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During the COVID-19 pandemic, policymakers had to quickly offer telehealth services to address older adults' needs. This study aimed to understand the experiences of providers who implemented a telephone-based telehealth tool named Socio-Geriatric Evaluation (ESOGER), which assessed health and social isolation risks in community-dwelling older adults in Quebec (Canada). This qualitative study used 20 semi-structured online/phone interviews with health and social service providers coming from publicly-funded healthcare facilities and community organizations. We included adopters and non-adopters of the telehealth tool. Interviews were audio-recorded and transcribed verbatim. We used reflexive thematic analysis to interpret the data. Three dimensions of providers' practice influenced the tool's implementation: service organization, working conditions, and interactions with older adults. Participants reported that the tool fostered continuity of care, provided guidance for their pandemic-related new tasks, and helped identify and support socially isolated older adults. Challenges to implementation included limited appropriateness of the telehealth tool for diverse services, feasibility barriers to adopting a new tool amid the health crisis, and acceptability challenges with some older adults. Despite relevance of the telehealth tool for providers, organizational, professional, and interactional barriers could hinder implementation success. Participatory approaches to telehealth may be promising avenues for future policies in this field. [ABSTRACT FROM AUTHOR]

Background and Objectives People aged 65 and older, deemed most "vulnerable" by public health, were targeted by the coronavirus disease 2019 protection measures, which sought to minimize physical contact and social activities. Older adults living alone were particularly affected by these measures. However, such measures meant to protect the older population may not have necessarily reflected older adults' individual prioritization choices. This study therefore aimed to understand how protecting oneself over the virus was considered in the prioritization of other health and social needs of older adults living alone during the pandemic. Research Design and Methods This study adopted a qualitative design. A total of 17 semistructured interviews were conducted between May 2021 and June 2022 with older adults living alone. All interviews were audio-recorded and transcribed verbatim. A reflexive thematic analysis as defined by Braun and Clarke was performed. Results Our analysis showed 2 forms of prioritization across 2 themes. This first theme focused on participants who reported prioritizing protecting themselves over the virus by limiting in-person contact and activities. The second theme showed that although several participants reported that protecting themselves over the virus was important to them, the prioritization of this need was not shared by all and, in some cases, evolved over the course of the pandemic. Discussion and Implications Our study demonstrated heterogeneity in the prioritization of older adults needs. Future public health recommendations should consider these variations in the needs and priorities of older adults when determining public health measures. [ABSTRACT FROM AUTHOR]

Context The COVID-19 pandemic may have particularly impacted older adults living alone who are at increased risk of social isolation and its negative consequences. This risk may have been further exacerbated due to public health measures and disruption of services and social support. Objective This study aimed to understand the experiences and social connectedness of older persons living alone during the COVID-19 pandemic in Quebec. Study design A qualitative study with 14 semi-structured interviews was conducted by telephone. The first part of the interview guide focused on social isolation and perceptions of loneliness, while the second part focused on of their perceived impact of the pandemic on their health and social network during the third to the fourth wave of the pandemic. Two independent analysts used Dedoose[R] software to conduct an inductive thematic analysis based on the transcribed interviews. Population studied Persons aged 65 and over living alone. Setting An urban (Montreal) and semi-rural (Chaudiere-Appalaches) region of Quebec, Canada. Results We suggest two preliminary themes from our analysis: (1) autonomy and adaptability in the face of the pandemic, (2) the importance of social connections and services in close proximity. Despite challenges posed by the pandemic participants consistently reported a strong desire to limit burden to their family and pride in maintaining their autonomy. While some participants reported a deterioration in their physical and mental health due to the confinement measures, most reported little impact on their sense of loneliness. The fact that they had already been living alone for several years helped them to readily adapt. Day-to-day interactions with their immediate environment (neighbors, pharmacist, etc.) and helping others (accompanying friends, organizing social activities, etc.) within this network were consistently found to be important coping mechanisms. Conclusions Neighborhood contacts and services in close proximity were found to be important elements in promoting the well-being of older persons living alone. Health professionals should consider the importance of social interactions in close proximity when caring for older persons living alone., Presenters Nadia Sourial, PhD, Elise Develay, MSc, Amelie Quesnel-Vallee, Paul Holyoke, Lise Dassieu, Patrick Archambault, MD, FRCPC, MSc, Claire Godard-Sebillotte, MD, MSc, Sathya Karunananthan, Svetlana Puzhko, PhD, [...]

Context The eConsult service is an online system that primary care practitioners (PCP) submit questions concerning their patients' care to specialists and receive a response within one week. Responses can include suggestions for treatment, recommendations for referral, or requests for additional information. Objective The objective is to examine the use of natural language processing (NLP) in automatic identification of frailty in patient cases and explore semantic characteristics of such cases that distinguished them from non-frailty cases to help refine and inform the definition of frailty and provide its reusable knowledge. Study Design We conducted a machine learning (ML) experimentation using NLP to assess frailty in a dataset of cases submitted through eConsult Service. We used text data prepared and vetted by the experts, as training material to achieve accurate prediction of 'frail' cases automatically. Setting or Dataset In this study, we selected contrasting samples from eConsult cases submitted in the Champlain health region between 2018 and 2019 and filtered them by patient's age 65 and the use of term frail or frailty in their case description. Non-frailty cases were selected among younger patients below 65 years old in whom PCP did not refer to as frail. Population Studied PCPs can keep communicating with the specialist until they are satisfied with the answers to close the case. The population is an unbiased random sample of PCP communications, that were then labeled. Outcome Measures We used 10-fold cross-validation to measure precision, recall, F1 and accuracy to evaluate the results. Results Using text from electronic conversations between primary care providers and specialists we developed a champion algorithm (Random Forest with Bag-of-Words as data representation) that predicted frailty cases with an accuracy of 94% (0.12). This study also provided evidence of semantic characteristics that were specific to frail cases. Among several frail cases, the most frequent topic-terms were related to medications: daily dose, recommended medication and best treatment. Conclusion It was possible to automatically identify Frailty cases in eConsult system with high accuracies using NLP. Noteworthy is that no other patient data were required. The predictions can inform and assist practitioners recognize frailty in patient cases and as a result, provide organized and reusable knowledge to enhance the quality of service for frail patients., Presenters Dr. Arya Rahgozar, PhD, Douglas Archibald, PhD, Sathya Karunananthan, Clare Liddy, MD, MSc, CCFP, Amir Afkham, BEng Hnrs, Erin Keely, [...]

Health disparities exist across different linguistic groups. Language barriers in primary care can negatively affect access to healthcare services and the quality and safety of care at the end-of-life. This study will take a novel, in-depth look at the experience of language- and/or cultural-discordant care for adults from linguistic minority groups through the eyes of primary care physicians providing palliative and/or end-of-life care. Language and cultural discordance means that the physician and patient do not speak the same language or are not from the same cultural background. Qualitative data from primary care physicians (n = 12–24) providing language-discordant end-of-life care to Francophone and/or Allophone older adults across different care models and diverse geographies in Ontario will be collected through semi-structured interviews. Reflexive thematic analysis will be used to report themes within the data and consider the influence of the social locations of the researcher and research participants, geographic considerations impacting service provision, and barriers imposed by differing primary care funding structures on the provision of palliative and end-of-life care for linguistic and cultural minority groups in Ontario. Findings from this study will identify the interconnections among language and cultural discordance, care model, geographic region, and physician perceptions of their combined effects on access to, and quality of, palliative and end-of-life care. This evidence will be key to informing clinical practice guidelines and mobilizing change to improve primary care access and quality for adults at the end-of-life from linguistic and cultural minority populations across Ontario. [ABSTRACT FROM AUTHOR]

Aims and Objectives: To describe characteristics of service utilization by advanced practice nurses (APNs) employing an electronic consultation (eConsult) service in their care for older adults. Background: Canada's aging population is projected to place unprecedented demands on the healthcare system. APNs, which include clinical nurse specialists (CNSs) and nurse practitioners (NPs), are nurses with advanced knowledge who can independently provide age‐appropriate care. eConsult is a secure web‐based platform enabling asynchronous, provider‐to‐provider communication. APNs can send and receive eConsults to address patient‐specific concerns. Methods: This is a retrospective analysis of eConsult utilization and user survey data for cases completed in 2019, reported in line with the STROBE guidelines. Eligible eConsults included those that had APN involvement (as a referrer or responder) and were concerning an older patient (≥65 years). Descriptive statistics were used to analyse service utilization and survey response data. Results: Of 430 eligible eConsults, 421 (97.9%) were initiated by NPs and the rest by physicians. 23 (5.3%) were received by a CNS, of which 14 (3.3%) involved an NP‐to‐CNS exchange. Median specialist response interval was 0.9 days. 53% of eConsults was for dermatology, haematology, cardiology, gastroenterology and endocrinology. 73% of eConsults avoided a face‐to‐face referral after the consultation. In 90% of eConsults, APNs rated the service as helpful and/or educational. Conclusions: Through eConsult, APNs can collaborate with each other and physicians to access and provide a breadth of advice facilitating timely specialist‐informed care for older patients, thus helping to alleviate some of the demands placed on the healthcare system. Relevance to Clinical Practice: There is an opportunity for APNs to further adopt eConsult into their clinical practice, and this can, in turn, support the integration of the APN role in the health workforce. Patient or Public Contribution: Current APN eConsult users were involved in the study design and interpretation of results. [ABSTRACT FROM AUTHOR]

Health disparities exist across different linguistic groups. Language barriers in primary care can negatively affect access to healthcare services and the quality and safety of care at the end-of-life. This study will take a novel, in-depth look at the experience of language-and/or cultural-discordant care for adults from linguistic minority groups through the eyes of primary care physicians providing palliative and/or end-of-life care. Language and cultural discordance means that the physician and patient do not speak the same language or are not from the same cultural background. Qualitative data from primary care physicians (n = 12-24) providing language-discordant end-of-life care to Francophone and/or Allophone older adults across different care models and diverse geographies in Ontario will be collected through semi-structured interviews. Reflexive thematic analysis will be used to report themes within the data and consider the influence of the social locations of the researcher and research participants, geographic considerations impacting service provision, and barriers imposed by differing primary care funding structures on the provision of palliative and end-of-life care for linguistic and cultural minority groups in Ontario. Findings from this study will identify the interconnections among language and cultural discordance, care model, geographic region, and physician perceptions of their combined effects on access to, and quality of, palliative and end-of-life care. This evidence will be key to informing clinical practice guidelines and mobilizing change to improve primary care access and quality for adults at the end-of-life from linguistic and cultural minority populations across Ontario. [ABSTRACT FROM AUTHOR]

Clinicians and researchers have shown increasing interest in frailty. Yet, there is still considerable uncertainty regarding the concept and its definition. In this article, we present perspectives on key issues and controversies discussed by scientists from 13 different countries, representing a diverse range of disciplines, at the 2006 Second International Working Meeting on Frailty and Aging. The following fundamental questions are discussed: What is the distinction, if any, between frailty and aging? What is its relationship with chronic disease? Is frailty a syndrome or a series of age-related impairments that predict adverse outcomes? What are the critical domains in its operational definition'? Is frailty a useful concept? The implications of different models and approaches are examined. Although consensus has yet to be attained, work accomplished to date has opened exciting new horizons. The article concludes with suggested directions for future research.