VaD 75.3±10.2; p < .01). NPS were common in all three diagnoses. Controlling for age, VaD patients had significantly more agitation (p < .05; VaD 40%, AD 14%), aberrant motor problems (p < .05; VaD 31%, AD 12%), and sleep disturbances (p < .05; VaD 57%, AD 17%) than AD patients, but not more than mixed AD and VaD. VaD patients had significantly more depression than patients with mixed AD and VaD (p < .01; VaD 48%, mixed AD and VaD 20%). Irrespective of diagnoses, there was significantly more left, right, and total frontal WMH in those with delusions compared with those without (p < .01; delusions 1/0 = 519.4 mm3/181.2 mm3; 525.0 mm3/180.6 mm3; 1044.4 mm3/362.0 mm3, respectively). There was also more left, right, and total frontal WMH in those with hallucinations compared with those without (p < .05; hallucinations 1/0 = 400.4 mm3/193.3 mm3;405.7 mm3/192.3 mm3; 806.1 mm3/385.7 mm3, respectively). No other NPS were associated with WMH. Conclusions: NPS were prevalent in AD, VaD, and mixed AD and VaD, but their frequencies varied amongst the different dementia causes. Agitation, depression, sleep disturbances, and aberrant motor behaviour were most prevalent in VaD. Volumetric analysis revealed significantly more left, right, and total frontal WMH in patients with delusions and hallucinations versus those without these NPS. These differences are likely related to underlying pathology and warrant further study, as they have implications for treatment., Background: The ongoing pilot implementation of remote monitoring devices for dementia patients is facing impending dangers. The government perceives the initiative as an IT-based therapy for complementing pharmaceutical and non-pharmaceutical therapies, while health policy formulators are promoting the initiative because of its usefulness for tracking dementia patients. However, misconceptions are building up by the families of dementia patients and carers who will administer the surveillance therapy whenever it goes live regarding its compliance with best clinical practices in the areas of legal, data sharing, privacy, and security issues. Usually, experience shows that lack of acceptability and design flaws are central to the failures of most health service initiatives at the implementation and post-implementation stages over the years. Therefore, this paper investigates the aforementioned issues from the perspectives of families of dementia patients and carers. The results obtained suggest strategies for improving the success of the remote surveillance initiatives after implementation. Objectives: This study examined the perspectives of families of dementia patients and carers on resiliency, privacy, legal, and security of smart devices for tracking dementia patients. Tracking of vulnerable patients involves police and ambulance system. Thus, this study further seeks to proffer strategies for reducing the growing cost of managing dementia patients. Method: Thirty-six mental health and admiral nurses in UK and abroad participated in the survey. We introduce smart devices to them as knowledge-based systems for tracking dementia patients who are vulnerable to self-discharge. The inclusion and exclusion criteria are respondents that have experiences with patients officially diagnosed for early-onset dementia or late-onset dementia and with the following three characteristics: 1) acute dementia patients (ADP) are disorientated and confused patients, vulnerable to wandering, lost or putting family members, friends and carers into distress situations; 2) strong-minded dementia patients (SDP) are aggressive patients who discharge themselves against medical advices without referring to Mental Health Review Tribunal (MHRT) or certified by doctors; 3) isolated dementia patients (ISP) are patients that live alone and take care of themselves without recourse to relatives, friends or carers. Results: The degree of resiliency of smart devices if they are suddenly compromised by hackers is unanimous affirmed as an important issue to be investigated thoroughly. The results demonstrate that 86.10% of participants agree that some of the information regarding the patients can be adapted to many uses, while 44.40% believe that smart devices may have false positives detection rate. The results reveal correlations between IT-based therapy and continuous training, while 50.40% say patient’s health records are indirectly transferred to vendors of smart devices to manage. Conclusions: Continuous education and development of operational policies to cover privacy and security issues in the administration of smart devices are strategies to improve perceptions of mental health nurse, carers, and families. There is need to strengthen mental health laws to protect carers who will generally administer IT-based therapies. Unlawful accessibility to the devices and alerts they generate must be prevented using suitable Intrusion Detection and Prevention Procedures (IDPP) in accordance with best clinical standards., Background: The discovery of dementia sickness which often results into sudden declination or deterioration in the memory functionality and social functions of affected persons is a central problem in the social health-care services over the years. Several research findings have supported doll therapy in a recent decade. However, the methodology for applying doll therapy suffers moral criticisms in social care setting across the globe despite the benefits that are associated with the therapy whenever it is compared with pharmaceutical interventions. Firstly, critics are of the view that modelling specially loved personalities in the form of pets are deliberate attempts to reduce the dignity, worth, efforts, and invaluable contributions that the affected patients have done to the society during their active years. Secondly, conventional doll therapy is seen as dehumanizing and harmful to the mind of aspiring and productive youths. Thirdly, doll therapy is applied in fragments to patients without compliance to the best clinical practices. Consequently, this study proposes automated doll therapy for treating dementia patients in order to lessen the above issues. The results show that automated doll therapy has positive effects on society, patients, families, friends, and carers of dementia patients. Further analysis suggests that automated doll therapy is compliance to best clinical practices. Objective: The study reviews methodology for applying doll therapy against best clinical practices. Method: Thirty-four mental health practitioners, and 26 friends and family members of dementia patients volunteered to participate in the survey. The sample population were selected based on their experiences in in-patient wards in North, East, West or South of England. Participants were exposed to methods, strengths, and weaknesses of conventional and computer aided devices (CAD) methods for applying dolls to a group of dementia patients in a multimedia room within an in-patient. Thereafter, participants were interviewed on their perceptions on both methods. Their responses transcribed immediately. The perceptions of the respondents were repeated clarifications to improve data reliability and validity, and the results obtained were statistically analyzed. Results: Analysis of the results underpinned four hypotheses: 1) The perception that automated doll therapy will be better than the conventional method for managing dementia patients is high; 2) Automated doll therapy shows possibility of stabilizing emotions of patients with mild dementia problems to a certain degree; 3) Automated doll therapy suggests potential improvements in the perceptions of families, friends, and carers of dementia patients; 4) Automated doll therapy suggests positive impacts on social interactions among dementia patients in all age range of dementia patients. Conclusions: This survey suggests strategy for improving the efficacy and perception of families, friends, and carers of dementia patients on doll therapy irrespective of the ages of the patients. More so, 73.33% of the population sample agree that automated doll therapy is indicative of compliance to best clinical practices for treating dementia patients. Approximately 58.33% of the respondents elaborate health and safety issues, maintenance cost, training, and suitable space to set up a media room to implement the therapy as major barriers to the implementation of this framework., Background: Selective attention, the ability to maintain mental focus, declines across normal aging. This decline is exaggerated in Alzheimer’s disease (AD), which is reflected by increased reaction times and error rates on the Stroop task, a classic measure of selective attention. While it has been well established that impairment in selective attention is a common symptom of AD, often occurring early on in the disease, the neural correlates underlying these deficits remain elusive. The default mode network (DMN), a collection of functionally related brain areas, normally exhibits task-induced deactivation. However, this pattern of activation is altered in AD. We hypothesized that less DMN deactivation may contribute to errors in selective attention, especially in the AD group. Methods: Using an event-related Stroop task in a functional MRI paradigm, we tested 10 patients with mild Alzheimer’s disease (mean age 73.9±8.4) and 10 healthy elderly (HC) (mean age 63.6±7.8). To analyze failures of selective attention, we assessed the differences in neural activity preceding an incongruent error between HC and AD. Results: The AD group had significantly slower reaction time for incongruent stimuli compared to the HC group t(18) = −3.85, p < .05. The AD group also made significantly more incongruent errors than the HC group t(18) = −2.98, p < .05. The HC group showed greater activation in the left anterior cingulated cortex (ACC), left precuneus, left superior frontal gyrus, bilateral middle frontal gyrus, and right insula, all of which have been previously implicated in the Stroop task. In contrast, the AD group showed greater activity in more parietal and posterior regions, including the right lingual gyrus, right superior parietal lobule, and right inferior parietal lobule. Interestingly, the AD group also showed significant activity in the ACC and precuneus; however, this activity was lateralized to the right. Furthermore, the ACC activity in the AD group was more inferior compared to the HC group, and the precuneus activity was more superior to the HC group. Conclusions: While it is not surprising that the ACC was activated in both groups since its involvement in conflict detection, activation of different areas within these relatively large structures suggests that the ACC and precuneus are differentially affected by the disease. Thus the AD group showed more default mode network activity and the HC group showed more frontal activity preceding errors in the Stroop task. This result suggests that the neural correlates underlying errors of selective attention are different in AD than in HC., Background: Attentional lapses can occur on a daily basis and disrupt the completion of goal-oriented tasks. While the neural correlates of attentional lapses have been studied in young adults, it is unclear whether the mechanisms behind this phenomenon change with age. Methods: We scanned healthy young (n = 12) and older (n = 28) adults with functional magnetic resonance imaging while participants performed a trial-by-trial attention task, the Stroop task, where we measured the response time to each stimulus. We defined an attentional lapse as a longer response time relative to the average response time, and a fast reaction as a faster response time relative to the average. Results: Young and older adults performed equivalently on all behavioural measures, such as reaction time and accuracy (both p > .05). We found parietal regions in the default mode network, including the precuneus and inferior and superior parietal lobules, exhibited greater activity as reaction time to stimuli increased. Compared to fast reactions, attentional lapses were preceded by decreased activity in frontal attentional regions, including the anterior cingulate and inferior, middle, medial, and superior frontal gyri (all p < .05). These frontal areas also displayed significantly greater post-stimulus activity during attentional lapses compared to faster responses, potentially as a mechanism to recover from the initial lapse of attention. Older adults displayed reaction time-modulated activity in a greater number of frontal cortices and in more dorsal default mode regions, relative to young adults. Conclusions: Our results support previous research that activity in frontal and parietal regions of the attentional and default mode networks contribute to lapses of attention. Our results also suggest that the neural correlates of attentional lapses change with healthy aging, reinforcing the idea of functional plasticity to maintain high cognitive function throughout the lifespan., Objective: We investigated the relationship between the precuneus volumes (a component of the Default Mode Network or DMN) and cognitive scores, including scores of verbal memory, in older and younger adults to assess possible functional differences among age groups. Methods: A high-resolution anatomical scan was acquired with a T1-weighted, 3D MP-RAGE sequence in 30 older adults (21 cognitively normal and 9 patients with mild cognitive impairment or MCI); mean age 71.5 years and in 12 younger adults, mean age 23 years. Full cognitive testing had been administered to all subjects within 1–3 weeks of the MRI. The cognitive testing included the California Verbal Learning Test (CVLT), the Montreal Cognitive Assessment (MoCA), the Mini-Mental State Exam (MMSE), and the Stroop test. Manual precuneus segmentation followed previously described anatomical guidelines, marked in the sagittal plane and then segmented in the coronal plane. Precuneus volumes were normalized by total intracranial volume (ICV). Pearson correlations were used to analyze the relation between precuneus volumes and cognitive scores. Results: Patients with MCI had significantly lower cognitive scores and precuneus volumes compared to the cognitively normal older control group and to the younger group. Among the 30 older participants there were highly significant correlations between the right precuneus and the CVLT short and long delay free and cued recall scores (SDFR r = 0.636, p < .0001; SDCR r = 0.593, p < .001; LDFR r = 0.551, p < .005; LDCR r = 0.634, p < .0001), and with the CVLT Learning Slope (LS) (r = 0.67, p < .0001). The left precuneus correlated only with the CVLT LS (r = 0.49, p < .01). There were also significant correlations between the Stroop, MoCA, and MMSE scores and the right and left precuneus volumes (p < .01 to p < .0001) among the older population, but there was no correlation between precuneus volumes and any of the cognitive scores in the younger population. Conclusions: The volume of the right precuneus appears to be related to scores of verbal memory in older adults but not in younger adults. Selective attention and scores of general cognitive function are also related to right and left precuneus volumes in older adults but not in younger adults. This may explain lack of deactivation of the precuneus during task performance among older adults., Background: We wanted to investigate whether amateur musical training and leisure playing can protect Alzheimer’s patients from degenerating their episodic memory for music, and to compare these effects with the deficits produced by Alzheimer’s disease (AD) using conventional memory measures. Methods: We recruited an amateur piano player with a 10-year history of studying music and the DSM IV diagnosis of probable AD. The patient was visited at his home each day for a week to conduct logical memory testing, as well as episodic memory testing specific to music. The logical memory section from the Wechsler Test was conducted at 1 and 15 minutes. Similarly, the patient was first shown the piece “A Winter Scene” and asked to sight-read the first 8 bars and then play the 8 bars with both hands from memory at 1 and 15 minutes. Results: The patient’s performance on the memory test was very poor at onset and showed no improvement over the course of the study. His ability to sight-read the 8 bars of music on the first day was intact and accurate. His immediate recall of the music on the first day showed accurate performance of the first 3–4 bars of music with notes played in both hands. From the second to the fifth day, the patient demonstrated difficulties remembering the melody line, especially in the left hand. The patient, however, was able to recall the right hand melody for the first 3–4 bars correctly on most days. Despite minimal improvements within the first five days, the patient’s performance on the sixth and seventh days reveals nominal improvements in musical expression. On the sixth day, he was able to recall four full bars of music with no errors in the right hand. On the last day, he accurately performed the four bars with both hands for the first time. Even when playing incorrectly, the patient remained within the music’s A-minor key. Conclusion: Our case study reveals differences in the way AD affects logical memory and episodic memory for music. The patient had deteriorated in logical memory, but was able to retain musical literacy, memory of music, music sensibility and, most importantly, the ability to learn music after repeated trials. Like our previous work on professional artists, our findings here suggest that exposure to music training and performance at an amateur level can preserve the brain’s memory networks involved in musical expression when faced with neurodegenerative disease., Background: Dementia is a highly prevalent condition among elderly residents in long-term care (LTC) facilities. BPSD can significantly increase both residents’ mortality risk and the burden on the health-care system. A large body of research has identified the importance of BPSD in the management of dementia in LTC. Yet very few studies have assessed the prevalence of BPSD in LTC as a function of the time of day during which symptoms are evaluated (i.e., day vs. evening vs. night). This is an important knowledge gap to be addressed, given that some symptoms may occur more frequently at or after dusk than during daylight hours, and that their emergence at a specific time of day may be associated with different risk factors. Objectives: To characterize and compare the prevalence of BPSD in a LTC setting as evaluated by front-line staff who work during the day, evening, and night shifts. Methods: As part of a larger study examining BPSD prevalence and incidence, we assessed neuropsychiatric symptoms of LTC residents over a 3-month period. Frequency and severity of symptoms over a 2-week window were assessed using the Neuropsychiatric Inventory Nursing Home Version (NPI-NH) during the day shift (07:00–15:00), the evening shift (15:00–23:00), and at night (23:00–07:00). The Cohen-Mansfield Agitation Inventory and the Pain Assessment Checklist for Seniors with Limited Ability to Communicate were also administered for all study residents. Results: A total of 72 residents were evaluated: 56 during the day, 44 during the evening, and 46 at night. Twenty-three residents were evaluated by staff from all three shifts, 24 by staff from two shifts and 25 by staff from one shift only. The prevalence of BPSD was 62.5% during the day, 68.2% during the evening, and 39.1% at night. Among residents who were awake at night, the proportion exhibiting BPSD was 50%. The percentage of residents identified as having more than 4 clinically significant BPSD symptoms increased significantly from 10.7% during the day to 34.1% in the evening (χ2 = 8.12, df = 1, p = .004), a possible indication of sundown syndrome. Agitation/aggression and irritability were the most frequently reported BPSD by all shifts, whereas apathy, anxiety, and sleep dysregulation were more frequently reported during the day, evening, and night, respectively. Conclusions: Our findings are consistent with data reported in previous studies which found BPSD prevalence in LTC as being above 60%, with agitation/aggression and irritability being the most common symptoms. We found evidence of an increased BSPD symptom load during the evening (sundowning) as compared with daytime, and a decrease in BPSD prevalence at night. Our results highlight the importance of considering the time of day during which BPSD symptoms are evaluated in LTC residents., Background: Older adults diagnosed with mild cognitive impairment (MCI) are considered as a high-risk population for progression to Alzheimer’s Dementia (AD) (e.g., Gauthier et al.; 2006), with a high conversion rate to AD (Chertkow et al.; 2008, Defranceso et al.; 2010)—up to 80%, within five years (Peterson et al.; 2004). Memory clinics in Canada offer clinical research trials to evaluate innovative treatment options, with a hope to ameliorate and/or delay disease progression from MCI to dementia. Multi-component cognitive training studies for MCI have yielded interesting results (e.g., Cipriani et al.; 2006, Talassi et al.; 2007, Rozzini et al.; 2007). One such promising technique was developed and validated by Belleville and colleagues (2006; MEMO program) for improving episodic memory function, subjective memory rating, and self-rating of well-being in amnestic MCI (aMCI) patients. Objective: Our study aimed to replicate the results of Belleville and colleagues (2006) with some modifications: 1) a bigger sample size, 2) inclusion of a wider range of MCI sub-types (not only aMCI), 3) inclusion of a Lifestyle Training control group to account for placebo effects and the impact of psychosocial interactions on cognition, and 4) the use objective primary outcome variables from CANTAB (Cambridge Neuropsychological Test Automated Battery) and neuropsychological tests. Methods: We conducted a pseudo-randomized clinical trial in which a treatment group (TR, N = 24, male =9) and a life-style training control group (Control, N = 20, male = 10) underwent a combined Relaxation/Tai Chi Therapy training for 3 weeks and a 6-week training using a modified MEMO method, while the Control group received 6 weeks’ health and lifestyle training program (e.g., discussing factors contributing to diabetes, the importance of exercise, how to prevent falls). All participants were older Francophone adults (age = 69.23±8.78 years, education = 15.50±4.34 years) referred to DMHUI Memory Clinic and having a diagnosis of one of the four subtypes of MCI. Significant medical, psychiatric, neurological or cognitive co-morbidities were ruled out. Participants were tested before and after intervention with cognitive screeners, computerized cognitive tasks, neuropsychological testing, and questionnaires about mood and subjective judgment of memory. Results: Preliminary results on Repeated Measure ANOVA controlling for age and education indicate a significant treatment (pre/post) effect (F(1,40) = 4.22; p =.047) and an age-by-treatment interaction (F(1,40) = 5.55; p =.023) on the CANTAB Short Reaction Time. A tendency towards a reduced number of errors (F(1, 3) = 2.99; p =.093) and improved strategy use (F(1,33) = 2.618; p =.115) was observed in the TR vs. Control group for the CANTAB Spatial Working Memory test. No effects were found on CANTAB Paired Associate Learning first trial memory score, Paired Associate Learning total errors, and Short Reaction Time Accuracy, or on formal neuropsychological testing of attention and memory, MMSE, MoCA, Squire Subjective Memory Questionnaire, mood, and self-esteem scales, when controlling for age and education. Feasibility and clinical implications will be discussed. Final results will inform about the effect of cognitive remediation and help determine best practice in the care of MCI patients., Background: Older persons with advanced Alzheimer’s disease or related disorders (ADR) receive numerous medications to treat an average of 21 health conditions. This is problematic given that the likelihood of drug–drug interactions and adverse drug events increase with the number of medications prescribed. Emergence of symptoms such as agitation, depression, constipation, and pain may in fact be due to adverse events caused by medications originally prescribed for the purposes of long-term prevention strategies. However, as ADR progresses, the objectives of care should shift from a curative to a palliative approach, and medication regimens should be revised and adjusted to reflect this change. There is limited research providing evidence with regard to the risk-benefit profiles of many medications for this specific patient population. Research evaluating interventions in which medication profiles are reviewed and adjusted in ADR patients is even more lacking, thereby underlining the need for new evidence-based guidance. Objectives: A scoping review of the literature and an ensuing Delphi panel were conducted to answer the following questions: 1. What criteria exist to determine whether a medication is still appropriate in patients with advanced ADR? 2. Which medications may be considered inappropriate for these patients? 3. Do interventions to optimize medication use in these patients currently exist? Methods: Phase I consisted of a scoping review (NICE, Cochrane Collaboration, Arksey and Levac). Thirteen scientific databases and websites of scientific and gray literature were searched in order to select articles for inclusion using an iterative process. Identified studies were analyzed by two independent reviewers. Studies were included if they were a guideline, review or a primary study, focusing on patients with ADR, at end-of-life, or the elderly, in either a palliative care, long-term care facility (LTCF), or unspecified setting. Letters, editorials, meeting abstracts or studies taking place in a hospital or ambulatory setting were excluded. In Phase II, a Delphi panel following the RAND approach sought consensus from 15 expert clinicians (family physicians, geriatricians, nurses, pharmacists, social workers, and an ethicist) to identify medications deemed inappropriate within the Quebec clinical care context. Interventions judged as promising and applicable were also identified. Results: The search strategy identified 6,186 references, of which 356 were retained after double screening. Forty articles were identified as being specifically relevant to the research questions at hand, among which 25 intervention studies provided evidence of small but significant reductions in potentially inappropriate medications, adverse events or medication load without associated consequences to morbidity or mortality. The Delphi panel produced three lists of medications: medications always appropriate, medications mostly appropriate, and medications rarely appropriate in these patients. The panel also identified promising key elements of a complex intervention to optimize medication use in this patient population. Conclusion: Medications frequently prescribed for patients with advanced ADR in LTCFs were categorized as being either always, mostly or rarely appropriate. Several key elements of multidisciplinary interventions involving patients, families, and care teams appear promising for improving medication use among this vulnerable patient population: a pilot study for such an intervention is under way., Background/Objective: Psychotic symptoms in dementia are associated with several negative outcomes, such as earlier institutionalization and increased caregiver stress. Most studies of psychosis in dementia have involved patients with moderate to severe cognitive impairment. Few have examined development of psychotic symptoms in patients who were non-psychotic at baseline. Knowledge of psychosis risk factors at the mild cognitive impairment or early dementia stage is important for understanding the mechanisms underlying psychosis in dementia, and for developing effective prevention and treatment strategies. Our objective was to examine factors associated with the development of delusions and hallucinations in a large sample of patients with an initial diagnosis of amnestic mild cognitive impairment (aMCI, CDR = 0.5) or early stage probable Alzheimer’s disease (AD, CDR = 1.0) who were non-psychotic at baseline. Methods: ADNI data for participants with aMCI (n = 397) or AD (n = 193) at baseline were examined. Individuals with psychosis at baseline were excluded, as were those who developed both delusions and hallucinations as their initial presentation of psychosis, resulting in a sample of 473 never psychotic and 79 who developed delusions (n = 56) or hallucinations (n = 23) as their initial psychotic symptom. The presence of delusions and hallucinations was ascertained from informant ratings on the Neuro-psychiatric Inventory Questionnaire (NPI-Q). Patients with/without delusions or hallucinations were compared with respect to demographic, genetic, and vascular risk factors (history of hypertension, baseline smoking) using chi-squared tests and t-tests. Results: A small minority of participants with an initial diagnosis of aMCI developed psychosis. Most of these (55.8%) had progressed to AD by the visit at which symptoms were first reported, with onset of psychosis typically occurring more than 6 months after dementia diagnosis (7.5 months for delusions, 13.2 months for hallucinations). In the combined aMCI/AD sample, more patients developed delusions (10.1%) than hallucinations (4.2%). Age, race (white vs. non-white), gender, baseline smoking status, history of stroke, and presence or number of ApoE-E4 alleles were unrelated to development of psychosis. Having a history of hypertension was associated with development of delusions, while patients who developed hallucinations had a lower level of education and lower baseline MMSE score (p < .05). Conclusions: Psychotic symptoms affect a significant minority of patients with early-stage AD. Hypertension was identified as a potentially modifiable risk factor for delusions in dementia. Participants who developed hallucinations had less education than those who were never psychotic, although the average person in both groups had some post-secondary schooling. Lower education is well-recognized as a risk factor for dementia in general, but the possibility of a relationship to hallucinations requires further evaluation. The finding of differing risk factors for delusions and hallucinations suggests that dementia with psychosis is not a unitary construct, and future studies should examine these symptoms separately., Background: The treatment and care methods used for Alzheimer’s disease (AD) operate within the perceptions of our culture; thus, developing care models for AD individuals is influenced by popular language and attitudes. Critical reflection of our culture and its influences unveils how it impacts beliefs and behaviours; from a health perspective, cultural biases could translate into certain diagnoses and treatment options prescribed by practitioners. Negative misconceptions about people with AD cause unhelpful behaviours that focus on the symptoms of dementia rather than the remaining abilities of the people affected. These misconceptions are reflected in the language associated with AD, which is consistent with the terminology used for “zombies” in media, reflecting our society’s negative views of aging with memory loss. This association is important since 81% of adult Canadians felt they would be treated and viewed differently if others knew they had received an AD diagnosis (Werner & Davidson; 2004). Objectives: This paper explores how references to zombies may limit care in North America by framing an individual as ‘dead’ rather than building upon treatments involving social approaches. This paper does not intend to imply causality, rather to associate the perception of AD individuals as zombified with the dominant care approach in North America. In contrast, Danish perceptions driving care are documented to highlight differing perspectives. Methods: Conducting a review of the zombie trope, its impact on stigma, identity, and care of those with AD, it was it was found that the ‘living-dead’ language was thematic throughout both lay and academic literature. Some examples that illustrate this theme include ‘living dead,’ ‘undead,’ and ‘death in slow motion’. Using this zombie language is not conducive to improving quality of life for those with AD. Results: Though attention for AD is increasing, it often propels a negative view through terms such as ‘living-death’. The presentation of AD in this way focuses on the fear of falling ill, rather than on the way persons with dementia are making the best of their abilities. The ‘living-death’ stigma correlates with the inhibition of developing social care approaches to AD treatment. Unfamiliarity and lack of knowledge incite fear about the illness, and if AD is continuously pushed away with negative stereotyping, we may never truly hear the voices of those with AD. The ‘living-dead’ perception of AD requires scrutiny because this popularised assumption shapes views, and continues to burden current AD practices despite the changes that we see occurring; discrimination and dehumanisation still need to be challenged. Conclusions: Treatment of dementia varies around the world, and through this exploration I propose that being reflective of our perceptions can lead to better quality of care for those with AD. All individuals exist within a dynamic web of relationships that form who we are and how we behave in the world; awareness of this interconnection reveals how our culture impacts AD., Background: The cognitive and neuropsychiatric symptoms associated with Parkinson’s disease dementia (PDD) and dementia with Lewy bodies (DLB), collectively known as Lewy Body Disease (LBD), are primarily treated with cholinesterase inhibitors (ChEIs). However, there is significant variability in adverse effects and response among LBD patients taking ChEIs. Objectives: To examine the efficacy of ChEIs in treating cognitive and neuropsychiatric symptoms of LBD longitudinally using brain perfusion SPECT. Methods: 53 patients diagnosed with PDD or DLB according to standard criteria were initiated on ChEI therapy and prospectively assessed for efficacy and adverse effects. A standardized neuropsychological battery, the Neuropsychiatric Inventory (NPI), and brain ECD-SPECT were ascertained at baseline (no treatment) and at 24 weeks. A repeated measures ANOVA design was used to determine change over time in these measures. Results: LBD patients treated with ChEIs showed significant improvements in visuospatial, attention, and phonemic fluency tasks (p < .05). They also showed significant reductions in the frequency and severity of visual hallucinations as assessed by the NPI-hallucinations subscale (NPI-HS; p < .05). Furthermore, as visual hallucinations diminished, perfusion in the right occipital lobe increased (r = −0.460, p < .05). Preliminary genetic analysis of the butyrylcholinesterase K-variant was not associated with response. Conclusions: Treatment with ChEIs was found to be effective in reducing visual hallucinations and improving cognitive function. The negative correlation found above suggests that perfusion in the occipital region could be developed as a bio-marker for use in distinguishing between LBD responders and non-responders to ChEIs in terms of visual hallucinations., Background: Retirement/residential homes (RHs) are a generally underappreciated component of the health-care system. A prevalence of > 70% dementia is recognized in long-term care homes, but the prevalence in RHs has not been established. The average age in both types of homes is approximately 86, and chronic geriatric conditions are common in both. In Ottawa, Ontario there are far more RH places (8,500) than long-term care beds (5,500). A previous study in an Ottawa RH showed recognized dementia in 40% and dementia screening was positive in an additional 32%. This study in the Prince of Wales Manor (POW) goes one step further in that specially trained nurses did a comprehensive cognitive assessment and, with geriatrician review, a diagnosis of normal cognition, mild cognitive impairment (MCI) or dementia was established. Methods: After resident/family consent,73 POW residents underwent: 1) chart review to establish residents with a diagnosis of MCI or dementia; 2) screening (Cognitive Quickscreen:CGS) of all residents without a diagnosis of MCI or dementia (the CQS was three-item: recall, clock drawing, and animal fluency); 3) cognitive assessment for those failing the CGS by trained nurse assessors (see assessment guide); and 4) diagnostic review by a geriatrician and resident attending physician to establish a cognitive diagnosis. Results: Chart review showed 30 residents with dementia (41%), 2 residents with MCI (3%), and 41 residents with neither (56%). The CQS results in the 41 remaining residents revealed 73% failure, 12% pass in all 3 items, and 15% refusal. The 30 residents failing the CQS and the 2 residents with MCI had comprehensive cognitive assessment, and provisional diagnoses were that 15 residents had dementia (22% of the original sample of 73 residents minus the 6 refusers). Additionally, 8 residents were felt to have MCI. Overall 45 of 67 residents (67%) were felt to have dementia, 8 (12%) had MCI, and only 14 (21%) were felt to be cognitively normal. Conclusions: Retirement/residential homes have a very high prevalence of dementia (67% in this study) with approximately 1 out of every 3 cases of dementia being unrecognized (15 out of 45 total). A cognitive screening and assessment program using a structured dementia assessment guide can be utilized in a time- and resource-efficient manner to address this important health-care issue. RH residents without a diagnosis of dementia or MCI should be screened for dementia at admission and regularly after admission., Background: The time required to complete a comprehensive geriatric assessment is significant, and the demand for specialized geriatric services is increasing through the current demographic shift in the Canadian population. Within a specialized memory clinic, more time is required to dictate detailed comprehensive geriatric assessment clinic visit reports. A timely report to the hospital electronic record is an essential element of good specialist care. To reduce report production time, an innovative solution was designed and implemented in the clinic’s new longitudinal research registry and documentation system. A novel approach to the automatic generation of a smart narrated synoptic report was developed allowing for reports to be autopopulated with the required patient data. Methods: Using computer-programming semantics, a report template was created for the initial assessment. The smart report template employed the use of algorithms to determine: 1) what clinical information will be reported; 2) whether the report will be in short or long form; 3) the specific places in the report where information from the clinical database would be injected; and 4) how the information is visually presented in the report. The wording generated in the smart report is determined through the logical analysis of the patient data collected. For example, depending on the context of the pronoun use, the gender (male/female) stored in the database indicates which version of the pronoun should be used. Results: These reporting algorithms can potentially have various steps of decision-making, or nodes, each with increasing complexity. When using a smart report template to generate a clinic report, each algorithm in the report is automatically evaluated by the system. The generated report shows the cumulative results from the algorithms as a complete, finished report. The user is presented with an automatically generated report that can then be modified and customized to meet any special needs for that particular report. The user may edit the final report by traditional keyboard, via dictation, or by inserting a report snippet. A report snippet is a predetermined piece of code which can represent a standard report element (e.g., a standard page letterhead), a data element extracted from the system (e.g., the patient’s birth date or referring physician’s name, etc.), or an automatically evaluated logic statement (as in the example of pronoun use above). Once inserted into the report, the report snippet is fully rendered, displaying the final report content which can be manually edited by the user. Conclusions: The use of the customized smart synoptic reporting solution has anticipated benefits on geriatric clinical practice. Since most of the report is automatically generated from a customized template, the amount of dictation time required is reduced. The use of this solution can improve report accuracy through the use of a standardized template, which can then be customized and sent to multiple recipients in short or long form. Smart reports can increase the timeliness of new reports, as reports can be generated at the end of the visit in short form with recommendations and instructions for patients and caregivers., Background: Current registries, information systems, and family practice electronic medical record systems are generic in nature and are not tailored to a specialist’s workflow or clinic needs. The use of an efficient data collection system, along with the application of an effective workflow model, can lead to significant improvements in the quality of health care provided to patients. We have developed a unique longitudinal web-based tracking system for patient treatment, outcome management, clinical reporting, and research. Methods: The system’s design was informed by health-care providers, a review of existing systems, and published literature. Several modules have been established to address the concerns of the adopting clinic, including: patient demographics, course of symptoms, co-morbid illnesses, medications, cognitive testing, physical and neurological examination, diagnoses, synoptic and detailed reporting, and data analysis for both clinical and research purposes. Conditional patient access provides an interactive model of care to the clinic and allows for future expansion with a patient portal. In a traditional system, baseline information is typically collected manually by a health-care provider using a paper-based form. These forms are transcribed or coded into an electronic database of patient record. This method of retrospective data entry leads to various quality control issues. To address this challenge, our platform was designed to be used not only with web-capable desktop and tablet devices, but with kiosk systems, as well. Various techniques were established to improve quality control and to ensure the accuracy of patient records. Demographic data can be imported or entered directly into the database by the patient, registration clerk or clinician. Furthermore, field validation is used to ensure that no data are missing or incorrectly filled. All data collection forms are clinical workflow oriented, with built-in secondary form validation, autocomplete, autosave, and dropdowns to facilitate fewer entry mistakes. Results: The resulting increase in quality control ensures accurate patient record entry—the more accurate the data, the more accurate the statistical analysis. The platform has been customized to provide the following system-wide features: side-by-side comparison of past and current information; real-time data entry collaboration between interdisciplinary team members; forms are modular in design to allow for easy expansion; look-up lists (e.g., national medication repository, clinic staff, past occupations, hobbies, standardized diagnostic codes from the US National Alzheimer’s Coordinating Centre); digital capture of cognitive tests; synoptic reporting; interactive progress notes and comments; simplified web-based modelling and statistical analysis tools. Conclusions: The benefits of utilizing such a registry platform can significantly increase both the quality of care provided to patients and the efficiency of clinical practice. Our registry can allow for the measurement of the quality of care indicators, reduce clinical and data-entry errors, and facilitate research since all clinical data can be analyzed statistically in real time., Background: Brain disorders that lead to aberrations of affect, cognition, and behaviour (ABC) constitute a growing and resource-demanding health crisis in Canadian society. The number of individuals with dementia, which is an important disorder of ABC, is rapidly increasing. Specialist input is often sought in the diagnosis and treatment of dementia. However, several specialties and subspecialties manage dementia, including geriatric medicine, neurology, geriatric psychiatry, and Care of the Elderly family practice. Other specialists, including neurosurgeons, are becoming involved in the management of dementia. Many of these specialists have either “learned on the job” or taken informal additional training to acquire special competency in the area, without standardization or formal recognition of that training. Creating a standardized training program for physicians wanting to acquire additional competency in disorders of ABC would assure quality of care and attract more physicians to this area, which will be needed to cope with the increased burden that will be posed by ABC disorders. Such training would gather specialists into a more harmonized community of practice in disorders of ABC, and could lead to the emergence of transdisciplinary knowledge and competencies that will allow trained physicians to better cope with these conditions, especially dementia. Methods: The Department of Psychiatry at the University of Toronto recently sponsored a meeting for a “grass-roots” group of specialists from across Canada, who all deal with disorders of ABC to a substantial degree in their practice. They explored the creation of a Royal College of Physicians and Surgeons of Canada (RCPSC) Diploma program in disorders of ABC. This presentation highlights the results of that meeting and forthcoming efforts. Results: There was broad consensus that such a Diploma program would be useful. The precise name of this field of training is still being debated, although the preliminary frontrunner is “Integrative Brain Medicine”. A consensus definition for this field of study was agreed upon. A “core” training program for the Diploma was proposed, to be accompanied by additional specific “streams” that trainees could choose to focus on, including one in dementia. Conclusions: A transdisciplinary team of medical educators, with the support of RCPSC, is developing a new Diploma training program to formally recognize training in disorders of ABC, including dementia, and to boost the number of physicians undertaking this training. This is a meaningful step to stem the “rising tide” of these disorders. The Diploma program proposed at the Toronto meeting is being refined with further input from interested stakeholders being sought and warmly welcomed, with the goal of presenting a full proposal to the RCPSC in the spring of 2014. Please contact the first author, Dr. Alex Henri-Bhargava, at alexhb@uvic.ca to participate., Background: Traditionally physicians have viewed mild memory complaints in older people to be benign. However, subjective memory complaints in people who have “normal” cognition on testing is termed Subjective Cognitive Impairment (SCI), a pre-MCI stage, and may last up to 15 years. Memory loss as a self-observed complaint is more easily identified than changes in executive function. Identifying people with MCI who are at increased risk for dementia/Alzheimer’s disease, and arranging for follow-up is the current best practice recommendation from the Third Canadian Consensus Conference on the Diagnosis and Treatment of Dementia (CCCDTD3). For the last five years, we have advertised during Alzheimer Awareness Month (January) and Senior’s Awareness Month (June) for people 55 years and over who have memory concerns, who are interested in research, and who have not had a stroke. Objectives: 1) To classify the clinical suspicion of memory complaints in respondents and offer follow-up. 2) To complete clinical assessments in those with a clinical suspicion of MCI or dementia on case finding, confirm a clinical diagnosis, and offer research studies for which they may be eligible. Methods: Over the last 5 years a total of 166 people 55 years and over responded to newspaper advertisements with self-reported memory concerns. Participants received cognitive screening tests using the standardized MMSE, the MoCA, the 15-point GDS, the AD8, the Cornell Scale for Depression in Dementia, and the Lawton Brody Activities of Daily Living Scale. The test results were case-conferenced with a geriatrician and a clinical suspicion of SCI, MCI, depressive symptoms, mixed picture, possible dementia or other was given. All participants agreed for their test results to be sent to their family physician. Fifty-eight individuals have repeat measures on these tests from 2009 to 2013. Results: Of the 58 follow-up subjects, 45 returned for follow-up after one year and 29 returned for follow-up after two years. In 2013, of those 58 follow-up participants, 54% (31) had no change on their cognitive tests. However 33% (21) had declined over the 5 years and 10% (6) had improved. Of those who were given the clinical suspicion of SCI in 2009 or 2010, 39% had progressed to amnestic MCI or multiple-domain MCI. Those individuals who reported depressive symptoms in 2009 (32%) tended to have lower scores on the GDS and Cornell on follow-up visits. Individuals who declined follow-up appointments maintained that their memory was ‘fine’ and no longer wished to be followed. Conclusions: Of those who returned for follow-up, 33% progressed to MCI within 5 years; however, they only represent 35% of the total sample. Therefore a conservative estimate would be 12% of the participants progressed to MCI. It is uncertain whether those who declined follow-up represent individuals who have reverted to ‘normal.’ Limitations: 1) The participants are drawn from those who have insight to changes in their memory, therefore it may understate the total number; 2) 65% to date have elected not to return for follow-up., Background: A growing number of middle-aged individuals presenting with concerns of memory loss and decreased mental efficiency are being diagnosed with previously unrecognized attention deficit/hyperactivity disorder (ADHD). However, specific neuropsychological tools to differentiate adult ADHD from prodromal Alzheimer’s disease or mild cognitive impairment (MCI) are lacking. One of the core deficits that have been consistently associated with both childhood and adult ADHD is impairment in inhibitory control, as commonly measured using the Stop Signal Task (SST). One study has found mild differences in inhibitory control between MCI and normal controls (NC), but this is still being investigated. Deficits in visual working memory (VWM) have also been reported in both ADHD and MCI. These deficits can be examined using a task that specifically distinguishes random errors from errors due to the inability to divert attention from non-target objects to target objects during visual encoding. No previous studies have yet examined performance on these specific measures in adult ADHD and MCI. Objectives: The aim of the present study is to compare performance on both the SST and this VWM task between individuals with ADHD and MCI and examine potential correlations with regional grey matter volumes. We hypothesize that deficits in inhibitory control and VWM errors due to non-target responses will discriminate ADHD from MCI. Our second hypothesis is that ADHD subjects will show increased medial and lateral prefrontal cortical thinning and lower putamen and caudate volumes than both MCI and NC. Methods: 25 ADHD and 25 single and multi-domain amnestic MCI participants will be recruited from the memory clinic at Sunnybrook Health Sciences Centre. All participants will be assessed using the Adult ADHD Self-Report Scale-V1.1 and Connors’ Adult ADHD Rating Scale-S:L. The Albert and Peterson Criteria will be used to diagnose MCI. The SST will be administered to obtain measures of inhibitory control, response latency and variability, and error monitoring. Intra-individual variability will be studied using ex-Gaussian fitting, and error monitoring will be assessed based on the extent to which participants slow their response following inhibition failures. A previously described VWM task will be administered in which multiple items are presented in the visual field and the subject must recall the colour of a probed item. The proportions of target responses, non-target responses, and random errors will be calculated for each participant. Discussion: Results will be compared between groups using Analysis of Covariance (ANCOVA), correcting for age and education. Assessments of memory, attention, and executive function will be obtained through standard neuropsychological testing. Cortical thickness and grey matter volumes of targeted structures will be measured from structural 3D T1 MRI using a previously published semi-automatic pipeline. Partial correlations, controlling for age and education, will be used to assess the relationship between neuropsychological measures and brain volumetrics. Significance: This study will explore the utility of neuropsychological tools to differentiate ADHD among middle-aged patients presenting with memory complaints from MCI. This study will also provide the foundation for a larger project aimed at examining the relationship between ADHD and Alzheimer’s disease in the baby boomer population., Background: Vitamin D (25OHD) insufficiency has been associated with cognitive decline and dementia. In addition to comparatively worse global cognitive performance, individuals with deficient or insufficient vitamin D levels (less than 75 nmol/L) tend to perform worse on tasks of executive functioning. It remains unclear if “supratherapeutic” levels (100 nmol/L or greater) are associated with even better cognitive performance than sufficient levels. The present study sought to address this question, hypothesizing that executive functioning tasks would be most associated with vitamin D insufficiency (less than 75 nmol/L) and that cognitive performance would not differ significantly between those with sufficient and supratherapeutic levels. Methods: Healthy adults, at least 20 yrs of age participated in the winter phases of the D-COG (Nov. 2010–March 2011) and D-COG2 (Nov. 2011–March 2012) studies. Cognitive testing consisted of the Symbol Digit Modalities Test, Verbal (phonemic) Fluency, Digit Span, and CANTAB computerized battery. Body mass index (BMI) and mood (i.e., Beck Depression Inventory-II) were also assessed. Participants were also asked about vascular risk factors and physical activity. Serum vitamin D (25OHD) levels were analyzed via liquid chromatography/mass spectrometry. PTH, phosphorous, and ionized calcium levels were also obtained. Results: Data from the D-COG (n = 43) and D-COG2 (n = 99) were pooled due to identical study protocols. The 142 participants were 56.3±14 yrs old with 14.9±4 yrs of education and 71.8% female. They were categorized into the following three groups depending on vitamin D levels: Insufficient (less than 75 nmol/L; n = 73); Sufficient (75–99.9 nmol/L; n = 36), and Supratherapeutic (> 100 nmol/L; n = 33). Vitamin D levels were significantly correlated with performance on Verbal Fluency (partial correlation corrected for age, education, r = .23, p = .01), and the mean scores differed between groups: Insufficient 12.9±4.2, Sufficient 13.2±4.2, Supratherapeutic 16.7±6.6, ANCOVA(covariates: age, yrs of education), F(4, 140) = 6.30, p = .0001. Post hoc Scheffe analyses indicated significant differences between the Supratherapeutic and both the Insufficient (p = .002) and Sufficient (p = .01) groups. Vitamin D sufficiency status remained an independent predictor of Verbal Fluency performance, even after correction for multiple potential confounders including age, education, sex, BMI, amount of physical activity, vascular risk factors, and depression (linear regression, p = .001). Conclusions: Vitamin D levels were positively and linearly associated with performance on verbal fluency, a task that assesses executive functioning and language. Surprisingly, Supratherapeutic levels were associated with even better performance than sufficient levels on this task. Importantly, however, these sufficiency categories are based on bone health guidelines and the optimal level of vitamin D for cognition is not known. This study suggests that levels exceeding 100 nmol/L may be optimal for at least some aspects of cognition, including executive functioning and perhaps language. What effects vitamin D supplementation has on these and other cognitive domains is not known, but is currently being tested in a randomized supplementation study., Background/Objective: Impaired memory is a core component of Alzheimer’s disease (AD), and patients with AD have been shown to have increased impairments in working memory. Along with this loss in memory, patients also often experience difficulties in attention and, in fact, studies have posited that it is the attentional impairments that underlie many of the deficits in cognition and function seen in patients with AD. Our team has developed the Visual Attention Scanning Tool (VAST), an eye-tracker which enables real-time measurements of attention patterns towards competing visual stimuli. The objective of the present analysis is to observe the spontaneous visual scanning patterns of AD patients in the presence of novel and repeated stimuli using a modified n-back paradigm in order to explore working memory in a naturalistic setting. Methods: This is cross-sectional study of patients with mild to moderate Alzheimer’s disease (probable AD by NINCDSARDRA criteria, with a Mini-Mental State Examination score > 10). Visual attention was assessed using the VAST system. Patients were presented with 48 slides, each containing four images simultaneously presented. All four images have similar complexity, valance, and arousal. Two images on each slide were novel and two were repeats of images that were shown previously—repeats of one slide back (n = 1) and 2 slides back (n = 2). Images on each slide were arranged 2 by 2, with the position of the novel stimuli and previously shown stimuli randomly intermixed. Comparisons between and within groups were conducted using two way ANOVA. Results: 61 patients have been recruited to date (37 AD, 24 controls). Overall, the average age was 74.6±9.2 years, with patients with AD being older than controls (77.1 vs. 70.7 years). The average Mini-Mental State Examination score was 24.4±4.2, with AD patients having a lower score (22.1 vs. 28.0). There was a significant main effects of disease (F1,118 = 23.5, p < .0005) and image type (F1,118 = 79.3, p < .0005), as well as an interaction between factors (F1,118 = 9.6, p = .002) for relative fixation time in the 1-back condition. Similar results were found in the 2-back condition: disease (F1,118 = 10.6, p = .001) and image type (F1,118 = 5.2, p = .024) main effect, in addition to a significant interaction (F1,118 = 5.7, p = .018). Discussion: These preliminary data for our n-back paradigm of working memory suggest that the orientation towards novel stimuli observed in cognitively intact subjects was not observed in AD patients. These findings suggest that working memory deficits can be detected in AD patients without requiring verbal communication., Background: Neuropsychiatric symptoms associated with dementia present significant challenges to family caregivers and health providers, yet data illustrating variation in the prevalence and correlates of symptoms across care settings or by sex are scarce. We sought to estimate the prevalence and associated correlates of neuropsychiatric symptoms across home care (HC), long-term care (LTC), and complex continuing care (CCC) settings and by sex. Methods: Cross-sectional study of all HC clients (n = 470,183), LTC residents (n = 127,285), and CCC residents (n = 93,206) aged 50+ years assessed with the Resident Assessment Instrument (RAI-HC or RAI 2.0) in Ontario, Canada from 2004 to 2010. Multivariable logistic regression models were used to identify correlates of neuropsychiatric symptoms across care settings, for total samples and stratified by sex. Results: There were 100,500 (21.4%, 95% CI 21.3–21.5%) HC clients, 72,732 (57.1%, 95% CI 56.9– −57.4%) LTC residents, and 23,459 (25.2%, 95% CI 24.9–25.4%) CCC residents with a diagnosis of dementia. The severity of impairment associated with dementia generally increased from HC to LTC to CCC; however, there were important differences across care settings. LTC residents with dementia were significantly older, more likely to be women, to exhibit depression and aggressive behaviours, and to be receiving 1+ antipsychotics and/or antidepressants, whereas those with dementia in CCC (despite showing comparable levels of cognitive impairment to LTC residents with dementia) were more likely to be functionally dependent, to have significant health instability, and to have a recent decline in mood, apathy, anxiety (and use of 1+ anxiolytics), and loss of appetite. The proportion of persons with dementia exhibiting 1+ neuropsychiatric symptom(s) was higher in LTC and CCC (∼ 98%) than in HC (∼ 61%). Adjusting for age, cognitive and functional status, women with dementia were significantly more likely to exhibit depression and anxiety, appetite/eating issues, delusions (HC & LTC), and night-time behaviours (LTC). Conversely, men with dementia were significantly more likely to exhibit agitation/aggression/disinhibition, apathy (LTC & CCC), irritability, motor disturbance (CCC), and hallucinations (HC). The percentage of HC clients with a distressed caregiver was higher among males with dementia and for both men and women, increased with number of neuropsychiatric symptoms. The associations between age, functional and cognitive impairment levels, and selected neuropsychiatric symptoms were generally similar for females and males with dementia, although there were some notable differences. For example, female HC clients with dementia showed stronger associations between increasing cognitive impairment and agitation/aggression/disinhibition and irritability, whereas male HC clients with dementia showed stronger associations between increasing cognitive impairment and anxiety. Conclusions: We observed significant differences in the profile of neuropsychiatric symptoms among persons with dementia across care settings and by sex. These differences suggest the need for more targeted care planning and interventions to better prevent and manage select neuropsychiatric symptoms across the care continuum., Background/Objectives: Alzheimer’s disease (AD) leads to cognitive declines in language, memory, and executive function, affecting an individual’s ability to complete activities of daily living (ADLs) independently. At the moderate and severe stages of AD, there is a need for formal caregivers (e.g., a nurse, personal support worker) to assist residents with AD during the completion of self-care tasks (e.g., grooming and washing). Unfortunately, breakdowns in communication commonly occur between formal caregivers and residents with AD during ADLs, leading to strained communication interactions and task completion difficulties. The systematic examination of which verbal and nonverbal task-focused communication strategies caregivers’ use to support residents with AD during task completion has been done. However, there is a need for the systematic examination of (1) which communication strategies contribute to fewer communication breakdowns during daily tasks, and (2) which communication strategies effectively repair communication breakdowns when they do occur. This systematic observational comparison study aims to examine which task-focused communication strategies formal caregivers’ use to repair communication breakdowns that occur while assisting residents with moderate and severe AD during the completion of a basic ADL: teeth-brushing. Methods: Fifteen (15) formal caregivers (personal support worker = 14; nurse = 1) and thirteen (13) residents with a confirmed diagnosis of AD (moderate = 6; severe = 7) participated in this study. Participating caregivers and residents with AD were recruited from two different community-based, long-term care facilities. Established caregiver–resident dyads were observed during the completion of six separate teeth-brushing sessions (78 teeth-brushing sessions in total). Each teeth-brushing session was transcribed verbatim into the Systematic Analysis of Language Transcripts (SALT), a language analysis software program. Next, utilizing conversation analysis (CA) method and the trouble source-repair (TSR) sequence paradigm, communication breakdowns were identified. In addition to the identification of communication breakdown and repairs, instances of no trouble source-repair (NTSR) sequences were identified. Finally, the TSR sequences (i.e., trouble source, repair signal, repair type, and resolution) and the NTSR sequences will be coded. Descriptive statistics will be used to analyze the relative frequency of task focused communication strategies occurring during TSR sequences and NTSR sequences as a function of disease severity. Correlation analysis will be used to examine the relationships between the resolution of repair strategy (outcome) and the relative frequency of communication strategies as a function of disease severity. Results: Across 78 observed teeth-brushing sessions, 215 TSR sequences and 150 NTSR sequences were identified. Agreement analysis was performed on 20% of the transcripts using occurrence percent agreement. Two raters showed 92% agreement for the identification of TSR sequences and 92.4% agreement for the identification of NTSRs. The complete analysis of the TSR sequences and the NTSR sequences is currently underway. Conclusion: We will present results and conclusions at the 7th CCD. Findings from this study will help to understand further which communication strategies are most effective when assisting residents with AD during daily activities. Moreover, findings from this study will be used to help inform the development of evidence-based communication guidelines for caregivers assisting individuals with AD., Background: The NIMH-Provisional Diagnostic Criteria for depression of Alzheimer’s Disease (PDC-dAD) have been proposed over a decade ago. However only few studies examined the validity of depression scales, including the Cornell Scale for Depression in Dementia (CSDD) and the Montgomery-Ãsberg Depression Rating Scale (MADRS), for this novel diagnostic approach to depression of AD (dAD). The validity of brief self-report scales with a parallel version for informant to provide collateral input for assessment of depression of AD has not been examined. Objectives: To study the validity of the Geriatric Depression Scale (GDS-30) developed for older adults and validated for the DSM [Major Depressive Disorder (MDD)] in detecting dAD, and to compare the subject (GDS-30) to the informant scale (GDS-IF-30). Methods: Subjects with AD and their informants, recruited at the UBCH-CARD (Clinic for Alzheimer Disease and Related Disorders) completed the GDS-30 and GDSIF-30, Neuropsychiatric Inventory (NPI) (informants), Quality of Life in AD (QoL-AD), and Montreal Cognitive Assessment (MoCA) (subjects). Subjects were assessed by a UBCH-CARD clinician for dAD according to the NIMH-PDC. Inclusion criteria were: a) subject meets possible or probable AD criteria (Mini Mental State Examination (MMSE) = 10 to 26); b) is able to communicate in English; c) has a knowledgeable informant who has contact at least 3–4 times/week. To examine concurrent validity, we performed ROC analyses on the accuracy of GDS scores in detecting a dAD diagnosis. To examine convergent validity, we computed correlations between GDS, NPI depression item scores, and QOL-AD. To examine discriminant validity, we performed correlations between GDS and MoCA scores. Results: The sample consisted of 21 subject/informant dyads (subject mean age = 71.33; mean education = 14.67; mean MMSE score = 22.2; 11/21 (53%) were men). Six subjects were found to have dAD (mean age = 69.33; mean education = 14; mean MMSE = 23.5; 50% were men) and 15 were non-dAD (mean age = 72.13; mean education = 14.93; mean MMSE = 21.6 (n = 14); 53% were men). The AUC for GDS-30 was 0.79 (p value = .027) with the optimal cut-off score of 8 (sensitivity = 67%, specificity = 80%, positive Likelihood Ratio of 3.33). For GDSIF-30, AUC was 0.83 (p value = .048) with the best cut-off score of 15 (sensitivity = 83%, specificity = 93%, positive Likelihood Ratio of 12.50). GDS-30 and GDSIF-30 were positively correlated (r = 0.635; p value = .05). GDS-30 and GDSIF-30 were inversely correlated with QOL-AD (r = −0.552, and −0.524, respectively). GDS-30 and GDSIF-30 were not correlated with MoCA (r = −0.043, and 0.047, respectively). Conclusions: The Geriatric Depression Scale based on subject and informant showed good accuracy in detecting dAD. The cut-off scores for dAD were lower than those reported for DSM-MDD. The correlation between GDS-30, GDSIF-30, NPI-depression item, and QOL-AD support the depression scales convergent validity. The lack of correlation between GDS-30 and GDSIF-30 and MoCA supports the depression scales discriminant validity. Overall, the study provides validity of inference for GDS-30 and GDSIF-30 with a limited sample of 21 dAD and non-dAD., Background: “Poster cortical atrophy (PCA) is a neurode-generative syndrome that is characterized by progressive decline in visuospatial, visuoperceptual, literacy, and praxic skills. The progressive neurodegeneration affecting parietal, occipital, and occipitotemporal cortices that underlies PCA is attributable to Alzheimer’s disease in most patients.”(Crutch et al., 2012; pg. 170.) The role of occupational therapy (OT) in Alzheimer’s disease (AD) is widely recognized, particularly related to memory. However, in some AD variants, such as PCA, the initial core clinical manifestation is progressive visual dysfunction and not memory. There is growing recognition for the importance of the OT role in the management of PCA, though few resources exist to inform practice in this area. Overview: A brief review of the clinical features and subsequent safety concerns of PCA will be provided, as well as the limited options for pharmacotherapy and non-pharmacologic therapy management. The OT role and general intervention strategies for patients with PCA will be presented, including a recently developed set of recommendations for OT intervention for use with patients experiencing AD-related visual dysfunction. The process of developing an OT specific resource for clinicians providing direct and consultative services for patients with AD-related visual dysfunction will be discussed. The interprofessional context of the tool and the tool itself will be reviewed with recommendations for its use, including practical visual aid interventions and adaptations that address 7 main areas of concern in relation to visual dysfunction in dementia. A brief description of an early stage, international systematic study looking at the effectiveness of visual compensatory strategies for this population will be discussed. Conclusion: While prevalence and incidence of PCA are currently unknown, with the rapidly expanding older population and forecasted increase in dementia in the coming decades, it is evident that the incidence of PCA will expand and subsequently the demand for OT services to optimize the independence and safety of this population at home. Occupational therapists who are experts in the analysis of function that are aware of the issues regarding PCA play a vital role in the management of this patient population for which no other management currently exists. While there is considerable research demonstrating the impact of visual impairment on ADL and IADL performance in the older adult population and the research examining the effect of OT in this area is growing, further research is required to measure the unique contributions of OT, especially for people with PCA, for which no research current exists., Introduction: Corticobasal syndrome (CBS) is a progressive, neurodegenerative condition typified by asymmetric motor symptoms (dystonia, rigidity, akinesia, myoclonus) in the setting of cortical sensory impairment, apraxia, and in prototypic cases, alien limb phenomenon. A diversity of pathologies including Alzheimer’s disease (AD), Lewy body disease (LBD), and cerebrovascular disease have been associated with CBS. Similarly, AD is itself associated with significant phenotypic variation and may result from an array of genetic mutations, in particular in presenilin-1 (PS1), presenilin-2, and amyloid precursor protein, all producing a highly aggressive, early-onset phenotype. PS1 in particular has been described in association with a heterogeneous phenotypic array, although not as CBS. Here we describe the first known association between a novel PS1 mutation and CBS in two brothers, one with right-predominant CBS, and the other with left-predominant CBS. These cases illustrate not only remarkable phenotypic mimicry, with an AD gene resulting in CBS, but also the phenotypic heterogeneity that may result even when the same causative mutation is present. Methods: Two brothers were assessed at the Sunnybrook Health Sciences Centre, Toronto, Canada between October 2008 and June 2010 (Brother RP: follow-up 11 months with 3 visits; Brother LP: 19 months with 4 visits). Both underwent detailed neurologic assessment including physical examination, screening blood work, detailed conventional neuropsychological testing, MRI (1.5 T), and SPECT (T99 ECD). Both brothers consented to and underwent post-mortem pathologic assessment, as well as genetic analysis by deep gene sequencing for PSEN1 mutations. Case Descriptions— Case 1: Right Predominant (Brother RP). RP was a 55 y.o. dentist with right arm myoclonus, dystonia, and mild rigidity for about 1 year prior to initial presentation. His wife also noticed word-finding difficulties, poor comprehension, and empty speech for 2 years, with significant apathy and depression emerging more recently. On initial examination he had impaired stereognosis and graphesthesia, subsequently developing significant apraxia. Based on these findings RP met criteria for probable CBS2. Post-mortem confirmed Braak stage VI/VI Alzheimer’s pathology. Genetic analysis demonstrated a PSEN1 mutation of phenylalanine to leucine at codon 283 (F283L). Case 2: Left Predominant (LP). LP was a 56 y.o. urban planner with left arm myoclonus and apraxia at initial presentation and left predominant akinesia and rigidity emerging 1 year later. Initial examination demonstrated impaired stereognosis and graphesthesia on the left. At last follow-up, he additionally had left arm and leg weakness, left facial droop, and left tongue fasciculations. Mood or behaviour was normal. LP’s speech was slowed at onset, eventually becoming nonsensical. Based on these findings, RP met criteria for probable CBS2. Post-mortem confirmed Braak stage VI/VI Alzheimer’s pathology. As with PR, LP demonstrated the same F283L mutation of PSEN1. Position-specific independent counts (PSIC) analysis yielded a score of 2.5, suggesting good likelihood of protein dysfunction resulting from this mutation. Conclusions: This is, to our knowledge, the first description of an autosomal dominant case of AD resulting in the CBS phenotype, caused by a novel F283L mutation in PSEN1. Further, these cases, presenting on opposite sides of the body, illustrate how phenotypic heterogeneity can occur despite identical genotype., Background: Elderly nursing home residents often have multiple medical co-morbidities and are prescribed numerous medications. With the use of more medications comes the risk of adverse drug reactions due to pharmacokinetic and pharmacodynamic changes, as well as drug interactions. Previous studies have found a relation between polypharmacy and a higher number of care problems (falls, pain, or constipation). There are various criteria regarding medications that are potentially inappropriate in the geriatric population, such as the Beers criteria; however, there seems to be less known about the use of medications and nutritional supplements which are generally not considered harmful, but may no longer be providing benefit, and which may be worsening quality of life, particularly in late dementia. Method: After appropriate ethics approval, we conducted a chart review on nursing home residents with advanced dementia (Fast Stage 7) living on dementia units at 4 nursing homes. De-identified data were sent to a clinical advisory team consisting of a pharmacist, a specialist in the use of nutrient supplements, a family physician with expertise in the care of the elderly, and a geriatric psychiatrist. The advisory team members completed standardized questionnaires regarding the appropriateness and potential problems with each medication and nutritional supplement, taking into consideration a clinical summary (prepared by the first author) on each study participant. A follow-up meeting with the advisory team reviewed and debated the results of the questionnaires and attempted to come to consensus decisions about the use of each medication based on the clinical context of each patient. Results were summarized by the first author. Results: Consensus was achieved on many, but not all, of the individual medications prescribed, with differences related to the clinical experiences and specialty of the advisory team member. Many vitamins were prescribed at excessive doses, while other recommended vitamins were not prescribed at adequate doses, or frequency. Reasons for administration of PRN medications were often not specified, contributing to the risk of prescribing of those medications for inappropriate reasons (such as using antihistamines for sleep or behavioural problems). Medications with a long time to benefit and significant adverse effects (such as statins) were prescribed in some patients, even those with short anticipated life expectancy and challenges with oral medication administration. Conclusions: In end-stage dementia there are many factors to consider when determining which medications may or may not be appropriate. Determining medication appropriateness is simpler when a particular medication is known to have significant adverse effects with little benefit. Choosing appropriate medications is more complicated when the medication has few or mild side effects, but a long time to benefit. Many of these patients have swallowing difficulties and medications can contribute to overall burden of illness., Background: Reaction to a diagnosis of dementia among patients and caregivers varies. Factors predicting reaction to such a diagnosis in a clinical setting are, however, not well characterized. Understanding of the contribution of such factors, possibly including psychiatric and other co-morbidities, knowledge of dementia, and degree of social support, may help guide individualized approach to disclosure. Methods: A comprehensive search of articles investigating reaction to a diagnosis of dementia was conducted. Results: The majority of research is largely qualitative consisting of semi-structured interview and limited to small numbers of patients. Many earlier studies revolved around the decision to disclose a diagnosis of dementia. Only one study, of absent or mild dementia, used a validated scale administered prospectively. Conclusions: Evidence outlining the factors contributing to reaction to a diagnosis of dementia is lacking. Only one study administered a validated scale, an unlikely component of routine interview and an uncertain outcome measure of reaction to diagnosis. There is a need to quantitatively explore the contribution of variables, (e.g., co-morbidity and educational level), including those gleaned on interview such as life reflection and strength of social support.

Background/Purpose: The 85+-year-old population – the “oldest old” – is now the fastest growing age segment in Canada. Although existing research demonstrates high health services utilization and prescribed medications in this population, little epidemiological evidence is available to guide care for this age group. Objective: To describe the epidemiological characteristics of common health conditions and medication prescriptions in the “oldest old”. Methods: We conducted a retrospective chart review of all family practice patients aged ≥ 85 (N = 564; 209M:355F) at Sunnybrook Health Sciences Centre, Toronto. Electronic medical records were reviewed for all current chronic conditions and medication prescriptions, and then stratified by sex and age subgroup (85–−89, 90–94, 95+) for descriptive analysis. Results: On average, patients experienced 6.4 concurrent chronic conditions and took 6.8 medications. Most conditions were related to cardiovascular (79%) and bone health (65%). Hypertension (65%) was the most common condition. Bone-related conditions (e.g., osteoarthritis, osteoporosis) and hypothyroidism predominantly affected women (p < .001), while coronary artery disease and T2DM were more prevalent in men (p < .05). The top two prescribed medications were Atorvastatin (33%) and ASA 81 mg (33%). Males were more likely to be prescribed lipid-lowering medications, while females were more likely to receive osteoporosis therapy (p < .001). Patients received less lipid-lowering therapy with increasing age (p < .001). Discussion & Conclusion: Multimorbidity and polypharmacy are highly prevalent in patients over 85. Most clinical concerns in this population relate to cardiovascular and bone health; medications predominantly treat risk factors. In the absence of epidemiological data to guide clinical decision-making, this study provides a first look at the common health concerns and medication profiles in this population., Background/Purpose: Although a serious public health concern, very little is known about the neurocognitive basis of suicidal behaviour in the elderly. Here we aimed at: 1) assessing alterations in cognitive inhibition in suicidal depressed elderly people, and 2) reviewing the literature on cognitive inhibition and decision-making in elderly suicidal behaviour. Methods: First, we compared 20 currently depressed patients, aged 65 and older, who had recently attempted suicide to 20 elderly subjects with a current depression but no personal history of suicide attempts and 20 elderly controls. Different aspects of cognitive inhibition were examined: access to relevant information (reading with distraction task), suppression of no longer relevant information (Trail Making Test, Rule Shift Cards), and restraint of cognitive resources to relevant information (Stroop Test, Hayling Sentence Completion Test, Go/No-Go task). Second, systematic MEDLINE literature search was performed on neurocognitive deficits in suicidal behaviour. References from our research group’s online database were also selected (http://www.bdsuicide.disten.com). Results: After adjustment for age, depression intensity, Mini-Mental Status Examination score, and speed of information processing, suicidal depressed elderly people showed significant impairments in all three domains of cognitive inhibition in comparison to the affective and healthy control groups. Moreover, the results of a meta-analysis study will also be presented. Discussion & Conclusion: Cognitive inhibition deficits and impaired decision-making appear to be part of a series of cognitive deficits and may impair the patient’s capacity to respond adequately to stressful situations, which could subsequently lead to an increased risk of suicidal behaviour during late-life depression. Suicide prevention interventions may be developed to specifically target cognitive impairment in depressed elderly people., Background/Purpose: Anticholinergic drugs may induce cognitive decline in older adults, but data are conflicting. One research challenge is ascertaining the effect of different exposure & outcome definitions on measures of association. Methods: Using baseline and 1-year follow-up data from 131 community patients aged 60+, we applied 4 measures of anticholinergic drug exposure (the Anticholinergic Drug Burden Index (DBI), ACB, ADS & ARS, and 4 definitions of cognitive decline (neuropsychological test raw change scores, the RCI, the standardized regression based change score (SRB), and the clinical diagnosis of a new mild neurocognitive disorder according to DSM-5 criteria). The frequency of classification for each patient and the number needed to harm (NNH) was calculated according to each exposure & outcome definition. The consistency of associations between drug exposure & cognitive decline was examined using logistic regression models for each definition. Results: The Anticholinergic DBI identified the smallest number of patients with an increase in anticholinergic exposure (n = 18) and the ACB identified the largest number (n = 23). The RCI identified cognitive decline in only 6 patients; 12 patients were diagnosed with a new mild neurocognitive disorder, 44 had changes in raw neuropsychological test scores, and 99 had changes on the SRB measure. The NNH ranged from 0–100. A significant association between increased anticholinergic drug exposure & cognitive decline was found in only one model that used the Anticholinergic DBI and the SRB measure of cognitive decline on the Trail B test (OR 2.2; 95% CI −1.1–8.06). Discussion & Conclusion: The choice of definition by which to classify drug exposure and cognitive decline has a significant effect on the results of causal association studies., Background/Purpose: Few studies in long-term care (LTC) have examined the feasibility and acceptability of knowledge translation (KT) programs. We conducted a qualitative evaluation of LTC professionals’ experience with a multifaceted, interdisciplinary KT intervention. Methods: We invited Medical Directors, Directors of Care (Nursing), and Consultant Pharmacists who participated in the Vitamin D and Osteoporosis Study (ViDOS), a randomized controlled trial conducted in 40 Ontario LTC homes (19 intervention, 21 control). ViDOS objectives were to evaluate the feasibility and effectiveness of a KT model to increase the use of osteoporosis/fracture prevention strategies. Multifaceted components included: 3 webinar presentations by expert opinion leaders, audit & feedback, point-of-care tools, internal champions, and action planning for quality assurance. In this qualitative evaluation study, we conducted individual, semi-structured telephone interviews and analyzed transcripts using thematic framework analysis. Results: Overall, 4 Directors of Care, 7 Consultant Pharmacists, and 2 Medical Directors participated. Medical Directors were not included in group comparisons due to the limited sample size. Most respondents (10/13) attended all sessions and thought it was a valuable experience. The on-site involvement of an expert opinion leader was seen as most useful by all participant groups. Perceived utility of the other KT components varied by group: Directors of Care highly valued audit & feedback, whereas Consultant Pharmacists highly valued small-group learning and internally nominated champions. Common themes for improvement were ready-touse educational fact sheets and having expert opinion leaders attend in person or via video conference. Discussion & Conclusion: The ViDOS intervention was well-received by study participants we interviewed. Lessons learned in this study can inform future KT initiatives in LTC., Background/Purpose: Older men receiving ADT for prostate cancer have a 5–10 fold increased rate of bone loss and up to 20% fracture risk by 5 years of treatment. Guidelines exist for bone-loss management in this population, but adherence is poor. We assessed the knowledge and current practices regarding bone-loss management in a sample of Canadian prostate cancer (PC) specialists. Methods: Using Dillman’s tailored design method, a questionnaire was distributed to Canadian PC specialists through three major specialty organizations. Results: 156 PC specialists completed the questionnaire. Awareness of recommendations for frequency of repeat bone mineral density (BMD) scans (76.3%) and vitamin D use (70.3%) was relatively high, but lower for calcium intake (53.2%) and amount of weekly exercise (20.7%). A minority were aware of the true prevalence of osteoporosis in otherwise healthy 60-year-old males (27.3%), the risk of developing osteoporosis after 1 year of continuous ADT (37.8%), and the excess fracture risk after 5 years on ADT (14.7%). 34.4% of respondents reported routinely ordering BMD tests pre-ADT treatment and 36.6% ordered routine BMD tests after initiating ADT. Most reported routinely recommending exercise, calcium, and supplemental vitamin D. The most significant barriers to implementing the recommendations were lack of time to counsel patients and lack of supporting structures (e.g., patient education). Discussion & Conclusion: Participants were fairly knowledgeable regarding recommendations for managing bone loss in men on ADT. However, there were gaps in knowledge regarding risk of developing osteoporosis and in clinical surveillance and risk assessment. These findings suggest the need for knowledge translation strategies and tools to address this gap between evidence and clinical practice., Background/Purpose: An audit was conducted on the recorded reason for invasive treatments in older patients. According to the British Geriatric Society and NICE guidelines catheterisation and regular sedation should be avoided in elderly patients especially those with delirium. Additionally, many studies have been conducted showing a link between sedation and delirium. The aim of the study was to discern whether invasive treatments such as the use of catheters, cannulas, intravenous antibiotics, and the provision of sedatives is justified, as these procedures have associated risks including delirium. Methods: Data were collected data from three Geriatric Medicine wards, looking at the first 48 hours of care. Data were assembled on patient demographics, patient’s AMT score, invasive procedures conducted, and the reason for the procedure. The gold standard for this audit is that 100% of procedures are provided with a reason in the notes. Results: 72% of patients were Caucasians, the mean age 84.6 ± 8.0 (SD), and 50% of patients in the audit were classed as delirious. The findings show that 98% of invasive procedures were not clearly justified in the notes, regardless of whether the patient was suffering from delirium. 97% of cannulas inserted were not justified in the notes and was the most common invasive procedure. Discussion & Conclusion: These results are in agreement with the hypothesis that the majority of procedures will not have a clear justification in the notes. A justification column could be added in order to make doctors think twice about their reasoning for providing these treatments and thus prompt doctors to provide a reason for these invasive procedures., Background/ Purpose: The management of multimorbidity in the oldest old (aged ≥ 85) is recognized as one of the most pressing challenges facing clinicians. Given the increasing prevalence of T2DM in this population, a more precise understanding of the epidemiology of co-existing chronic illnesses is necessary to guide therapy. Objective: To characterize co-morbidity in T2DM patients aged ≥ 85 in primary care. Methods: We conducted a retrospective chart review of family practice patients aged ≥ 85 at Sunnybrook Health Sciences Centre, Toronto. Electronic medical records were reviewed for all chronic conditions. For all T2DM patients, each condition was coded as “concordant/discordant” with diabetic care (whether it is related to its pathophysiologic risk profile or management complications), “symptomatic/ asymptomatic” (whether it causes symptoms noticeable to the patient), and “clinically dominant/not dominant” (complex or serious enough to eclipse the management of all other health conditions). We recorded the total number of co-morbid conditions (other than diabetes) in each category for each patient. Results: T2DM patients comprised 16% (n = 91; 42M:49F) of all patients aged ≥ 85. On average, each patient experienced 6.8 co-morbid conditions other than diabetes (range: 2–16); patients generally had discordant and symptomatic co-morbidities (p < .001). 47% (n = 43) of our sample had at least one clinically dominant condition. Discussion & Conclusion: Co-morbidity is highly prevalent in very old type 2 diabetic patients. Most co-morbid chronic conditions are symptomatic and discordant with diabetes care. A significant proportion of these patients also suffer from clinically dominant conditions. In the absence of evidence-based care guidelines for this age group, it may be beneficial to focus therapy on the management of symptoms and functional limitations rather than aggressively pursuing risk factor modification., Background/Purpose: Men receiving androgen deprivation therapy for prostate cancer have low knowledge of osteoporosis (OP) and are engaging in few healthy bone behaviours (HBBs). A multi-component intervention was piloted in this population, and changes in OP knowledge, self-efficacy, health beliefs, and engagement in HBBs were evaluated. Methods: A pre–post pilot study was performed in a convenience sample of men recruited from the genitourinary clinics at Princess Margaret Hospital. Men were sent personalized letters explaining their dual X-ray absorptiometry (DXA) results and fracture risk assessment with an OP-related education booklet. Participants completed questionnaires assessing OP knowledge, self-efficacy, health beliefs, and current engagement in HBBs at baseline (T1) and 3 months post-intervention (T2). Paired t-tests and McNemar’s test were used to assess changes in outcomes. Results: A total of 148 men (median age 72) completed the study. There was an increase in OP knowledge (9.7 ± 4.3 to 11.4 ± 3.3, p < .0001) and feelings of susceptibility (16.5 ± 4.3 to 17.4 ± 4.7, p = .015), but a decrease in total self-efficacy (86.3 ± 22.9 to 81.0 ± 27.6, p = .007) from baseline to post-intervention. Men made appropriate changes in their overall daily calcium intake (p ≤ .001), and there was uptake of vitamin D supplementation from 44% (n = 65) to 68% (n = 99) (χ2 = 24.6, p < .0001). Men with bone loss (osteopenia or OP) had a greater change in susceptibility (1.9 ± 4.3 vs. −0.22 ± 4.2, p = .005) compared to men with normal bone density. Discussion & Conclusion: Our results provide preliminary evidence that a multi-component intervention such as the one described can lead to increased knowledge, feelings of susceptibility regarding OP, and uptake of some HBBs., Background/Purpose: Fitness-to-drive guidelines recommend employing the Trailmaking B test (a.k.a. Trails B), but do not provide guidance regarding cut-off scores. There is ongoing debate regarding the optimal cut-off score on the Trails B test. Objective: To address this controversy by systematically reviewing the evidence for specific Trails B cut-off scores (e.g., cut-offs in both time to completion and number of errors) with respect to fitness-to-drive. Methods: Systematic review of all prospective cohort, retrospective cohort, case-control, correlation, and cross-sectional studies reporting the ability of the Trails B to predict driving safety that were published in English-language, peer reviewed journals. Results: 47 articles were reviewed. None of the articles justified sample sizes via formal calculations. Cut-off scores reported based on research include: 90 seconds, 147 seconds, 180 seconds, and < 3 errors. Discussion & Conclusion: There is support for the previously published Trails B cut-offs of 3 minutes or 3 errors (the ‘3 or 3 rule’). Major methodological limitations of this body of research were uncovered including: 1) lack of justification of sample size leaving studies open to Type II error (i.e., false-negative findings), and 2) excessive focus on associations rather than clinically useful cut-off scores., Background/Purpose: The Geriatric Medicine (GM) academic half-day (AHD) at the University of Toronto is targeted to structured teaching of the CanMEDS roles. This seminar series must fulfill learners’ needs, GM program mandates, and the RCPSC standards for structured education. Given that the University of Toronto has the largest GM program in Canada, the aim is to produce a competency-based AHD framework that can be translated to other Canadian GM programs. Methods: The RCPSC CanMEDS framework for educational design was utilized. A literature review and a national needs assessment surveying the trainees were conducted. Subsequently, an audit and blueprint of the current AHD curriculum at the University of Toronto were completed. Those domains that were less emphasized were the focus of improvement. Suggestions were made through an educational consultation to improve the structured teaching. Results: The literature review found no publications related to a Canadian GM AHD curriculum. The needs assessment demonstrated satisfaction in training of all domains, but lesser satisfaction in three areas: the sciences of aging, ethical and legal issues, and formal teaching of the Manager role. The four most formally taught GM specific enabling competencies were Medical Expert 2.1, Manager 1.3, Scholar 3.2, and Medical Expert 3.1. An educational consultation provided practical suggestions for improvement. Discussion & Conclusion: The AHD at the University of Toronto is one example of structured teaching, but as a 2-year, weekly seminar series, GM residents invest a great amount of time in this formal education. Peer-reviewed educational tools are available to further enhance the AHD teaching. Improvements to meet the needs of the learner, program, and RCPSC are currently being implemented., Background/Purpose: Medication-related problems are common, costly, associated with poor outcomes, and are potentially preventable in older adults. Older adults with cognitive impairment are at higher risk of adverse drug reactions. The retirement home (RH) setting is a prime opportunity to intervene to screen for cognitive impairment and for medication review. Methods: This project is a two-phase project taking place in a RH setting. The first phase included resident chart review for diagnosis of dementia or MCI, then cognitive screening using the Dementia Quick Screen (Mini-Cog & animal fluency). Screen failure lead to full assessment. The second phase included an intervention with Medchecks by pharmacist using the anticholinergic load scale and the Ottawa Top Ten Tool (OTTT). OTTT was developed after a thorough review of the literature/available tools with subsequent geriatrician panel review for the Top 10 higher risk drug classes with practical recommendations. All were sent to the treating physician for review. 3-month follow-up was done to identify physician acceptance of recommendations. Barriers to acceptance will be reviewed. Results: 75 residents were included in study. Per chart, 45 had normal cognition so were included in the memory screen: 32 (71%) failed screening. Medchecks were done on 48 residents (16 with dementia). Total of 78 recommendations (range 0–5 & mean 1.6 per resident) were made. 11 (14%) anticholinergic-related, 11 (14%) OTTT-related, and 56(72%) were other pharmacist recommendations. 31(40%) recommendations were accepted by treating physician; 4 (5%) were rejected; 43 (55%) pending. Discussion & Conclusion: Cognitive screen and Med-checks using the new OTTT & anticholinergic load scale should be incorporated in RH setting to improve care of this aging population., Background/Purpose: The loss of muscle mass, sarcopenia, in older adults is an important marker of frailty due to the association with mobility decline, falls, fractures, and mortality. However, dynapenia, the loss of muscle strength, has been shown to manifest earlier than sarcopenia, and is more consistently associated with disability and mortality. It is unknown whether dynapenia is associated with early gait disturbances, specifically gait variability. Gait variability is a measure of gait regulation, and high gait variability has been proposed as an early marker of mobility decline and a predictor of falls. Therefore, our aim was to determine if dynapenia in community older adults is associated with poorer gait performance, specifically high gait variability. Methods: In 184 community-dwelling older adults (aged ≥ 75), muscle weakness was assessed by measuring the average grip strength in the dominant hand using a handheld dynamometer. Gait variables were assessed under “usual” and “fast” pace conditions using an electronic walkway. Relative risk analysis evaluated the association of muscle weakness to each of the gait parameters. Results: Older male adults in the lowest quartile of grip strength (< 20.67 kg) had slower gait velocity [mean %CoV (SD) = 82.93 (34.51)] [RR (95% CI) = 1.53(0.58,4.06)], and increased stride time variability [mean %CoV (SD) = 5.81(1.94)] [RR (95%CI) = 1.71(0.82,3.57)], then those in the highest quartile of grip strength (≥ 32.33 kg). Results were similar in female participants. Discussion & Conclusion: Our findings have interesting clinical implications because muscle strength assessments can be used in the clinic as an early screening tool to detect those with high gait instability, risk of falls, and mobility decline., Background/Purpose: The purpose of this study is to investigate the integration of two non-intrusive approaches to monitoring home care clients’ activity level, along with access to best practice guidelines for clinicians at the point of care. A prototype Remote Activity Monitoring and Guidelines System has been developed that uses a GPS-equipped Blackberry to monitor an elderly client’s mobility outside the home. The System includes a pressure-sensitive mat that is placed under a regular bed mattress and can monitor sleep disturbances, and how long it takes to enter and exit the bed. Methods: A proxy client who is over the age of 65 with chronic health issues was invited to carry a Blackberry and to use a pressure sensitive mat to collect data about the client’s physical activity. After a period of 7 days, 4 different nurses made home visits to the proxy client, where a research member observed clinicians interacting with the prototype System in the client’s home. Results: The findings indicated the value of the mobility-related data to gerontological clinicians when they plan care to address the aging needs of their home care clients. The results also suggested the usefulness and placement of the Best Practice Guidelines in the electronic user interface. The observational data generated information about the clinicians’ needs and interaction with the prototype in actual home care setting. Discussion & Conclusion: This study provides important implications about the value of remote monitoring technology in providing clinical support to assist gerontological clinicians’ decision-making process when planning care for seniors in home care settings., Background/Purpose: Receiving rehabilitation enables geriatric patients to regain their function prior to return home. However, long waiting times associated with access to rehabilitation are detrimental to the quality of care for geriatric patients. Methods: Geriatrics consults at the Royal Victoria Hospital and the Montreal General Hospital for 1 year were examined. Relevant information in the consultations was extracted. OACIS was consulted to determine the date of discharge to rehabilitation or home and the number of medications prescribed. The admission/discharge logbooks of the Geriatrics Units were also examined to determine the date of transfer to these units. Statistical analysis was performed on these data using SPSS. A survey of geriatric health professionals determined the reasonable waiting time. Results: The mean waiting time was 11.4 days for outside rehabilitation or home and 4.3 days for the Geriatrics Units. A theoretical reasonable waiting time of 48 hours was defined from a survey of health professionals. Only 7.5% of patients were admitted within this theoretical time frame to outside facilities or home and 44% to a Geriatrics Unit. We didn’t find any patient characteristics (age and number of medications) that contributed to explain the waiting time for rehabilitation. Discussion & Conclusion: This study documents the long waiting time for patients who were recommended for rehabilitation by the Geriatric Consultation Team. The percentage of patients whose waiting time was lower or equal to the reasonable waiting time set by geriatrics health professionals was quite low. However, the waiting times for the Geriatrics Units were significantly lower than those for outside facilities or home. Discharging efficiently to rehabilitation could decrease length of stay and improve patient turnover., Background/Purpose: Hip fracture is the leading cause of transfer to acute care for long-term care (LTC) residents. Osteoporosis and falls put LTC residents at a high risk for fractures that lead to pain, loss of mobility, heavy costs to patients their families and to the health-care system, and increased mortality. Effective prevention includes pharmaceutical and non-pharmacological interventions to decrease fractures. Methods: We conducted a pilot telephone survey of LTC residents’ family members to inform investigators who are adapting the 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis for use in LTC. The 10 questions addressed awareness of and preference for falls and fracture prevention interventions available in LTC. Data were analyzed using frequency counts for closed-ended questions and Thematic Framework Analysis for the open-ended ones. Results: 91% of the 11 respondents supported osteoporosis medication use if indicated, while expressing concerns about potential side effects and polypharmacy issues. All respondents supported Vitamin D supplements without any concerns; 82% supported calcium + vitamin D use, but worried about swallowing difficulties. Participants felt pain prevention and preserving quality of life were among the most important outcomes for their family members, and extending life was among the least important outcomes. Discussion & Conclusion: Results from this pilot survey indicate family members support pharmaceutical interventions, per recommendations in the 2010 Clinical Practice Guidelines for reducing the risk of fractures and falls in LTC residents. Many of them believe pain prevention and quality of life are more important than extending life, which should be considered in guideline development for this population., Background/Purpose: Inappropriate prescribing in the elderly population is associated with adverse drug events and increased hospitalization, ultimately reducing quality of life and increasing mortality rates. The aim was to measure the prevalence of inappropriate prescribing in elderly patients with dementia at Ayrfield Medical Practice in Kilkenny, Ireland. The 2012 Beers Criteria was the standard used for comparison. The Beers Criteria was developed to improve the quality of care for elderly patients and provide physicians with a guideline for safe prescribing. Methods: Medical charts of 80 patients ≥ 65 years old with documented dementia at a primary care centre were studied. The range of age was between 65 and 98 years of age, the mean age was 83.5 years (± SD 9.3). Of the patients studied, 67.5% were female. Patients’ current diagnoses and medications were documented and the Beers Criteria was applied to measure the prevalence of inappropriate prescribing. Results: The mean number of diagnoses per patient was 3.3 (± SD 1.8) and the mean number of medications prescribed per patient was 9.3, ranging from 0–22. Beer’s criteria identified a total of 129 inappropriate medications in 72.5% (58) of patients. Medications with strong anticholinergic properties (antidepressants, antihistamines, anti-parkinson agents, skeletal muscle relaxants, antipsychotics, antimuscarinics, and antispasmodics) accounted for the majority of inappropriate medications and were prescribed to 66.3% (53) of patients. Discussion & Conclusion: Potentially inappropriate drug prescribing is widespread among elderly patients. Regular review of medications by a primary care team and cessation of inappropriate medications should be incorporated into intervention strategies to reduce the number of inappropriately prescribed medications and associated adverse outcomes., Background/Purpose: Medication-related adverse events are a significant cause of morbidity and mortality in the geriatric population. With the percentage of Canadians over age 65 expected to double within the next 20 years, educating medical trainees about appropriate prescribing of medications for geriatric patients is becoming increasingly important. Using the internal medicine teaching ward, this study explored the teaching discussions that occur with respect to prescribing, and the use of potentially inappropriate medications (PIMs). Methods: Four admission histories for elderly patients were scripted to include learning opportunities regarding geriatric prescribing. A simulated student orally presented 1–3 admission histories to each of 24 internal medicine ward attending physicians (12 geriatricians and 12 internists) who were instructed to respond as they normally would during morning rounds. Semi-structured interviews following the case discussions explored how attending physicians chose the topics they talked about. Transcribed audio-recordings of 66 case review discussions were analyzed using template and inductive analysis for teaching scripts pertaining to PIMs. Results: Twenty of 24 interviews involving the review of 54 patient cases have been completed. Geriatrician and non-geriatrician attendings varied in terms of their degree of uptake of the geriatric prescribing teaching and learning opportunities built into the cases. Preliminary analysis of 20 completed interviews will be presented. Discussion & Conclusion: Teaching about geriatric prescribing and PIMs on the internal medicine clinical teaching wards can play a crucial role for the care of geriatric patients. Our study is the first to examine the teaching discussions around the prescription of medications for older adults in the context of the general medicine ward., Background/Purpose: Children born to mothers of advanced or adolescent ages face increased risk for multiple health problems. In this study, we investigated whether individuals born to mothers of these ages were more likely to experience frailty later in life. Methods: This was a retrospective cohort study of the Health and Retirement Survey, including 3,080 Americans age 50+ (mean = 58.2 ± 5.5 years, 54% women) for whom maternal age data were collected. Frailty was assessed using a 33-item frailty index; participants with scores 0.25 were considered frail. Maternal age at participants’ time of birth was categorized as older (35 years) or younger (< 20 years), compared to a reference group (20–34 years). Results: Mean maternal age was 22.7 ± 6.5 years. After controlling for participants’ age, gender, and education level, being born to an older mother was associated with higher risk for frailty compared to the reference group (OR = 1.61, 95% CI = 1.05–2.48), as was being born to a younger mother (OR = 1.40, 95% CI = 1.15–1.71). When maternal education level was added to the regression model, being born to an older mother was no longer associated with higher risk for frailty (OR = 1.52, 95% CI = 0.98–2.34), but being born to a younger mother remained associated with higher risk, at a similar level (OR = 1.41, 95% CI = 1.15–1.72). Discussion & Conclusion: Among middle-aged and older Americans, being born to an older mother is not associated with greater risk for frailty once maternal education is taken into account. However, being born to an adolescent mother is associated with higher risk for frailty later in life, regardless of maternal education level., Background/Purpose: Social vulnerability has been shown to be associated with mortality in Canadian populations. The purpose of this study was to investigate whether social vulnerability can predict mortality in middle-aged and older Europeans, after considering frailty. Methods: This was a secondary analysis of the first wave of SHARE (Survey of Health and Retirement in Europe), which began in 2004 and included a probability-based sample of non-institutionalized participants aged 50+ from 11 European countries. We used the deficit accumulation approach to create a frailty index and a social vulnerability index. The frailty index included 70 health deficits from the physical health, behavioural risks, cognitive function, and mental health sections of the main questionnaire. The social vulnerability index included 29 social factors from the drop-off questionnaire. For each index, an individual’s score reflects the proportion of deficits present out of the total possible deficits. Results: 18,289 participants were included in the analysis (age 65.0 ± 9.67, 45.9% male). The mean frailty index score was 0.15 ± 0.11 and the mean social vulnerability index score was 0.32 ± 0.09. Social vulnerability significantly predicted 5-year mortality when controlling for age and sex (adjusted hazard ratio = 1.33, confidence interval 1.25–1.42, p < .001). This association remained significant when additionally controlling for frailty (adj. HR = 1.09, CI 1.01–1.17, p = .02). Discussion & Conclusion: Similarly to Canadian populations, social vulnerability appears to be an important component for mortality risk stratification in middle-aged and older Europeans. Future investigations are needed to focus on the clinical implications of social vulnerability in older patients., Background/Purpose: The relationship between increased arterial stiffness and cardiovascular mortality is well-established in older adults. Short-term vigorous exercise interventions have been shown to reduce arterial stiffness in older adults with T2DM. We examined whether training type (aerobic training versus strength training) influences the improvement in arterial compliance in older adults with Type 2 diabetes complicated by co-morbid hypertension and hyperlipidemia. Methods: A total of 45 older adults (mean age 72.3 ± 0.7 years) with diet-controlled or oral hypoglycemic-controlled T2DM, hypertension, and hypercholesterolemia were recruited. Subjects were randomly assigned to one of three groups: an aerobic group (6 months vigorous aerobic exercise, AT group, n = 20), a strength training group (6 months strength training, ST group, n = 15), and a control group (no training, C group, n = 10). Exercise sessions were supervised by a certified exercise trainer three times per week. Arterial stiffness was measured as pulse-wave velocity (PWV) using the Complior device. Results: There was a significant difference in the response to training (group × time) between the AT and NA groups for both radial (p = .011) and femoral (p = .017) PWV. This was primarily due to an improvement in the AT group after 3 months training as compared to control (p < .001 radial PWV; p < .001 femoral PWV), that was not maintained at the 6-month mark for either radial or femoral PWV. Discussion & Conclusion: Our findings indicate that in older adults with T2DM, long-term strength training resulted in no improvement in measures of arterial stiffness, while aerobic exercise resulted in short-term improvements in arterial stiffness that became attenuated over the long term., Background/Purpose: Our program aims to provide physicians with Enhanced Skills in Care of the Elderly training. The program has undergone significant educational changes in the last year. Methods: The COE Program was established at the University of Alberta in 1993. To date, 51 residents have completed the program. Program description: 6 months to 1 year Enhanced Skills Diploma Program with core program requirements including geriatric inpatient, geriatric psychiatry, ambulatory, continuing care, and outreach. There is a longitudinal clinic component and a research project requirement. The program is designed to cover 85 core competencies encompassing the CanMEDS-Family Medicine Roles. Results: With the increased complexity of the frail elderly we are expanding the program to a 1-year program for the majority of residents, with an exit exam upon completion. This exit exam is comprised of MCQ and geriatric assessment observation with patient encounter. We have been able to increase our positions to four 1-year positions from four 6-month positions. With the increase of the program to 1 year, we have added new rotations in Palliative Care and significantly developed the community experience with rotations in Continuing Care which includes Supportive Living and a Home Living rotation. We have also introduced the electronic Competency Based Achievement System to give formative feedback to our residents. Discussion & Conclusion: There is a need for Care of the Elderly physicians to provide clinical care, as well as educational, administrative, and research roles to meet the health-care needs of medically complex seniors. We have made changes to our program to prepare residents for these roles., Background/Purpose: Post-operative delirium is associated with pain but also from the use of analgesics. Gabapentin has an opioid sparing effect and reduces pain in the acute post-operative period. The study objective was to determine the treatment effect of perioperative gabapentin on the incidence of post-operative delirium among elective total knee arthroplasty (TKA) patients. Methods: 161 patients with American Society of Anesthesiology (ASA) physical status class I–III scheduled for elective total knee arthroplasty at an orthopedic centre were randomized to receive gabapentin 200 mg (n = 83) or placebo (n = 78) before surgery and up to 3 days post-operatively. Incident delirium in the post-operative period was determined by a validated chart abstraction tool. A subset of charts was abstracted by two independent reviewers to determine inter-rater reliability. Data abstractors and patients were blinded to the study drug allocation. Results: Inter–rater agreement was good (κ = 0.83). Baseline characteristics, co-morbidities, type of anesthesia and analgesia, and previous exposure to gabapentin between the 2 groups were similar. Incident delirium in gabapentin (12%) and placebo (9%) groups was not significantly different (p = .53; absolute risk reduction −3.1%, 95% CI −12.5 to 6.4%). The mean duration of delirium in both groups was 1 day. Discussion & Conclusion: Perioperative gabapentin was not effective for the prevention of post-operative delirium in elective TKA patients nor did gabapentin have an effect on delirium duration., Background/Purpose: The objectives are: to describe factors associated with multi-morbidity in community-dwelling older adults; and to determine if a simple measure of multi-morbidity predicts death over 5 years. Methods: Analysis of an existing population-based cohort study. Population: 1751 community-dwelling adults, aged 65+, were interviewed and followed over 5 years. Measures: Age, gender, marital status, living arrangement, and education were all self-reported; the Mini-Mental Status Examination (MMSE), the Center for Epidemiologic Studies—Depression (CES-D), and the Older Americans Resource Survey (OARS). The measure of multi-morbidity was a simple list of common health complaints and diseases, followed by an open-ended question of other problems. These were summed and the score ranged from 0 to 16. Death and time of death were determined over the 5-year interval by death certificate, administrative data, and proxy report. Analysis: Cox proportional hazards models were constructed for time to death. Results: Multi-morbidity was more prevalent in women, older age groups, those with lower education levels, lower MMSE scores, more depressive symptoms, and higher levels of disability. Multi-morbidity was a strong predictor of mortality in unadjusted models—the Hazard Ratio (HR) and 95% confidence interval (95% CI) was 1.09 (1.05, 1.12). In models adjusting for age, gender, education, marital status, living arrangement, the CES-D, and the MMSE, this effect persisted: the HR and 95% CI was 1.04 (1.00, 1.08). However, after adjusting for functional status, the effect of multi-morbidity was no longer significant. Discussion & Conclusion: Multi-morbidity strongly predicts 5-year mortality, and the effect may be mediated by disability. The cumulative effect of health problems, however minor, is associated with poor outcomes. Guidelines and clinical care models must consider multi-morbidity., Background/Purpose: Older patients often pose a challenge to physicians who must determine which patients are good candidates for invasive cardiac procedures, a decision often left to clinical gestalt. The concept of frailty, a multidimensional approach to stratify older patients by physiology and function rather than age, has been associated with poor outcomes. However, due to the lack of consensus on significant measures and the increased time and personnel required, routine frailty assessments are not often used. Methods: A retrospective chart review was completed on 171 consecutive patients over the age of 85 who underwent PCI between 2007 and 2010. Four outcomes were evaluated: major adverse cardiac event, in-hospital death, increase in creatinine by > 25%, or any in-hospital complication. Sixteen demographic, clinical and frailty variables were studied. Results: The univariate analysis, using chi square for categorical and t-test for continuous variables, found that patients presenting with cardiogenic shock or urgent PCI had an increased risk for each of the four outcomes. A logistic regression with the outcome “any in-hospital complication”, found that the “inability to walk without an aid or assistance” (OR 3.9 (95% CI 1.8, 8.5)) was associated with in-hospital complications. Discussion & Conclusion: Our study found that patients over the age of 85, who were unable to walk without an aid or assistance, were 3.9 times more likely to have a post-PCI in-hospital complication. Asking a patient this simple question about their mobility is both quick and straightforward. A larger prospective study will need to assess whether this type of question could be used as a bedside screening tool to predict poor outcomes in older adults undergoing PCI., Background/Purpose: There is paucity of information concerning the epidemiology of multimorbidity in the frail elderly in Alberta. Four rehabilitation wards at a Rehabilitation Hospital have collected data from 2003–2012 for each admission. The de-identified data include ICD-10 diagnosis codes, length of stay (LOS), admission and discharge dates, admission and discharge Functional Independence Measure (FIM) scores, and age of patients. The objective is to begin analyzing and characterizing multi-morbidity in the geriatric population of Alberta. Methods: Data for 2010–12 were separated. A list of all present ICD-10 codes was formed. ICD-10 codes were put into diagnosis groups, which were then counted. The number of ICD-10 codes per patient was counted. The rate of FIM change (FIM efficiency) was calculated according to the equation: (Discharge FIM-Admission FIM)/Length of Stay). Regression analysis was performed to compare the relatedness between FIM Efficiency and Admit FIM, Length of Stay, and Number of Diagnosis Codes. Results: Initial analysis of codes of interest showed that 0% of this geriatric population had a code for chronic obstructive pulmonary disease, congestive heart failure, or urinary tract infection. Regression analysis revealed that Admission FIM and LOS are significant with FIM Efficiency, but Number of Diagnosis Codes is not. Discussion & Conclusion: The ICD-10 codes do not reflect expected prevalence for major chronic diseases. This may be a result of codes forming a present problem/treatment list, rather than a list of all diagnoses. There is a need for another study to fully describe the epidemiology of multi-morbidity in this population., Background/Purpose: Wounds, such as diabetic, venous ulcers, pressure ulcers, and surgical wounds, present a significant economic burden on health-care systems. High-quality cost-effectiveness evidence may play a role in considering resource allocation. We conducted a systematic review of cost-effectiveness analyses (CEAs) of wound care interventions to evaluate the methodological quality and cost-effectiveness of this evidence-base. Methods: Potentially relevant material was identified through searching MEDLINE, EMBASE and the Cochrane Library. Inclusion criteria included CEAs assessing any type of intervention for treating wounds in adults. Two reviewers independently screened search results and abstracted data from relevant articles in duplicate. The methodological quality of the included CEAs was appraised using the Drummond tool. Results: 6199 titles and abstracts and 421 full-text articles were screened for inclusion. Of these, 35 CEAs (including 12 cost-utility analyses) were included. The majority of the included CEAs (69%) focused on elderly patients. Only 12 CEAs were deemed to be high-quality (including one from Canada). Seven high-quality CEAs found the following interventions were cost-effective: pentoxifylline plus usual care versus standard compression with external treatment, 4-layer high-compression bandages versus short-stretch high-compression bandages, multi-disciplinary community wound care teams versus usual nursing care, hyperbaric oxygen therapy plus standard care versus standard care alone, becaplermin gel containing recombinant human platelet-derived growth factor plus standard care versus usual wound care alone, and ertapenem versus piperacillin/tazobactam. Discussion & Conclusion: We identified a large research gap in CEAs of wound care interventions, and the quality of the evidence is limited., Background/Purpose: Older adults have multiple chronic health and social conditions, requiring expertise from different health-care professionals. With the proportion of older adults increasing, it’s important for these professionals to work together effectively. Interprofessional education (IPE) (when two or more professionals learn with, from, and about each other to improve collaboration and quality of care) has been incorporated into policy, systems, and curricula globally. However, the impact of IPE remains unclear. An updated systematic review was performed to assess the effectiveness of IPE interventions on professional practice and health outcomes. Methods: We searched MEDLINE, CINAHL, and the Cochrane EPOC Register from 2007 to 2010. Additional articles were identified through reference lists and discussion with experts. Randomised controlled trials (RCTs), controlled before and after (CBA), and interrupted time series (ITS) studies of IPE interventions reporting objectively measured or self-reported (validated instrument) patient and/or health-care process outcomes were included. Two reviewers independently assessed potential study eligibility, performed data abstraction, and quality assessments. Results: Three studies met inclusion criteria. The CBA study reported improvements in presurgical procedure briefings and teamwork behaviours in the operating room of a community hospital. One RCT showed mixed results with no change in adverse patient outcomes, but a reduction in process outcomes (time from decision to perform a caesarean section to incision) in a labour and delivery team. Another RCT did not demonstrate an impact on primary care management of asthma. Discussion & Conclusion: Although studies suggest some positive impact, the difficulty of drawing conclusions about the effectiveness of IPE remains. Due to the heterogeneous and small number of studies with methodological limitations, further rigorous study designs are warranted., Background/Purpose: Cognitive impairment can affect driving performance among older drivers. The objective of this study was to examine the association between selected cognitive measures and self-reported driving comfort, abilities, and behaviours. Methods: We conducted a cross-sectional analysis of data from the first year of the Candrive II prospective cohort study, a 5-year longitudinal study of healthy drivers aged 70+ from seven Canadian cities. Cognitive assessment tools included: the Montreal Cognitive Assessment (MoCA) and Trail Making Tests, parts A and B. Driver perceptions were assessed using the Day and Night Driving Comfort scales and the Perceived Driving Abilities scale, while driving practices were captured by the Situational Driving Frequency and Avoidance scales and the Driving Habits and Intentions Questionnaire. Results: A total of 928 drivers, 62.2% male, with a mean age of 76.2 ± 4.8, were recruited. Univariate regression analyses revealed that the times to complete Trails A and B were modestly associated with self-reported driving avoidance, day and night driving comfort, and perceived driving abilities (p < .05). The association persisted after adjusting for age and sex, as well as variables pertaining to health, vision, mood, and physical functioning. Neither MoCA total score nor errors on Trails A and B were associated with any of the self-reported driving variables (p >.05). Discussion & Conclusion: Time to complete Trails A and B was statistically significant, but only modest predictors of self-reported driving comfort, abilities, and behaviours in this cross-sectional analysis. Results from the prospective follow-up of this cohort of older drivers will help clarify the relationship between cognitive performance and self-reported driver perceptions and driving restrictions., Background/Purpose: Hospital malnutrition is prevalent in elderly and contributes to loss of functional status, increases morbidity, mortality, length of stay and cost of care. Nutritional interventions improves outcomes in hospitalized elderly. Systematic service of diet based solely on age is not customary in adult acute care settings. Methods: As part of the OPTIMAH approach of care, we analyzed the protein and caloric content of every available diet at the Montreal University Hospital and compared it to metabolic requirements of hospitalized elders (75 yrs). Results: Most diets did not meet increased metabolic needs of the hospitalized elder population. Thus, we elaborated a menu that fulfills nutritional requirements and preferences of elders. New enrichment processes were developed to minimize cost. We modified the distribution process to ensure automatic serving of the OPTIMAH diet to this population. Nutritionists, diet technicians, and nurses on ward received a short training to inform them of the new diet and process of distribution. Nurses and physicians were sensitized to avoid prescribing restricted diets unless part of immediate essential medical treatment. Six months after the availability of the OPTIMAH diet throughout the 3 sites of the Montreal University Hospital, 74% of elder hospitalized patients were receiving this adapted diet. Discussion & Conclusion: The new OPTIMAH diet more closely fulfills the metabolic needs of elders in acute care. It is the first step to prevent in-hospital malnutrition. Adult acute care services should, like pediatric health services, offer adapted diets according to age. Government norms and correspondent financing should be readjusted to meet elders’ metabolic requirements to prevent costly complications related to hospital-acquired malnutrition., Background/Purpose: Education is an important component of dementia treatment for patients and their support networks. To compliment recommending education available from the Alzheimer Society of Canada, practical booklets were developed to improve the written educational material available regarding dementia. Methods: Hobbs, Hurley and Rhynold wrote three booklets: An Introduction to Dementia, The Dementia Compass, and Later in the Dementia Journey. Dougan designed an eye-catching theme to appeal to a wide audience. These booklets have been piloted in the Horizon Health Network, New Brunswick. A satisfaction survey was given to 25 patients and/or caregivers attending the Geriatric Medicine Ambulatory clinics at St. Joseph’s Hospital in Saint John, NB at follow-up appointments. Email feedback was also solicited. Results: As of September 2012, six sites in New Brunswick have ordered a total of 4151 booklets. Survey results averaged > 9/10 on the visual analog scale with a score of 10 indicating “very helpful”. Email feedback was positive with some suggestions for improvements. By survey, clinic attendees often indicated they were not interested in reading the material online. Discussion & Conclusion: Future directions: The writing team has always made the free distribution of these booklets their priority. Now that these booklets are available, the focus has shifted to increase distribution through written and online versions., Background/Purpose: Osteoporosis Canada’s Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis (OCG) provide guidance for the management of individuals 50 years and older at risk for fractures. However, OCG cannot benefit long-term care (LTC) residents if physicians perceive barriers to their application. Our objectives are to explore current practices to fracture risk assessment by LTC physicians, and describe barriers to applying OCG for fracture assessment and prevention in LTC. Methods: A cross-sectional survey was conducted with the Ontario Long-Term Care Physicians Association using an online questionnaire. Closed-ended responses were analyzed using descriptive statistics and thematic framework analysis for open-ended responses. Results: We contacted 347 LTC physicians; 88 submitted completed surveys (81% men, mean age 60 years (SD 11), average 32 [SD 11] years in practice). 87% of LTC physicians considered the prevention of fragility fractures important, but a minority (34%) reported using validated fracture risk assessment tools, while 33% did not use any. Clinical risk factors recommended by OCG for assessing fracture risk considered applicable included: glucocorticoid use (99%), fall history (93%), age (92%), and fracture history (90%). Recommended clinical measurements considered applicable included: weight (84%), TSH (78%), creatinine (73%), height (61%), and Get-Up-and-Go (60%). Perceived barriers to assessing fracture risk included difficulty acquiring necessary information (35%) due to lack of access to tests (bone mineral density, X-rays) or obtaining medical history; resource constraints (30%); and a sentiment that assessing fracture risk is futile in this population because of short life expectancy and polypharmacy (28%). Discussion & Conclusion: These findings highlight the necessity to adapt the OC guidelines so they are evidence-based and applicable to LTC, and to disseminate them to LTC physicians., Background/Purpose: We conducted a systematic review examining the comparative safety and efficacy of cognitive enhancers for patients with Alzheimer’s disease (AD). Numerous outcomes to assess AD were identified but selecting optimal ones for inclusion in our systematic review remained unclear. We compiled the identified outcomes and surveyed decision-makers to identify relevant outcome measures for inclusion in our systematic review. Methods: A systematic review was conducted on cognitive enhancers for AD by searching MEDLINE, EMBASE, and the Cochrane Library. Subsequently, two reviewers independently abstracted outcome measures used to assess cognition, function, behaviour, and global status. The identified outcome measures were compiled and sent to 36 clinicians (geriatricians from the Divisions of Geriatric Medicine at the University of Toronto and McMaster University) and 17 health policy-makers (from Health Canada) using FluidSurvey. Participants voted on the utility of 72 cognition measures, 29 function measures, 13 behavioural measures, and 12 global status measures using a 7-point Likert scale ranging from not important to most important. The scores for each scale were averaged to obtain a rating per scale. Results: 60% of invitees completed the survey. The average ratings per scale ranged from 6.50 to 2.97. The top-rated scale for cognition was the Trail Making test (average score 5.80), for function was the Activities of Daily Living (6.50), for behaviour was the Brief Neuropsychiatric Inventory (5.53), and for global status was the Clinician Interview-based Impressions of Change plus Caregiver Input (6.10). These results were used to inform data abstraction for our systematic review. Discussion & Conclusion: Our results can inform clinicians and researchers about relevant outcomes to assess patients with AD., Background/Purpose: In Canada, cognitive enhancers such as donepezil, rivastigmine, galantamine, and memantine have been approved for use in AD. Our objective was to examine the comparative efficacy and safety of these agents through network meta-analysis (NMA). NMA is an extension of traditional meta-analysis, and covers both indirect treatment comparison and mixed treatment comparison. Methods: Experimental and observational studies were identified through searching electronic databases (e.g., MEDLINE, AgeLine) from inception to 2011. Studies reporting on adverse events, cognition (e.g., Alzheimer’s disease assessment scale – cognitive subscale [ADAS-cog]), function, behaviour or global status were included. Reviewers independently screened search results and abstracted data from relevant articles in duplicate. Methodological quality was appraised using the Cochrane Risk of Bias for experimental studies and the Newcastle Ottawa scale for observational studies. Random effects and network meta-analyses were conducted. Results: A total of 132 randomized controlled trials, 4 non-randomized clinical trials, 2 controlled before-after studies, and 44 cohort studies were included after screening 15,676 titles and abstracts and 964 full-text articles. Preliminary results from the NMA indicate the following drugs performed better than others on cognition as per the ADAS-cog scale (listed in descending order): donepezil 10 mg, donepezil 5 mg, galantamine 16–24 mg, and memantine 20 mg. For nausea, use of the following drugs resulted in lower proportions of patients experiencing nausea (listed in descending order): memantine 20 mg, rivastigmine patch 9.5 mg, placebo, and donepezil 5 mg. Discussion & Conclusion: Donepezil 5–10 mg was most effective at improving cognition for patients with AD. The cognitive enhancer with the lowest risk of nausea was memantine 20 mg. These results can be used by patients and clinicians to tailor their AD treatment by specific cognitive enhancers., Background/Purpose: Individuals with mild cognitive impairment (MCI) suffer from memory problems without significant limitations in activities of daily living (ADL). Cognitive enhancers are used to treat dementia, but their effectiveness for MCI is unclear. We conducted a systematic review to examine the comparative efficacy and safety of cognitive enhancers for patients with MCI. Methods: Experimental studies were identified through searching electronic databases (e.g., MEDLINE, EMBASE). Studies examining cognitive enhancers in MCI and reporting on adverse events, cognition (Mini-Mental State Exam [MMSE], Alzheimer’s disease assessment scale – cognitive subscale [ADAS-cog]) or function (Alzheimer’s disease cooperative study: ADL inventory [ADCS-ADL]) were included. Two reviewers independently screened search results, abstracted data, and appraised risk of bias using the Cochrane risk of bias tool. Random effects meta-analysis was conducted. Results: Nine randomized controlled trials were included after screening 15,676 titles and abstracts and 964 full-text articles. No significant findings were observed for impact on cognition (MMSE: 3 RCTs, mean difference [MD] 0.14, 95% confidence interval [CI] −0.22, 0.50, ADAS-cog 5 RCTs, MD −0.52, 95% CI −1.09, 0.06), although there was a trend towards favouring cognitive enhancers. Similarly, function was not significantly impacted (ADCS-ADL, 2 RCTs, MD 0.30, 95% CI −0.26, 0.86) and no trend was observed. Cognitive enhancers were associated with a higher risk of nausea (5 RCTs, relative risk [RR] 2.95, 95% CI 2.48, 3.52), diarrhea (5 RCTs, RR 2.71, 95% CI 1.90, 3.85), and vomiting (3 RCTs, RR 4.40, 95% CI 3.21, 6.03). Discussion & Conclusion: Cognitive enhancers did not improve cognition or function among patients with MCI and were associated with a greater risk of nausea, diarrhea, and vomiting., Background/Purpose: Venlafaxine is a commonly prescribed antidepressant, but it is unknown whether its noradrenergic effects impart an increased cardiovascular risk. Objective: To examine the cardiac safety of venlafaxine relative to sertraline in older patients. Methods: We conducted a retrospective cohort study using administrative health-care databases in Ontario, Canada. We included all patients aged 66 years or older who commenced treatment with either venlafaxine or sertraline between April 1, 2000 and March 31, 2009. We used inverse probability of treatment weighting (IPTW) with the propensity score to account for observed systematic differences between the two treatment groups. The primary outcome was a composite of death or hospitalization for acute myocardial infarction or congestive heart failure within the first year of therapy. In secondary analyses, each outcome was examined separately. Results: We studied 48,876 patients initiated on venlafaxine and 41,238 patients initiated on sertraline. Of these, 4259 (8.7%) and 3459 (8.4%) experienced the primary outcome, respectively. We found no significant difference in the risk of adverse cardiac events with venlafaxine relative to sertraline (hazard ratio 0.97; 95% confidence interval 0.94 to 1.02). Secondary analyses revealed no differences in the risk of death or acute myocardial infarction between the two drugs, but the risk of heart failure was unexpectedly lower among patients treated with venlafaxine (hazard ratio 0.87; 95% CI 0.80 to 0.95). We found consistent results after stratification according to pre-existing cardiovascular disease. Discussion & Conclusion: As compared with sertraline, venlafaxine is not associated with an increased risk of adverse cardiac events in older patients., Background/Purpose: Frequent users of emergency departments, clinics and hospitals utilize a disproportionately large amount of health-care resources, thereby reducing efficiency and decreasing overall quality of care. As such, efforts have been made to implement quality improvement (QI) strategies targeting this population. Our systematic review aims to identify effective care coordination QI strategies for frequent users. Methods: We searched multiple databases (e.g., Cochrane Library, EMBASE, MEDLINE) from earliest date to March 2012. Additional citations were identified by scanning the reference lists of included studies. Citations and full-text articles were screened by two independent reviewers and relevant studies were abstracted and appraised for quality in duplicate using the Cochrane Effective Practice and Organization of Care tool. Random effects meta-analyses were conducted using data from randomized clinical trials (RCTs). Results: We screened 9564 citations and 132 full-text articles resulting in the inclusion of 44 relevant studies, including 36 RCTs. The three most commonly examined QI strategies were case management, self-management, and team changes. Nineteen studies included only patients with mental illness, while 25 included patients with other chronic illnesses. Our overall meta-analyses identified that QI strategies were effective in reducing the mean length of stay in all patients. In studies including patients with chronic illness, QI strategies effectively reduced the number of patients with emergency visits and the number hospitalized. QI strategies did not significantly reduce clinic visits or the number of patients hospitalized in studies including patients with mental illness. Discussion & Conclusion: QI strategies can reduce utilization in patients with chronic conditions. However, patients with mental illness may be more difficult to target with these QI strategies., Background/Purpose: Acute and chronic wounds result in substantial costs to our health-care system and significantly impact quality of life. Although a number of interventions are available to treat wounds, optimal strategies for wound care remain unclear. Our objective was to identify effective wound care interventions from high-quality systematic reviews in the literature. Methods: A search was conducted using MEDLINE, EMBASE and the Cochrane Library. Citations and full-text articles were screened in duplicate to include systematic reviews of adult patients receiving wound care. Two reviewers independently abstracted study characteristic and outcome data from the included reviews and appraised review quality using the AMSTAR tool. Results: From the 6199 titles and abstracts and 421 full-texts screened for inclusion, 110 systematic reviews were included. Fifty-seven reviews included meta-analyses and approximately 40% were rated as high-quality. From the highest quality meta-analyses, we identified a number of effective interventions across 5 wound types: 2-layer stockings, high-compression stockings, 4-layer bandages, elastic bandages, multi-layer high-compression, elastic high-compression, Pentoxifylline with or without compression, Cadexomer iodine, and engineered skin in patients with leg ulcers; air-fluidized beds, foam mattresses, hydrocolloid dressing, nutritional support and electrotherapy for pressure ulcers; granulocyte-colony stimulating factor, hydrogel dressing, hyaluronic acid, low-frequency/high-frequency ultrasound, and skin grafts for patients with diabetic ulcers; skin grafts and silver dressing for mixed chronic wounds; and honey for patients with burns. Discussion & Conclusion: Our results can be used by clinicians and patients to tailor treatment by wound type. Further analysis of this data through network; meta-analysis will be of utility to decision makers, as it will allow ranking of the effectiveness of all wound care interventions in the literature., Background/Purpose: Osteoporosis affects over 200 million people worldwide at a high cost to health care. Guidelines are available, but many patients are not receiving appropriate care. We developed an osteoporosis knowledge translation (Op-KT) tool to support clinical decision making: a tablet-initiated risk assessment questionnaire (RAQ), which generates best practice recommendations for physicians; and a customized education sheet for patients. We evaluated its impact on the initiation of appropriate osteoporosis disease management in primary care. Methods: Following an implementation plan in 3 family practices in Hamilton, Ontario that included workflow analysis, the Op-KT tool was evaluated using an interrupted time series design. This involved multiple assessments 12 months before (baseline) and 12 months after introducing the tool. Analysis included segmented linear regression models and analysis of variance. Results: Five family physicians from 3 practices participated; 2840 patients (mean age 67 years; 79% women) were eligible (31% of the practice population). Time series regression models showed an increase from baseline in the initiation of bone mineral density testing (3.2%; p = .02), any osteoporosis medication (0.5%; p = .0064), and calcium or vitamin D (1%, p = .0013). The RAQ was completed without prompting by 351 patients (mean age 64 years; 77% women; mean time to completion 3.43 minutes). Of these, 276 patients (79%) were at risk for osteoporosis (1 major or 2 minor risk factors). Discussion & Conclusion: Our multi-component Op-KT tool significantly increased osteoporosis investigations in 3 family practices. The study highlights the potential of using decision support tools at the point of care in busy, short-visit practices to facilitate patient self-management., Background/Purpose: Almost 30,000 patients annually experience a hip fracture in Canada. They tend to be older, frail with multiple chronic illnesses, including a high incidence of dementia and delirium. For many, the hip fracture results in poor outcomes including loss of function and use of ALC (alternate level of care) beds. In 2011 Bone and Joint Canada (BJC) worked with health-care professionals from across the country to develop a National Hip Fracture Toolkit, which was based on available evidence and a consensus building approach, to provide clinical and system best practices to better manage these patients and return them home. Methods: A knowledge translation approach was used to assist provinces to review their performance and to facilitate uptake of best practices. Identified barriers to care included the management of frail patients and their co-morbidities, access to rehabilitation, weight bearing, and patient education. Results: All provinces participated in the KT strategy at a national level, as well as hosting provincial and local events to measure their performance against the Toolkits recommendations. Care maps were implemented at a provincial level, and local improvement initiatives were undertaken in all provinces in 2012/2013. Surgeon practices to promote weight bearing were investigated and patient education materials were developed. In Ontario, recommendations on best practice were made for future funding of hip fracture patients. Discussion & Conclusion: The National Toolkit provides a system and clinical practice information on pre-operative, surgical, and post-operative care. It uses a multidisciplinary and multi-faceted approach to the clinical and operational management of older hip fracture patients and has improved care across the country., Background/Purpose: The UK Commissioning for Quality and Innovation Dementia (CQUIN) framework (2012) aims to facilitate early identification of patients with dementia during their inpatient stay and ensure they are referred to appropriate services. Step 1 is to find all patients over age 75 years meeting the inclusion criteria. Step 2 is assessment using a screening questionnaire, AMTS, collateral history, examination, and investigations, in order to stratify all patients as suspected dementia, known dementia or no cognitive impairment. Step 3 is referral to memory services or GP for further follow-up. We aimed for rapid assessment of all patients over 75 years of age admitted acutely to achieve 90% compliance in Steps 1–3. Methods: All patients over 75 were identified on a daily basis. A pro forma was developed and available in all wards. Junior physicians in elderly care wards assessed patients during daily rounds. The roles of the memory nurses were changed to supervise data collection and review patients in other wards. Results: The total number of patients assessed in September was 341/377 (90.5%) and October 2012 465/494 (97%). Of these patients with a diagnosis of delirium or who scored positively on the screening question, 113/113 (100%) and 192/198 (97%), respectively, had a dementia diagnostic assessment. In September 54/55 (98.2%) and October 133/133 (100%) of patients with suspected dementia were referred for further follow-up who might have been missed with standard care. Discussion & Conclusion: Implementation of the UK Dementia (CQUIN) framework is achievable through staff education, change in working practice, and clear implementation of protocols, with little extra resources. Early recognition of suspected dementia increases early access to appropriate support for patients and their careers., Background/Purpose: Our objective was to examine the impact of specialized palliative care (PC) (defined as a physician consultation focusing on PC needs, lasting at least 40 minutes) for adults 70 and older on: (a) use of chemotherapy within 14 days of death, (b) more than one emergency department (ED) visit, (c) more than one hospitalization, and (d) at least one intensive care unit (ICU) admission, all within 30 days of death. Methods: A retrospective population-based cohort study using linked administrative databases in Ontario was conducted with patients diagnosed with advanced pancreatic cancer from 1 Jan 2005 to 31 Dec 2010. Multivariable logistic regression analyses were performed with the above quality indicators as the outcomes of interest and PC as the exposure, adjusting for other variables (age, sex, comorbidity, rurality, and health region). Results: Of 6,076 patients with advanced pancreatic cancer, 58% were age 70 or older, and 5,381 had died at last follow-up. 57% (1251/2187) of those younger than 70 and 49% (1565/3194) of those 70 and older received a PC consultation (p = .0001). PC was associated with a lower odds (OR) of aggressive care among all age groups: 0.34 (95% CI 0.25–0.46) for chemotherapy; 0.12 (95% CI 0.08–0.18) for ICU; 0.19 (95% CI 0.16–0.23) for multiple ED visits; and 0.24 (95% CI 0.19–0.31) for multiple hospitalizations near death. Older age was also associated with lower odds of aggressive care for all four outcomes. Discussion & Conclusion: In patients with advanced pancreatic cancer, PC is associated with less frequent aggressive care across all age groups, but PC consultation and aggressive care were both less likely in older patients (70+)., Background/Purpose: To meet the challenges of population aging and increasing multimorbidity, significant reform to health-care systems is underway. New models of care include the patient-centred medical home and interprofessional team-based approaches; however, there has been limited exploration of the effectiveness of such interventions for patients with multimorbidity. To evaluate both the clinical-effectiveness and cost-effectiveness of a team-based model of primary care specifically designed for older patients with multimorbidity. Methods: Multi-site randomized controlled trial of the IMPACT clinic (Interprofessional Model of Practice for Aging and Complex Treatments). Inclusion criteria: patients aged 65+, three or more chronic diseases requiring monitoring and treatment, five or more long-term medications, and minimum of one functional ADL limitation. Exclusion criteria: home-bound or institutionalized patients, or deemed unsuitable by the usual family physician. The IMPACT team comprises family physicians, specialist physicians, visiting nurse, pharmacist, community social worker, occupational therapist, physiotherapist, dietitian, and care navigator. IMPACT patients are scheduled for extended visits (1.5 to 2 hours) during which the full team works collaboratively with the patient and family caregiver(s) to address current medical, functional, and psycho-social issues. During the visit, a pro-active interprofessional care plan is developed, a comprehensive medication review is conducted, and a discussion of anticipatory care planning is initiated. Results: Primary outcomes include Emergency Department visits, hospitalizations, and physician visits. Secondary outcomes include patient satisfaction, family caregiver satisfaction, provider satisfaction, quality of life, caregiver strain, and interprofessional team function. Discussion & Conclusion: This RCT will contribute much-needed evidence on the effectiveness of a team-based primary care intervention for older patients with multimorbidity., Background/Purpose: Cancer is a disease that mostly affects older adults. A geriatric assessment (GA) has been recommended for older adults to assist with treatment decision-making. The aims of review: 1) to provide an overview of the use of GA in oncology; 2) to examine feasibility and psychometric properties; 3) to systematically evaluate the effectiveness of GA in predicting/modifying outcomes. Methods: A systematic review of literature published between November 2010 and July 2012. Articles published in 5 databases in English, Dutch, French, and German were included. Articles were selected and reviewed by 2 independent reviewers. Results: 34 manuscripts reporting on 33 studies were identified. The quality of most studies was moderate to good. Of all studies, 14 were prospective, 8 cross-sectional, 5 retrospective and 7 others (mostly phase II trials of a new treatment regimen). A GA was shown to be feasible, the time needed to complete ranged between 5 and 120 minutes, were mostly conducted in the outpatient oncology setting by nurses, and most often included the domains activities of daily living, co-morbities, cognitive function, depression, medications, and fall risk assessment. Four studies examined psychometric properties of the GA with satisfactory results, and 18 studies examined the predictive ability of the GA and showed that components of the GA predicted treatment toxicity and overall survival. Discussion & Conclusion: Although the studies showed that GA was feasible and had predictive validity, there has not been a randomized controlled trial showing the effectiveness of the GA in improving outcomes for older adults with cancer., Background/Purpose: The capacity for bone repair and regeneration diminishes with age. This prolongs fracture healing time and, in some instances, results in non-union, requiring extensive surgery. The mechanism behind this is not known; however, studies thus far have assumed the reason to be a decrease in the capacity of bone marrow mesenchymal stem cells (MSCs) to differentiate into bone-forming cells (osteoblasts). We found that old MSCs can be “rescued” to behave like young MSCs when cultured in media pre-treated by young cells. These findings implicate the presence of a “youth factor” that is secreted by young bone marrow cells and is able to rescue the aged phenotype of old cells. Thus, the purpose of this study is to determine the cell type responsible for rescue of osteoblast differentiation in old cells, and to determine its effects on fracture repair in old mice. Methods: Bone marrow cells were isolated from young and old mice. Osteoblast differentiation in culture was determined by quantifying colony forming unit-osteoblast. Fracture repair was assessed using a tibial fracture mouse model. Results: Co-culture of old cells with young hematopoietic stem cells (HSCs) promoted osteoblast differentiation of these old cells. Interestingly, an adherent F4/80+ cell population (a marker of monocyte–macrophage cell lineage) was identified in young, but not old, HSC cultures. In culture, exposing old MSCs to media pre-treated by young macrophages induced osteoblast differentiation of these cells. Furthermore, bone marrow transplantation of young F4/80+ cells into old mice resulted in improved fracture repair. Discussion & Conclusion: This study demonstrates that young macrophages secrete soluble factors that can rescue osteoblast differentiation and improve fracture repair in older animals., Background/Purpose: The Canadian Institute of Health Information (CIHI) designates patients who remain in hospital after their acute care phase is completed as Alternate Level of Care (ALC) patients. Understanding who the ALC population is in hospital is needed. Methods: All ALC patients Horizon Health Network (HHN) as of Feb 9, 2012 were identified. A data collection tool, designed for the study, was used to review charts. Results: There were 413 ALC patients identified, occupying 25.2% of all hospital beds within HHN. A stratified random sample from 7 hospitals comprised the sample of 223. Two were excluded due to long length of stays, giving a sample of 221.The mean age was 78.4 years. Prior to admission, 51 (23.1%) were living in a care institution in the community. Dementia was a diagnosis in 53.9%. The overall mean length of stay until data collection was 293.4 days. Six months later, 81 (36.7%) were still in hospital, 32 (14.5%) had died, and 65(29.4%) were discharged to nursing home. For those discharged to a nursing home, the mean length of stay was 262.8 days. For those still in hospital, the mean length of stay was 683.9 days. Discussion & Conclusion: The majority of ALC patients are elderly with dementia. Six months after data collection, the majority remain in hospital with a mean length of stay of almost 2 years. Even those who went to a nursing home, the length of stay was almost 9 months., Background/Purpose: Identifying measures to predict short-term toxicities in patients undergoing intensive chemotherapy (IC) for acute myeloid leukemia (AML) is needed. Emerging data suggest that quality of life (QOL) assessment and/or physical performance measures (PPMs) may predict outcomes in oncology, although there are no data in AML patients. Methods: We conducted a prospective, longitudinal study of adults (age 18–59) and older (age 60+) AML patients undergoing IC. Prior to starting IC, patients completed the EORTC QLQ-C30 and FACT-Fatigue, in addition to PPMs (grip strength, timed chair stands, and 2-minute walk test). Outcomes included 60-day mortality, intensive care unit (ICU) admission, and achievement of complete remission (CR). Logistic regression was used to evaluate each outcome. Results: Of the 243 patients (median age 57.5 yrs), 56.7% were male, and 96 (40%) were older. 60-day mortality, ICU admission, and CR occurred in 9 (3.4%), 15 (6.2%), and 171 (70.4%), respectively. In univariate regressions, neither QOL nor PPMs were predictive of 60-day mortality (all p > .05), whereas cytogenetic risk group (p = .04), ICU admission (p ≤ .001), and remission status at 30 days (p = .006) were. Fatigue was a significant predictor of ICU admission (p = .02), whereas QOL and baseline PPMs were not. In univariate analyses, higher Charlson score was a significant predictor of both ICU admission (p = .01) and remission status at 30 days (p = .002). Neither QOL nor PPMs were predictive of achieving CR (all p > .05). Findings were similar among the subset of older patients. Discussion & Conclusion: Baseline QOL and PPMs were not associated with short-term mortality, ICU admission, or achievement of CR after the 1st cycle of chemotherapy for AML., Background/Purpose: Self-rated health (SRH) has been shown to predict functional status in older adults, but this has less often been examined for older cancer patients. The aim of this study was to determine the association between SRH and functional status, comorbidity, toxicity of treatment, and mortality in older newly diagnosed cancer patients. Methods: Patients aged 65 and over, newly diagnosed with cancer, recruited at the Jewish General Hospital. SRH was evaluated prior to treatment, and at 3, 6, and 12 months. Functional status (Instrumental Activities of Daily Living (IADL), Basic Activities of Daily Living (ADL), ECOG Performance Status (ECOG PS), and frailty markers (low grip strength, mobility impairment, physical inactivity, cognitive impairment, mood impairment, and poor nutritional status) were measured at baseline, 3, and 6 months. Treatment toxicity and mortality were abstracted from the chart. Chi-square tests and t-tests were used to compare patients who rated their SHR as fair/poor/very poor to those very good/good with regard to functional status, frailty, and co-morbidity. Logistic and Cox regression were used to examine the association between baseline SRH and treatment toxicity/time to death. Results: There were 112 participants, median age 74.1. At baseline, 74 (66.1%) had a good SRH and 38 (33.9%) had poor SRH and those had more co-morbidities, more frailty markers present, lower ECOG PS and IADL impairments. We found no association between SRH and toxicity or mortality. Discussion & Conclusion: There was a moderate correlation between SRH and the number of frailty markers, IADL disability, and co-morbidities, but SRH did not predict toxicity or mortality., Background/Purpose: People over the age of 60 account for 60% of paramedic responses in Canada. Many of these calls are not life-threatening or time-sensitive. Paramedics have a unique opportunity to engage people in their homes and they often see people in vulnerable circumstances. The field of Community Paramedicine is growing in Ontario and across Canada due to its potential to provide alternative patient care pathways. In 2006, Toronto Emergency Medical Services (EMS) established its Community Referrals by EMS (CREMS) program to link patients with Community Care Access Centres (CCAC). With a simple phone, call paramedics identify and connect patients with community support services. Methods: To determine the effectiveness of the Community Paramedicine program, 904 patients referred to CCACs in 2011 were evaluated for improved outcomes and reduced reliance on EMS. The 6-month period prior to initiating the CCAC referral was compared to the 6 months post-CCAC referral. Results: The total calls to EMS were reduced from 2,715 to 1,340 for this patient group. Transports to emergency departments also decreased from 1654 to 582. Paramedics spent less time overall with these patients, reduced from 4597.28 hours to 1898.87 hours. Based on the decreased transports and time spent assessing and treating these patients, cost savings have been estimated to be as high as $321,600.00 for the 6-month post-referral period. Discussion & Conclusion: Community Paramedicine offers an innovative, cost effective opportunity to improve the health care of elders wishing to age and live at home independently. Future directions will include exploring an expanded scope of clinical, practice for paramedics, and a more systematic evaluation of the CREMS program with an eye toward broader implementation., Background/Purpose: Men with PCa on ADT are at risk of decreased bone mineral density (BMD) and osteoporosis. Guidelines recommend referral to specialized clinics, but the quality of care in osteoporosis clinics and benefits to patient have never been reported. Methods: Charts for 67 men (mean age 74.2 yrs) on ADT referred to an academic osteoporosis clinic between 2010 and 2011 were reviewed. The following quality of care issues were examined: (a) services provided to PCa patients receiving ADT (e.g., screening, preventing, and treating osteoporosis); (b) use of Canadian guidelines to target appropriate therapies. Results: 56 (83.6%) received continuous ADT for a mean of 27.4 ± 30.7 months at the baseline visit. 37 (55.2%) had osteopenia and 15 (22.4%) had osteoporosis. At initial consultation, 55.2% were taking 1000 mg calcium daily from all sources, while 26.9% were taking more than 1200 mg; 22.4% were taking Vitamin D 3 months. For lifestyle recommendations, 71.4% of sedentary patients were advised to increase exercise. Of the 39 (70%) and 24 (39.2%) patients who were not taking appropriate amounts of calcium and vitamin D, respectively, 100% were recommended to adjust their intake to guideline levels. Discussion & Conclusion: The osteoporosis clinic performed a comprehensive assessment and recommended guideline-based bone health care for the vast majority of men on ADT, suggesting a systematic approach to assessing bone health is associated with high rates of guideline-adherent care., Background/Purpose: Metastatic castration-resistant prostate cancer (mCRPC) is characterized as disease progression despite adequate androgen deprivation therapy (ADT). Although chemotherapy for mCRPC prolongs survival, whether its impact on elderly-relevant outcomes and toxicity differ by frailty status is not known. Methods: Men aged 65+ with mCRPC who were starting first-line chemotherapy were enrolled in this longitudinal prospective pilot study. Elderly-relevant information was collected at baseline and before the start of each chemotherapy cycle. Frailty was assessed by the Vulnerable Elders Survey (VES-13), functional status by OARS-IADL, social activities limitation and support by MOS measures, and FACT-G and FACT-P for general and prostate-specific quality of life (QOL), respectively. Physical function was assessed by timed up and go (TUG), timed chair stands, and grip strength. Changes in outcomes were analyzed between frail vs. non-frail patients using Student’s t-test and linear regression. Results: 21 patients (mean age 74), of whom 11 were frail (VES-13 3), were assessed. Generally, at baseline frail patients were slightly older and scored lower than non-frail patients in QOL, functional status, physical function, and social support and activities. However, frail patients improved more than non-frail patients in all domains, except TUG. 18% of frail patients died during the course of therapy compared to no deaths in non-frail patients. Discussion & Conclusion: Frail patients, as determined by VES-13 3, with mCRPC may represent a heterogeneous population; one group destined to die soon and the other who may do well with chemotherapy. Further research and patient recruitment is needed to determine whether a subset of frail older patients would benefit from first-line chemotherapy treatment., Background/Purpose: The Clock Drawing Test (CDT) is a screening tool used by physicians for detecting dementia in the clinical setting and is commonly used for identifying drivers with a dementia whose driving skills may have declined to an unsafe level. However, the accuracy of the CDT for detecting declines in driving due to a dementia is not well-established and is confounded by the presence of multiple scoring systems. The purpose of the study was to examine the intra-rater reliability of a novice scorer; the inter-rater reliability between a novice scorer and a trained clinician; and the relationship between different CDT scoring methods and on-road driving performance. Methods: 50 cognitively impaired and cognitively intact participants completed the CDT and an on-road assessment. A novice scorer and a trained clinical geriatric specialist scored the clocks using 4 CDT scoring systems (Rouleau, Shulman, Freund, and MoCA). Results: The intra-rater reliability of the novice scorer across the four scoring schemes was high (Pearson’s r of 0.85 to 0.90, all p = .01), as was the inter-rater reliability between the Novice Scorer and the Geriatric Specialist (Pearson’s r of 0.68 to 090, all p = .01). None of the CDT scores were significantly related to on-road outcomes. Discussion & Conclusion: Although there was good intraand inter-rater reliability for the scoring systems tested, none of the CDTs examined were significantly associated with on-road outcomes, indicating that use of CDT scores is most likely to result in erroneous driving decisions for cognitively impaired patients., Background/Purpose: In 2010, Baycrest implemented a Slow Stream Rehabilitation Program (SSR) to deliver a low-intensity long-duration rehab for frail seniors’ post-acute hospitalization. To examine the change in function, length of stay, and discharge destination of patients admitted to SSR. Methods: Psychosocial and functional measures were administered to patients on admission and discharge to the SSR Unit. Results: Over a period of 15 months, 105 patients (70% of all admissions) were recruited; mean age was 82, mean stay in acute care was 32 days, and the mean LOS in SSR was 88 days. On admission, 85% had mild/moderate to severe cognitive impairment (MoCA: 26) and 78.5% were dependent with transfers with or without devices. Mean admission FIM: 51 and discharge FIM: 74; admission Berg Balance Scale (BBS): 10 and discharge BBS: 19.7. On admission 51% could ambulate 10 steps with a device and 80.4% on discharge. Upon discharge, 68% were discharged home or to other community residences; 24% to Long-Term Care (LTC) and 9% went to acute care. Discussion & Conclusion: This study confirms that the SSR population is a frail elderly group admitted after a mean of 32 days in acute care. With low functional ability on admission, this group was able to achieve over 80% ambulation with or without a device and had a mean discharge FIM of 74. After 88 days of low-intensity rehab, 68% were able to return to community living. After a long acute hospital stay, frail older adults with cognitive impairment can benefit from slow stream rehabilitation to prepare them for living in the community rather than going to LTC., Background/Purpose: Residents who are international medical graduates (IMGs) are a heterogeneous group of learners with distinct backgrounds of ethnicity, religion, and culture. They came from various countries with differing medical education standards, societal values, and professional codes of conduct. When training and working in Canada, IMG residents may experience trans-cultural challenges. The purpose of this study is to identify cultural strengths and challenges that IMG family medicine residents encounter when working and training within the Canadian medical context, and to identify the values, behaviours, and codes of conduct expected of family physicians working in Canada. Methods: Focus group with seven academic/community preceptors who teach residents. Qualitative data were transcribed and analyzed for emerging themes. Results: Distinctive Canadian socio-medico-cultural values were identified in six theme areas – communication, gender, cultural awareness, ethics, medical knowledge, and social hierarchy. IMG residents were noted to possess strengths in: ability to speak multiple languages; establishing rapport with patients of a similar culture; understanding culturally-defined gender roles; knowledge of global diseases; skilled at procedures; proficient in making diagnoses based on clinical indicators; and possessing a sense of responsibility to the greater community. The challenges that IMG residents were noted to encounter include: difficulty with language nuances; culturally-defined gender interactions; challenges of dealing with patients from diverse cultural groups; limited understanding of ethics; disease-focused care; hierarchical/didactic approach to learning; and tendency not to ask questions during the learning process. Discussion & Conclusion: Cultural gaps appear to be present when IMG residents interface within the Canadian medical context. Identification of trans-cultural challenges will assist in the development of teaching resources for use in IMG resident training., Background/Purpose: The purpose of this study is to develop a novel interdisciplinary pain management (IPM) model to better treat and manage pain within the elderly population residing in long-term care institutions. Methods: This project is being carried out as a multiphase study: Medical record review of 180 patient charts characterizing the usual care model currently relied upon in representative facilities.One-on-one staff oriented interviews discussing staff perceived barriers, challenges and strengths concerning current pain management practices. Grounded theory will be utilized to analyze transcripts and develop theories.Focus group session aimed at further exploring themes developed during one-on-one interviews.Details of the interdisciplinary model will be delineated. This phase will encompass creation of all educational materials, tools, and standard operating procedures.Implementation of model will take place via comparison study. A cohort of residents will have pain scores measured before (usual care) and following implementation of interdisciplinary pain management model. Results: An interdisciplinary pain management model for patients in long-term care facilities is established. Implementation and trialing of the interdisciplinary model will prove to be more beneficial than the standard care model. Ultimately, this will be demonstrated by an overall improvement in resident pain scores. Discussion & Conclusion: The development and utilization of an interdisciplinary pain management model will provide a useful and efficacious method to treat pain in the aged living within long-term care facilities., Background/Purpose: The growing number of elderly patients with multiple chronic conditions presents a pressing challenge to the Canadian health-care system. Current practice models are not well suited to this challenge. Our primary objective was to design and evaluate a new interprofessional care model for community-dwelling seniors with complex health-care needs. A secondary objective was to explore the potential of the new model as an interprofessional training opportunity. Methods: The IMPACT clinic (Interprofessional Model of Practice for Aging and Complex Treatments) features an extended visit (90 minutes) with a comprehensive interprofessional team. The model is designed to be patient-centred and family-friendly and attempts to bridge primary care, specialty care, and community care. IMPACT was pilot-tested at one site and peer-modeled at three other sites. A multi-method evaluation included a chart audit, survey of team function, and qualitative interviews with patients/families. Results: Observed benefits of the IMPACT clinic include: significantly more time and “space” for the patient and family to discuss current concerns; reduction in repeat visits and multiple referrals; enhanced real-time information-sharing; improved professional understanding of other disciplines; greater satisfaction among health-care providers; and enhanced interprofessional learning among clinical trainees. Challenges included: extended length of visits proved exhausting for some frail patients; interprofessional team-based models perhaps not optimal for patients with sensory impairments or severe mental health concerns; and scheduling issues sometimes arose owing to the number of clinicians involved. Discussion & Conclusion: Evaluation of the IMPACT clinic is encouraging with positive feedback from patients/ families, team members, and clinical trainees. Interprofessional care models hold great promise for meeting the challenge of complex chronic disease in the elderly. Further evaluation is underway., Background/Purpose: Medical Directors in LTC homes in Ontario are increasingly being faced with adminstrative needs of a more complex patient population and in an environment of increased legislative and regulatory oversight. There are roles identified within the LTC Homes Act, as well as key roles outlined in Medical Director Contracts agreed to by MOHLTC and the OMA. The Ontario Long Term Care Physicians is a non-profit organization with close to 300 members who are physicians working in LTC homes in Ontario. The organization runs a clinically focused conference each fall and increasingly is aware of administrative skills and expertise for which many members may not have received formal training. In addition, we hear from members challenges they face with being informed of important system changes and new programs being implemented. The purpose of the survey was to identify perceived and unperceived learning needs of physicians working in Long Term Care to explore future educational initiatives. Methods: Unrestricted grant received from Pfizer to develop a LTC physician survey and begin developing educational initiatives based on outcomes of the survey. Survey questionnaire developed with input from OLTCP board member working group. Survey was circulated via OLTCP database. Survey results then analysed and presented to OLTCP board and membership. Results: Survey identified perceived and unperceived learning needs in areas of legislative requirements, quality improvement, program management, high-risk clinical areas, and working with teams. Barriers to involvement in areas of administration included time and knowledge, not lack of interest. The details of these results will be shared in the poster format. Discussion & Conclusion: Survey identified key learning needs that are facing medical directors in LTC homes that are integral to the role of Medical Director. The OLTCP has explored training programs and conferences in North America and has determined that the content areas of the Core Curriculum on Medical Direction in LTC run by the American Medical Directors Association in the United States best matches the learning needs we have identified. We have now developed goals and objectives for an equivalency curriculum, and are in the process of developing the curriculum to address medical direction and leadership skills required to be an effective medical director in LTC., Background/Purpose: As the life expectancy and chronicity of health conditions affecting Canadians continues to rise, the assessment of autonomous decision-making capacity becomes an issue of increasing importance. Adults with diseases and disabilities are at particular risk in this regard. Comprehensive assessments and realistic interventions that employ the least intrusive and least restrictive measures possible have been determined to be the most ethical and desirable. Methods: The inter-disciplinary DMC Model was developed based on a literature search, environmental scan, needs assessment, surveys, and discussions with inter-disciplinary groups at various health-care sites within Covenant Health in 2006. An iterative process was used to formulate a model, which was then implemented in the Covenant Health and AHS sites, Edmonton zone, from 2007–2012. Results: This model was “provincialized” through the AHS Seniors Health Cognitive Strategic Planning Committee and has been made available for use provincially. It includes a care map, worksheets, and staff training workshops and in-services, and an inventory of educational materials. Staff trained in the assessment of decision-making capacity and use of the model (e.g., physicians, psychologist, nurses, nurse practitioners, social workers, occupational therapists, care co-ordinators) effectively implemented the DMC Model in Edmonton and Calgary zones, and to varying degrees in the other zones from 2010–2012. Discussion & Conclusion: The DMC Model offers a holistic inter-disciplinary approach to capacity assessment that maximizes client autonomy, offers the least restrictive and intrusive solutions, and facilitates inter-disciplinary and inter-organization collaboration., Background/Purpose: In a re-analysis of data from the Canadian Study of Health and Aging, non-traditional risk factors, which were not typically associated with dementia, were found to impact an individual’s level of frailty and subsequently their risk of Alzheimer’s disease (AD). We examined whether an index consisting of such factors could predict future reports of incident AD and dementia, as well as mortality, in a similar manner to traditional risk factors, in a larger, multinational cohort. Methods: Secondary analyses were conducted on data from the Survey of Health, Ageing, and Retirement in Europe and consisted of cognitively healthy individuals 50 years or over, from 12 European countries (N = 11,817). Three AD risk factor indices (RFIs) were constructed to predict a ∼ 4-year risk for a self or informant report of AD, dementia, and survival; a 31-item non-traditional RFI, a 6-item traditional RFI, and a 37-item combined RFI. Results: After adjusting our risk model for age, sex, education, and traditional risk factors for AD, the non-traditional RFI significantly predicted the risk of dementia (OR = 1.49, 95% CI 1.34–1.67), and mortality (OR = 1.53, 95% CI 1.19–1.96) after an average of 4.3 years. The combined RFI exhibited the strongest prediction of dementia (OR = 1.79, 95% CI 1.38–2.32) and mortality (OR = 1.68, 95% CI = 1.50–1.89). Discussion & Conclusion: The typically small impact of health deficits that are not traditionally associated with AD can significantly increase one’s risk of both dementia and mortality when combined. Health professionals should place greater importance on the examination of overall health decline, rather than solely assessing traditional risk factors for illness., Background/Purpose: Based on clinical trials, treatment of metastatic castration-resistant prostate cancer (mCRPC) with chemotherapy is seen to improve disease control and survival in older men (age 65+). Its effects, though, on the daily functioning, physical performance, and quality of life (QOL) in elderly men outside the clinical trial setting are not well understood. Methods: Men aged 65+ with mCRPC starting first-line chemotherapy at a tertiary cancer centre were enrolled in this prospective observational pilot study. Physical function was assessed with the timed up and go (TUG) test, Timed Chair Stands, and grip strength. Functional status was measured using the OARS-IADL questionnaire, in addition to social activities limitations and social support (MOS measures). Patients completed the FACT-P and FACT-G to measure prostate-specific QOL and general QOL, respectively. Assessments were completed before each cycle of chemotherapy. Pre–post within-group comparisons were done using Student’s t-tests and linear regression. Results: 25 patients (mean age 75) receiving Docetaxel + Prednisone were enrolled, 3 of whom died and 2 dropped out. Both general and prostate-specific QOL improved over a median of 6 cycles. Patients’ instrumental activities of daily living (IADL) scores remained stable over time. On average, grip strength was stable, and lower extremity function improved on both the TUG and Timed Chair Stands. Discussion & Conclusion: Contrary to our hypotheses, QOL improved in this frail elderly cohort, and IADL function remained stable. Although physical function remained stable or improved during first-line chemotherapy, there was significant variability among individual patients. Older men with mCRPC appear to tolerate first-line chemotherapy fairly well in terms of QOL and geriatric domains., Background/Purpose: Despite treatment of the associated condition delirious persons do not always recover, for unknown reasons. We sought to derive and validate a prognostic model to predict poor recovery after an episode of delirium based on early admission characteristics. Methods: This prospective cohort study consecutively enrolled older medical in-patients (admitted to London Health Sciences Centre) from the community. Participants were screened for delirium. Delirious (by the Confusion Assessment Method) patients were followed in hospital and after discharge.The primary outcome was poor recovery, in delirious patients, defined by death, institutionalization or functional decline (decreased activities of daily living), at discharge or 3 months after discharge, elicited from the medical chart or post-discharge caregiver telephone interviews. Results: 1235 medical in-patients (mean age 82.6 years, 42% male) were screened. Delirium occurred in 355 (or 29%) and recovery status was known in 342 (96%). Fifty-four patients (15%) died in hospital and 24% (n = 86) were discharged to a permanent residential institution. At a median of 103 days after discharge, another 97 (or 48%) delirious individuals who were discharged from hospital, had poor recovery (one deceased, 50 institutionalized, and 46 with decreased activities of daily living ability), resulting in an overall rate of poor recovery of 69% (237). Poor recovery was associated with advanced age, lower baseline function, not being on a benzodiazepine prior to admission, hypoxia, having higher delirium severity scores, and acute renal failure. This model was predictive of poor recovery in the validation sample (ROC area of 0.68, 95% CI: 0.57–0.80). Discussion & Conclusion: Results suggest that poor recovery after delirium is common, and is associated with certain characteristics available on admission., Background/Purpose: The Regroupement des Unités de courte durée gériatriques et des services hospitaliers de gériatrie du Québec (RUSHGQ) is a community of practice, established in 2010, bringing together health professionals and managers working in GAU. It was previously observed that the quality of care processes varies between GAU. The mobility committee of the RUSHGQ recommends that all GAU units use similar gait and balance scales to standardize patient evaluation, management and follow-up in Quebec. The objectives of the study are: 1) to characterize scales used by physiotherapists; and 2) to inquire about scales that must be used to assess patients with moderate-to-severe gait and balance disorder. Methods: Two surveys were held among physiotherapists and physical rehabilitation therapists working at a GAU unit (n = 48) associated with the RUSHGQ. Results: Overall, professionals from 36 GAU responded to one or both surveys. The most frequent scales used by the participants are Berg Balance Scale (BBS)–97%; Timed Up and Go Test (TUG)–80%; and walking speed test–57%. Those tests (BBS, TUG, and walking speed test) were also the most frequently recommended by the participants for assessing a patient with moderate-to-severe gait and balance disorder. Discussion & Conclusion: The mobility committee of the RUSHGQ recommends that the assessment of gait and balance disorders should include at least the Berg Balance Scale, the Timed Up and Go Test, and a walking speed test., Background/Purpose: Traditionally physicians have viewed Subjective Cognitive Impairment (SCI) in older people to be benign and related to age-associated memory loss. However, research in this field suggests that people who self-report memory problems, but score normal on cognitive testing, have a higher rate of progressing to mild cognitive impairment (MCI). Methods: Over the last 4 years a total of 165 people over 55 responded to newspaper advertisements with self-reported memory loss. Participants received cognitive screening tests using the standardized MMSE, the MoCA, the 15-point GDS, the AD8, the Cornell Scale for Depression in Dementia, and the Lawton Brody Activities of Daily Living Scale. The test results were case conferenced with a geriatrician, and a clinical suspicion of normal, SCI, MCI, depressive symptoms/mixed picture, possible dementia or other was given. 46 individuals have repeat measures on these tests from 2009 to 2012. Results: In 2012, of those 46 follow-up participants, 54% had no change on their cognitive tests. However 33% had declined over the 4 years and 9% had improved. Of those who were given the clinical impression of SCI in 2009 or 2010, 39% had declined to amnestic MCI or multiple-domain MCI. Those individuals who reported depressive symptoms in 2009 (32%) tended to have lower scores on the GDS and Cornell on follow-up visits. Discussion & Conclusion: In studies published on SCI, those who self-report memory problems compared to normal health controls are at greater risk of declining to MCI. Our study captured this trend as 39% of those with SCI had declined to MCI within 4 years. Those with depressive symptoms may have improved with non-drug/drug approaches., Background/Purpose: Many older adults are prescribed benzodiazepines despite their association with cognitive decline, postural instability, falls, hip fractures, and a five-fold risk of hospitalization after a motor vehicle collision. Yet, 16% to 33% of elderly, community-dwellers use benzodiazepines, and 54% use them daily. In this review, we address the approach to discontinuation and effective alternative options. Methods: MEDLINE (1946–2012), EMBASE (1980–2012), and the Cochrane Database of Systematic Reviews (2005– 2012) were searched. The following key search terms were used: MeSH & EMBASE terms for benzodiazepines, sleep initiation and maintenance disorders, drug withdrawal and abuse terms, and keywords for sleep, addiction, dependence, and insomnia, as well as specific drug names and terms for taper, withdrawal, and alternative therapies. Results: Chronic benzodiazepine use is associated with many adverse outcomes. Hospitalization may play a pivotal role in both the initiation and discontinuation of sedative hypnotics. There is a paucity of long-term data for the use of non-benzodiazepine sedative hypnotics. Cognitive behavioural therapy, brief behavioural interventions, and benzodiazepine tapering protocols have shown proven benefit in benzodiazepine discontinuation. Discussion & Conclusion: There may be evidence for non-benzodiazepine sedative hypnotics; however, there is a paucity of long-term, placebo-controlled studies to support their safety, and some evidence to suggest harm in the frail older adult. Cognitive behavioural therapy and/or the use of a taper protocol may increase the success of withdrawal and improve sleep parameters. Exercise, sleep education, massage, and brief behavioural intervention are excellent non-pharmacological options for managing insomnia and for aiding discontinuation. Lastly, it is important to be cognizant of the impact that prescribing sedative hypnotics in hospital can have on long-term use., Background/Purpose: Clinical practice guidelines are intended to improve patient care. Clinicians may not be able to implement guideline recommendations because of time pressures, which are particularly challenging in primary care. We aimed to quantify the time required to implement guideline recommendations regarding the most common chronic diseases in older adults, including hypertension, diabetes, dyslipidemia, asthma, chronic obstructive pulmonary disease, and chronic kidney disease. Methods: We determined the time required to apply national guidelines to a cohort of primary care patients. Eight Canadian clinical practice guidelines addressing management of chronic diseases in adults were reviewed. Their recommended interventions, along with the indications for each intervention, were identified. Three primary care physicians reviewed each recommendation and identified the time required to perform it on an average patient. A cohort of 160 randomly selected patients aged 55 years from a university-affiliated primary care clinic was analyzed to determine how often each intervention should be applied to these patients. These data were used to estimate how much time it would take a clinician to apply guideline recommendations to his or her practice. Results: 103 different interventions from 8 clinical practice guidelines were identified. The total time required to apply these interventions to the selected cohort of patients was 340 hours (SD ± 189). Extrapolating this value to a clinical roster of 1000 patients, 266 working days would be required each year to implement the recommended interventions. Discussion & Conclusion: The implementation of chronic disease guideline recommendations in primary care requires a prohibitive amount of time. Guideline developers should consider the time required to implement their recommendations when drafting clinical practice guidelines., Background/Purpose: Quebec will face accelerated aging of its population in the years to come. Its health-care system will have to adapt to this situation in order to assure efficiency and relevance of interventions to meet the growing needs. The model of care of the Geriatric Evaluation and Management Unit (GEMU) is a well-known hospital-based mode of organization of geriatric services, and its efficiency has been proven. However, the implementation of this model of care within various Quebec hospitals has brought a noticeable heterogeneity in the care practices among GEMUs. We then want to provide hospital managers with a tool which would define the processes and framework needed to efficiently run GEMUs. This tool would direct the evaluation and development of these services with a strong scientific basis. Methods: We first did a worldwide literature review and identified two recent meta-analyses on the efficiency of GEMUs. The studies included in the two meta-analyses were rigorously selected and both were analyzed. We also included in our review a Quebec Delphi study on selection criteria applicable to the GEMUs in Quebec. Results: We extracted and categorized all the process of care items from the studies including: patient selection, type of ward, type of health centre, composition of the geriatric team, and evaluation and treatment processes. Discussion & Conclusion: This tool will allow the decision makers and hospital managers to conduct evaluation and development of GEMUs in Quebec and elsewhere., Background/Purpose: Studies have shown increased adverse outcomes are related to hospital admissions from Long-Term Care (LTC) homes, often for etiologies that could be safely treated in the facility. We examined the reasons for transfer and outcomes of LTC residents admitted to Hamilton Health Sciences (HHS) hospitals. Methods: Patient matched hospital and LTC home charts were retrospectively reviewed for all HHS hospital admissions transferred from LTC homes during 4 non-consecutive months in 2011. We considered patient demographics, events leading to transfer, diagnosis, and course during admission to hospital. Data presented within are limited to the analysis of hospital medical charts. Results: A total of 201 charts were reviewed. Altered level of consciousness (21%), dyspnea (18%), and fever (9%) were the most frequent events leading to transfers from LTC homes. Most patients (33%) transferred for altered LOC were diagnosed with either a urinary tract infection (UTI) or pneumonia. A total of 47 patients experienced an adverse event(s) while hospitalized. Fifteen patients were transferred despite a “do not hospitalize” order. Advanced directives were not documented in 34 patients on arrival to the hospital. Discussion & Conclusion: The rate of adverse events in patients transferred from LTC homes to hospitals is high. An intervention aimed at identifying early signs of altered level of consciousness, as well as treating frequent causes, such as UTI’s and pneumonia in the LTC homes, may prevent avoidable transfers to hospitals. There is a need to improve discussions and documentation of advanced directives, as well as a system to ensure these are followed., Background/Purpose: Hyponatremia has been associated with increased mortality and length of stay (LOS) in hospitalized patients. However, other adverse associations such as falls or syncope, fractures, unplanned readmission, need for inpatient rehabilitation, and change in discharge destination to a more dependent category have not been widely studied. Our aim was to investigate these associations. Methods: This is a retrospective case control study of patients admitted with hyponatremia (serum Na ≤ 134 mEq/l) under the General Internal Medicine Unit during a 6-month period. The relevant data were collected by explicit medical record review and analyzed in univariate and multivariate models. Data from 3 months in patients aged 65 years are presented. Results: The prevalence of hyponatremia was 21%. Hyponatremia had a significant univariate association with LOS (OR 1.03 p = .016), unplanned readmission within 30 days (OR 2.43, p = .017), falls or syncope at presentation (OR 4.0, p < .001), and admission diagnosis of metabolic disorders (OR 17.27, p < .001). However, after adjustments hyponatremia was independently associated with only unplanned readmission within 30 days (OR3.0, CI: 1.4, 6.6; p = .005), falls or syncope (OR 4.4, CI: 2.2, 9.0; p ≤ .001), and admission diagnosis of metabolic disorders (OR13.7, CI: 3.1, 60.0; p = .001). Although other predefined adverse associations more frequently occurred in hyponatremic patients, they were not significant. Discussion & Conclusion: The study confirms the association between hyponatremia and falls or syncope. Among the adverse outcomes of hospitalization, hyponatremia was independently associated with only unplanned readmission within 30 days. Falls or syncope at presentation and admission diagnosis of metabolic disorders appear to have a greater association with LOS than hyponatremia. The study was probably underpowered to assess other outcomes., Background/Purpose: In 2011, the Memorial University Family Medicine (FM) Residency Program introduced a Care of the Elderly (COE) rotation to enhance residents’ skills in managing the complex health issues of the elderly population. The purpose of this project was to understand FM residents’ perceived needs in COE training and to evaluate the COE rotation with respect to these needs. Methods: Survey methodology was used with the pre-rotation survey designed to evaluate perceived needs in COE training and the post-rotation survey designed to assess whether learning needs where addressed. Results: The pre-rotation survey was sent to 57 FM residents with a response rate of 40%. The majority of students indicated a need for further training in COE topics. Students identified that in certain areas further training was necessary or essential. These included managing polypharmacy (65.2% identified this as essential), managing the behavioural and psychological symptoms of dementia (52.2% as very necessary and 39.1% as essential), and managing chronic wounds (65.2% as very necessary). The post-rotation survey was sent to 11 FM residents with a response rate of 82%. Most students felt learning needs were fully satisfied in the following areas: performing a dementia assessment (55.6%); distinguishing between dementia, delirium and depression (55.6%); and managing the behavioural and psychological symptoms of dementia (66.7%). Discussion & Conclusion: Memorial University FM residents recognize the need for COE training. With the growth of the elderly population, newly trained family physicians must be prepared to provide these patients with appropriate care. This COE rotation addresses most learning needs. However, results from our survey indicate that there is room for improvement., Background/Purpose: The most common cognitive screening tool used by family physicians is the Folstein Mini-Mental State Examination (MMSE). In 2009, Brown et al. created a new cognitive screening test called the Test Your Memory (TYM), which is unique in the fact that it is a patient self-administered exam. In a system where family physicians and other specialists are pressed for time, the TYM offers a potential to save 10 minutes of screening time. This study aimed to determine the validity of the TYM tool in comparison to the traditional MMSE in a Canadian primary care sitting. Methods: Patients aged 65 and older attending a regularly scheduled appointment in two family physician offices in New Brunswick were invited to participate in the study. Participants had to complete the self-administered Test Your Memory tool and complete a MMSE. Results: A total of 52 participants completed the study. The mean TYM score was 44.7/50 (SD 2.4) and the mean MMSE score was 27.8 (SD 5.6). The Pearson correlation coefficient between the TYM and MMSE is R2 = .58. This is a significant correlation with a p-value of .01. A score of ≤ 42/50 on the TYM had a 100% specificity for picking up patients who will score < 24 on the MMSE. The sensitivity of the TYM was 100% and the specificity was 81.6%. Discussion & Conclusion: This study validates the TYM test as a screening tool in a Canadian primary care population. However, the strength of the TYM test is in its negative predictive value in participants who score above 42., Background/Purpose: Sedentary behaviour 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 behaviour in seniors, we examined the relationship between sedentary behaviour and cardiometabolic risk in physically active older adults. Methods: 54 community-dwelling men and women 65 years of age (mean 71.5 years) were enrolled in this cross-sectional observational study. Subjects were in good health and free of known diabetes. Activity levels (sedentary, light activity, moderate activity, and vigorous activity time per day) were recorded with accelerometers worn continuously for 7 days. Cardiometabolic risk factors measured consisted of the American Heart Association diagnostic criteria for metabolic syndrome (waist circumference, triglycerides, high-density lipoprotein (HDL), systolic blood pressure, fasting glucose), as well as low-density lipoprotein (LDL). The relationships between activity measures and cardiometabolic risk factors were examined. Significant variables were entered into a multivariate regression model. Results: All but 1 subject met Canada Health guidelines for an active “fit” adult. Despite this, the average proportion of time spent at a sedentary activity level each day was 72.7%. From the regression analysis, the only significant association found was between LDL and sedentary time, with LDL detrimentally associated with average sedentary time per day (Standardized Beta Correlation Coefficient 0.302, p < .05). Discussion & Conclusion: Sedentary behaviour is associated with an adverse metabolic effect on LDL in older adults, even those who meet Canada Health guidelines for an active “fit” adult. Emphasizing activities that reduce sitting (e.g., standing desks, less television) may be a practical recommendation to reduce sedentary behaviour in older adults., Background/Purpose: Post-operative delirium in older adults is a common complication of surgery with significant consequences. Delirium often portends poorer clinical outcomes including increased mortality, length of stay, and increased likelihood of discharge to a facility. The role of antipsychotics to prevent post-operative delirium has not been well-established. We therefore wished to determine the effectiveness of antipsychotics in preventing postoperative delirium. Methods: We searched online literature databases and registers for randomized controlled trials (RCTs) of adults undergoing surgery who were given antipsychotics to prevent post-operative delirium, using a placebo as the comparator. Two researchers independently reviewed citations and abstracts, selecting those meeting inclusion criteria. Quality was assessed via the Cochrane risk of bias tool. Random effects meta-analysis and meta-regression were conducted. Q-statistics and I2 were used for assessment of heterogeneity. Results: We evaluated 4340 citations from our initial search and from this reviewed 32 full-text articles. Five randomized controlled trials met criteria for inclusion. Antipsychotics were found to reduce post-operative delirium [OR: 0.41; 95% CI: 0.235 to 0.744]. The effect-size estimate was heterogeneous [Q-value: 15; p = .003; I2 = 75] and overall significant [p = .003]. Further examination of the heterogeneity showed that several factors could help reach statistical homogeneity: acuity of surgery (elective vs. mixed acute/elective), anti-psychotic type (generation), and method of administration. Meta-regression showed that as one gets older and as the dosage in chlorpromazine equivalents increases, the Log Odds Ratio increases. Discussion & Conclusion: Within the limits of few RCT’s available, antipsychotics appeared to reduce the incidence of post-operative delirium in a variety of surgical settings. Larger, well-designed RCTs are needed to help confirm our findings., Background/Purpose: Patients with mild cognitive impairment (MCI) and significant amyloid burden on PiB PET imaging manifest impaired performance on episodic memory tasks when compared to MCI patients with lower amyloid burden. This association has yet to be defined with regards to non-episodic memory tasks. Therefore, we sought to further characterize the cognitive profile of subjects with MCI who underwent PiB PET imaging. Methods: Forty-six subjects aged 60–90 with a clinical diagnosis of MCI underwent neurospychological evaluation. PiB PET images were obtained within 8 months of a subject’s cognitive assessment. Subjects were matched for age and education and classified as PiB− (SUV < 1.5; n = 22) or PiB+ (SUV > 1.5; n = 24). The results from the neuropsychological evaluation were compared between groups and correlated with amyloid burden. A regression analysis was conducted to determine whether amyloid burden was a predictor of cognitive performance. Results: There were no significant group differences on global cognitive measures. There was considerable overlap between PiB+ and PiB− subjects on all cognitive domains, but the PiB+ subjects performed significantly worse than PiB− subjects on tasks of episodic memory and executive functioning. Regression analysis showed that amyloid beta deposition was a significant predictor of performance on episodic memory and inhibition. Discussion & Conclusion: These preliminary results suggest that MCI patients who are considered to be prodromal Alzheimer’s disease may be distinguishable by the presence of impairment in both episodic memory and inhibition. Future studies may be useful for addressing whether a specific neuro-psychological battery can aid in early diagnosis of dementia., Background/Purpose: Frail elderly adults are particularly vulnerable to medication errors when transitioning from hospital to home. The objective of this study is to describe the prevalence and causes of medication discrepancies (MDs) in geriatric community-dwelling adults during this transition period. Methods: A descriptive study was carried out from a community hospital setting in British Columbia, Canada. The study population consists of patients 70 years and older who met selection criteria for home visits within 24–72 hours after hospital discharge by a Geriatric Transition Nurse (GTN) between November 2011 to May 2012. Using the Medication Discrepancy Tool, the GTN performed medication reconciliation between discharge medications and medications individuals were taking at home. Patient-level and system-level factors contributing to the MDs were identified. Results: Out of the 100 patients seen by the GTN, 65% were female and 85% were on five or more medications at the time of discharge. 72% of patients had five or more co-morbid chronic conditions. Medication reconciliation identified 46% of patients with at least one medication discrepancy. More than half of MDs were caused by patient-level factors and the remainder were caused by system-level factors. The most common reported patient-level factors were: non-intentional non-adherence and intentional non-adherence. The most frequently seen system-level factors were: incomplete/inaccurate/illegible discharge instructions and not recognizing patient’s lack of support. In some instances both types of factors contributed to the occurrence of a medication discrepancy. Discussion & Conclusion: Medication discrepancies in the frail elderly are common when transitioning from hospital to home. Identifying common patient-level and system-level factors may serve as starting points when designing quality improvement efforts with the aim to decrease medication discrepancies., Background/Purpose: In 2010, Osteoporosis Canada developed guidelines for the diagnosis and management of osteoporosis for people > 50 at high risk of fragility fractures. These guidelines did not address frail elderly where access to diagnostic technology, such as bone mineral density, and research is limited. Methods: We used the GRADE process to develop guidelines applicable to frail elderly with over 50 stakeholders, including resident/family representatives of long-term care, interdisciplinary health professionals, and program managers. We surveyed the panel to determine questions and outcomes most relevant for this population. We searched the literature for baseline risks of fractures and intervention effects. When making recommendations, we discussed benefits/harms, strength of evidence, values/preferences, and resources. Results: In addition to outcomes from the 2010 guidelines, this panel identified mobility, pain, and quality of life as important in this population. However, few studies reported these outcomes. To make recommendations, the panel considered absolute risk differences in outcomes with or without treatment, which are calculated from baseline risks. It was critical that the panel agreed on baseline risks which can vary between low- and high-risk groups. Agreement was challenging, but the process was enlightening to recognize gaps/uncertainties in existing research. When evidence in frail elderly was lacking, the panel assessed the applicability of effects found in other populations to make recommendations. The GRADE process incorporated values/preferences, particularly of families and residents, which was uniquely challenging in view of life expectancy, multiple co-morbidities, and serious consequences of fractures. Discussion & Conclusion: The GRADE process helped identify gaps in the literature for important outcomes, the impact of baseline risks, and the importance of balancing benefits and harms, and their value and consequences in this population., Background/Purpose: Since 2006, the Ontario Osteoporosis Strategy for Long-Term Care has engaged in outreach activities to increase uptake of evidence-based osteoporosis/fracture prevention strategies (www.osteoporosislongtermcare.ca). A baseline environmental scan revealed a wide spectrum of prescribing practices between LTC homes reflecting the lack of standardized guidelines and academic detailing. The objective of the present study was to describe current osteoporosis prescribing practices across Ontario LTC homes. Methods: In August 2012, de-identified medication/demographic data were downloaded from Medical Pharmacies, a pharmacy provider for approximately one-third of Ontario LTC homes. After excluding 40 LTC homes participating in a targeted intervention (ViDOS), we analyzed data for 166 LTC homes. The percentage of residents receiving 1) Vitamin D (800 IU/day), 2) calcium ( 500 mg/day), and 3) osteoporosis medication was calculated for each LTC home. Mean (95% CI) LTC home prescribing rates and ranges are reported. Results: The analysis cohort was 21,699 residents, mean age 83.5 (SD: 10.7) years, 70% women. 57% of LTC homes were for-profit, 45% affiliated with a corporate chain, 61% had age-100 residents. Mean LTC home prescribing rates were 59.9% (95% CI: 57.2, 62.6) for vitamin D, 32.2% (95% CI: 30.2, 34.2) for calcium, and 18.5% (95% CI: 17.4, 19.7) for osteoporosis medications. Prescribing rates were normally distributed and ranged from 22.3%–94.9% (vitamin D), 1.6%–78.4% (calcium), and 0%–55.9% (osteoporosis medications). Discussion & Conclusion: Although there was a range in prescribing between LTC homes, our results indicate that wide-scale implementation of outreach activities resulted in uptake by many LTC homes, particularly for Vitamin D, with half the homes prescribing at approximately 60% or better. Currently, osteoporosis consensus guidelines for LTC are being developed., Background/Purpose: Currently far too many seniors (∼ 20%) consume inappropriate benzodiazepines, which increase the risk of adverse drug reactions and unnecessary hospitalizations among community-dwelling elders. As of 2012, the new Beers criteria lists all benzodiazepines as drugs to avoid in the elderly no matter the half-life. Methods: A written educational tool was mailed to 144 benzodiazepine consumers aged 65 years recruited from community pharmacies. Knowledge and beliefs about inappropriate prescriptions were queried prior to and 1-week after the intervention. Primary outcome was a change in risk perception. Explanatory variables were a change in knowledge and beliefs about medications, as well as cognitive dissonance occurrence. Self-efficacy for tapering and intent to discuss discontinuation were also measured. Results: Post-intervention, 65 (45.1%) of chronic benzodiazepine consumers (mean duration use 10.5 years, SD 8.2 years) perceived increased risk. Increased risk perceptions were explained by better knowledge acquisition (mean change score 0.9, 95% CI (0.5, 1.3)), and a change in beliefs (BMQ differential mean change score −5.03, 95% CI (−6.4, −3.6), suggesting elicitation of cognitive dissonance. Experience of cognitive dissonance was associated with a 6-fold higher likelihood of patients reporting increased risk perception (OR = 6.61 95% CI (3.2, 13.8)). Intent to discuss discontinuation of benzodiazepines with a doctor (83.1% vs. 44.3%, p < .001) was higher among participants who perceived increased risk. Discussion & Conclusion: Risk perception on benzodiazepines can be altered through direct delivery of an educational tool to aging consumers. Results suggest patients could potentially be targeted directly with information to catalyze discontinuation of inappropriate prescriptions., Background/Purpose: Gait and cognition are interrelated. Executive dysfunction is associated with slower gait. It is unknown if memory dysfunction, a cardinal sign in MCI, is associated with the gait disturbances seen in MCI. The objective was to determine if gait in older adults with MCI varies by subtype: amnestic (a-MCI) or non-amnestic (na-MCI) type. Methods: Older adults with MCI from the “Gait and Brain Study” were included. Cognition was evaluated using MMSE, MoCA, Trails Making Test A and B, Rey Auditory Verbal Learning Test, Digit Span Test, and Letter Number Sequence Test. Gait performance (velocity and gait variability) was evaluated with the GaitRITE® mat under usual walking and three dual-task conditions (walking while: naming animals out loud, serial subtractions by 1s and serial subtractions by 7). Participants were divided into a-MCI and na-MCI by episodic memory test. The relationship between cognitive subtype and gait was evaluated with multivariable linear regression. Results: Fifty-six participants (mean age 76.3 ± 7.2 years, 50.9% female) were included. Thirty-eight were a-MCI and 18 were na-MCI. Groups were similar in age, co-morbidities, and history of previous falls. The a-MCI participants walked slower than na-MCI (98.5 vs. 112.2 cm/sec, p < .03) in all test conditions. Regression (adjusted for age, sex, physical activity, number of co-morbidities, and executive function) showed a-MCI was associated with slower gait under usual and dual-task conditions and higher gait variability (p < .001) under dual-task tests. Discussion & Conclusion: Episodic memory impairment was associated with poor gait performance, in particular under dual-task conditions. This suggests slow gait and higher variability under dual-task testing is a motor feature in a-MCI independent of executive dysfunction., Background/Purpose: Assessing frailty should be an essential part of the care of older adults. Several scales have been proposed to quantify frailty and the operational criteria of each scale vary. The purpose of this study was to compare the prevalence of frailty in community-dwelling, middle-aged and older Europeans as estimated by eight scales and to examine the agreement among scales in classifying participants as frail. Methods: 27,527 participants aged 50+ years (mean age 65.3 ± 10.5, 54.8% women) from the 11 countries (Austria, Belgium, Denmark, France, Germany, Greece, Italy, Netherlands, Spain, Sweden, Switzerland) which participated in the first wave of the Survey of Health, Ageing and Retirement in Europe comprised the study sample. Frailty was operationalized, based on eight scales: frailty phenotype, a 70-item Frailty Index, a 44-item Frailty Index based on a Comprehensive Geriatric Assessment, Clinical Frailty Scale, Edmonton Frail Scale, Groningen Frailty Indicator, Tilburg Frailty Indicator, and “FRAIL” scale. A score threshold was assigned for each scale to represent the frailty state, based on the relevant literature. Results: The prevalence of frailty ranged from 44% (Groningen scale) to 6% (FRAIL scale). About half of participants were categorized differently between scales. 49.3% of participants were categorized as non-frail by all scales, and 2.5% were categorized identically as frail by all scales. Discussion & Conclusion: Frailty scales capture related but distinct groups of individuals, and each scale provides different estimates of frailty prevalence. Future studies should compare various scales using data from clinical settings., Background/Purpose: Hip fracture patients are at high risk for recurrence. Appropriate pharmacotherapy reduces this risk and is associated with reduced mortality after hip fracture, but a care gap exists for fracture prevention in these patients. This evaluation determined rates of osteoporosis treatment and bone mineral density (BMD) testing in hip fracture patients following discharge from a rehabilitation unit. Methods: A prospective cohort study of hip fracture patients aged 50 on an inpatient rehabilitation unit in 2008 and 2011. Patients were seen by a nurse specialist, and encouraged to see their family physician for further assessment and treatment. Physicians were sent a letter indicating the need to follow up with their patient. Patients were contacted following discharge from hospital to determine treatment rates. Results: Of 310 eligible hip fracture patients admitted to the rehabilitation unit in the years studied, 207 patients were reached post-discharge and provided data. Of patients who were not previously taking osteoporosis medication, 50% of patients had osteoporosis treatment initiated by 6 months following discharge. By 2 months following discharge, 46% of patients in the 2008 cohort had a new BMD performed or scheduled, while this was true for 14% of patients from the 2011 cohort. 35% of patients in 2011 had not seen their family physician by 2 months following discharge. Discussion & Conclusion: Rates for osteoporosis treatment and BMD were higher than those reported in the literature for patients not enrolled in case manager programs. BMD testing declined from 2008 to 2011. Lower treatment rates may be due to concerns regarding bisphophonates. There remains room for improvement for follow-up with family physicians., Background/Purpose: Assessing fitness to drive in patients with dementia is challenging. The SIMARD was developed as a tool to assist with assessing fitness to drive. This study compares the clinical decision made by a geriatrician regarding driving with the score on the SIMARD. Methods: Patients seen by geriatricians with a diagnosis of dementia or mild cognitive impairment, who had had a SIMARD test completed after the clinical decision regarding driving was made, were included in the sample. Charts were reviewed to gather diagnosis, driving status and history, cognitive and functional information. Results: Sixty-three patients were identified and 57 met the inclusion criteria. The mean age was 77.07 years. Alzheimer’s dementia in 22 (38.6%) patients was the most common diagnosis. The mean MMSE was 24.85 (SD 3.34) and the MoCA was 19.85 (SD3.58). The mean SIMARD score was 37.16 (SD 19.54). Twenty-four patients had a SIMARD score below 31, 28 scored between 31–70, and 5 scored greater than 70. Of those scoring less than 31, 8 patients continued to drive, 3 of whom had passed a driving test performed by the Department of Public Safety of New Brunswick. In the 5 patients who scored greater than 70, 2 had their licenses revoked by the geriatrician. Discussion & Conclusion: There did not appear to be a clear association between the SIMARD score and the clinical decision made by the geriatrician., Background/Purpose: Cancer survivorship programs often focus on modifiable behaviours such as smoking and alcohol use and physical activity. Whether these behaviours differ among elderly survivors and whether special considerations should be given to these elderly cancer survivors (age 65+) is unclear. Methods: 616 adult cancer survivors (23% elderly) across multiple solid and haematologic malignancies and treatment trajectories were surveyed about smoking, alcohol, physical activity, and attitudes and knowledge about effects of these habits on cancer outcomes. Multivariate logistic regression models evaluated the effect of age on these factors. Results: 9.0% of elderly survivors were current smokers; 35.7% had been binge drinkers recently or in the past (5 or more standard drinks per day for male; 4 or more for female); 24.0% were not meeting exercise guidelines (150 minutes of moderate-to-vigorous intensity activity per week). Compared to younger survivors, elderly were one-third as likely to be current smokers (p < .0001), but twice as likely to be ex-smokers than never smokers (p < .0001). They were half as likely to know how smoking affected cancer treatment (p = .007) or prognosis (p = .008). Elderly were one-third as likely to binge drink (p < .001), twice as likely to perceive alcohol as improving survival (p = .018), and half as likely to receive information about alcohol use (p = .042). Meeting exercise guidelines at diagnosis (p = .015) and improving/maintaining them after treatment (p = .016) were lower in elderly survivors, but perceived benefits/harms of exercise did not differ with age. Discussion & Conclusion: Elderly cancer survivors have different smoking, alcohol, and exercise characteristics from younger survivors. Survivorship programs may need to tailor counseling by age group., Background/Purpose: Indwelling urinary catheterization is a ubiquitous procedure in the inpatient setting: between 16% and 25% of hospitalized patients will receive an in-dwelling catheter at some point during their stay. While sometimes medically indicated, previous studies have shown that between 21% and 52% of catheters are used unnecessarily, exposing patients to significant morbidity and mortality, including increased risk of urinary tract infection and bacteremia. Here we present the results of a multi-modal educational intervention directed at reducing the overuse of catheters in a large teaching hospital. Methods: The multi-modal intervention targeted nurses and used a variety of approaches to improve catheter use, including small group meetings, educational posters, and modifications to the patient chart. The study patient population included all admitted patients to internal medicine, surgery, and orthopedic surgery, as well as the GIM/ACE Unit from 1 September 2009 to 1 October 2011. Data were structured and analyzed as an interrupted time series using a segmented regression approach. Results: A total of 14,531 patients, 1,878 of whom were catheterized, were included in this study. A decrease in mean catheter days per patient of between 5.8 and 9.7 days (p < .01) across the wards under study was observed after the intervention. The proportion of patients catheterized decreased by between 0.35%/month and 0.93%/month (p < .01); ultimately % patients catheterized halved from 15% pre-intervention to 7% post-intervention. A trend of greater discharges directly home was observed in older (65+) patients. Discussion & Conclusion: A multi-modal educational intervention using nurse education and process changes resulted in a significant reduction in catheter days per patient and the proportion of patients catheterized., Background/Purpose: Life course influences on health may be most evident at older ages. In a large sample of middle-aged and older Europeans, we compared grip strength, cognitive performance, and walking speed between native-born participants, immigrants who were born in low- and middle-income countries (LMICs), and immigrants who were born in high-income countries (HICs). Methods: This is a retrospective cohort study of the Survey of Health, Ageing, and Retirement in Europe, including 33,745 participants age 50+ in 14 countries (mean age = 64.9 ± 10.2 years; 54% women). Four performance-based measures were assessed: grip strength, delayed recall, and verbal fluency were measured in all participants, while walking speed was measured only in individuals age 75+. Analyses were divided by participants’ current residence in either relatively wealthier Northern/Western or relatively poorer Southern/Eastern Europe, and adjusted for age, gender, and education. Results: About 7% of participants (n = 2,369) were immigrants. In Northern/Western Europe, compared to native-born participants, LMIC-born immigrants demonstrated weaker grip strength (mean 32.8 kg vs. 35.7 kg, p < .001), and lower delayed recall (3.0 vs. 3.6, p < .001) and verbal fluency scores (16.1 vs. 20.4, p < .001), but similar walking speed (0.66 m/sec vs. 0.72 m/sec, p = .1). HIC-born immigrants demonstrated grip strength (34.7 kg), delayed recall (3.4), and verbal fluency performance (18.5) lower than native-born participants, but higher than LMIC-born immigrants (p < .001). In Southern/Eastern Europe, scores did not differ between groups on any measure. Discussion & Conclusion: Middle-aged and older immigrants demonstrated worse physical function and cognitive performance than native-born Europeans in Northern/ Western Europe, but not in Southern/Eastern Europe. Country of birth and current country of residence were each associated with these performance-based measures of age-related health., Background/Purpose: The importance of traditional risk factors on prediction of adverse events has been established for many chronic diseases. A recent study demonstrated that even non-traditional risk factors, when considered in consort, predicted dementia similarly to any traditional risk factors. The objective of this study was to investigate contributions of non-traditional risk factors to coronary heart disease (CHD) events. Methods: This analysis included community-dwelling adults with no history of CHD (n= 2669, mean age 46.4 ± 19.1 years, 48.6% men) who participated in the 1995 Nova Scotia Health Survey. We constructed 3 risk factor indices (RFIs): 1) a 17-item non-traditional RFI (e.g., sinusitis, arthritis); 2) a 9-item traditional RFI (e.g., hypertension, diabetes); and 3) a combined RFI (all 26 items). Ten-year risks of CHD-related hospitalization and mortality were evaluated. Results: The non-traditional RFI score was significantly predictive of CHD-related hospitalizations and deaths, even after controlling for the traditional RFI (age and sex adjusted hazard ratio [adj. HR] 1.26; 95% CI 1.09–1.44). However, including all possible variables in the combined RFI predicted the highest rate of CHD events (adj. HR 1.55; 1.36–1.76). Considered separately, the traditional and non-traditional RFIs similarly discriminated participants who had CHD events from those who did not (area under receiver operating characteristic curve [AUC] 0.70, CI 0.67–0.74; vs. 0.69, 0.65–0.73). When all variables were combined in an index, the AUC was significantly higher (combined RFI = 0.76; 0.720.79). Discussion & Conclusion: The accumulation of non-traditional risk factors adds a unique contribution to the prediction of CHD hospitalizations and mortality. This supports the idea that maintenance of general health lowers risk for late-life disease.

Trihalomethanes (THMs) levels were determined in water samples collected from Riviere du Poste and Mont Blanc treatment plants found in Southern Mauritius. A gas chromatograph coupled with an electron capture detector (GC-ECD) was used to analyse the samples. An average of 20.3mg/L of total THMs was obtained with a range of 13.0mg/L to 24.8mg/L.Keywords: Trihalomethanes, gas chromatography, electron capture detector.

England.To investigate the proportion of tuberculosis (TB) cases attributable to recent transmission and factors associated with clustering.Demographic, clinical and microbiological surveillance data were collated from all new culture-confirmed cases in 1998. Using insertion sequence (IS) 6110 restriction fragment length polymorphism (RFLP) typing, strains were classified as clustered (identical patterns) or unique and risk factors were determined using multivariable logistic regression.RFLP patterns were available for 2265 of 3713 (61%) cases: 1808 hador=5 IS6110 copies, while 372 cases were in 152 clusters, giving an estimated proportion due to recent transmission of 12.2%.Pulmonary disease (aOR 1.6; 95%CI 1.1-2.2), previous treatment (aOR 3.7; 2.2-6.5) and homelessness (aOR 5.5; 1.2-24.1) were independent risk factors for clustering. Fourteen per cent of patients of Indian subcontinent origin were clustered compared with 27% of white patients. Many clusters spanned ethnic groups (45%) and geographical regions (47%).The calculated proportion of TB cases due to recent transmission is low.Adjusting for missed cases and study duration, it increases to 27.6%. Many cases may arise from reactivation or acquisition outside England. Transmission within England accounted for approximately one in four cases and occurred over wide geographic areas, between ethnic groups and among the homeless. Molecular epidemiology can inform local and national public health action.