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In 2015, it was estimated that worldwide 47 million people had dementia, increasing to 75 million in 2030 and 132 million by 2050. Nearly 9.9 million people are expected to develop dementia each year, which translates to one new case every three seconds. While dementia occurs across all levels of socioeconomic status, nearly 60% of people with dementia currently live in low‐ and middle‐income countries (LMICs) and most new cases (71%) are expected to occur in those countries. The majority of people with dementia in those countries do not have access to care and support.

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.

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

Background Atrial fibrillation is associated with higher mortality. Identification of causes of death and contemporary risk factors for all‐cause mortality may guide interventions. Methods and Results In the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF) study, patients with nonvalvular atrial fibrillation were randomized to rivaroxaban or dose‐adjusted warfarin. Cox proportional hazards regression with backward elimination identified factors at randomization that were independently associated with all‐cause mortality in the 14 171 participants in the intention‐to‐treat population. The median age was 73 years, and the mean CHADS 2 score was 3.5. Over 1.9 years of median follow‐up, 1214 (8.6%) patients died. Kaplan–Meier mortality rates were 4.2% at 1 year and 8.9% at 2 years. The majority of classified deaths (1081) were cardiovascular (72%), whereas only 6% were nonhemorrhagic stroke or systemic embolism. No significant difference in all‐cause mortality was observed between the rivaroxaban and warfarin arms ( P =0.15). Heart failure (hazard ratio 1.51, 95% CI 1.33–1.70, P CI 1.51–1.90, P Conclusions In a large population of patients anticoagulated for nonvalvular atrial fibrillation, ≈7 in 10 deaths were cardiovascular, whereas Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 00403767.