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Background Information: Limited research has suggested that rural residents are at increased risk of dementia. Objective: The objective of this study is to determine if rural residence is associated with dementia using both cross-sectional and prospective analyses. Methods: In 1991, 1763 community-dwelling adults aged 65+ participated in the Manitoba Study of Health and Aging (MSHA), which sampled all regions of the province of Manitoba. Baseline measures included age, gender, years of education, the Modified Mini-Mental State Examination (3MS), and rural/urban status. Rural was defined as a census subdivision with a population, Background Information: The MoCA is a widely accepted screening tool which tests multiple cognitive domains. It is currently being used to diagnose degree and types of cognitive impairment. Objective: The aim of our study is to identify and measure test variability between two or more tests among a group of patients diagnosed with mild cognitive impairment (MCI). Methods: A retrospective study was performed on a sample of patients attending the Memory Clinic of Jewish General Hospital between January 2005 and December 2012. Inclusion criteria included: aged 60 and over who had a minimum of two visits and were diagnosed with MCI and who remained clinically stable over follow-up. The data were analyzed using SPSS, then a repeated ANOVA model was performed to test the variation in the mean between each group. The groups were analyzed according to age gender, education level, and MoCA score. Result: 345 MCI individuals met these criteria. Visits range from 2–5 (mean of 2.8) with MoCA testing over 2–7 years of follow-up. Mean MoCA score was initially 23.49 (SD of 2.95). The study showed no significant changes in MoCA score over time. Evaluation of 37 patients who had 5 visits showed a variance ranging from 1–11 points during the study period. 35% showed a score range of 4 points, 29.7% showed a variance greater than 4 points (max 11), while 35% showed only 1–3 points score difference over the follow-up period. Conclusion: Even in MCI patients who did not progress, the MoCA usually varies by 4 points during follow-up visits. A change in MoCA score from one visit to the next should not be taken as inevitable evidence of progression., Background Information: Individuals with diabetes are at an increased risk of cognitive decline and dementia compared to age-matched, non-diabetic controls. Recent population cohort studies further suggest that higher blood glucose levels among individuals with diabetes incrementally increased the risks for developing dementia even after controlling for major cardiovascular risk factors. Thus, improving glycemic control in adults with diabetes has been postulated as a potential modifiable risk factor for preventing cognitive impairment and dementia. Methods: Database searches of CENTRAL, Embase, MED-LINE, and Ovid HealthSTAR were conducted from 1966 to December 2013, and supplemented with searches of conference proceedings and manual reviews of bibliographies of retrieved articles. Randomized controlled trials (RCTs) examining the risk of dementia, global cognition, and psychomotor efficiency among individuals achieving intensive glycemic control (i.e., HbA1c ≤ 7.0%) compared to standard glycemic control (i.e., HbA1c > 7.0%) were included. Results: Seven RCTs were included in the systematic review and meta-analysis. Achieving intensive glycemic control was not associated with benefits in global cognition (SMD: 0.07, 95% CI: −0.29 to 0.42) or psychomotor efficiency (SMD: 0.55, 95% CI: −0.08 to 3.24). One RCT examined the association between intensive glycemic control and dementia, and no statistically significant reduction in the relative risk was observed. Conclusion: There is currently insufficient evidence to support the hypothesis that achieving intensive glycemic control is associated with benefits in cognition among adults with type 2 diabetes. Furthermore, these estimates of effect need to be interpreted with caution given the presence of statistical heterogeneity., Objective: Antipsychotics are commonly used in behavioural and psychological symptoms of dementia (BPSD). However, due to safety profile, the medical literature supports their use only in severe cases. Currently, there is a paucity of data regarding their use in short-stay units. Our primary objective was to determine which antipsychotics were most frequently used in the short-stay behavioural unit of the Montreal General Hospital. Our secondary objective was to determine their efficacy and incidence of side effects. Methods: This is a retrospective chart-review study of 88 patients admitted between May 2009 and July 2012 with an average age of 80 years old. BPSD were divided in categories inspired by the “Neuropsychiatric Inventory”, including agitation, paranoid ideas, etc. Results: Only 13 patients (14.8%) did not receive antipsychotics. At admission, 30 patients (34.1%) were already on an antipsychotic; however, 51 patients (58%) were discharged on an antipsychotic. Regularly administered Quetiapine was the most commonly prescribed first line agent (28.4%), followed by Haloperidol as needed (26.1%). A second antipsychotic was needed in 54 patients (61.3%). The most common BPSD encountered was agitation (29.2%) and 37 side effects were noted, including sedation (12.5%) and falls (10.2%). Furthermore, there was a significant loss of autonomy in that 39 patients newly required long-term placement and there was more than a 20% decline observed in the independence for ADLs (activities of daily living). Conclusion: Antipsychotics were frequently used in our unit and were associated with significant side effects, including sedation and loss of autonomy. We believe that such a high use of antipsychotics was associated with the observed functional decline. Quetiapine was the most commonly used, possibly because of the desired sedation effect., Background Information: The evidence on the use of ‘as required’ or prn medications in the older population is limited. Objectives: To determine the appropriate use of opioid analgesics, benzodiazepines, antipsychotics, antiemetics, and non-steroidal anti-inflammatory drugs (NSAIDs) for patients aged 75 years and older. Methods: A list of patients aged 75 years and older discharged from medical and acute geriatric medical units within a consecutive four-week period were generated. Patients with a change of care and those deceased were excluded. The remainder were investigated for the presence of prn medications in their discharge summary. The demographics included age, gender, and residence. Indications for the prn medications and geriatric syndromes (falls, delirium, and dementia) were also obtained. Results: A total of 24 prn medications were present in 23 of the 104 discharged patients. Of these, 8 were new and 16 were pre-existing. Only 10 of the latter were used during admission. Seventy per cent were discharged home. Half of the prn medications were opioid analgesics, followed by benzodiazepines (21%), antiemetics and antipsychotics (both 13%), and NSAIDs (4%). Eleven of the 23 patients had one or more of the geriatric syndromes. Discussion: Twenty-two per cent of older patients discharged in a four-week period have a prn medication documented in the discharge medication list. Majority of these patients are home-dwelling and nearly half of the patients have one or more of the geriatric syndromes. As such these patients are more prone to adverse effects. Over one-third of the preexisting prn medication were not used during the admission, but documented in the discharge medication list. Conclusion: Prn medications should be reviewed during admission and be judiciously documented in the discharged medication list., Background Information With the growing immigrant population in Canada, an accurate assessment tool is needed for those who are from culturally and linguistically diverse backgrounds. Many common cognitive screening tools are not ideal for these populations due to the dependency on English proficiency. In 2004, the Rowland Universal Dementia Assessment Scale (RUDAS) was created to address cognitive screening in culturally and linguistically diverse populations. A systematic review of the literature is warranted to determine whether the RUDAS has been validated in a diversity of populations as this may provide another easily administered and freely available cognitive screening tool for clinicians. Methods: A literature search was performed in MEDLINE, Embase, PsycINFO, CINAHL, and other relevant databases from date of onset to January 2014. Reference lists of articles were hand-searched and authors were contacted for further relevant studies. All studies comparing the RUDAS with other cognitive testing or a neuropsychological assessment were included. Abstracts and full-text of articles were reviewed independently by two authors. The data were extracted using a standardized protocol and the quality of studies was evaluated using the QUADAS-2 tool. Results: Ten studies meeting the pre-specified inclusion criteria were found from five different countries. A total of 3,194 patients were analyzed with varying levels of cognitive impairment. Results indicate that the sensitivity and specificity of the RUDAS is superior to the MMSE. Furthermore studies indicate that the RUDAS is more useful in those with lower education and those from linguistically diverse backgrounds. There was stronger clinician preference for RUDAS compared to the MMSE. Conclusions: The RUDAS is a useful short cognitive screening tool, particularly for individuals from linguistically diverse backgrounds., Background Information: There are two types of hip fractures: intertrochanteric and subcapital. Both types can have associated vertebral fractures. In this study, we explored the nature of vertebral fractures in the two hip fracture populations in an effort to gain insight into their etiology. Methods: This was a retrospective analysis of 120 patients: 40 with subcapital fractures and vertebral fractures, 40 with intertrochanteric fractures and vertebral fractures, and 40 with vertebral fractures only. Based on Genant’s semiquantitative assessment method, the distribution, type, and severity of each patient’s vertebral fractures were described. Results: Patients with subcapital fractures had significantly fewer total vertebral fractures (p = .005 and p = .019), vertebral fractures from T4–T10 (p = .005 and p = .042), and vertebral fractures at the T7–T8 peak (p = .002 and p = .003) than patients with intertrochanteric fractures and those with vertebral fractures alone. The number of vertebral fractures from T11-L4 and at the T12-L1 peak did not differ among the groups. Patients with subcapital fractures were more likely to have only one vertebral fracture (p < .001). Only the distribution of vertebral fractures between those with intertrochanteric fractures and those with vertebral fractures alone was significantly correlated (r = .6496, p = .009). Conclusion: The distribution of vertebral fractures among patients with subcapital fractures differed from the other fracture groups. Patients with subcapital fractures were more likely to have only a single vertebral fracture, while patients with intertrochanteric fractures and those with only vertebral fractures were more likely to have multiple vertebral fractures throughout the thoracolumbar spine. The subcapital and vertebral fractures of some patients may be a consequence of trauma and not osteoporosis., Background Information: Over 35 million people worldwide currently live with dementia. A phenomenal proportion of the care provided to these individuals is provided by unpaid, family caregivers. These caregivers are often overwhelmed by the numerous stresses imposed on them, resulting in deterioration of their own health, social isolation, loss of income, and distress. Caregiver interventions have been shown to improve caregiver mood and morale, to reduce caregiver strain and to delay transition of the person with dementia to long-term care. Due to the nature and intensity of care that is required, flexible and user-friendly methods of providing interventions to caregivers have been explored. Objective: The purpose of this review was to evaluate the evidence regarding Web-based resources as an avenue for providing support to caregivers. Methods: We performed a systematic review of the literature using search terms such as “dementia”, “caregiver”, “support”, and “interventions”. We searched Ovid Medline, PubMed, Embase, and CINAHL to October 2013. The abstracts were reviewed and full text articles were included. Studies were included if they were in English and were systematic reviews, randomized controlled trials or other intervention studies that examined internet or Web-based interventions for caregivers of persons with dementia. Results: Only 13 studies met all eligibility criteria. Positive outcomes from included studies of internet caregiver resources demonstrated increased caregiver confidence in decision-making, increased self-efficacy, improved perceptions of the positive aspects of caregiving, and significant reductions in stress, strain, anxiety, and depression in caregivers. Conclusion: Family caregivers are an integral, yet increasingly overburdened, part of the health care system. Given the many demands placed on family caregivers of persons with dementia, the potential for caregivers to access support services from the convenience of their own home, such as Internet resources, is attractive., Background Information There is a strong predilection for REM sleep behavioural disorder (RBD) to occur in synucleinopathies, a group of neurodegenerative disorders that includes Parkinson’s Dementia and Dementia with Lewy Bodies (DLB). RBD often precedes the onset of Parkinsonism and degenerative dementia in both Parkinson’s disease and Dementia with Lewy Bodies. This suggests an interconnection between RBD and degenerative dementias. Objective: To identify the interplay between the presence of RBD and the progression of DLB. Method: In this single centre, retrospective study, the medical charts of 47 patients with clinically suspected DLB were reviewed. Baseline demographic data were collected with respect to presenting cognitive and functional scores, age of dementia onset, DLB clinical characteristics, gender, ethnicity, education, co-morbidities, use of medication, and RBD age of onset/symptomology/treatment when applicable. Progression is defined by the average change over a three-year period in cognitive (3MS) and activities of daily living (Lawton Scale) scores. Chi square tests were performed between the control (patients with DLB without REM sleep behaviour disorder) and experimental (patients with DLB and REM sleep behavioural disorder) groups with respect to changes in cognitive (3MS) and activities of daily living (Lawton Scale) scores over time. Results: Chi square tests demonstrate no significant difference between the progression of DLB with or without RBD (p value of .333). Conclusion: An association cannot be made between RBD and DLB progression. The frequent tendency of RBD to occur in synucleinopathies and rarely in tauopathies supports the concept of a selective vulnerability in key neuronal networks. This selective vulnerability may result in RBD development in, but not progression of, RBD., Background Information: Historically, identification rates of mental health disorders in seniors presenting in primary care settings are low. There have been repeated calls for standardized ‘screening’ of mental health disorders for seniors, with the goal of enhancing detection and more timely intervention. Objective: The primary objective of this grant-funded project was to develop a standardized, user-friendly toolkit for the early identification of mental health issues in seniors for use in both rural and urban primary care settings in Alberta. Methods: Systematic reviews of the literature initially were conducted for anxiety, dementia, depression, and substance use disorder. Studies meeting inclusionary criteria (e.g., assessment of predictive properties, used a gold standard for diagnosis, targeted the population of interest, etc.) were included. Following the systematic reviews, an external Expert Panel provided validation of the selected psycho-metrically sound tools for use in the toolkit. Health-care professionals in both rural and urban primary care settings then provided input on the feasibility of use of the selected tools in their setting. Results: Screening tools were identified for each of the four disorders, with all tools meeting a number of criteria, including a high degree of accuracy in identifying those with and without the disorder, ease of administration (e.g., short, easy to score), and non-proprietary. Conclusion: The development of a standardized, user-friendly toolkit for the early identification of mental health issues in seniors for use in both rural and urban primary care settings in Alberta represents an important and foundational step toward increasing rates of early detection and improving treatment of mental disorders. To facilitate uptake, Web-based and print versions of the toolkit will be developed and available to health-care professionals., Background Information: Day centre programs, such as CHOICE, help support older people who are experiencing multiple ongoing health problems, with the goal of allowing them to remain living independently in their own homes longer, and to reduce their use of in-patient and emergency unit services. Since CHOICE’s inception, there have been changes to the health-care system, including an increased orientation to ‘aging in the right place’. Goals of this research were to describe the characteristics of CHOICE clients and to determine their use of other segments of the health-care system (e.g., Emergency room visits). Methods: Retrospective chart review of 195 clients at two Edmonton CHOICE Day Care sites. Results: Mean age was 79.91 (SD=8.09); 56% were female; with an average of 6.78 (SD=2.58) co-morbidities; 45% of the clients had a dementia. Clients scored below the cutoffs for impairment on all cognitive (MMSE/MoCA) and functional (FAB/Berg/Tinetti) tests, except the Tinetti on admission. Emergency room visits (1.26 vs. 0.52) and hospitalizations (1.26 vs. 0.52) decreased significantly in the one-year period pre- vs. post-CHOICE admission. Incidence of falls declined by 80% from pre-admission to one-year post-admission. Conclusion: CHOICE client profiles are consistent with the program’s mandate. Attendance at the CHOICE program was found to be associated with significant decreases in emergency room visits, hospitalizations, and incidence of falls. Day programs appear effective in not only reducing the use of acute care costs by medically complex community dwelling seniors, but also in allowing CHOICE attendees to remain living independently in their own homes longer., Background Information: In the absence of an advance care plan (ACP), patients with end-stage serious illnesses or injuries who can no longer speak for themselves may be subjected to unwanted invasive treatments or interventions. Hospitalist physicians can contribute to the quality and dignity of end-of-life care by eliciting advance care preferences with patients and families while the patient is still capable of consenting to, or refusing, treatment or other care. Objective: The purpose of this study was to determine whether physician-to-physician conversation about their own advance care preferences increases the likelihood that they may talk with patients about the patient’s ACP. Methods: Over a two-week period, the hospitalist study lead engaged 107 physician colleagues in informal conversations about their own advance care planning. After responding to two standard questions, the physician received an “Advance Care Planning Matters!” button and information card. A follow-up survey was delivered two weeks later. Results: 72% of survey respondents (n=46) spent time thinking more about their own advance care preferences subsequent to the conversation and 18 (39%) discussed these preferences with loved ones. Sixteen (35%) then explored their loved ones’ ACP preferences. Eight (17%) indicated they now had an increased level of comfort talking about ACP with patients. Thirty-eight (82%) thought physicians who have gone through their own ACP journey are more likely to talk with patients about ACP, and 38(82%) thought physician-to-physician conversations can increase their comfort in doing so. Conclusion: Physicians who journey through their own ACP may be more likely to talk with patients about ACP, and physician-to-physician conversations can increase their comfort in initiating these talks., Background Information: In a series of four case studies, frail seniors recently discharged from an acute care admission and referred to geriatric outreach teams were asked to identify the ‘team’ helping to keep them independent at home and to rate their perceptions of the relationships between each provider. Providers were then contacted and their perceptions of the inter-relationships were rated. Methods: The patient and provider inter-relationship ratings were then analyzed using social network analysis. Results: The analysis reveals the complexity and diversity of home and community-based ‘teams’, compares the perceptions of patients and providers, and indicates the ‘centrality’ of outreach teams in these post-discharge situations., Background Information: In recent years there has been an increase in pharmacist-managed anticoagulation programs. However, anticoagulation management services (AMS) for patients in supportive living have not been examined. Objective: This study examines pharmacist-managed versus comprehensive multidisciplinary physician-managed anticoagulation monitoring. Methods: We conducted a retrospective review of patients enrolled in a seniors’ day program (physician-managed) vs. Pharmacare’s supportive living AMS (pharmacist-managed) using case control methodology. The primary outcome was time in therapeutic range (TTR), with TTR determined by using both the fraction of International Normalized Ratio (INR) values method and Rosendaal’s linear interpolation method. Secondary outcome measures were frequency of INR testing and adverse events, including major bleeding and thromboembolic events. Results: The pharmacist-managed AMS had a TTR of 69.8% vs. 64.7% (p < .01) in the physician-managed group using fraction of INRs method, with TTR values of 74.0% vs. 75.3% respectively (p < .01) using the Rosedaal method. Pharmacist-managed AMS had a lower, but non-significant, sub-therapeutic frequency (INR < 1.5) of 2.8% vs. 1.9% using fraction of INRs method and higher, 1.0% vs. 1.1% using the Rosendaal method. Pharmacist-managed AMS had a higher, but non-significant, supra-therapeutic frequency (INR > 5) of 0.9% vs. 0.7% using fraction of INRs and 0.5% vs. 0.2% using the Rosendaal method. The percentage of patients experiencing adverse events was non-significant in pharmacist-managed vs. physician-managed AMS, with major bleeding events at 4.4% vs. 4.7%, respectively; thromboembolic events at 2.2% vs. 3.7%, respectively. Conclusion: Pharmacist-managed AMS demonstrated non-inferiority compared to the multidisciplinary physician-managed AMS. Differences in TTR varied as a function of methodology (e.g., use of fraction of INRs or the Rosendaal linear interpolation method), with these differences confounded by practice settings and access to INR testing., Background Information: There is extensive evidence that exercise, even moderate amounts, improves health. The literature also shows that decreased activity or inactivity is detrimental to health and wellness. This study examined the feasibility of measuring physical activity of in-patients in a geriatric rehabilitation setting using a custom-built, tri-axial accelerometer, in preparation for a study of the effectiveness of a mobility program. Methods: A tri-axial accelerometer housed in a custom-built package was used to track the ambulatory movement of patients in a tertiary rehabilitation hospital. Patients were asked to participate once they were assessed as ‘Independent’ or ‘Supervised’ by a physical therapist. Those who agreed to participate were asked to wear the device until discharge. The device was secured to the lower leg. Each accelerometer was individually calibrated using a standardized distance and validated throughout the trial. Ambulation was determined using the horizontal and vertical components of the acceleration data. A thermometer was used to confirm that the device was being worn. Results: 13 patients (8F 5M) agreed to take part. The average age was 83 yrs. Six were classified as ‘Independent’ walkers and 7 as ‘Supervised’. Ten patients completed the study; one withdrew and two were stopped due to changes in their medical condition. Total distance walked in the 6 days prior to discharge averaged 6,529 m (+ 4,313 m), 4,152 m (+ 1,331 m) for females and 8,917 m (+ 5,126 m) for males. Thermometer data confirmed the wear time indicated by the accelerometer measure. Conclusion: Measuring physical activity in an older population presents challenges. This study demonstrated that measuring ambulation with a custom-designed/built device is feasible in an older in-patient population., Background Information In the past, persons with MS died younger than the general population. Since the 1990s, important treatment-related changes, including disease modifying drugs, have been introduced which might influence MS outcomes. This study examined whether such changes are reflected in Canadian MS mortality rates. Methods: Statistics Canada provided data on deaths due to MS from 1975 to 2009 and population statistics. Average annual MS mortality rates per 100,000 population were calculated for each 5-year period within this time span, along with rates for each year and for the entire 35-year period, by gender and age. Results: The 35-year Canadian MS mortality rate was 1.23; trend analysis indicated that annual rates were stable over this time span. The 35-year rate for females was higher (1.45) than for males (0.99), with both female and male rates remaining stable over time. Regardless of gender, trend analysis showed a significant decrease in mortality rates for persons with MS under age 40 and a significant increase for persons over 60. The mortality rate for females under 40 dropped from 0.11 in 1975–79 to 0.05 in 2005–09 and rose from 0.51 to 1.00 for those over 60. The mortality rate for males under 40 dropped from 0.06 to 0.03 and rose from 0.34 to 0.52 for those over 60. Discussion: More persons with MS still die under age 60 than members of the general population. However, there has been a shift to later age at death, according to Canadian MS mortality rates, that has especially benefited women. The fact that persons with MS are living longer suggests that more health and social services will be required to meet the particular needs of those aging with MS., Background: What is the adherence to guidelines in Hospital-acquired pneumonia? What is the adherence to guidelines in aspiration pneumonia? Methods: Ethics and a site approval Chart Review from Grey Nuns Community Hospital. 207 charts were pulled; 108 charts with diagnostic code hospital acquired pneumonia were pulled, from 10/1/2008 to 09/30/2011. 227 charts with diagnostic code aspiration pneumonia were found, from 10/1/2008 to 09/30/2011; 99 charts were randomly selected out of those 227 charts. Information on demographic, comorbidities, antibiotics used and length of therapy, mortality, ICU admission, mortality, and admitting services was gathered. Information on whether or not swallowing assessment was done, and on chest X-ray, MRSA positive, and VRE positive was also gathered from the charts. Results: Hospital-acquired pneumonia group, guidelines were followed in 44.9% of the time Aspiration pneumonia group, guidelines were followed 64.5% of the time. Discussion: This study showed that the guidelines were commonly noted when it came to hospital-acquired pneumonia. The dose of levaquin was often followed n too low, which could be explained by the fact that Alberta Health has a pathway for community-acquired pneumonia but nothing for hospital-acquired pneumonia. Mortality rates were higher in the group where guidelines were followed, which could be explained by the fact that the sicker patients were more likely to have guidelines followed, and the sicker patients were more likely to pass away. Conclusion: A revised standard order sheet for hospital pneumonia would be beneficial., Background Information: Edmonton’s Home Living Geriatric Consult Team (GCT) is a community-based interdisciplinary team that provides in-home comprehensive geriatric assessment and interventions for unstable elders receiving home care (HC) support. It was designed with the goal of reducing avoidable emergency department visits, hospital admissions, and early institutionalization through the early identification of high-risk elders and immediate intervention. Objective: The purpose of this project was to evaluate the effectiveness of the GCT based on the experiences of its stakeholders: geriatric patients, their caregivers, HC case managers, and family physicians. Methods: Data from family physicians were collected through anonymous surveys while semi-structured interviews were conducted for HC case managers, patients, and their caregivers. Both quantitative and qualitative analysis of data will be performed. Ethical considerations have been supported by ARECCI guidelines. Results: Results to date include interview responses from six patients and eight caregivers. Overall, patients and caregivers reported that: 1) They felt involved in GCT discussions and decisions about care; 2) They believed GCT involvement was necessary and played a direct role in allowing patients to remain at home; and that 3) GCT involvement lessened the burden of being a caregiver. Results from family physicians and HC case managers are pending and will be incorporated once complete. Discussion: Given its unique position in primary care, the GCT has the ability to facilitate collaboration between HC case managers and family physicians in the parallel care of complex geriatric patients, thus bridging the gap between these two major care providers. An understanding of GCT stakeholders’ experiences and perceptions is fundamental to program success. Conclusion: Although the primary intention of this project was for GCT quality improvement, our findings may also have useful implications for future innovation in geriatric care., Background Information: Type 2 diabetes is a common condition in hospitalized geriatric patients. We modified the Canadian Diabetes Association (CDA) flow sheet for use on a geriatric in-patient rehabilitation unit to evaluate our performance on indicators of quality care and feasibility of using this tool to optimize diabetes management. Methods: The flow sheet was piloted from October 2011 to October 2012. The care of diabetic patients was guided by the flow sheet, but was otherwise “as usual” care with no other formal interventions. Results: 28 diabetic flow sheets were collected, with completion rates for each item ranging from 61% to 100%. House staff required reminders to complete the flow sheet and its use varied with different attending physicians. 89% of patients had an A1c ordered or available, 32% had an ACR done in hospital, and 64% a documented sensory foot exam. 71% were on a statin, 64% on ASA, and 50% on an ARB/ACEi. 25% of patients had an annual eye exam arranged and 18% had nail care arranged. 43% had the influenza, and 21% the pneumococcal vaccines. Discussion: House staff regularly checked A1c and ensured patients were on appropriate medications. However, clarification of the status of interventions usually done as outpatients (eye exams, community nail care, and vaccinations) was less commonly completed. Conclusion: Use of a modified CDA flow sheet with geriatric in-patients is feasible to audit and encourage guideline-directed diabetes care. Better integration into the patient’s chart, use within an electronic patient record, and house staff training would improve its utilization and effectiveness. The diabetes flow sheet may have a role as a communication tool with primary care physicians to identify items requiring follow-up upon discharge., Background Information: Benzodiazepines are frequently used for extended periods of time and are associated with significant morbidity in older adults. Objective: The purpose of this presentation is to describe the contributions from health professionals in the development and implementation of an interprovincial benzodiazepine de-prescribing guideline. Methods: Canadian Institute of Health Research funding was received to conduct an expert and stakeholder 1.5 day planning meeting regarding interprofessional approaches to benzodiazepine tapering. Objectives were to discuss challenges related to benzodiazepines, critique a proposed interprofessional model for de-prescribing benzodiazepines, and identify interventions and evaluation strategies for implementing the model. Discussions and presentations were recorded and transcribed. Activities and outcomes are presented descriptively. Results: Nineteen local service providers and 14 stakeholders, in addition to the 5 members of the research team, participated in the meeting. Key messages identified by the participants were: adaptability of the de-prescribing model, the need to address the challenges of implementing changes in a structured and highly regulated environment such as long-term care, the impact or liability of de-prescribing on the prescriber and other health professionals, and the challenge of changing practice amongst established health professionals. Development and implementation of a benzodiazepine ‘deprescribing guideline’ was discussed. The RE-AIM (reach, effectiveness, adoption, implementation, maintenance) model (a 5-dimensional framework that increases chances of an intervention being successful in “real world” settings) was chosen to frame further intervention and evaluation work. Conclusions: Health professionals are supportive of guidelines for benzodiazepine de-prescribing. Evidence to support positive impact of benzodiazepine tapering is available to guide development of a de-prescribing guideline. The primary concern is related to usability of such a guideline and implementing the practice into a culture of prescribing., Background Information The Queen’s Geriatric Interest Group (QGIG) is a student-based initiative developed to foster interest in the field of geriatric medicine, with goals of increasing overall knowledge of geriatric care and to increase recruitment to geriatric-focused fields. Pre-clerkship observerships have been documented as valuable methods in increasing exposure and interest to a given specialty of medicine. QGIG leaders collaborated with the Division of Geriatric Medicine to arrange scheduled observerships at St. Mary’s of the Lake Hospital, a health-care centre with a focus on specialized geriatrics and complex continuing care. Methods: Given challenges of student and preceptor schedules, four-hour observerships were organized for weekend mornings. Students participated in “on-call rounds” on the geriatric rehabilitation unit under supervision of the resident and/or attending physician. Students were given small roles including patient assessment, appropriate chart documentation, and reviewing medication lists. After each experience, students were asked to comment on strengths, weaknesses, and recommendations for the experience. The UCLA Geriatric Attitude Survey (GAS) was used pre- and post-observership to determine changes in participant attitudes towards geriatric medicine. Results: A total of 50 students participated in the observer-ship program between February 2013 and January 2014. Students viewed the observerships as providing excellent role models for geriatric care and subjectively increased their interest in the specialty. Analysis of student attitudes towards geriatrics pre- and post-observership is ongoing., Background Information: Current electronic medical record systems are not tailored to the workflow of a specialized geriatric clinic. Systems that can be adapted to meet the needs of a geriatric clinic rarely allow the collected data to be analyzed for research purposes. Also, mobile touch-based computers have become popular amongst health-care workers, but this technology has not been quickly supported by health-care organizations. Many software solutions are not practical and lack usability due to the usage of small buttons, fonts, complex menu systems, and challenging user interfaces. Method: We have developed a Web-based geriatric patient registry system that is usable on both desktop and tablet computers. The system was designed to allow for the capture of all data points commonly collected in a comprehensive geriatric assessment, including patient demographics, referral information, histories, review of symptoms, physical assessment, differential diagnosis, and plans for future care. Results: The system allows for the user to digitally capture tests including the SMMSE, GDS, BNA, ADL, FAQ, and Zarit Burden Interview, among others. From collected data, the system generates clinic notes and reports, potentially reducing, or in some instances eliminating, dictation time. Lastly, the system has been designed for use in clinical research, with data anonimization and analytical tools built into the application. Data can also be analyzed using statistical analysis software such as SPSS and SASS. Conclusion: Through the use of this system, we anticipate an increase both the quality of care provided to patients and efficiency of clinical practice. Although this system is in its “beta testing” stage, we anticipate this system will decrease visit length and dictation time, facilitate clinical research, and accurately measure quality of care indicators., Background Information: As the number of Canadians aged 65 years and older continues to rise, more attention has been given to home-based health care. Homebound seniors have higher rates of diseases, chronic medication use, emergency department visits, hospitalizations, and challenges in accessing care. Despite this growing concern, the number of physicians participating in house calls is declining. Family Medicine residents have generally perceived lack of training as a significant factor limiting their likelihood of pursuing house calls in the future. Many academic centres have looked into instituting a structured homebound seniors program as part of residency training to improve resident knowledge, skills, attitudes, and confidence in performing house calls. Method: A survey was distributed to Family Medicine residents from all 15 teaching sites at the University of Toronto. Sites having either a structured or non-structured homebound seniors program implemented in the residency curriculum were compared to assess if there is a difference in resident perception of house calls. A needs assessment of resident perspective on improving the house call curriculum was also performed. Results: The study demonstrated with strong statistical significance that structured programs compared to non-structured programs increase resident exposure, positive attitudes, confidence, and plans of pursuing house calls in their future practice. Similarly, a strong correlation of increasing exposure to house calls was associated with higher resident satisfaction. The needs assessment demonstrated that training on billing, procedures, having increased supervision, and greater exposure to house calls would improve their experience during residency. Conclusions: There are positive implications of this study for the health-care system, medical education system, practitioners, patients, and families in improving and sustaining care for homebound seniors, which can be implemented at a national level., Background Information: The use of psychotropic and analgesic medications is common in older adults and may be associated with drug–drug interactions (DDI) and adverse effects. DDI can be based on Phase 1 metabolism (oxidation/ reduction, including the cytochrome p 450 system) or phase 2 metabolism (conjugation or the UGT and ABC transporters). Objective: The aim is to assess the prevalence of possible metabolic drug interactions with psychotropic and analgesic medications in octogenarians. Methods: Retrospective chart review of all consecutive patients seen at the outpatients Senior’s Clinic at the University of Alberta in 2012. Each subject’s medication list was analyzed and coded, regarding substrate and inhibitor of enzymes in Phase I and Phase II systems and for polypharmacy (use of 5 or more prescribed medications). Psychotropic and pain medications were analyzed for interaction with the phases of metabolism. Simple descriptive statistics, chi-square and logistic regression analysis were done using SPSS. Results: Mean age was 85.9 years (SD 4.09) and 259 (69%) were females. Polypharmacy was seen in 253 (68%) subjects. Out of 372 subjects, 90 subjects (24%) were found to have potential drug interactions within their list of medications. Fifteen subjects (4%) who were taking pain medications and 75 subjects (20%) who were taking psychotrophic medications had possible metabolic drug interactions. Polypharmacy was associated with a 3.5 fold increase in the risk of metabolic drug interactions, OR 4.46, 95% CI 2.27–8.74 (p < .0001). Conclusion: In this study, a significant proportion of octogenarians who were on pain and psychotrophic medications had possible metabolic drug interactions within their list of daily medications. Increasing awareness and knowledge of metabolic drug interactions is important to choose safe drug combinations and to prevent toxicity., Background Information: Fragility fractures secondary to osteoporosis are associated with excess mortality and disability among older individuals. Studies have consistently reported low rates of osteoporosis screening; however, few have examined which patient and physician factors influence screening uptake and pharmacotherapy for osteoporosis. Methods: A retrospective chart review was conducted among 455 individuals (281 women and 174 men) age 65 or greater with at least one clinic visit between 2011 to October 2013. Components of the Fracture Risk Assessment Tool (FRAX), Charlson Comorbidity Index, Osteoporosis Self-Assessment Tool (OST) score, and patient and physician sociodemographic variables were extracted using a standardized data extraction form. The outcomes of interest were the proportions of individuals who received bone mineral density screening and subsequent bisphosphonate therapy. Results: Three hundred seventy-one patients (69.7%) had received at least one bone mineral density screening. Multivariate analysis revealed that women compared to men were more likely to receive osteoporosis screening (OR=4.17, 95% CI: 2.47–7.02). Furthermore, individuals with a female physician (OR=3.87, 95% CI: 2.20–6.81), previous fragility fracture (OR=14.92, 95% CI: 3.41–65.22), previous breast or prostate cancer (OR=4.43, 95% CI: 1.17–16.87), and a positive screen on the OST (OR=2.40, 95% CI: 1.32–4.362.20–6.81) were more likely to receive bone mineral density test. Male and female physicians were equally as likely to prescribe bisphosphonates for individuals with osteoporosis. However, individuals with an active solid or hematological malignancy were less likely to receive bisphosphonate therapy (OR=0.49, 95% CI: 0.07–0.75). Conclusions: Compared to women, men continue to be underscreened for osteoporosis. Screening and pharmacotherapy for osteoporosis is multifactorial and influenced by patients’ current co-morbidity burden and fracture risk., Background Information Inflammation is a risk factor for osteoporosis. Treating inflammation may improve bone mineral density (BMD). Objective: This study aimed to examine if anti-rheumatic drugs for rheumatoid arthritis (RA), psoriatic arthritis (PsA), psoriasis (PSO), and ankylosing spondylitis (AS) improve BMD. Methods: MEDLINE, Embase, and Cochrane were searched from 1960 to present for English-language randomized controlled trials conducted in adults. Studies were grouped based on disease, treatment type, and site of BMD measurement. Differences in change of BMD (ΔBMD) between treatment and control were standardized across included studies to yield standardized mean difference (SMD). Results: 13 studies were eligible (11 RA, 0 PsA, 0 PSO, 2 AS). For RA, less hand bone loss was seen with TNF inhibitors (TNFi) (SMD ΔBMD = 0.33, 95% CI 0.13–0.53, p = .001, I2=0%) and corticosteroids (SMD ΔBMD = 0.51, 95% CI 0.20–0.81, p =.001, I2=0%). TNFi had neutral effect on lumbar spine (LS) and hip BMD. Corticosteroids had negative effect on LS (SMD ΔBMD = −0.30, 95% CI −0.55 to −0.04, p =.02, I2=52%) but neutral effect on hip. For AS, increase in BMD was seen with TNFi on both LS (SMD ΔBMD = 0.96, 95% CI 0.64–1.27, p < .001, I2=16%), and hip (SMD ΔBMD = 0.38, 95% CI 0.13–0.62, p = .003, I2=0%). There was insufficient data to meta-analyze other diseases and other DMARDs. Conclusion Based on our RA analysis, TNFi yielded less hand bone loss, where synovitis is often present, but had no effect on LS and hip BMD. Corticosteroids also yielded less hand bone loss, but it had negative effect in LS and not the hip. For AS, TNFi increased BMD., Background Information Geriatric patients are at high risk for in-hospital deconditioning, malnutrition, and poly-pharmacy, resulting in delayed discharge and iatrogenic complications. Parameters for improving the care of geriatric patients on the Clinical Teaching Unit (CTU) were proposed by internal medicine residents during academic half-day. The parameters include: 1) obtaining patient’s body weight (admission & weekly); 2) supplementing all patients with daily oral Calcium and Vitamin D, and weekly bisphosphonate, where appropriate; and 3) reviewing patient’s diagnoses and medications weekly in writing. Methods: Reminders in person/in writing to all (1st intervention) and in email to senior residents (2nd intervention) were implemented to improve compliance with the above measures. Electronic progress forms were initiated as a 3rd intervention. During the second year of the study, we developed a pre-printed CTU admission order set that included multiple “elderly-friendly” measures (4th intervention). Retrospective chart review was performed of all geriatric patients discharged from CTU at Royal University Hospital in Saskatoon from September 2012 to April, 2014. Results: In the first year 317 charts were reviewed. Our study found that the 1st intervention resulted in improvement in ordering of weights during admission (from 33% to 38%), Ca/Vitamin D supplementation (from 33% to 56% and from 45% to 65%, respectively), and medication reconciliation (from 20% to 35%). The 2nd intervention was found to be less effective, with medication reconciliation dropping to 32%; returning to 34% after initiating the 3rd intervention. The 3rd intervention was paradoxically associated with decreased ordering of weights. Final evaluation of the impact of the pre-printed CTU admission orders is pending. Conclusion: Education and active involvement of residents can improve the implementation of “elderly-friendly” basic health measures on a provincial CTU., Objective: To determine whether bilingualism is associated with dementia in cross-sectional or prospective analyses of older adults. Methods: In 1991, 1616 community-living older adults were assessed and followed five years later. Measures included age, gender, education, subjective memory loss (SML), and the modified Mini-Mental State Examination (3MS). Dementia was determined by clinical examination in those who scored below the cut point on the 3MS. Language status was categorized based upon self-report into three groups: Monolingual English, Bilingual English, and English as a Second Language (ESL). Results: The ESL category had lower education, lower 3MS scores, more SML, and were more likely to be diagnosed with Cognitive Impairment, No Dementia (CIND) at both time 1 and time 2, compared to English-speakers. There was no association between being bilingual (ESL and English bilingual vs. Monolingual) and having dementia at time 1 in bivariate (OR (95% CI)=0.76 (0.41, 1.43)) or multivariate analyses (OR (95% CI)=0.84 (0.77, 0.92)). In those who were cognitively intact at time 1, there was no association between being bilingual and having dementia at time 2 in bivariate (OR (95%)=0.99 (0.61, 1.59) or multivariate analyses (OR (95%)=0.94 (0.88, 1.01). Conclusions: We did not find any association between speaking more than one language and dementia., Background Information: The association between benzodiazepines and the risk of falls in the elderly is well described. It remains unknown whether urinary incontinence mediates this risk. Objective: The aim of this study was to assess the impact of urinary symptoms on the risk of falls among chronic benzodiazepine users. Methods: A cross-sectional analysis was conducted using baseline data from 303 older benzodiazepine users enrolled in a randomized trial. A history of falls was ascertained by self-report. The presence of incontinence was defined as a score ≥ 1 on the International Consultation on Incontinence Questionnaire (ICIQ). Medication history, including daily benzodiazepine dose (converted to lorazepam equivalents), was obtained from pharmacy renewal profiles. The Montreal Cognitive Assessment (MoCA) was used to ascertain cognitive status. The prevalence of falls in participants with and without incontinence was compared with descriptive statistics; the magnitude of association was ascertained using univariate logistic regression. Results: Of 303 chronic benzodiazepine users (mean duration of use = 10 years), 85 (28%) reported a history of falls and 66 (21.8%) reported incontinence. Participants reporting incontinence were twice as likely to report a history of falls than continent individuals (40.9% vs. 24.5%, respectively, p = .01, OR 2.1; 95% CI 1.2–3.8). Age (mean 74.5 vs. 74.9,), MoCA score (mean 25.8 vs. 25.3), and benzodiazepine dose (mean 1.3 mg lorazepam/day vs. 1.2 mg/day) did not differ between the incontinent and continent participants (p > .05). Conclusion: Urinary incontinence was significantly associated with a history of falls in this older cohort of chronic benzodiazepine users. Further investigation is required to elucidate the temporal relationship between “rushing to the bathroom” and falling, as well as the causal contribution of other functional/mobility impairments., Background Information: Geriatric assessment and treatment units (GATUs) in acute care hospitals that electively admit frail older adults have all but disappeared. Objective: The study objective is to describe the characteristics and outcomes of patients admitted to a GATU located in a chronic hospital/rehabilitation setting, which primarily admits patients from the community, distinguishing it from Acute Care for Elders units. Methods: A retrospective chart review was conducted on patients discharged from the GATU between April 9, 2012 and June 3, 2013. Descriptive statistics were used to characterize the patient sample. Statistical differences were explored using paired t-tests. Results: 102 patients were included, representing 111 admissions. The mean age was 82.0 (±7.9) years. Most patients were female (81.4%), widowed (61.8%), and admitted from the community (76.5%). The most common reasons for admission were pain management, falls, and deconditioning. The average number of co-morbidities per patient was 7.9 (range 2–19). On admission, the average Berg Balance Scale score was 28.5 (±13.0) and 74.2% were at medium or high risk for falls. Patients stayed on the unit an average of 28.3 (±12.0) days. On discharge, 72.1% were independent in ambulation vs. only 47.1% on admission (p < .0001), while 75.8% were independent in transferring vs. 66.7% on admission (p = .15). On discharge, 82.7% used a walker vs. 69.3% on admission (p = .03). The average Functional Independence Measure total score on discharge was 97.4 (±15.1) vs. 93.0 (±15.2) on admission (p < .0001). Of those admitted from the community, 89.7% returned to the community. Conclusions: The majority of patients on the GATU improved in mobility and functional status and returned to the community, demonstrating that frail patients with complex needs can benefit from a GATU in a non-acute care setting., Background Information: Rapid detection and relief of pain is challenging when caring for older patients in the Emergency Department (ED). Fractures, a common reason for ED visits cause acute pain, which if relieved rapidly, improves well-being and reduces adverse events. The aim of this quality improvement initiative was to improve pain management and reduce adverse events including delirium, length of stay, and return visits in patients 75 years and older presenting with a fracture at any of three hospital EDs in Montreal, Canada. Methods: A multifaceted intervention was developed based on data collected from electronic medical records and surveys of ED professionals and patients. A stepped-wedge design was used to implement the intervention sequentially; data are collected each time a site begins the intervention. Primary outcome is time to optimal pain management. Results: Prior to intervention, we identified 95 patients (67% women, mean age 84 6 years) with 102 fractures over a two-month period. Median length of stay was 11 (IQR: 7.1–23.3) hours. Pain score was documented during the ED stay in 44% of patients with median time to documentation of 5 (IQR: 2.2–7.2) hours; 25% had no score documented. The median time to first analgesic was 3.4 (IQR: 1.8–5.5) hours, 27% did not receive any analgesia. Surveys distributed to 81 physicians and 198 nurses identified barriers to optimal pain management: time constraints, lack of resources and monitoring and potential adverse events. Results post-implementation at two EDs will be presented. Conclusion: There is an important care gap in documentation and timely management of pain. Anticipated contributions of the PAINFREE initiative will be the development of tools to facilitate best practices for pain control and consequently improve outcomes., Background Information: Population aging has contributed to increasing falls in the older population. Fall detection has been widely studied, but most studies have not addressed possible physiological causes. This study examined the feasibility of simultaneously measuring stability and vital signs in real time to better understand the possible linkages. Methods: The tilt angle of the body was logged while walking. Detection of a “near fall” or “fall” event was defined as a tilt angle greater than 45° and an impact acceleration > 2g, respectively. Oxygen saturation, heart rate, and body temperature were sampled once per minute and synchronized with the fall detector. Results: Devices were tested on 7 healthy subjects performing activities of daily living between 16 to 40 hours over 5 days. The mean tilt angle was 24°±15°. The false-positive rate was 0.11%. The mean heart rate, oxygen saturation, and skin temperature were 72.2±10.0 heart bpm, 97±2% and 29.7±1.8°C, respectively. An 84-year-old woman volunteered to test the device at home for 6 hours: average tilt angle was 28°±17°; heart rate, oxygen saturation, and body temperature averaged 75.4±6.9 bpm, 94.6±1.7%, and 33.0±0.8°C, respectively. Conclusion: This study supported the feasibility of combining fall detection with real-time physiological monitoring. Measurements taken by the physiological monitor agreed with expected values from the literature. These results were based on a one-day trial and further study is required to correlate the vital signs and the risk of falls., Background Information: To review the impact of provider-based, organizational strategies in acute care settings to improve pneumococcal vaccination rates among patients at risk of pneumococcal disease (i.e., those over 65 years, and 2–64 years of age with high-risk medical conditions). Methods: A search was conducted using MEDLINE, Scopus, CINAHL, and Web of Science databases for hospital-based, in-patient studies which evaluated strategies to improve pneumococcal vaccination rates. Studies published in English from 1983–2013 were included. Results: A total of 34 studies were included; 14 studies evaluated physician reminders such as chart or paper reminders, pre-printed orders (PPOs), and computerized reminders, and 26 standing orders programs (SOPs). Pre/post design was the most common study design; only 7 studies had a control group. Overall, 31 studies showed improvements in the rate of pneumococcal vaccination following intervention, of which 18 were statistically significant. Physician reminders resulted in 29%–67% immunization rate, PPCO 5%–42%, and SOPs 3%–78%. Discussion: Although this review found higher immunizations rates with SOPs, the impact on immunization rates in eligible patients varied significantly. The quality and design of the studies makes interpretation of the best approach challenging. High-quality, randomized-controlled studies are required to determine the true effect of each type of institutional immunization strategy. Conclusion: Hospital-based interventions improve pneumococcal vaccination in older adults and younger individuals at risk. Further research is required to determine the ideal intervention., Background Information: The Canadian Association of Interns and Residents (CAIR) Specialist Forum Project Proposal September 2013 was aimed to create a health human resources platform in Canada by providing residents with reliable information on physician employment opportunities in Canada. Objectives: 1. Determine number of Specialist Geriatricians (SpGrtn) in geriatrics; 2. Estimate the societal need; 3. Project the number of SpGrtns physicians retiring in geriatrics within the next 5 to 10 years. Methods: In the absence of an available benchmark, we used a physician/population ratio of 1.25 SpGrtns/10,000 people 65+2 or 1 SpGrtn/ 4,000 people 75+3, and 2011 Canadian Census data (med population projections 65+ or 75+) over ten years. We estimated the anticipated retirement of present Canadian SpGrtns as 40 years beyond their medical degree (MD). Results: In January 2014, there were 285 practicing SpGrtns and 134 Care of the Elderly (CoE) trained physicians, an increase of 11% and 30%, respectively, from the 2011 estimate. The calculated need in 2014 is 445 SpGrtns (1.25/10,000 65+) or 610 (1/4,000 75+). The calculated need for SpGrtns in 2021 is 567 (1.25/10,000 65+) or 756 (1/4,000 75+). Across Canada, at least 10 SpGrtns are trained annually (100 in 10 years). Between 2012 and 2021, approximately 95 of the existing SpGrtns will have practiced 40 years. Conclusions: As a preliminary response to the CAIR initiative, we have estimated that in 2021 there will be 290 SpGrtns (285−95+100) resulting in a shortfall 277 Sp-Grtns (567-290) in Canada. This is sufficient justification for continued efforts to attract Canadian medical trainees to the field of Geriatric Medicine and to recruit geriatric specialists to Canada. Caveat: Not all SpGrtns and Coe MDs are working full time in geriatrics, so the short fall will be even worse., Background Information: Cognitive impairments are prevalent in heart failure and have been mechanistically linked to cerebral hypoperfusion. This relationship has been based solely on measurements of cerebral blood flow (CBF) in the supine position; however, upright postures common to daily living may pose an additional challenge. Objective: The purpose of this study was to examine CBF in response to upright sitting in heart failure patients and healthy controls. Methods: Twenty-two heart failure patients (age=69±9 years, ejection fraction=33±11%) were age- and sex-matched to twenty-two healthy controls (age=70±9 years). Participants were administered the Montreal Cognitive Assessment (MoCA) to assess global cognition. Gait speed was calculated by utilizing an 8 m usual speed walking test. The right internal carotid artery diameter and mean flow velocity was obtained with ultrasound when supine and seated to provide a quantitative measure of CBF. Results: Heart failure patients scored lower on the MoCA (24±3) than their healthy counterparts (28±1; p < .001) and had a slower gait speed (heart failure=0.98±0.2 m/s, control=1.3±0.2 m/s; p < .001). Furthermore, the drop in CBF from supine to seated was greater in the heart failure patients (−40 mL/min) than healthy controls (−5 mL/min; p = .001) and translated to a 15% and 0.02% average drop from baseline values, respectively. Conclusions: Importantly, this is the first time CBF has been measured in an upright position in a heart failure population. The found reduction from supine may have important clinical implications on cognition., Background Information: Previous studies using Rasch analysis in Brazilian, US, and Chinese samples have yielded mixed conclusions regarding the unidimensionality of the GDS-15, suggesting that differences in test language or sample characteristics may influence psychometric properties. Objective To estimate the psychometric properties of the GDS-15, including the extent to which they are influenced by test language and cognitive ability among Canadian elders referred to a university-based geriatric outpatient clinic. Methods: Patient data were obtained through retrospective analysis of a clinical database in two geriatric outpatient clinics in Montréal, Québec. GDS data (n = 214) were recorded from 178 patients (M=81.0, SD=6.3, 68% females) tested with English (n = 130), French (n = 64) or Italian (n = 20) test forms. Cognitive ability was measured by the Mini-Mental State Examination and Montreal Cognitive Assessment. Data analysis in RUMM 2030 was conducted to determine whether the GDS fit a Rasch Measurement Model based on item response theory. Results: A significant item-trait interaction indicated poor fit of the GDS-15 to a unidimensional Rasch model (chi2=83.5, p < .001). Three misfit items were “Feeling life is empty” (overfit), “Prefer to stay at home” and “Problems with memory” (underfit). Removal of these items yielded a unidimensional dataset (chi2=35.9, p = .06). The item “feeling happy” showed differential item functioning (DIF) by test language and the question “afraid that something bad will happen” showed DIF by cognitive ability. Conclusion: Fear about the future contributes more to severity of depressive symptoms among more cognitively intact patients. Revisiting the French translation of item “feeling happy” may further improve the validity of this tool. Clinicians should consider administering a 12-item GDS to obtain the most psychometrically valid measure of depressive symptoms in geriatric outpatient settings., Background Information: The perception that gait is an automatic motor task, requiring minimal cognitive processes, is too simplistic. It is well established that at least one cognitive domain, executive function (EF), plays an important role in controlling gait, its dysfunction and falls. Nonetheless, the role of additional cognitive domains, including memory, remains unknown. Individuals with mild cognitive impairment (MCI) are at greater risk for falls, mobility decline and, as expected, cognitive deterioration—representing an ideal target population to explore this relationship. Objective: Our aim is to identify associations between deficits in specific cognitive domains and gait variability (GV), an accepted marker of gait control and future falls. Methods: Older adults with MCI were cognitively assessed for EF (Trail Making A&B), attention (Digit Span), language (Boston Naming), working (Letter Number Sequencing), and episodic memory (Rey Auditory Verbal Learning). Gait assessments performed under usual gait (UG) and dual-tasking (DT) conditions using an electronic walkway (GaitRITE®). Gait variability was evaluated using the co-efficient of variation. Results: Sixty-four MCI participants (Mean age: 76.0±6.7 and 57% males) were included. Multi-variable linear regression analysis (adjusted for potential confounders) indicated under both walking conditions EF, attention, working memory, and episodic memory were significantly associated with GV (p, Background Information: Frail elderly home care patients are at high risk of drug-related problems (DRPs). While the involvement of a pharmacist has been shown to reduce polypharmacy in the geriatric population, the role of the pharmacist in home care remains poorly defined. Purpose: To determine the frequency of DRPs in the elderly home care population and the uptake of medication modification recommendations made by pharmacists to physicians after a home visit. Methods: In this cross-sectional observational study, the pharmacist performed a medication assessment by chart review for 81 home care patients (age ≥ 65). The Pharmaceutical Care Network Europe Drug Related Problems (PCNE) classification system and the 2012 Beers List of drugs to avoid in the elderly were systematically applied to patients’ medication profiles by a pharmacist to determine the frequency of DRPs. Forty-one patients additionally received pharmacist home visits. The uptake of pharmacist recommendations by the treating physician was recorded. Results: Pharmacists identified 213 DRPs (mean 2.63±1.9 per patient), with 41% of patients receiving at least one inappropriate Beers list medication. Home visits significantly increased the detection of DRPs from 1.5±1.2 DRPs prior to the visit, to 2.9±1.8 after the home visit (p < .001). The most frequent DRPs were a potential or manifest adverse drug event (49%), an untreated indication (20%) or a non-optimal drug treatment (19%). The treating physicians adopted 70% of pharmacist recommendations. Discussion: Home visit by a pharmacist facilitate the detection of DRPs among high-risk home care patients. This is the first study to use the PCNE classification to evaluate DRPs in the home care setting. Conclusion: The results support the inclusion of home-based medication assessment by pharmacists for high-risk home care patients., Background Information Despite guidelines recommending against the use of benzodiazepine drugs for older adults aged 65 years and older, their use is still highly prevalent in Canadian elders and may be responsible for hundreds of millions of dollars in extra medical expenditures. The effect of direct patient education to catalyze collaborative care for reducing inappropriate prescriptions remains unknown. Objective The objective of this study was to compare the effect of a direct-to-consumer educational intervention against usual care on benzodiazepine discontinuation in community-dwelling older adults. Methods: This was a cluster-randomized trial set in the general community. A total of 303 chronic benzodiazepine users, aged 65–95 years, were recruited from 30 community pharmacies. The active arm received a de-prescribing patient empowerment intervention describing the risks of benzodiazepine use and a step-wise tapering protocol, while the control arm received usual care. The main outcome consisted of benzodiazepine discontinuation at 6 months post-randomization, ascertained by pharmacy medication renewal profiles. General estimating equations were used to account for possible clustering. Results: Two hundred and sixty-one participants (86%) completed the 6-month follow-up. Sixty-two per cent of recipients in the intervention group initiated conversation about benzodiazepine cessation with a physician and/or pharmacist. At 6 months, 27% of the intervention group had discontinued benzodiazepine use compared to 5% of controls (risk difference 23%, 95% CI 14–32%, ICC 0.008, NNT=4). Dose reduction occurred in an additional 11% (95% confidence intervals 6–16%). Neither age greater than 80, sex, duration of use, indication for use, dose, previous attempt to taper nor concomitant polypharmacy (≤ 10 drugs/day) had a significant interaction effect with benzodiazepine discontinuation in multivariate sub-analyses. Conclusion: Direct-to-consumer education effectively elicits de-prescribing of benzodiazepines in older adults., Background Information: Previous studies have demonstrated that aerobic exercise interventions have a positive impact on sleep quality in older adults. Little work has been done however, on the impact of sedentary behaviour (such as sitting, watching television, etc.) on sleep efficacy. Methods: 54 community-dwelling men and women > 65 years of age living in Whistler, British Columbia (mean 71.5 years) were enrolled in this cross-sectional observational study. Subjects were in good health and free of known diabetes. Measures of sleep efficiency, as well as average waking sedentary (ST), light (LT), and moderate (MT) activity, were recorded with SenseWear accelerometers worn continuously for 7 days. An initial univariate analysis of activity measures, alcohol consumption, sleep efficiency, age, and gender was performed and significant variables (p < .10) were then entered into a stepwise multivariate regression model. Results: From the univariate regression analysis, there was no association between sleep efficiency and the predictors LT and MT. There was a small negative association between ST and sleep efficiency that remained significant in our multivariate regression model containing alcohol consumption, age, and gender as covariates. (Standardized Beta Correlation Coefficient −0.322, p = .019). Although significant, this effect was small (an increase in sedentary time of 3 hours per day was associated with an approximately 5 per cent reduction in sleep efficiency). Conclusions While light and moderate physical activity had no association with sleep efficiency, sedentary behaviour had a statistically significant, but clinically small, negative association with sleep efficiency. This suggests that interventions to reduce sedentary time will have a beneficial, but small, impact on quality of sleep in older adults, Background Information: Early motor changes associated with later adult aging predicts cognitive decline, suggesting that a “motor signature” can be detected in pre-dementia states. Objective: Our aim was to determine whether gait performance in older adults with mild cognitive impairment (MCI) differs based on their cognitive subtype classification: amnestic (a-MCI) or non-amnestic type (na-MCI). Methods: Older adults with MCI and cognitively healthy controls (CHC) from the “Gait and Brain Study” were assessed for global cognition and specific cognitive domains with a neurocognitive test battery. Mean gait velocity and stride time variability were evaluated with the GaitRITE® under usual and three dual-task conditions. The relationship between cognitive group (a-MCI vs. na-MCI) and gait parameters, including velocity and variability, was evaluated with linear regression models and adjusted for potential confounders. Results: Ninety-eight older participants, 56 MCI (mean age 76.3±7.2 years and 50.9% female) and 42 CHC (mean age 71.2±4.50 and 73% female) were included. Thirty-eight participants were a-MCI and 18 were na-MCI. Groups were similar in age, co-morbidities, and history of falls. Amnestic-MCI participants walked slower than na-MCI in all test conditions (p < .05). Multivariable linear regression (adjusted for age, sex, physical activity level, number of co-morbidities and executive function), showed a-MCI was significantly associated with slower gait under usual and dual-task conditions and higher variability under dual-task (p < .01). Conclusion: Participants with a-MCI, specifically with episodic memory impairment had poor gait performance, particularly under dual-task. Our findings suggest that slow gait and higher stride time variability is a distinct ‘motor signature” in a MCI., Background Information: Many age-related health problems have been associated with dementia, leading to the hypothesis that late-life dementia may be determined less by specific risk factors and more by the operation of multiple health problems in the aggregate. Our study addressed: 1) how the predictive value of dementia risk varies by the number of deficits considered, and 2) how traditional and nontraditional risk factors compare in their predictive ability. Methods: Older adults in the Canadian Study of Health and Aging who were cognitively healthy at baseline were analyzed (men = 2,902, women = 4,337). Over 10 years, 44.8% men and 33.4% women died; 10.2% men and 9.1% women developed dementia. Forty-two self-rated health problems, including, but not restricted to, dementia risk factors were coded as deficit present/absent. Variable numbers of potential deficits were randomly selected to construct an index of proportional presentation of the deficits. Results: Age-adjusted odds ratios per additional deficit were 1.27 (95% CI 1.23–1.34) in men and 1.16 (1.12–1.19) in women in relation to death, and 1.18 (1.12–1.25) in men and 1.08 (1.04–1.11) in women in relation to dementia. The index’s predictive value increased with the number of deficits considered, regardless whether they were known dementia risks. The index constructed using all the available deficit measures in the dataset best predicted death and dementia in both men and women (C-statistics: 0.71±0.02 for death; 0.67±0.03 for dementia). Conclusions: The variety of items associated with dementia suggests that some part of the risk might relate more to aberrant repair process, than to specifically toxic results., Background Information: Older adults admitted to the intensive care unit (ICU) are seriously ill, but many are also frail. Here we evaluated the frailty of older ICU patients using a Frailty Index (FI) based on health deficit accumulation. We examined the FI in relation to short-term survival in a specialized geriatric ICU, in comparison with several prognostic ICU scores. Methods: Geriatric ICU patients (aged 65+ years) at the Liuhuaqiao Hospital, Guangzhou, China, admitted between July and December 2011, were studied (N=155; age 82.7±7.1 years; 87.1% men). Patients were followed to 300 days, by which 38.7% had died (n=60; including 27 who died within 30 days). The FI was calculated as the proportion., Background Information In a culturally diverse and ageing society like Canada, the development of cultural competency skills has become a necessity for health professionals. Research in cultural studies has given rise to effective methods and practices for working with ethnicities. Objective: To develop communication and learning tools to assist health professionals to provide culturally competent care through effective communication with their patients. Methods: Based on ethno-cultural and multicultural theoretical perspectives, we used communication tools in the published literature and developed new self-assessment and cultural understanding tools for cultural competency skill development. Eleven teaching videos based on our research in ageing ethnic communities were also incorporated. Results: This work resulted in an eight-module, structured course on cultural competency skill development. The tools utilized for cultural competency skill development include: 1) the Health Professionals Self-Assessment of Cultural Competency (HPSACC) Questionnaire—used for self-assessment of one’s own beliefs, values, and attitudes; 2) cultural understanding and insight into patients values, beliefs and attitudes—gained through the BRIDGES model; 3) the LEARN Model—facilitates intercultural communication; and 4) strategies for life-long learning are identified. The range of issues addressed by the videos include: (a) traditional roles of family care; (b) cultural issues in obtaining consent; (c) cultural issues in compliance; (d) language diversity in health care; (e) generational views on personal directives; (f) cultural issues in end-of-life; (g) challenging cultural norms; and (h) cultural influence in family decisionmaking. An evaluation component is also included. Discussion The tools can be applied to a wide range of health professionals’ learning and provide effective methods for working with ageing populations. Conclusion: The development of cultural competency skills is a life-long process that requires ongoing training and practice., Background Information: Family doctors play a central role in looking after the complex medical needs of growing population of seniors in Canada. The University of Alberta Family Medicine Residency training program is expanding its options for training a new generation of family physicians competent in providing care to the elderly in line with the College of Family Physicians of Canada Triple C curriculum and the mandate for more integrated experiences. Methods: The traditional Care of the Elderly rotation is offered to the Family Medicine residents on their second year of training (PGY-2).The rotation includes 4 weeks at one of the acute care sites and provides residents with the combination of acute care and ambulatory experience under the preceptorship of the Care of the Elderly physicians. In 2011, a formalized Integrated Care of the Elderly option became available for PGY-1 residents. This option provides a longitudinal experience under the supervision of a family medicine preceptor and a Care of the Elderly mentor. It is enhanced by long-term care, community, and specialty clinic experiences during PGY-1 and PGY-2 training. Results: The enrolment: 2011–2012: 5 (8%), 2012–2013: 8 (13%), 2013–2014: 8 (13%). The study will compare the educational, clinical, and academic activities offered within the 4-week and integrated learning options. Conclusion: In summary, there is an obvious interest in Integrated Care of the Elderly as a viable alternative to the more traditional 4-week rotation in geriatrics. More research is needed to assess the strengths and areas for improvement for both models to ensure that future family physicians have adequate skills and knowledge to look after Canada’s aging population., Background Information: Mild cognitive impairment is a growing public health concern, affecting up to 19% of the population aged 65 and older. Approximately 10% of those with MCI will convert to dementia every year. Thus, there is a focus on identifying effective strategies to prevent its progression to dementia and limit associated morbidity. Our systematic review aims to evaluate high-quality evidence on interventions for MCI. Methods: We included randomized clinical trials (RCTs) and systematic reviews evaluating pharmacologic or nonpharmacologic interventions on patients 65 years of age or older with MCI. Studies were eligible if they were published in English, included a comparison group, and evaluated cognitive, functional, quality of life or safety outcomes. Studies that examined patients of normal cognition or dementia were included if outcomes of MCI patients were reported separately. Literature was obtained by performing a comprehensive search of MEDLINE, Embase, CINAHL, and Cochrane Central Register of Controlled Trials. Two reviewers independently assessed 6,078 titles and abstracts and 237 full-text articles for eligibility. Results: Thirty-two articles met our inclusion criteria and have been included for data-extraction and quality assessment using the Cochrane Effective Practice and Organization of Care (EPOC) risk of bias tool. Eight of the studies were systematic reviews and 23 were RCTs. Twenty studies investigated acetylcholinesterase inhibitors, including two that studied acetylcholinesterase inhibitors combined with antidepressants and one trial with a Vitamin E treatment arm. Two studies investigated other pharmaceuticals (Piribedil, transdermal nicotine). Five studies investigated natural supplements, vitamins or Chinese herbal remedies. Five studies investigated non-pharmaceutical interventions including brain stimulation, dietary interventions, and cognitive-training programs. Conclusions: Various strategies for MCI have been evaluated. Data synthesis is underway and results will be available by March., Background Information: A gap exists between research and clinical practice in long-term care (LTC). While there is ample literature discussing interventions for dealing with behavioural and psychological symptoms of dementia (BPSDs), not all of these strategies are practical or easy to implement in a clinical environment. BPSDs are expressed differently in each person, which makes predicting problematic behaviours and finding appropriate solutions difficult. Sensory integration is one promising area of therapeutic interventions for BPSDs. This annotated literature review will provide staff with a useful summary of new and current interventions for addressing BPSDs in LTC. Methods: A literature review of sensory integrative interventions designed to reduce BPSDs will be completed. Sensory systems that will be studied include proprioception, vestibular sensation, tactile senses, audition, and vision. Staff members with different clinical roles will also be interviewed. They will judge the utility of the interventions and be asked to comment or revise the approaches. Staff interviews will also uncover what are perceived to be barriers to implementing interventions in clinical practice. This project will expose new interventions and confirm the use of current interventions for ameliorating BPSDs. Results: Results are forthcoming. This will include a staff annotated literature review which will provide an up-to-date summary of practical interventions for use in LTC. Conclusion: The transmission gap between evidenced-based interventions and clinical implementations in LTC needs to be addressed. This review will help staff make more informed care decisions and improve the quality of care they are able to provide. This review will also uncover areas where an organization can better support staff willing to implement evidence-based interventions., Background Information: The objective of the ViDOS cluster randomized trial was to evaluate the feasibility and effectiveness of a knowledge translation (KT) intervention aimed at integrating evidence-based osteoporosis/fracture prevention strategies in long-term care (LTC) homes. The target audience was interdisciplinary care teams (physicians, nurses, pharmacists, dietitians). Methods: We randomized 40 LTC homes in Ontario, Canada to intervention (n=19) or control (n=21) arms. The 12-month intervention included three interactive educational meetings presented by an expert opinion leader, action planning for quality improvement, audit and feedback review, and distribution of educational materials. Prescribing outcomes were collected at baseline and at twelve months. The primary outcome was prescribing of Vitamin D ≥ 800 I U/day; secondary outcomes were calcium ≥ 500 mg/day and osteoporosis medications (high-risk residents only). The difference between treatment arms in mean home-level prescribing change is reported with 95% confidence intervals (95% CIs) adjusted for clustering. Analyses were intention to treat. Results: At baseline, 5,478 residents, mean age 84.4 (SD 10.9) years, 71% female, resided in 40 LTC homes, mean size=137 beds (SD 76.7). Post-randomization, seven LTC homes declined to participate. Over 12-months, the mean home-level prescribing change for vitamin D ≥ 800 IU/day was 22.2% in the intervention arm vs. 7.5% in the control arm (between group difference = 14.7%, 95% CI: 13.1, 16.2). Mean home-level prescribing change for calcium ≥ 500 mg/ day was 8.8% in the intervention arm vs. 1.8% in the control arm (between group difference = 7.0%, 95% CI: 6.2, 7.9). There was no significant difference in prescribing between arms for osteoporosis medications. Conclusion: Our KT intervention significantly improved prescribing of vitamin D and calcium, and is a model that could potentially be applied to other topics requiring quality improvement., Background Information: Vitamin D status is low in the elderly and especially in long-term care (LTC) residents. Low Vitamin D is associated with increased risk for osteoporotic fracture. Osteoporosis Canada recommends Vitamin D supplementation in all patients at high risk of fracture. Objective: The purpose of this study is to evaluate the prevalence of Vitamin D supplementation in LTC residents, and the characteristics of those with and without supplements. Methods: Ethics approval was obtained. Subjects were recruited from five LTC facilities in Edmonton, Alberta. After consent, chart review, clinical evaluation, and blood work was completed. Results: 100 subjects (29 men, 71 women) were recruited with an average age of 81 years (range 59–93). Vitamin D levels ranged from 13–243 nmol/l, with an average of 75.1 nmol/l. 29% had levels below 50 nmol/l and 63% below 80 nmol/l. The rate of Vitamin D supplementation was 63% in total, but 48% in men versus 69% in women. Age, history of falls, history of fractures, MMSE, BMI, and calcaneal ultrasound were comparable in the two groups. The diagnosis of osteoporosis was higher in the supplement group (57% vs. 18%). The level of 25(OH)D was 113.5 nmol/l (75–243) in the supplement group and 46.7 nmol/l (13–69) in the non-supplemented group. Conclusions: This study documents the high prevalence of Vitamin D insufficiency in this group of LTC residents. Men had lower Vitamin D status than women, and a lower level of supplementation. The risk of falls was high in those on and off supplements. This study highlights the need for further education on Vitamin D supplementation., Background Information: The Team Standardized Assessment of a Clinical Encounter Report (StACER) was designed for Geriatric Medicine residency programs to evaluate Communicator and Collaborator competencies. There are no studies of validity, reliability or acceptability in spite of its mandatory use. It is unknown whether a geriatrician’s assessment reflects the observations made by the interdisciplinary team. Objective: To determine the inter-rater reliability of the items on the Team StACER among interdisciplinary team members and between geriatricians. Other objectives were to determine the face validity, discriminatory power, and acceptability of the instrument as a feedback tool. Methods: Postgraduate trainees in Family, Internal, and Geriatric Medicine at the University of Toronto were recruited from July 2010 to November 2013. The Team StACER was completed by two geriatricians and interdisciplinary team members based on observations during a geriatric medicine team meeting. Raters completed a survey that was previously administered to Canadian geriatricians to assess face validity. Trainees completed a survey to determine the usefulness of this instrument as a feedback tool. Inter-rater reliability was determined using the Prevalence Adjusted Bias Adjusted Kappa (PABAK). Comments were reviewed by thematic analysis by two reviewers. Results: 30 postgraduate trainees from three sites participated. A mean of 5.67 Team StACERs were completed per trainee, with 93% completed by two geriatricians. The PABAK range for Communicator and Collaborator items were 0.87–1.00 and 0.86–1.00, respectively. The instrument lacked discriminatory power, as all trainees scored “meets requirements” in the overall assessment. Face validity was limited by dichotomous choices. 93% and 86% of trainees found feedback based on the instrument useful for developing Communicator and Collaborator competencies, respectively. Conclusion: The Team StACER has adequate inter-rater reliability, but poor discriminatory power. Trainees felt it provided useful feedback on Collaborator and Communicator competencies., Background Information: Medication use and prescribing in older adults can be challenging due to lack of geriatric-specific health information. Health professionals refer to product monographs for this information; however, there are situations where there is little information regarding older adults. Objective: The purpose of this study was to examine the geriatrics-specific content in product monographs for products introduced to the Canadian market. Methods: Products approved since 1994 were identified through Health Canada. Medications or biological products that could be used by older adults were included. Information related to the geriatric population was abstracted from the standard monograph categories: general information, pharmacokinetics, pharmacodynamics, precautions, warnings, adverse effects/events, dosage information, clinical trial inclusion, and geriatric specific clinical trials. Data were analyzed descriptively. Results: A total of 296 drug monographs were evaluated from 75 different drug manufacturing companies. Antineoplastic agents had the highest proportion of drugs studied, 36 out of 296 (12%). Two hundred eighty-two (95%) included general information on the geriatric population; 147 (50%) had information on dosing in the geriatric population. Inclusion of reference to geriatrics in the section on clinical trials was noted at 173 (58%), whereas only 11 (4%) included specific details about geriatric-focused clinical trials. The majority (200 [67.6%]) included geriatric pharmacokinetics content, and 6 (2%) included pharmacodynamics content. The adverse effects information specific to geriatrics was found in only 31 (10%) of the product monographs. Discussion: Many product monographs include general precautions about drug use in the elderly. However, disclaimers and encouraging prescribers to use caution, or noting that information is not available, is inadequate to support safe and effective drug use in seniors. Conclusions: Most drug product monographs in Canada have limited information that is specific to the elderly population., Background Information: Two commonly used cognitive screening tools in Canada are the Folstein Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). In 2009, Brown et al. created a new cognitive screening test called the Test Your Memory (TYM), which is unique in the fact that it is a patient self-administered exam. In a system where family physicians and other specialists are pressed for time, the TYM offers a potential to save screening time. Objective: This study aimed to determine the validity of the TYM tool in comparison to the traditional MMSE and the MoCA in a Canadian Geriatric Assessment clinic setting. Methods: Patients aged 65 and older attending a regularly scheduled appointment at one of three geriatric clinics in Edmonton, Alberta were invited to participate in the study. Participants had to complete the self-administered Test Your Memory tool in addition to the MMSE ± the MoCA as part of their geriatric assessment. Results: A total of 36 participants completed the study. The Pearson correlation coefficient between the TYM and MMSE is R2 = .689 and the coefficient between the TYM and the MoCA is R2 = .508. Scores for the TYM had statistically significant correlation to the MMSE and MoCA, but sensitivity, specificity, and positive predictive value of the TYM was poor. Conclusions: This study was not able to validate the TYM as a good clinical cognitive screening tool. The greatest value of the TYM may be in its negative predictive value., Background Information: The proactive geriatric trauma consultation service started at St. Michael’s Hospital (SMH) in September 2007. Patients aged ≥ 65 years admitted to the Trauma service are referred to the GTCS for a comprehensive geriatric assessment within 72 hours. The GTCS includes a geriatrics nurse specialist and geriatrician. Recommendations focus on early involvement in prevention and management of age-specific complications, and discharge planning. In a previously published before and after case series, we demonstrated a significant decrease in delirium, consultations to Internal Medicine and Psychiatry, and discharge to long-term care. Objective: To determine the sustainability of impact of a proactive GTCS. Methods: Patients aged ≥ 65 years admitted to the Trauma service from July 2012 to December 2013 were prospectively recruited for this sustainability case series and received a proactive geriatric trauma consultation. Geriatric specific in-hospital complications, trauma quality indicators, discharge destination, rate of recommendation adherence, and consultations were determined. Proportions were compared using the Fisher exact test. Results: 138 patients were identified and 82 (59.4%) patients consented to participate. 66 charts have been reviewed thus far. Compared to the post-intervention phase of the case series, there was no difference in the sustainability phase in Internal Medicine consultation (p = .10), Psychiatry consultation (p = 1.0) or delirium rates (p = 0.57). The rate of adherence to recommendations made by the GTCS team was 80.8% during the sustainability study, which was not different from the post-intervention phase (p = .72). No patients were discharged to long-term care. Conclusions: Decreases in delirium, consultations to Internal Medicine and Psychiatry, and discharge to long-term care were sustained outcomes in this proactive geriatric trauma consultation model. A prospective interrupted time-series study is underway at a second site, Sunnybrook Health Sciences Centre, and will guide the feasibility and generaliz-ability of impact on quality outcomes., Background Information: Understanding the awareness of fall risk factors by adults is an important start to educational interventions. Since its development in 2002, the Falls Risk Assessment Questionnaire (FRAQ) has been administered in older adults to assess awareness and perception of falls risk. Objective: The objective of this pre/post study was to further validate the FRAQ as being responsive to change. Methods: Seniors (≥ 65 years) who attended one of six standardized 1-hour falls education programs in the community offered by Alberta Centre for Injury Control and Research from Sep-Dec 2013 were recruited. The presentation focused on fall risks and prevention strategies. Each participant completed the FRAQ before and after the presentation. The FRAQ is a 22-item questionnaire that assesses the knowledge of risk factors (medical, environmental, pharmacologic, physical) for falling, as well as demographics, medical, and fall history, and risk factors. A score of 1 was given for each correct answer, with a summative score of 32. Results: Of 46 seniors who completed the survey, 36 completed both the pre- and post- measures. The mean age was 84.7±6.6 years; 83.7% (36) female. Arthritis or rheumatism was the most commonly reported condition (55.8%, n=24). The mean score before the educational intervention was 15.75 (SD 4.08). A total of n=25 (69.4%) had improved scores on the post-test. Conclusion: Initial results indicate responsiveness of the FRAQ in assessing falls risk awareness is congruent with increased knowledge and awareness., Background Information: Baycrest, the Toronto Central and Central Community Care Access Centres and North York General Hospital (NYGH), together with the Regional Geriatric Program, have established a model of integrated care for frail, older adults who are at high risk for ED visits, hospitalization, and institutionalization. The model, “The Integrated Community Care Team (ICCT)”, connects older adults living in north Toronto to a dedicated, inter-professional team consisting of primary, community, and specialty care resources. The ICCT model is unique in that it is not only client/family caregiver-centred, but it also tailors its services to the specific needs of community primary care physicians through a consultation, shared care or transfer of care approach. The ICCT model is further enhanced through a link with NYGH and Baycrest’s in-patient specialty services to ensure that major components of the patient journey across the continuum of care are integrated as part of the intervention. Objective: Its dual aim is to support medically frail older adults to experience care from one team and to support community primary care physicians with an integrated interdisciplinary team. Methods: An early phase mixed methods formative evaluation of the ICCT model is under way. The design emphasizes a quality improvement approach with the aim to provide continuous rapid-cycle improvement to the team. The quantitative evaluation will include data from the Resident Assessment Instrument–Home Care to describe the patient population, process measures to document service provision, the Zarit Burden Interview to capture caregiver burden, and the Dimensions of Teamwork Survey to evaluate inter-professional team function. The qualitative evaluation includes interviews with patients and their caregivers, primary care physicians, and team members to document the implementation experience and satisfaction with the model., Background Information: The COE Diploma Program is an accredited 6–12 month Enhanced Skills Program after 2 years of Family Medicine Certification (CCFP). In recognition of the growing mandate for COE Programs to directly assess residents’ clinical competence, we developed 85 Core Competencies (CCs) for COE residents (Year 3) and introduced them in 2010. Research objectives were to examine the effectiveness of the CCs for assessing COE residency competency and graduate ratings related to the CCs on the Un. of Alberta COE Graduates Survey. Methods: Data extraction from preceptor-completed resident evaluations on skills/abilities (e.g., comprehensive geriatric history, triaging patients) based on 5-point Likert ratings (e.g., rarely meets to consistently exceeds), with the items similar across rotations, and from graduate ratings on aspects of program (e.g., orientation, evaluation process, preparedness for practice) gathered from the Graduates Survey. Analyses were based on differences in preceptor and graduate ratings as a function of CCs implementation (e.g., post- vs. pre-implementation of the CCs). Results: Preceptor evaluations: n=9 and 8 for the pre- and post-CCs, respectively. Likert ratings overall were high across both time periods, with increases on 27/37 Objectives and all CanMEDS roles, though the increase was non-significant. COE Graduates Survey: n=7 and 5 for the pre- and post-CCs, respectively. Compared to pre-CCs, post-CCs graduates rated the admission process, orientation to the program, and the evaluation process of residents significantly higher (p = .014, .038, .038, respectively). Conclusion: The main purpose of the 85 CCs is to directly assess residents’ clinical competence. Residents have improved on most objectives of their evaluations since CCs implementation. Graduates also rated their evaluation process significantly higher since CCs introduction.

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